For discussion

November 2017

Engaging and Partnering with Tribes: American Indian Public Health Resource Center Improving Public Health

The American Indian Public Health Resource Center (AIPHRC) at North Dakota State University (NDSU), under the direction of Dr. Donald Warne, MD, MPH and Dr. Melanie Nadeau PhD, MPH, supports tribal nation public health efforts through a unique four-pronged approach. Integrating research, policy, education and services, the AIPHRC offers public health technical support to tribal nations across the United States. Donald Warne is the chair of the Department of Public Health at NDSU, and serves as the Senior Policy Advisor to the Great Plains Tribal Chairmen’s Health Board. Dr. Warne is a member of the Oglala Lakota tribe from the Pine Ridge Indian Reservation. He received his Doctor of Medicine from Stanford University and his Master of Public Health from Harvard University. Melanie Nadeau is the Operational Director/Assistant Professor of Practice for the AIPHRC. She is an enrolled member of the Turtle Mountain Band of Chippewa Indians. Dr. Nadeau received her undergraduate degree in psychology from the University of North Dakota and Master’s in Public Health and PhD in Epidemiology from the University of Minnesota. The AIPHRC also staffs a number of other individuals who contribute to the center’s mission. Ryan Eagle is an enrolled member of the Three Affiliated Tribes of the Fort Berthold Indian Reservation in North Dakota – the Mandan, Hidatsa, and Arikara Nation – and serves as the AIPHRC Research Project Manager. Ryan initially attended Fort Berthold Community College, where he received an Associate of Science in Environmental Science. Ryan continued his education at the University of North Dakota, where he received a Bachelor of Arts in Political Science and minors in Public Administration and Indian Studies. Vanessa Tibbitts, a member of the Oglala Lakota tribe, serves as the AIPHRC Public Health Education Project Manager. Vanessa received her Bachelor of Science in Human Services and her Master of Arts in Lakota Leadership and Management from Oglala Lakota College. Gretchen Dobervich serves as the AIPHRC Public Health Policy Manager. Gretchen received her Bachelor of Social Work from Minot State University and is a licensed social worker in the state of North Dakota. Gretchen represents District 11 in the North Dakota House of Representatives. The AIPHRC currently hosts a Centers for Disease Control and Prevention - Public Health Associate Program employee, Karla Checo. Karla earned her Bachelor of Arts in Chemistry from the University of North Carolina at Chapel Hill.

American Indians face the highest health disparities in the United States. In fact, American Indians have a 208% times greater chance of dying from diabetes, a 526% greater chance of dying of alcoholism, and a 60% greater chance of dying by suicide than their non-native peers (Indian Health Service. Regional Differences in Indian Health 2002-2003). Tribal communities work tirelessly, despite lack of funding and infrastructure, to improve the health of tribal members and reduce the disparity gaps. The Indian Health Service is consistently funded at less than 60% of the operating budget necessary to provide programs and services.

The desire to assist tribal nations in improving health outcomes inspired Dr. Don Warne to develop the American Indian Public Health Resource Center (AIPHRC) under the umbrella of the Public Health Department at North Dakota State University. Founded in August of 2014, the AIPHRC’s mission is to address American Indian public health disparities through technical assistance, policy development, self-determination feasibility analysis, education, research, and programming in partnership with tribes, in North Dakota, across the Northern Plains, and the nation.

In just three years the AIPHRC has worked with all four tribes in North Dakota, all of the nine tribal nations in South Dakota, the 11 tribal nations in Minnesota, the eight tribes in Montana, and the two tribal nations in Wyoming. In addition to providing technical assistance to all 34 tribes in a four state area, the AIPHRC has provided technical assistance to tribal nations as far away as Arizona.

Authority, Autonomy, and Self-Determination
There is a long history of universities and other institutions of learning approaching tribal nations to “research them.” After the research was completed, the outcomes were rarely, if ever, shared with the tribal community, leaving tribes unable to apply evidence-based findings to solving problems. The AIPHRC’s vision is engaging and partnering with tribes to improve the delivery of culturally appropriate public health services and functions in American Indian communities. The AIPHRC is changing the way research is conducted in tribal communities by assisting tribes in developing their own tribal research agendas and providing research technical assistance at the request of the tribe. Results are shared with the specific tribal community to aide in developing evidence-based approaches to public health issues.

In addition to research, the AIPHRC provides technical assistance and a toolkit that assists tribal nations seeking to assume responsibility for the management of healthcare services under Indian Health Service. This process is often referred to as “638ing”, after the Indian Self-Determination & Education Assistance Act (ISDEAA—PL 93-638), which gives tribal nations the right to manage their own education and healthcare services with funds that would have been both managed and used to provide services through Indian Health Services. This process allows tribal nations to determine where and how to allocate funds and services to best meet the health needs facing their specific community.

A Healthier Future
Educating public health professionals for the future is a need facing many tribal nations. The AIPHRC provides technical assistance in a variety of ways to help reach this goal. One initiative offers an Introduction to Public Health class at tribal colleges in North Dakota through the IVN (Interactive Video Network). The initiative generated great interest the first time it was offered – so much so that an attendee is currently pursuing the Master of Public Health degree at NDSU. NDSU currently offers the only Master of Public Health with a concentration in American Indian Public Health in the United States.

Another unique program is the Summer Undergraduate Research Program (SURP), which is offered each summer at NDSU through the AIPHRC. This two-week program offers tribal college students and recent graduates from American Indian high schools the chance to spend two weeks at NDSU learning about research careers in a variety of scientific arenas, as well as experiencing campus living.

The AIPHRC also assists tribal nations in planning conferences, workshops, and summits aimed at addressing a variety of public health issues. Staff are trained in Technology of Participation® facilitation and have facilitated meetings and conferences, including the Minnesota Tribal-State Opioid Discussion hosted by Governor Mark Dayton.

To learn more about the American Indian Public Health Resource Center or to request technical assistance go to https://www.ndsu.edu/centers/american_indian_health/.