Environmental Health in Indian Environmental Health in Indian Country: An exploration of Country: An exploration of

working with tribes in the U.S.working with tribes in the U.S.

CDC/NCEH/ATSDRCDC/NCEH/ATSDR

Office of Tribal AffairsOffice of Tribal Affairs

Public Health Summer Fellow Public Health Summer Fellow InternshipInternship

Melinda M. AdamsMelinda M. AdamsMentor: Annabelle AllisonMentor: Annabelle Allison

MSM PHSF InternshipMSM PHSF Internship 18 Minority students (6 Native American)18 Minority students (6 Native American) Stationed at Morehouse, Emory and CDCStationed at Morehouse, Emory and CDC Diverse educational backgrounds linked by Diverse educational backgrounds linked by

public healthpublic health 4 days a week dedicated to job placement4 days a week dedicated to job placement Fridays reserved for course in Fridays reserved for course in

Epidemiology/ public healthEpidemiology/ public health

About the intern…About the intern… Albuquerque, NMAlbuquerque, NM San Carlos Apache Tribe of ArizonaSan Carlos Apache Tribe of Arizona Recent Haskell Indian Nations University Recent Haskell Indian Nations University

graduategraduate Bachelor of Science- Environmental Science/ Bachelor of Science- Environmental Science/

Natural Resources Natural Resources PhD Nutritional Epidemiology (Purdue PhD Nutritional Epidemiology (Purdue

University)University) *Investigate health concerns within NA *Investigate health concerns within NA

communities that stem from exposure to communities that stem from exposure to nutritional/ environmental contaminantsnutritional/ environmental contaminants

Tradition/ Rich in historyTradition/ Rich in history Personalized attention to help Personalized attention to help

overcome educational, economical and overcome educational, economical and social barrierssocial barriers

Family-like atmosphere Family-like atmosphere Western education and traditional Western education and traditional

American Indian values American Indian values Encouraged to serve Indian Country!Encouraged to serve Indian Country!

Benefits of a Benefits of a Tribal College/ Tribal College/

UniversityUniversity

Office of Tribal AffairsOffice of Tribal Affairs‘ ‘ Helping American Indian and Alaska Helping American Indian and Alaska

Native Nations strengthen their Native Nations strengthen their capacity to preserve the capacity to preserve the

environment which is at the core of environment which is at the core of cultural identity and health’cultural identity and health’

NCEHNCEH Field and laboratory Field and laboratory

research to research to investigate effects of investigate effects of environment on environment on healthhealth

SurveillanceSurveillance Environmental Environmental

emergency responseemergency response Education & Education &

trainingtraining

ATSDRATSDR protect health & protect health &

environment from environment from hazardous hazardous substancessubstances

Public Health Public Health assessment of assessment of waste siteswaste sites

Health Health consultationsconsultations

Health Health surveillancesurveillance

RegistriesRegistries Training/OutreachTraining/Outreach

NCEH/ATSDR NCEH/ATSDR

NCEH and ATSDR have defined a NCEH and ATSDR have defined a shared vision for environmental shared vision for environmental public healthpublic health

Aims to establish common ground to Aims to establish common ground to build the national/international build the national/international resources for addressing resources for addressing environmental public health threatsenvironmental public health threats

Promote health by improving the Promote health by improving the environment in which we liveenvironment in which we live

Role of the OTARole of the OTA Assist NCEH/ATSDR with requests from Assist NCEH/ATSDR with requests from

tribes for consultation/public health tribes for consultation/public health assessmentsassessments

Works with external entities to fill data gaps Works with external entities to fill data gaps within tribal communitieswithin tribal communities Internal collaboration in solving health issuesInternal collaboration in solving health issues

Builds bridges between environmental Builds bridges between environmental health and environmental protection in health and environmental protection in Indian CountryIndian Country Main point of contactMain point of contact

