1. 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

2. 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.

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Questions? Carolyn Angus-Hornbuckle, JD
Director of Public Health Policy and Programs
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