Transcript Morehouse School of Medicine Public Health Summer Fellow

Environmental Health in Indian Country:
An exploration of working with tribes in
the U.S.
CDC/NCEH/ATSDR
Office of Tribal Affairs
Public Health Summer Fellow Internship
Melinda M. Adams
Mentor: Annabelle Allison
MSM PHSF Internship
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18 Minority students (6 Native American)
Stationed at Morehouse, Emory and CDC
Diverse educational backgrounds linked by public
health
4 days a week dedicated to job placement
Fridays reserved for course in Epidemiology/ public
health
About the intern…
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Albuquerque, NM
San Carlos Apache Tribe of Arizona
Recent Haskell Indian Nations University graduate
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Bachelor of Science- Environmental Science/ Natural
Resources
PhD Nutritional Epidemiology (Purdue University)
*Investigate health concerns within NA
communities that stem from exposure to
nutritional/ environmental contaminants
Benefits of a
Tribal College/ University
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Tradition/ Rich in history
Personalized attention to help overcome
educational, economical and social barriers
Family-like atmosphere
Western education and traditional American Indian
values
Encouraged to serve Indian Country!
Office of Tribal Affairs
‘ Helping American Indian and Alaska Native
Nations strengthen their capacity to preserve the
environment which is at the core of cultural
identity and health’
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NCEH
 Field
and laboratory
research to investigate
effects of environment
on health
 Surveillance
 Environmental
emergency response
 Education & training
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ATSDR
protect health &
environment from
hazardous substances
 Public Health
assessment of waste
sites
 Health consultations
 Health surveillance
 Registries
 Training/Outreach
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NCEH/ATSDR
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NCEH and ATSDR have defined a shared
vision for environmental public health
Aims to establish common ground to build the
national/international resources for addressing
environmental public health threats
Promote health by improving the environment
in which we live
Role of the OTA
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Assist NCEH/ATSDR with requests from tribes
for consultation/public health assessments
Works with external entities to fill data gaps
within tribal communities
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Internal collaboration in solving health issues
Builds bridges between environmental health and
environmental protection in Indian Country
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Main point of contact
Historic OTA Projects (2004)
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Hopi Reservation pesticides health
assessment
Tohono o’ Odham emergency
response capabilities
Squaxin Island Tribes of Puget fish
consumption survey
Port Graham Village council research
protocol
Tar Creek superfund site work on lead
Alaska FUDs
Navajo Nation Youth Risk Behavior
Survey
Salish/ Kootenai decrease in
Methamphetamine laboratories
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College of Menominee Nation building
environmental public health capacity
Navajo Nation dip vats Public Health
consultation
Confederate tribes of Colville public
health assessment/ petition procedure
St. Regis Mohawk tribe PCB research
Mold and moisture conditions in Native
American housing
Environmental health plan proposal
tribes impacted by Hanford Nuclear
reservation
Current OTA Projects – Summer 2008
Lummi Nation Specific Fish Consumption Survey
 Sisseton Sioux Nation concerns on Mold Issues
 Yurok nation of California wildfires
 Strategic development of current and future activities
* Health and environmental impacts of Uranium
contamination in the Navajo Nation
* Native American Environmental Health Research
Initiative
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Project 1: Navajo Uranium Mining
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In 1944-1986 4M tons of Uranium
extracted in the Navajo Nation.
Left the Navajo with a legacy of
 Over 500 abandoned uranium
mines (AUM’s),
 4 inactive uranium milling sites,
 1 former dump site,
 Contaminated ground water,
 Structures that contain elevated
levels of radiation
March 2008 - 5 year plan as
requested by House Committee on
oversight and government reform
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House committee asked BIA,
DOE, NRC, EPA and IHS to
develop a coordinated plan to
address:
 Assessment of
contaminated water sources
 Cleanup of contaminated
sites
 Alternate water supplies
 Assessment of AUM’s
 Case controlled studies of
health risks
Role of NCEH/ ATSDR
Waxman committee requested brief on:
Endeavors related to uranium contamination of water
supplies on Navajo land including:
 Projects NCEH/ ATSDR have done to date
 Plans for future work
 MOU’S with BIA where activities and funding
can be executed
 Other ways the agencies can contribute to the future
 Staff expertise (assessment/evaluation of
contamination)
Project 2: Native American Environmental
Health Research Initiative
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Yu’pik Eskimo/ Athabascans
High exposure to POPs
Elevated incidence of chronic disease
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Diabetes, Colon cancer
Coordinate analytical studies for POP evaluation
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University/ State partners (leverage resources to greatest
extent)
Role of OTA
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Establish contacts within the Alaska Native
American villages that are susceptible to health
disparities
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Chemical exposure through hunting and fishing
subsistence.
Exchange information with Tribal
environmental workgroups
Make site-specific visits in order to review the
policy and procedure that is necessary for
investigation
Project 3: Ambient air pollution in
Children with sickle cell
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NCEH Air Pollution and Respiratory Health branch
Ambient air pollution associated with increase risk
of respiratory complications
Goal: Determine if ambient concentration of air
pollutants in Atlanta, GA are associated with adverse
health effects in children with SCD
Role of the Intern
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Create survey database
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data entry design and structure management
Field equipment training session attendance
gain knowledge of state of the art monitoring
instrumentation
 accurate collection of respiratory health
measurements.
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Explore the collaboration of OTA and other
ATSDR branches
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Air Pollution and Respiratory Health
Training Session
Future OTA Projects
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Bridge the gap between Environmental concerns
and environmental health
Training programs for working in Indian Country
Continued education around traditional ways of life
through a Native perspective
Develop tribal-specific health models
Support in interpreting/ sharing data
Increase Staff/ Budget
Recommendations for the future
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Locations in addition to Atlanta
Survey tribal public health needs on a national
scale
Strengthen alliances
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Advocate for funding and programs
Tribal College/ University outreach
Conduct evaluations of OTA
Take home lessons - OTA
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Essential role – Tribal environmental/ Health issues
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Speaks for both parties
Trust between agencies and tribe
People who are enthusiastic and understanding
about culture
Recognize significance of Native American
perspective and input on environmental issues
Career opportunities/ serving the community
Thank you!
References
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Agency for health care Policy and Research. Sickle cell disease. Screening,
diagnosis, management and in new born and infants. Clinical Practice Guideline.
Rockville, MD: Agency for health care Policy an Research, 1993. Publication 930562
Report on the expert panel to evaluate ATSDR’s Office of Tribal Affairs. Prepared
by the Agency for Toxic Substance and Disease Registry. ERG Lexington, MA.
2007
http://www.atsdr.cdc.gov/HAC/PHAmanual/ch2.html