Nothing about our community, without our community. Tribes are sovereign nations and are therefore poised to determine the actions taken to promote health and prevent disease. For too long, data were collected on American Indian people and not returned to them by the Federal government upon their request for use to improve health and for advocacy for health. Tribal epidemiology centers (TECs) provide quality data analysis, culturally appropriate health information, and technical assistance for tribal communities to assist in knowledge enhancement, empowerment, and influence over their own health care and wellness. Through the advocacy of tribal leaders to gain access to data about tribes, the TECs were established through legislative enactment in 1996 to address American Indian and Alaska Native (AI/AN) population health deficiencies and gaps as a foundation for improving health policy and expenditure decisions on the local, state, and national levels. Four centers were established in 1996. Today, the program has expanded from 4 TECS to 12 TECs serving the nation's 12 Indian Health Service areas and Urban Indian Health programs.
The TECs' missions and visions are driven by the tribes and/or tribal organizations they serve. Most of the TECs, located at health boards or the equivalent, undertake all of their work on the direction of the population served through a formal resolution process that approves projects, grants, and contracts prior to them being undertaken. Tribal epidemiology centers are community driven. They address the priorities of tribal leaders and the Urban Indian Health Organization leaders regionally. As a result of this operational mechanism of programmatic development, TECs have a trusted relationship with AI/AN communities, tribal governments, and Indian Health Service, Tribal and Urban Health Programs.
Tribal epidemiology centers provide a vital link to AI/AN health data. These data influence health care policy funding and decision making, and they assist in strengthening the public health capacity of tribal communities.
Many of the TECs have provided tribe-specific Behavioral Risk Factor Surveillance Surveys, and several centers perform linkage correction of various state data sets, which allows for better quality data for AI/AN in these data sets. Tribal epidemiology centers also look not only at disparities and inequities but also factors that enhance resilience among AI/AN people and communities. Tribal epidemiology centers are pursuing ways to present data in more indigenous ways, including valued community input in collection and analysis. A cornerstone to improved public health capacity is ensuring the existence of valid and reliable data. Data analysis and information communication are needed by AI/AN communities and/or organizations in order for tribal leadership to have facts and tools needed to better prioritize their community health improvement decisions.
The Indian Health Care Improvement Act (IHCIA) was permanently reauthorized in 2010. This reauthorization defined TECs as “public health authorities” for purposes of the Health Insurance Portability and Accountability Act Privacy Rule for data sharing. The permanent reauthorization of IHCIA directs the secretary of the Department of Health & Human Services to grant each TEC access to use of the data, data sets, monitoring systems, delivery systems, and other protected health information in the possession of the secretary. It also requires that the Centers for Disease Control and Prevention provide technical assistance, and that Centers for Disease Control and Prevention work closely with each TEC in strengthening AI/AN disease surveillance.
“As a result of the reauthorization of the IHCIA in 2010, the TECs were designated as Public Health Authorities for health care improvement and gathering data for tribal programs. This function is essential to help tribes by providing better data access and availability by providing current information and profiles,” said W. Ron Allen, Tribal Chair and CEO of the Jamestown S'Klallam Tribe.
The TECs are poised to support Public Health Accreditation for Tribes by filling in data needs and other services as requested for those seeking accreditation. Tribal epidemiology centers have provided technical assistance for community health assessments and community health plans. Tribal epidemiology centers have a variety of areas of expertise and are generally poised to assist with domains 1, 3, 5, and 8, in particular; Domain 1: Conduct and disseminate assessment focused on population health status and public health issues facing the community; Domain 3: Inform and educate about public health issues and functions; Domain 5: Develop public health policies and plans; and Domain 8: Maintain a competent public health workforce.
“Like the Indian Health Care System, the TECs are underfunded to meet the actual data needs for the communities they serve. Funding levels from Indian Health Service have been essentially flat for 10 years,” states Brian Cladoospy, Chairman, Swinomish Indian Tribal Community.
Other federal agencies, such as the National Institutes of Health, Centers for Disease Control and Prevention, and Substance Abuse and Mental Health Services Administration, have provided funding to TECs. All TEC funding is through competitive grant and contract processes; in addition, some tribes provide funding for tribe-specific projects.
“The support of the Northwest Tribal EpiCenter (NWTEC) has helped the Shoshone Bannock Tribes continue our self-determination and sovereignty of our tribes in our development of activities and programs to improve the health of our tribal members. We appreciate the support of technical assistance and the consistent means of communication NWTEC provides to the tribes,” Tino Batt—Tribal Council Member Treasurer.
The TECs have been beneficial in providing data and support to the tribes and urban health organizations. As mentioned previously by tribal leaders, benefit of the TEC work has been seen and is strongly supported.