Native American Heritage Month

Tracking Environmental Health Data about Native Americans

“Data” is a buzzword in public health, but what does the word mean for the rest of us? Gathering data may sound like a snooze to non-scientists, but it is actually the beginning of scientific investigation. Whenever scientists and doctors are searching for the cause of a disease outbreak, data are the facts and statistics that help them find the answer.

Who Needs Data– and Why?

Data are also essential for making decisions about actions affecting public health. They help epidemiologists (disease detectives) identify people with health problems. Data on soil, air, and water quality help them learn if environmental issues could be one of the factors contributing to those health problems. In fact, all exciting scientific investigations begin with what may seem like the tedious task of deciding what data to collect and how to collect it.

The NCEH Environmental Public Health Tracking Branch is all about data. Go to the Tracking Network and you can search for data and information about a wide variety of environmental hazards, exposures, and health effects. You can even find data for specific states and counties, for example, how many people living in your zip code have asthma. Even with all the data and information currently on the Tracking Network, the program continues to look for ways to improve and expand.

Filling Data Gaps

Recently, the Tracking Program started a pilot project with the Great Lakes Inter-Tribal Epidemiology Center (GLITEC), the Wisconsin Tracking Program, and the Minnesota Tracking Program to begin filling gaps in data about American Indian/Alaska Native populations. These partners will explore the best ways to collect environmental health data for Tribes located in the Bemidji Area of the Indian Health Service (IHS). They will assess available data and then bring together different data sources to link environmental and health outcomes at a Tribal level.

Tribal Epidemiology Centers (TECs) serve the 12 IHS administrative areas across the nation. Congress authorized TECs in 1996 to improve and increase data collection in Indian country and to keep it secure and confidential. The TECs have developed high standards for using and sharing data. Now they are working to make data more accurate and available by collecting health and environmental information at the local Tribal level.

Place Is Everything

Although more American Indians and Alaska Natives (AI/AN) are moving to cities, many AI/AN populations still live on Tribal lands that hold both historical and cultural significance. Land is part of who Tribes are as nations and individuals. However, says Annabelle Allison (Associate Director for NCEH/ATSDR’s Office of Tribal Affairs [OTA]), “almost every tribal community faces some type of environmental hazard that affects AI/AN health, culture, language, lifestyles, and access to traditional and sacred practices.”

Kristin Hill, Director of GLITEC, agrees. She says, “The most common environmental health issues facing Tribes are those that limit the availability of subsistence food and medicines. These include water quantity and quality and soil composition and erosion. Indoor air quality resulting from commercial tobacco abuse and excessive mold found in Tribal housing is also a concern.”

GLITEC evaluated environmental health priorities and resources among the 34 Tribes in the Bemidji Area of Michigan, Minnesota, and Wisconsin and discovered that data on environmental health exposures and outcomes are limited for Bemidji Area Native Americans.

GLITEC and Tracking

Hill found a possible solution to increasing that data at a meeting of the National Tribal Environmental Health (NTEH) Think Tank, a group of 12 Tribal environmental health professionals from many different backgrounds. Brought together in 2011 by ATSDR’s Office of Tribal Affairs (OTA), Think Tank members are working together to make AI/AN environmental health issues more visible. At a meeting, Hill heard a presentation about CDC’s Environmental Public Health Tracking Network and contacted the program directly to ask about funding for a tracking project.

Annabelle Allison lent her support, and the Tracking Network proposed the project to the tracking programs in Wisconsin and Minnesota that already receive grants from the CDC Environmental Public Health Tracking Branch. Since the aim was to improve data for the entire Bemidji Tribal area, CDC provided funding directly to GLITEC to support Tracking activities in Michigan as well.

Although AI/AN Tribes are cautious about sharing personal information, they understand the need for data collection. Says Hill, “They have long recognized that if you aren’t counted, you are invisible and underrepresented. So, while Tribes want Tribal data to be collected, the ways data are described, released or used can be a concern.”

Beginning the Partnership

Hill notes that the first step in working with any community is establishing relationships and receiving commitment from community leaders and members. When working with AI/AN Tribes, she says, “It’s very important to establish trust through relationship building that is respectful of self-determination and sovereign status. The community must be engaged in a way to maintain ownership and control of activities. Honoring unique Tribal protocols takes time, so Tribal projects often move slowly.” For this project, a first step will be to get commitment from Tribal leaders in official documents stating their interest and cooperation.

Tracking Program representatives, Lina Balluz (branch chief), Rich Sullivan, and Alex Charleston recently traveled to Wisconsin to meet with the Bemidji Area Environmental Public Health Advisory Committee and begin the planning process. NCEH Tracking team members feel fortunate to be part of this unique partnership. “We’re excited to be working with Native American tribes to explore how tracking might be beneficial to them,” says Sullivan.

CDC staff will provide tracking resources and training to area project staff, and state tracking programs will share resources, new developments and expertise in tracking systems. The group knows that the first strategies and activities must clearly show Tribes the value of this project. After developing some specific, practical five-year goals, the committee focused on first year strategies to demonstrate the value of the project and reach those long-range goals. Dr. Balluz reports that these priorities include “gauging tribal participation, building partnerships and assessing the availability of environmental and health data.”

Overall, the October meeting was the promising beginning of an exciting partnership that will expand data for the Bemidji area Tribes and the Tracking Program. Summarizing the gathering, Alex Charleston says, “The October meeting was very productive and we covered a lot of topics. We came away with a very do-able list of priorities for the first year.”

Learn more about Tribal Epidemiology Centers

Learn more about the Great Lakes Inter-Tribal Epidemiology Center

Watch a video about Tribal relationships with the environment by the National Tribal Environmental Health (NTEH) Think Tank