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Addressing Data Inequities in American Indian Communities Through an Environmental Public Health Tracking Pilot Project

Lucas-Pipkorn, Samantha MPH; Tuomi, Ashley DHSc

Journal of Public Health Management & Practice: September/October 2017 - Volume 23 - Issue - p S28–S31
doi: 10.1097/PHH.0000000000000597
National Program: Research Article

National and state surveillance systems identify American Indians/Alaska Natives inconsistently and often inaccurately within their data sets. Consequently, communities may not be represented with data at the level of geography needed. Collecting and presenting environmental and health-related data to the public are done by state Tracking Networks. Great Lakes Inter-Tribal Epidemiology Center (GLITEC) conducted a groundbreaking 2014 Tribal Environmental Health Tracking pilot project that engaged tribes, an urban Indian community, 3 state health departments, a Tribal Epidemiology Center (TEC), and a federal agency. Two other TECs—the Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC) and Northwest Tribal Epidemiology Center (NW EpiCenter)—are now modeling GLITEC's project. They will forge active partnerships with at least one tribe and build relationships with state Tracking programs, explore environmental priorities, identify health outcomes of greatest concern for each community, and determine whether environmental or health inquiries can be addressed through state Tracking data. The Tribal Environmental Health Tracking pilot project provides an example of how state public health Tracking programs can be responsive to data inequities, build relationships between tribes/urban Indian communities, and increase their competency for working with indigenous communities.

Great Lakes Inter-Tribal Epidemiology Center, Great Lakes Inter-Tribal Council, Minneapolis, Minnesota (Ms Lucas-Pipkorn); and American Indian Health and Family Services of Southeastern MI, Detroit, Michigan (Dr Tuomi).

Correspondence: Samantha Lucas-Pipkorn, MPH, Great Lakes Inter-Tribal Epidemiology Center, 1300 South 2nd St #300, Minneapolis, MN 55454 (slucas-pipkorn@glitc.org).

This pilot project was made possible, through contracts with the Centers for Disease Control and Prevention, Minnesota Department of Health, and Wisconsin Department of Health Services.

The authors declare no conflicts of interest.

When Europeans first arrived, hundreds of independent nations were flourishing in what is now the United States. By 1900, war and disease had decimated a population of nearly 1 million American Indians, reducing it to 300 000. American Indians were not simply a separate racial group; they were a separate political group. The United States did not enter into treaties with American Indians because of their race but because of their political status as sovereign nations.1–4

Native American traditions are rooted in the environment, and many maintain interdependent relationships with the environment. Native peoples' proximity to and involvement with the environment make them particularly vulnerable to man-made hazards.5 Decades of industrialization have left many parts of the United States burdened with environmental hazards. These are often concentrated in minority, low-income neighborhoods, and across tribal communities.5

The Great Lakes are among the most essential water resources in the country. The lakes and their watersheds provide invaluable environmental and economic resources vital to the lives of countless people. Over many years, industrial activities, chemical spills, abandoned hazardous waste sites, and surface runoff have resulted in contamination within the Great Lakes Basin.6 Environmental hazards, ranging from smoke and air pollution to factors affecting diet and exercise, are known to contribute to many cancers from which American Indians/Alaskan Natives suffer disproportionately.7,8

Environmental problems and related adverse health outcomes have huge social and economic costs in Indian Country.* Therefore, it is critical to collect, analyze, and disseminate data that can be used to drive change in both governmental policies and business practices. Unfortunately, data collection in Indian Country poses many challenges, from initial collection to analysis and dissemination. Perhaps, the greatest challenge is access to applicable and timely health data. While many tribes collect environmental and health outcomes data, these are not readily shared across sectors within or among tribal communities. National and state surveillance systems data are often not useful for American Indian communities. For example, surveillance systems often present data at the state, county, and, more rarely, zip code or census block level; these are not a good geographical level fit for reservation or urban Indian community boundaries. An additional problem is that these national and state surveillance systems do not consistently or accurately collect race information, particularly for smaller racial groups within the United States.9

The Centers for Disease Control and Prevention (CDC) funds 26 state and local health departments to develop local Tracking Networks that collect, integrate, analyze, interpret, and disseminate environmental and health-related data via a Web site. Funded state and local health department networks feed into the CDC's National Environmental Public Health Tracking Network. Most state Tracking Networks present environmental and health-related data at the state, county, zip code, or census block level.10

Tribal Epidemiology Centers (TECs) were established under the Indian Health Care Improvement Act. They offer various types of support and services to tribes and urban Indian communities within each of 12 Indian Health Service Areas in the United States. The TECs also work with state and federal partners to improve public health capacity and increase the availability and reliability of data for American Indian or Alaska Native populations.9

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Project Implementation

In the summer of 2014, the Great Lakes Inter-Tribal Epidemiology Center (GLITEC) was contracted by the CDC to conduct the Bemidji Area Environmental Health Tracking Program pilot project. The Wisconsin Environmental Public Health Tracking Program and the Minnesota Environmental Public Health Tracking Program provided additional resources. The Bemidji Area Environmental Health Advisory Group provided advisement to the pilot project. One tribe in Minnesota, one tribe in Wisconsin, and one urban Indian community in the region participated in the pilot project (Figure). The pilot project year 1 objectives (August 1, 2014, to July 31, 2015) were to (1) assess ongoing environmental monitoring at the tribal level, (2) develop environmental priorities, and (3) identify health outcomes of greatest concern for each community.