Historic OTA Projects Historic OTA Projects (2004)(2004) Hopi Reservation pesticides Hopi Reservation pesticides

health assessmenthealth assessment Tohono o’ Odham emergency Tohono o’ Odham emergency

response capabilitiesresponse capabilities Squaxin Island Tribes of Puget Squaxin Island Tribes of Puget

fish consumption surveyfish consumption survey Port Graham Village council Port Graham Village council

research protocolresearch protocol Tar Creek superfund site work Tar Creek superfund site work

on leadon lead Alaska FUDsAlaska FUDs Navajo Nation Youth Risk Navajo Nation Youth Risk

Behavior SurveyBehavior Survey Salish/ Kootenai decrease in Salish/ Kootenai decrease in

Methamphetamine Methamphetamine laboratorieslaboratories

College of Menominee Nation College of Menominee Nation building environmental public building environmental public health capacityhealth capacity

Navajo Nation dip vats Public Navajo Nation dip vats Public Health consultationHealth consultation

Confederate tribes of Colville Confederate tribes of Colville public health assessment/ public health assessment/ petition procedurepetition procedure

St. Regis Mohawk tribe PCB St. Regis Mohawk tribe PCB researchresearch

Mold and moisture conditions Mold and moisture conditions in Native American housingin Native American housing

Environmental health plan Environmental health plan proposal tribes impacted by proposal tribes impacted by Hanford Nuclear reservationHanford Nuclear reservation

Current OTA Projects – Current OTA Projects – Summer 2008Summer 2008

Lummi Nation Specific Fish Consumption Lummi Nation Specific Fish Consumption SurveySurvey

Sisseton Sioux Nation concerns on Mold Issues Sisseton Sioux Nation concerns on Mold Issues Yurok nation of California wildfiresYurok nation of California wildfires Strategic development of current and future Strategic development of current and future

activitiesactivities

** Health and environmental impacts of Uranium Health and environmental impacts of Uranium contamination in the Navajo Nationcontamination in the Navajo Nation

** Native American Environmental Health Native American Environmental Health Research InitiativeResearch Initiative

Project 1: Navajo Uranium Project 1: Navajo Uranium MiningMining

In 1944-1986 4M tons of In 1944-1986 4M tons of Uranium extracted in the Navajo Uranium extracted in the Navajo Nation. Nation.

Left the Navajo with a legacy of Left the Navajo with a legacy of Over 500 abandoned uranium Over 500 abandoned uranium

mines (AUM’s), mines (AUM’s), 4 inactive uranium milling 4 inactive uranium milling

sites, sites, 1 former dump site, 1 former dump site, Contaminated ground water, Contaminated ground water, Structures that contain Structures that contain

elevated levels of radiationelevated levels of radiation March 2008 - 5 year plan as March 2008 - 5 year plan as

requested by House Committee requested by House Committee on oversight and government on oversight and government reformreform

House committee asked House committee asked BIA, DOE, NRC, EPA and BIA, DOE, NRC, EPA and IHS to develop a IHS to develop a coordinated plan to coordinated plan to address:address: Assessment of Assessment of

contaminated water contaminated water sourcessources

Cleanup of contaminated Cleanup of contaminated sitessites

Alternate water supplies Alternate water supplies Assessment of AUM’sAssessment of AUM’s Case controlled studies Case controlled studies

of health risksof health risks

Role of NCEH/ ATSDRRole of NCEH/ ATSDRWaxman committee requested brief on:Waxman committee requested brief on:

Endeavors related to uranium contamination Endeavors related to uranium contamination of water supplies on Navajo land including:of water supplies on Navajo land including:

Projects NCEH/ ATSDR have done to dateProjects NCEH/ ATSDR have done to date Plans for future workPlans for future work

MOU’S with BIA where activities and MOU’S with BIA where activities and funding can be executedfunding can be executed

Other ways the agencies can contribute to Other ways the agencies can contribute to the futurethe future

Staff expertise (assessment/evaluation Staff expertise (assessment/evaluation of contamination)of contamination)

Project 2: Native American Project 2: Native American Environmental Health Research Environmental Health Research

InitiativeInitiative Yu’pik Eskimo/ AthabascansYu’pik Eskimo/ Athabascans High exposure to POPsHigh exposure to POPs Elevated incidence of chronic disease Elevated incidence of chronic disease

