TRIBAL EPIDEMIOLOGY TOOLKIT
The CSTE Tribal Epidemiology Toolkit aims to identify high-quality resources and best practices for CSTE members working with Tribal Nations and Tribal Epidemiology Centers.
START THE TOOLKIT BELOW
The need for this toolkit was first identified in 2008 by the CSTE Tribal Epidemiology Subcommittee as a way to improve public health surveillance in Indian Country. The first toolkit was published in 2014. In 2023, CSTE collaborated with the Great Plains Tribal Leaders Health Board to update the toolkit to include current issues in Tribal public health epidemiology and provide new resources to CSTE members. The goal remains the same: To improve the health of American Indian and Alaska Native people through epidemiology.
How
TO USE THIS TOOLKIT
The toolkit is divided into six sections. Each section addresses an important issue specific to Tribal public health. The Toolkit is meant to be a starting point for CSTE members to learn more about Tribes and public health in Indian Country. It is recommended to read the background sections—including Tribal Background, Cultural Humility, and Sovereignty & Health Authority—first. You may navigate to each section using the icons below. It is not a comprehensive guide to working with Tribes, but a place for members to begin their learning about and work with Tribes and TECs. Specific questions about Tribes in your jurisdictions are best addressed to those Tribes.
The Toolkit
Data Is Essential
Find out why Tribal health authorities need data, current access challenges, and suggestions for improving Tribal data sharing.
Tribal Background
Learn critical history and context on the relationship between Tribal nations and the federal government, understand the Trust Responsibility, and learn the history of Indian Health Care.
Cultural Humility
Follow recommendations on working with people from other cultures.
Sovereignty & Health Authority
Understand two critical underlying principles for working with Tribal nations and Tribal public health authorities.
Data Collection, Access, & Sharing
Recognize key factors involved in the collection and use of AI/AN data, such as data sovereignty, legal factors, and techniques to improve data quality.
Tools & Resources
Find links to additional useful content, legal resources, and other information!
Why
THIS TOOLKIT IS NECESSARY
Tribes and Tribal Epidemiology Centers (TECs) play a unique role in the United States public health system. As sovereign nations, Tribes have the same rights and responsibilities to protect and promote the health of their members as the federal government or states.
Tribes have a special relationship with the federal government. Because of this relationship and Tribes’ status as sovereign nations, Tribes must be treated differently by federal, state, and local public health entities. However, many public health professionals may be unfamiliar with working with Tribes or TECs and not understand the important role Tribes and TECs play in our public health system.
While each Tribe is different and has different capacities, Tribes can provide a range of robust public health services to their members and communities.
Federal, state, and local public health agencies need to work with Tribes to provide the best possible public health services to AI/AN people and communities.
This toolkit describes ways for CSTE members and federal, state, local, and territorial public health agencies to improve relationships with Tribal public health agencies and how to address some of the greatest challenges facing Tribal public health agencies in protecting and promoting the health of their people, such as:
Misunderstanding of Tribal authority
Lack of access to timely, comprehensive data
Insufficient recognition of Tribal sovereignty, including data sovereignty
“By improving the working relationships between Tribal and non-Tribal public health agencies, we can begin to better address the health disparities experienced by AI/AN people and to achieve health equity for all Americans.”
Key Terms
DEFINITIONS
HIPAA
Health Insurance Portability and Accountability Act: Defines protected health information and outlines the ways in which PHI can be shared by covered entities without patient consent for public health purposes.
PUBLIC HEALTH AUTHORITY
An agency or authority of the United States government, a State, a territory, a political subdivision of a State or territory, or Indian tribe” as defined in HIPAA for the purposes of receiving protected health information. Tribal Epidemiology Centers are also PHAs for the purposes of HIPAA (25 USC 1621m).
AI/AN
American Indian/Alaska Native. Used throughout the document as this term and abbreviation is commonly used in public health literature.
IHCIA
Indian Health Care Improvement Act: Originally passed in 1976 and later amended, the IHCIA establishes the legal authorities for providing healthcare to AI/AN. TECs were established under the IHCIA beginning in 1992 and later confirmed as public health authorities when the IHCIA was permanently reauthorized as part of the Affordable Care Act in 2010.
PHI
Protected Health Information: AKA individually identifiable health information whose use is governed by HIPAA.
SOVEREIGNTY
TRIBE
- AI/AN tribe with “a government-to-government relationship with the United States with responsibilities, powers, limitations and obligations that are attached to that designation”. For the purpose of this toolkit, unless otherwise noted, Tribe refers to federally recognized Tribes.
- Tribal public health data: Health data on specific tribal members or data that is representative of a Tribe or Tribes
TRIBAL EPIDEMIOLOGY CENTER
Indian Health Service funded organizations that serve AI/AN communities through public health activities. TECs are Public Health Authorities for the purposes of HIPAA.