In the Great Lakes region, the top environmental issues affecting communities include contamination of traditional foods, indoor air pollution, mining, poor housing conditions, sludge sites, and use of woodstoves. These environmental issues concern 2 of the most vital resources: clean air and clean water. Themes that emerged in meetings with each community were similar to those cited in initial state Tracking program communications with data stewards and other stakeholders. The absence of data sharing, also known as “siloing,” within departments and sectors was surprising and often frustrating for tribal partners. Environmental data are not maintained in one singular format, presenting a barrier for both tribes. Different departments sometimes collected data on the same indicator, using formats based on funding entities' requirements and without making the information available to other stakeholders.11

Participants expressed a desire to collect environmental data in a meaningful way that would be useful for everyone in the community—not just the department collecting it or the agency receiving it. The lack of interdepartmental coordination, coupled with the lack of substantial reliable funding, has created a patchwork of available environmental data in Indian Country. Comprehensive data sharing across departments and sectors within a tribe can only be accomplished with significant direct investment to correct these issues.11

This project was in many ways a first of its kind to involve tribes, an urban Indian community, 3 state health departments, a TEC, and a federal agency. State Tracking programs and the CDC exhibited patience, flexibility, and respect for tribal sovereignty, allowing communities to ultimately decide the course of the project. The pilot project forged connections between tribes, an urban Indian community, the TEC, and state Tracking programs that would not have been made otherwise.11

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Implications for Policy & Practice

* The Tribal Environmental Health Tracking pilot project bolsters support of tribal sovereignty through the creation of more meaningful and useful data that communities can use to improve their health through appropriate dissemination of results and education that can ultimately lead to policy change at the local level.

* For communities, the pilot project is an opportunity to build relationships over time with state partners and content area experts to explore topics as they evolve.

* The Tribal Environmental Health Tracking pilot project is an example of how state Tracking programs can be responsive to data inequities, build relationships between tribes and urban Indian communities, and increase their competency for working with indigenous communities.

GLITEC subawarded to 2 other TECs in a new iteration of the initial pilot project—the Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC) that serves the 27 federally recognized tribes, bands, nations, and pueblos in Colorado; and the Northwest Tribal Epidemiology Center (NW EpiCenter) that serves the 43 federally recognized tribes in Idaho, Oregon, and Washington. The AASTEC and NW EpiCenter began their pilot projects in late 2016. They will model the GLITEC pilot project by forging an active partnership with at least one tribe and building relationships with state Tracking programs. The AASTEC has begun work with the New Mexico Tracking Program, and the NW EpiCenter is working with the Oregon Tracking Program. The AASTEC and NW EpiCenter pilot projects' objectives are to explore environmental priorities, identify health outcomes of greatest concern for each community, and discover whether any environmental or health inquiries could be addressed through state Tracking data. Both AASTEC and NW EpiCenter will build upon GLITEC's lessons learned and make adjustments according to their partners' needs and unique characteristics of each area.

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References

1. Pevar SL. The Rights of Indians and Tribes. 4th ed. New York, NY: Oxford University Press; 2012.
2. Pevar SL. The Rights of Indians and Tribes: The Basic ACLU Guide to Indian and Tribal Rights. 2nd ed. Carbondale, IL: Southern Illinois University Press; 1992.
3. Macklem P. Distributing sovereignty: Indian nations and equality of peoples. Stanford Law Rev. 1993;45(5):1311–1367.
4. Wilkins DE, Lomawaima TK. Uneven Ground: American Indian Sovereignty and Federal Law. Norman, OK: University of Oklahoma Press; 2001.
5. Michigan Department of Community Health. CDC's National Environmental Public Health Tracking Program: Michigan Environmental Public Health Tracking Network. http://http://www.michigan.gov/documents/mdch/MITracking_Accouncement_Fact_Sheet_482076_7.pdf. Published March 6, 2015. Accessed July 20, 2015.
6. Fond du Lac Band of Lake Superior Chippewa. Fond du Lac Resource Management. 2008 Integrated Resource Management Plan. Cloquet, MN: Fond du Lac Band of Lake Superior Chippewa.
7. US Department of Health and Human Services. Cancer and the environment: what you need to know, what you can do. https://http://www.niehs.nih.gov/health/materials/cancer_and_the_environment_508.pdf. Accessed February 10, 2017.
8. Foote M, Strickland R, Lucas-Pipkorn S, Williamson A. The high burden of cancer among American Indians/Alaska Natives in Wisconsin. Wisconsin Med J. 2016;115:11–16.
9. Tribal Epidemiology Centers. Best practices in American Indian & Alaska Native public health: a report from the Tribal Epidemiology Centers. http://http://www.glitc.org/forms/epi/tec-best-practices-book-2013.pdf. Published 2013. Accessed July 21, 2015.
10. Centers for Disease Control and Prevention. National Environmental Public Health Tracking. Background. https://http://www.cdc.gov/nceh/tracking/background.htm. Updated February 12, 2010. Accessed February 2, 2017.
11. Lucas-Pipkorn S. Bemidji Area Environmental Health Tracking Pilot Project White Paper. Atlanta, GA: Centers for Disease Control and Prevention; 2015.

*For the purposes of this article, Indian Country refers to land within the limits of an Indian reservation, dependent Indian communities, all Indian allotments still in trust located within reservations or not, and the 34 urban Indian communities across the United States. Cited Here...

American Indian population; environmental health tracking

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