Reliable population and other health data are central to decision making as communities work to define priorities, develop health improvement strategies, acquire resources, and implement effective interventions. However, the collection, analysis, interpretation, and dissemination of American Indian and Alaska Native (AI/AN) health data and information poses several challenges from access to important health datasets to racial misclassification of AI/ANs.1 Routine sampling methods of national health surveys that underreport AI/AN tend to pool with other groups to achieve statistical significance, a practice that obscures the disparities that this population experiences.
In 1996, 4 Tribal Epidemiology Centers (TECs) were created nationwide to improve public health infrastructure and address the lack of adequate disease surveillance and public health data for the AI/AN population. TECs were tasked to work with tribes to improve capacity for reliable data collection and analysis, and effectively disseminate health information and findings. Funding for these TECs was initially supported by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health; however, the Indian Health Service (IHS) Division of Epidemiology and Disease Prevention (DEDP) based in Albuquerque, New Mexico, began providing funds for the development of additional TECs in 2000. Initially, the TECs were situated at IHS Area Indian Health Boards throughout the country. This allowed TECs to receive health data directly from nearby tribal communities for surveillance purposes, and to provide high-quality and timely epidemiological research. Eventually, a total of 12 TECs were created, operated by 11 IHS administrative Area-wide Tribal health boards and participating Tribes and 1 supporting the public health needs of urban Indian organizations. As a result, the IHS DEDP office in Albuquerque, New Mexico, downsized and empowered each epidemiology center to serve its IHS area.
The TECs have a common mission: “to improve the health status of American Indians and Alaska Natives by identification and understanding of health risks and inequities, strengthening public health capacity, and assisting in disease prevention and control.”2 Yet, they are very diverse in programming, infrastructure, partnerships with government agencies, and access to funding for projects to meet the unique needs and priorities of their constituencies. In 2010, TECs were officially designated as Public Health authorities through the reauthorization of the Indian Health Care Improvement Act, providing them access to IHS data under the Health Insurance Portability and Accountability Act. This status authorized TECs to access data held by the Department of Health and Human Services. Today, TECs are funded by IHS and the CDC to conduct 7 core functions.2 TECs collect and monitor data in consultation with, and related to the objectives of IHS, Tribes, Tribal organizations, and urban Indian organizations through the following core functions:
- Evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health.
- Assist Indian tribes, tribal organizations, and urban Indian organizations in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data.
- Make recommendations for the targeting of services needed by the populations served.
- Make recommendations to improve health care delivery systems for Indians and urban Indians.
- Provide requested technical assistance to Indian tribes, tribal organizations, and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community.
- Provide disease surveillance and assist Indian tribes, tribal organizations, and urban Indian communities to promote public health.
TECs now play a pivotal role in working with tribal communities, urban Indian organizations, governmental agencies, and academic institutions in efforts to reduce AI/AN health disparities. By providing quality AI/AN health data and analysis, culturally respectful information and reporting, and insightful technical assistance, they represent an important connection to supporting tribal and urban Indian health policy, funding, and decision making. TECs work diligently to build and maintain trusted relationships with the tribal and urban Indian organization constituents in their regions through individualized public health assistance such as community health assessments and responsive dissemination of findings to promote empowerment of AI/AN communities in defining and addressing their own health care and wellness needs.
The featured articles in this supplement demonstrate the diversity of public health work conducted by TECs to support tribal and urban Indian communities across the country. The articles include important contributions to AI/AN public health interests that range from investigating risk factors of colorectal cancer to evaluating a hepatitis C virus telehealth program. This body of work demonstrates the critical role of TECs in providing culturally and scientifically rigorous data services to make visible the public health and wellness needs of the AI/AN population.
1. Haozous EA, Strickland CJ, Palacios JF, Solomon TG. Blood politics, ethnic identity, and racial misclassification among American Indians and Alaska Natives. J Environ Public Health. 2014;2014:321604.
2. Tribal Epidemiology Centers website. https://tribalepicenters.org/
. Accessed February 15, 2019.