Linking Indigenous Groups, National
Statistical Agencies, Health
Ministries
Mechanisms for linking these groups in
the United States of America
Canberra, Australia - November 2006
In linking Indigenous Groups, there are
approximately 561 sovereign Tribes, each…..
…. with (a) distinct
• tradition
• language
• migratory history
• geographic distribution
• population size
• gene flow, and
• culture
Intertwining and stand-alone entities
• Tribal nations eg. Navajo Nation
• Tribal consortiums eg. Three Affiliated Tribes
• Regional health boards/groups eg. Northwest
Portland Area Indian Health Board
• National entities eg. Indian Health Board,
National Congress of American Indians
• Health organizations eg. Association of
American Indian Physicians
• Task forces, committees eg. Tribal Leaders
Diabetes Committee
National Statistical Agencies/Health
Agencies or Entities
•Office of the Secretary (OS)
•Administration on Aging (AoA)
•Agency for Healthcare Research & Quality (AHRQ)
•Agency for Toxic Substances & Disease Registry
(ATSDR)
•Centers for Disease Control & Prevention (CDC)
•Administration for Children & Families (ACF)
National Statistical Agencies/Health
Agencies or Entities cont.
•Food & Drug Administration (FDA)
•Health Resources & Services Administration
(HRSA)
•Indian Health Service (IHS)
•Centers for Medicare & Medicaid Services (CMS)
•National Institutes of Health (NIH)
•Substance Abuse & Mental Health Services
Administration (SAMHSA)
Mechanisms for linking these groups in the United
States of America
1. Tribal-based Epidemiology Centers
2. Native American Research Centers for Health
Alaska
Seattle
Bemidji
Billings
Portland
Aberdeen
Phoenix
Navajo
California
Oklahoma
Nashville
Albuquerque
Tucson
Tribal Epidemiology Centers
(EpiCenters)
IHS Tribal Epidemiology Program
• Tribal-based Epidemiology
Programs created in response to
tribal requests to have:
– Timely health data
– Accurate health data
– Tribe-specific health data
• The very first Tribal Epi programs
were started in 1997
IHS Tribal Epidemiology Program
– Each program has its own goals and objectives
– Address regional tribal diversity re: health care
issues
– Utilize national, regional, state, service unit,
and community information sources as
reference
– Build tribal-based infrastructure
e.g., Northern Plains Tribal Epidemiology
Center
Mission…. to collaborate with Northern Plains American
Indian Tribes to provide health-related research,
surveillance, and training to improve the quality of life of
American Indians.
Goal… to provide accurate and timely health data to
member tribes.
Establishing expertise and capacity in three domains:
• Epidemiology
• Public Health Practice
• Research
e.g. Tribal Health Priorities
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Maternal and Child Health
Emergency Medical Services
Insufficient Funding
Alcohol and Substance Abuse
Diabetes
Lifestyle and Wellness
Heart Disease
Mental Illness
Cancer
Injuries
Dental Disease
SIDS
Environmental Health
Alaska Native Tribal Health Consortium
Southcentral Foundation
Aberdeen Area Tribal Chairmen’s Health Board
Black Hills Center for American Indian Health
Northwest Portland Area Indian
Health Board
California Rural Indian
Health Board
Inter Tribal
Council of Arizona,
The Navajo Nation
Inc.
Southern California Indian
Health Council, Inc.
White Mountain Apache
Albuquerque Area Indian Health Board
Tribal NARCH Centers
Great Lakes Inter
Tribal Council
Chickasaw Nation Health
Combined Tribal NARCH/Epi Centers
NARCH Overall Mission
• To reduce the mistrust of research by tribal communities by
conducting culturally appropriate research
• To increase the capacity of AI/AN health researchers and
students
• To form partnerships with academic institutions to conduct
intensive academic-level biomedical and behavioral
research.
• Funding Source:
– Indian Health Service
– National Institutes of Health (NIH)
NARCH Components
• Core: Provides administrative oversight and
coordination among NARCH projects and
activities.
• Pilot Projects: Establish baseline data and
justification for additional research
• Research Projects: Application of scientific
method to query hypotheses
• Training: Integral part of Projects or stand-alone
initiative
e.g. “Predicting
insulin resistance in
American Indian youth”
Principal Investigator: Jennifer Larsen, MD
University of Nebraska Medical Center
Sylvia Lasley, Research Assistant
•Developed in response to tribal diabetes programs current use
of Acanthosis Nigricans as a predictor for pre-diabetes.
•Purpose: To establish which biomarkers best predict insulin
resistance, including states of pre-diabetes.
•Tribal Benefit: The study will help identify the best ways to
identify youth at risk and assess effectiveness of present and
future diabetes intervention programs in AI youth.
Northern Plains NARCH III
Diabetes Screening
Specific Aims:
1.Determine the prevalence of impaired fasting glucose,
impaired glucose tolerance, and diabetes.
2.Compare severity of insulin resistance in those with and
without AN.
3.Compare AN to gender-specific BMI-percentile for age in their
ability to predict the presence of insulin resistance, and
develop a predictive model based on multiple biomarkers.
4.Determine which biomarker(s) best correlate with change in
insulin resistance after an intervention.
e.g. Northwest Portland Area Indian Health Board
Research Training Program
Project Director:
Thomas Becker, MD, PhD
Oregon Health and Sciences University
•Internships for medical students
•Scholarship support for graduate students (Master
level and above)
•Research skill development of Health Board
employees
Linking Indigenous Groups with
National Statistical Agencies
•Becoming familiar with capabilities, purpose,
experience and expertise
•Utilization of technical assistance
•Communicating tribal priorities and needs
•Representation on advisory committees
•Input into methods eg. sampling, sample size,
recruitment, analysis, reporting
•Funding opportunities
Linking Indigenous Groups with
National Statistical Agencies
•Access to protocols, data
•Collaboration on projects, initiatives
•Access to training opportunities
•Employment opportunities
•Networking opportunities
•Regular, ongoing communication
•Inclusion of indigenous needs, views, etc. in
Agency direction
Contact Information:
Francine C. Romero, PhD, MPH
Director, Jemez Health and Human Services
110 Sheep Springs Way
PO Box 279
Jemez Pueblo, NM 87024
Tel: 505-834-3028
email: [email protected]
website: www.aatchb.org