CDC Tribal Advisory Committee Update and Public Health Initiatives If creating a presentation for an NIHB board member or the Executive Director, please use this “notes” box to put the script or talking points. 2018 Annual Tribal Self-Governance Consultation Conference Albuquerque, New Mexico April 24, 2018

Indian Health Service & Public Health IHS provides or supports a wide range of activities including clinical care, facilities construction, infrastructure and public and community health As agencies are pressed to cut budgets, IHS has stated its priority is to provide quality direct health care services.

Indian Health Service & Cuts to Public Health FY 2019 President’s budget proposes cuts to some notable public health focused programs: Health Education – would be eliminated Community Health Representatives – would be eliminated Overall the Preventive Health Services would be decreased by ~69 million dollars (2018 funding level - ~158 million)

Indian Health Service & Public Health Investments FY 2019 President’s budget would retain certain programs advancing public health: Indian Health Service (IHS) Tribal Epidemiology Center (TEC) Program TECs provide support to Tribes for disease surveillance evaluation of public health programs Technical assistance to Tribes Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Indian Health Service & Public Health Investments 12 Tribal Epidemiology Centers (TEC) Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Indian Health Service & Public Health Investments Indian Health Service (IHS) Tribal Epidemiology Center (TEC) Program Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Indian Health Service & Public Health Investments Indian Health Service (IHS) Tribal Epidemiology Center (TEC) Program Current funding averages $341,000 per TEC Can cover salaries of a Director, one full-time Epidemiologist, administrative assistance/support; and implementation of one or two pressing disparity projects or tribal priorities. Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Indian Health Service & Public Health Investments Substance Abuse and Suicide Prevention Program (SASP) provides funding for prevention and intervention addressing methamphetamine and suicide in Indian Country funds 175 projects; ~ $32 million Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Indian Health Service & Public Health Investments Domestic Violence Prevention Program provides domestic violence and sexual assault prevention and intervention resources currently 83 projects; ~11 million Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Indian Health Service & Public Health Investments Special Diabetes Program for Indians provides funding for diabetes treatment and prevention 150 million dollars; supports 301 IHS, Tribal, and Urban Indian health grant programs President’s FY 2019 budget sustained funding levels but proposed to change the program from mandatory (what it currently is) and make it discretionary Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Indian Health Service & Public Health Investments Special Diabetes Program for Indians Tribal Leaders Diabetes Committee - provides recommendations on diabetes-related issues, with a focus on SDPI programs, to the IHS Director Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Indian Health Service & Investments Proposed under IHCIA A number of sections in the Indian Health Care Improvement Act looked to increase public health activities, and provided authority to do so Example - authorized a national CHAP program In many cases, no funding attached In sum– IHS is not able to provide enough funding to support a comprehensive public health approach Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Alternative Avenues of Support for PH The federal trust responsibility for health and public health services runs from the entire federal government to Tribes IHS is a key actor – but all HHS operating divisions have a role to play including the Centers for Disease Control and Prevention Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

CDC – Nation’s Lead Public Health Agency CDC has made some notable investments in Public Health for Indian Country but more can be done Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

CDC Tribal Advisory Committee: Priorities TAC has shared that CDC should: develop a policy for CIOs to engage with Tribes during the agency’s budget formulation process direct CIOs set aside funding to directly fund Tribal public health include Indian Tribes and Tribal organizations as eligible entities for direct funding in all FOAs require that states receiving CDC funds actively engage with Indian Tribe(s) within their state boundaries as part of program planning and implementation explicitly acknowledge the value and applicability of cultural and traditional practices as viable grantee activities Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services

Questions? Carolyn Angus-Hornbuckle, JD Director of Public Health Policy and Programs 202-507-4089 chornbuckle@nihb.org Two purpose areas have been established to help meet these goals: Purpose Area 1: Domestic and Sexual Violence Prevention, Advocacy, and Coordinated Community Responses Purpose Area 2: Provide Forensic Healthcare Services