1. 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

2. MSM PHSF Internship 18 Minority students (6 Native American) 18 Minority students (6 Native American) Stationed at Morehouse, Emory and CDC Stationed at Morehouse, Emory and CDC Diverse educational backgrounds linked by public health Diverse educational backgrounds linked by public health 4 days a week dedicated to job placement 4 days a week dedicated to job placement Fridays reserved for course in Epidemiology/ public health Fridays reserved for course in Epidemiology/ public health

3. About the intern… Albuquerque, NM Albuquerque, NM San Carlos Apache Tribe of Arizona San Carlos Apache Tribe of Arizona Recent Haskell Indian Nations University graduate Recent Haskell Indian Nations University graduate Bachelor of Science- Environmental Science/ Natural Resources Bachelor of Science- Environmental Science/ Natural Resources PhD Nutritional Epidemiology (Purdue University) PhD Nutritional Epidemiology (Purdue University) *Investigate health concerns within NA communities that stem from exposure to nutritional/ environmental contaminants *Investigate health concerns within NA communities that stem from exposure to nutritional/ environmental contaminants

4. Tradition/ Rich in history Tradition/ Rich in history Personalized attention to help overcome educational, economical and social barriers Personalized attention to help overcome educational, economical and social barriers Family-like atmosphere Family-like atmosphere Western education and traditional American Indian values Western education and traditional American Indian values Encouraged to serve Indian Country! Encouraged to serve Indian Country! Benefits of a Tribal College/ University

5. 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’

6. NCEH NCEH Field and laboratory research to investigate effects of environment on health Field and laboratory research to investigate effects of environment on health Surveillance Surveillance Environmental emergency response Environmental emergency response Education & training Education & training ATSDR protect health & environment from hazardous substances Public Health assessment of waste sites Health consultations Health surveillance Registries Training/Outreach

7. NCEH/ATSDR NCEH and ATSDR have defined a shared vision for environmental public health 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 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 Promote health by improving the environment in which we live

9. Role of the OTA Assist NCEH/ATSDR with requests from tribes for consultation/public health assessments Assist NCEH/ATSDR with requests from tribes for consultation/public health assessments Works with external entities to fill data gaps within tribal communities Works with external entities to fill data gaps within tribal communities Internal collaboration in solving health issues Internal collaboration in solving health issues Builds bridges between environmental health and environmental protection in Indian Country Builds bridges between environmental health and environmental protection in Indian Country Main point of contact Main point of contact

10. Historic OTA Projects (2004) Hopi Reservation pesticides health assessment Hopi Reservation pesticides health assessment Tohono o’ Odham emergency response capabilities Tohono o’ Odham emergency response capabilities Squaxin Island Tribes of Puget fish consumption survey Squaxin Island Tribes of Puget fish consumption survey Port Graham Village council research protocol Port Graham Village council research protocol Tar Creek superfund site work on lead Tar Creek superfund site work on lead Alaska FUDs Alaska FUDs Navajo Nation Youth Risk Behavior Survey Navajo Nation Youth Risk Behavior Survey Salish/ Kootenai decrease in Methamphetamine laboratories Salish/ Kootenai decrease in Methamphetamine laboratories 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

11. Current OTA Projects – Summer 2008 Lummi Nation Specific Fish Consumption Survey Lummi Nation Specific Fish Consumption Survey Sisseton Sioux Nation concerns on Mold Issues Sisseton Sioux Nation concerns on Mold Issues Yurok nation of California wildfires Yurok nation of California wildfires Strategic development of current and future activities Strategic development of current and future activities * Health and environmental impacts of Uranium contamination in the Navajo Nation * Native American Environmental Health Research Initiative