Diabetes, Colon cancerDiabetes, Colon cancer Coordinate analytical studies for POP Coordinate analytical studies for POP

evaluationevaluation University/ State partners (leverage University/ State partners (leverage

resources to greatest extent)resources to greatest extent)

Establish contacts within the Alaska Establish contacts within the Alaska Native American villages that are Native American villages that are susceptible to health disparities susceptible to health disparities Chemical exposure through hunting and Chemical exposure through hunting and

fishing subsistence. fishing subsistence. Exchange information with Tribal Exchange information with Tribal

environmental workgroupsenvironmental workgroups Make site-specific visits in order to Make site-specific visits in order to

review the policy and procedure that review the policy and procedure that is necessary for investigationis necessary for investigation

Role of OTARole of OTA

Project 3: Ambient air Project 3: Ambient air pollution in Children with pollution in Children with

sickle cellsickle cell NCEH Air Pollution and Respiratory NCEH Air Pollution and Respiratory

Health branchHealth branch Ambient air pollution associated with Ambient air pollution associated with

increase risk of respiratory increase risk of respiratory complicationscomplications

Goal: Determine if ambient Goal: Determine if ambient concentration of air pollutants in concentration of air pollutants in Atlanta, GA are associated with adverse Atlanta, GA are associated with adverse health effects in children with SCDhealth effects in children with SCD

Role of the InternRole of the Intern Create survey database Create survey database

data entry design and structure data entry design and structure managementmanagement

Field equipment training session Field equipment training session attendanceattendance gain knowledge of state of the art gain knowledge of state of the art

monitoring instrumentation monitoring instrumentation accurate collection of respiratory health accurate collection of respiratory health

measurements. measurements. Explore the collaboration of OTA and Explore the collaboration of OTA and

other ATSDR branchesother ATSDR branches Air Pollution and Respiratory Health Air Pollution and Respiratory Health

Training Session

Future OTA ProjectsFuture OTA Projects Bridge the gap between Environmental Bridge the gap between Environmental

concerns and environmental healthconcerns and environmental health Training programs for working in Indian Training programs for working in Indian

CountryCountry Continued education around traditional Continued education around traditional

ways of life through a Native perspectiveways of life through a Native perspective Develop tribal-specific health modelsDevelop tribal-specific health models Support in interpreting/ sharing dataSupport in interpreting/ sharing data Increase Staff/ BudgetIncrease Staff/ Budget

Recommendations for Recommendations for the futurethe future

Locations in addition to AtlantaLocations in addition to Atlanta Survey tribal public health needs on Survey tribal public health needs on

a national scalea national scale Strengthen alliancesStrengthen alliances

Advocate for funding and programsAdvocate for funding and programs Tribal College/ University outreachTribal College/ University outreach Conduct evaluations of OTAConduct evaluations of OTA

Take home lessons - OTATake home lessons - OTA Essential role – Tribal environmental/ Health Essential role – Tribal environmental/ Health

issuesissues Speaks for both partiesSpeaks for both parties

Trust between agencies and tribeTrust between agencies and tribe People who are enthusiastic and People who are enthusiastic and

understanding about cultureunderstanding about culture Recognize significance of Native American Recognize significance of Native American

perspective and input on environmental issuesperspective and input on environmental issues Career opportunities/ serving the communityCareer opportunities/ serving the community

Thank you!Thank you!

ReferencesReferences Agency for health care Policy and Research. Sickle cell disease. Screening, Agency for health care Policy and Research. Sickle cell disease. Screening,

diagnosis, management and in new born and infants. Clinical Practice Guideline. diagnosis, management and in new born and infants. Clinical Practice Guideline. Rockville, MD: Agency for health care Policy an Research, 1993. Publication 93-Rockville, MD: Agency for health care Policy an Research, 1993. Publication 93-0562 0562

Report on the expert panel to evaluate ATSDR’s Office of Tribal Affairs. Prepared 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. by the Agency for Toxic Substance and Disease Registry. ERG Lexington, MA. 20072007

http://www.atsdr.cdc.gov/HAC/PHAmanual/ch2.htmlhttp://www.atsdr.cdc.gov/HAC/PHAmanual/ch2.html