Partnership in Action: Identifying Disease Burden Among American Indian/Alaska Natives

BACKGROUND: American Indian/Alaska Natives (AI/ANs) are a distinct and unique population that experience a disproportionate burden of disease in the U.S. American Indians are not only a separate racial group, but also a distinct political group. Hundreds of independent nations were flourishing in what is now the U.S. when Europeans first arrived. The federal trust responsibility is the result of numerous treaties, executive orders, and court decisions that defines the relationship between the U.S. and Tribes and individual AIs. “A federal Indian reservation is an area of land reserved for a Tribe or Tribes under treaty or other agreement with the United States, executive order, or federal statute or administrative action as permanent Tribal homelands, and where the federal government holds title to the land in trust on behalf of the Tribe.” There are currently 566 federally recognized Tribes and 315 reservations covering roughly 55 million acres of land. Contract Health Service Delivery Area (CHSDA) counties are counties that include or adjoin AI reservations; they are commonly used when calculating AI health statistics using national or state datasets.  

METHODS: As an extension of the federal trust responsibility, Tribal Epidemiology Centers (TECs) were established. TECs serve AI/AN Tribal and urban communities by managing public health information systems, investigating diseases, supporting disease prevention and control programs, and coordinating public health activities with other public health authorities.    

RESULTS: Data play a large role in understanding health inequities. However, the true cost of diseases in death and disability among AI/ANs is often masked because of racial misclassification within mortality data or the systematic exclusion of AI/ANs from national surveys such as the National Health and Nutrition Examination Survey. When national surveys include AI/ANs, the methodologies typically under sample AI/ANs or combine them with other smaller populations, obscuring racial identification. To achieve sufficient statistical power, often several years of AI/AN data have to be aggregated and/or geographical areas have to be combined. This aggregation makes it impossible to determine trends or to identify geographical differences.  

CONCLUSIONS: A partnership between the Great Lakes Inter-Tribal Epidemiology Center (GLITEC), Minnesota Department of Health, and Wisconsin Department of Health led to novel ways of examining the burden of a disease among AI/ANs residing in Minnesota and Wisconsin. This project was an effort to understand health inequities in this distinct and unique population.