1. Using Public Health to strengthen Tribal sovereignty Joe Finkbonner RPh MHA, Executive Director Northwest Portland Area Indian Health Board

2. 2 Objectives of discussion Elucidate the necessity for sovereign tribal governments to develop public health codes and regulations Review and discuss meaning of sovereign Review definition and elements of public health

3. Sovereignty Supreme power or authority The authority of a state to govern itself. Autonomous state The quality or state of being sovereign. The status, dominion, power, or authority of a sovereign; royalty. Supreme and independent power or authority in a state. Rightful status, independence, or prerogative. A sovereign state, community, or political unit.

4. Public health definition the health of the population as a whole, especially as monitored, regulated, and promoted by the state.

5.  Tribes possess authority to act in matters of public health  Tribes hold public health authority as defined by the US Department of Health and Human Services  In addition to their inherent authority, tribes are authorized under Public Law 93-638, the Indian Self-  Determination and Education Assistance Act, to directly administer their own public health (and other) Programs.  Though some tribes may have laws requiring collaboration with other governments, there is no general legal  requirement that tribes share public health services with other entities. Tribes authority

6. http://iom.edu/Reports/1988/The-Future-of-Public-Health.aspx http://www.health.gov/phfunctions/public.htm  Core Functions of Public Health  Assessment  Policy development  Assurance  Purpose of Public Health  Prevent epidemics and spread of disease  Protect against environmental hazards  Prevent injuries  Promote and encourage healthy behaviors  Respond to disasters and assist communities in recovery  Assure the quality and accessibility of services Core Functions of Public Health Steering ”Public Health in America”

7. The 10 Essential Public Health Services 1. Monitor health status to identify and solve community health problems 2. Diagnose and investigate health problems and health hazards in the community 3. Inform, educate, and empower people about health issues 4. Mobilize community partnerships to identify and solve health problems 5. Develop policies and plans that support individual and community health efforts

8. The 10 Essential Public Health Services 6. Enforce laws and regulations that protect health and ensure safety 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable 8. Assure a competent public and personal health care workforce 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services 10. Research for new insights and innovative solutions to health problems

9. Essential Public Health Services

10. Elements of public health Promote health Protection from harm –Disease –injury

11. Public health powers Can hold someone without cause. police powers from the 10th Amendment to the Constitution, which reserves to the states the rights and powers "not delegated to the United States" which include protection of the welfare, safety, health and even morals of the public. Police powers include licensing, inspection, zoning, safety regulations (which cover a lot of territory), quarantines, and working conditions as well as law enforcement.

12. Police powers – cont’d Tribes also have police power authority to take actions that promote the health, safety, and welfare of their own tribal members. Tribal health authorities may enforce their own isolation and quarantine laws within tribal lands, if such laws exist.

13. Contact information Joe Finkbonner RPh MHA, Executive Director NW Portland Area Indian Health Board 2121 SW Broadway, Suite 300 Portland, OR 97201 Phone: 503.228.4185 Fax: 503.228.8182 Jfinkbonner@npaihb.org