12. Project 1: Navajo Uranium Mining 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 House committee asked BIA, DOE, NRC, EPA and IHS to develop a coordinated plan to address: House committee asked BIA, DOE, NRC, EPA and IHS to develop a coordinated plan to address: Assessment of contaminated water sources Assessment of contaminated water sources Cleanup of contaminated sites Cleanup of contaminated sites Alternate water supplies Alternate water supplies Assessment of AUM’s Assessment of AUM’s Case controlled studies of health risks Case controlled studies of health risks

13. 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 Projects NCEH/ ATSDR have done to date Plans for future work Plans for future work MOU’S with BIA where activities and funding can be executed MOU’S with BIA where activities and funding can be executed Other ways the agencies can contribute to the future Other ways the agencies can contribute to the future Staff expertise (assessment/evaluation of contamination) Staff expertise (assessment/evaluation of contamination)

14. Project 2: Native American Environmental Health Research Initiative Yu’pik Eskimo/ Athabascans Yu’pik Eskimo/ Athabascans High exposure to POPs High exposure to POPs Elevated incidence of chronic disease Elevated incidence of chronic disease Diabetes, Colon cancer Diabetes, Colon cancer Coordinate analytical studies for POP evaluation Coordinate analytical studies for POP evaluation University/ State partners (leverage resources to greatest extent) University/ State partners (leverage resources to greatest extent)

15. Establish contacts within the Alaska Native American villages that are susceptible to health disparities Establish contacts within the Alaska Native American villages that are susceptible to health disparities Chemical exposure through hunting and fishing subsistence. Chemical exposure through hunting and fishing subsistence. Exchange information with Tribal environmental workgroups Exchange information with Tribal environmental workgroups Make site-specific visits in order to review the policy and procedure that is necessary for investigation Make site-specific visits in order to review the policy and procedure that is necessary for investigation Role of OTA

16. Project 3: Ambient air pollution in Children with sickle cell NCEH Air Pollution and Respiratory Health branch NCEH Air Pollution and Respiratory Health branch Ambient air pollution associated with increase risk of respiratory complications 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 Goal: Determine if ambient concentration of air pollutants in Atlanta, GA are associated with adverse health effects in children with SCD

17. Role of the Intern Create survey database Create survey database data entry design and structure management data entry design and structure management Field equipment training session attendance Field equipment training session attendance gain knowledge of state of the art monitoring instrumentation gain knowledge of state of the art monitoring instrumentation accurate collection of respiratory health measurements. accurate collection of respiratory health measurements. Explore the collaboration of OTA and other ATSDR branches Explore the collaboration of OTA and other ATSDR branches Air Pollution and Respiratory Health Air Pollution and Respiratory Health

18. Training Session

19. Future OTA Projects Bridge the gap between Environmental concerns and environmental health Bridge the gap between Environmental concerns and environmental health Training programs for working in Indian Country Training programs for working in Indian Country Continued education around traditional ways of life through a Native perspective Continued education around traditional ways of life through a Native perspective Develop tribal-specific health models Develop tribal-specific health models Support in interpreting/ sharing data Support in interpreting/ sharing data Increase Staff/ Budget Increase Staff/ Budget

20. Recommendations for the future Locations in addition to Atlanta Locations in addition to Atlanta Survey tribal public health needs on a national scale Survey tribal public health needs on a national scale Strengthen alliances Strengthen alliances Advocate for funding and programs Advocate for funding and programs Tribal College/ University outreach Tribal College/ University outreach Conduct evaluations of OTA Conduct evaluations of OTA

21. Take home lessons - OTA Essential role – Tribal environmental/ Health issues Essential role – Tribal environmental/ Health issues Speaks for both parties Speaks for both parties Trust between agencies and tribe Trust between agencies and tribe People who are enthusiastic and understanding about culture People who are enthusiastic and understanding about culture Recognize significance of Native American perspective and input on environmental issues Recognize significance of Native American perspective and input on environmental issues Career opportunities/ serving the community Career opportunities/ serving the community

22. Thank you!

23. References 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 93- 0562 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 93- 0562 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 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 http://www.atsdr.cdc.gov/HAC/PHAmanual/ch2.html