ACTIVITY/MECHANISMS BUDGET SUMMARY

Department of Health and Human Services

Indian Health Service -- 75-0390-0-1-551

EPIDEMIOLOGY CENTERS

[Program Authorization]{.underline}

Program authorized by 25 U.S.C. 13, Snyder Act, P.L. 83-568, Transfer
Act 42 U.S.C. 2001, and P.L. 102-573, Title II, Section 214.

+-------------+-------------+-------------+-------------+-------------+
|             | 2002        | 2003        | 2004        | Increase    |
|             |             |             |             |             |
|             | Actual      | President's | Estimate    | or Decrease |
|             |             |             |             |             |
|             |             | Budget      |             |             |
+-------------+-------------+-------------+-------------+-------------+
| BA          | \$1,450,000 | \$2,950,000 | \$2,950,000 | \$0         |
+-------------+-------------+-------------+-------------+-------------+
| FTE         | 0           | 0           | 0           | 0           |
+-------------+-------------+-------------+-------------+-------------+

NOTE: These budget amounts are included in the Hospitals & Clinics
Sub-Activity.

**[PURPOSE AND METHOD OF OPERATION]{.underline}**

Although acquisition of medical data through development of information
systems is critical, just as important is the ability to analyze and
interpret the data. Because most medical data are complex, simple
reports automatically generated by computer systems cannot answer many
questions posed by health professionals and administrators. Trained
epidemiologists are needed to complete the system of health information
for tribes and communities.

The innovative Indian Health Service (IHS) Tribal Epidemiology Center
program was authorized by Congress as a way to provide significant
support to multiple tribes in each of the IHS Areas. Beginning in
FY 1996, four Centers were funded up to \$155,000 each. Since then,
these centers have proven that the concept is sound and worthy of
additional funding and expansion of the program. In response to a
"Request for Proposal" in FY 2000, the four original centers were funded
for another five years, and two new centers were funded. The annual
level of funding for FY 2002 is approximately \$207,000 for each center.
This primary source of increased funding was a \$500,000 increase in FY
2001 earmarked for HIV research.

There is growing consensus among Tribes that the regional Epidemiology
Centers could provide support for a variety of public health activities
that IHS is no longer able to provide. The proposed \$1.5 million
funding increase for FY 2003 will enable the six existing Epidemiology
Centers to adequately fulfill their mission of providing service to
tribal communities in their regions. A fully staffed center should be
composed of at least one physician or doctoral-level epidemiologist, two
Masters-level epidemiologists, and a statistician. For this size of
staff, with travel and office support, approximately \$500,000 is needed
for each center. Proposed funding in FY 2003 would allow IHS to add one
new epidemiology center in another region, as well as move closer to
that target level of base funding for each of the six existing centers.
No additional funds are requested for FY 2004.

Operating from within tribal organizations such as regional health
boards, the Epidemiology centers are uniquely positioned to be effective
in disease surveillance and control programs, and also in assessing the
effectiveness of public health programs. In addition, they can fill gaps
in data needed for Government Performance and Results Act (GPRA) and
Healthy People 2010. Some of the existing Epidemiology Centers have
already developed innovative strategies to monitor the health status of
tribes, including development of tribal health registries, and use of
sophisticated record linkage computer software to correct existing state
data sets for racial misclassification. These data may then be collected
by the National Coordinating Center at the IHS Epidemiology Program to
provide a more accurate national picture of Indian Health.

+-----------------------+---------------------------+-----------------+
| ######## **E          |                           |                 |
| PIDEMIOLOGY CENTERS** |                           |                 |
+-----------------------+---------------------------+-----------------+
| Northwest Portland    | Inter-Tribal Council of   | Alaska Native   |
| Epi Center            | Arizona Epi Center        | Epi Center      |
+-----------------------+---------------------------+-----------------+
| Great Lakes           | Seattle Indian Health Epi | United South    |
| Inter-Tribal Epi      | Center                    | and Eastern     |
| Center                |                           | Tribes, Inc.    |
|                       |                           | Epi Center      |
+-----------------------+---------------------------+-----------------+

Epidemiology Centers provide critical support for tribal efforts at
self-governing of health programs. Data generated locally and analyzed
by Epidemiology Centers enable Tribes to evaluate tribal and
community‑specific health status data so that planning and
decision-making can best meet the needs of their tribal membership.
Because these data are used at the local level, immediate feedback is
provided to the local data systems which will lead to improvements in
Indian health data overall.

Epidemiology centers assist tribes in looking at the cost of health care
for Indian people in order to improve the use of resources. In the
future, in the expanding environment of tribally operated health
programs, epidemiology centers will ultimately provide additional public
health services such as disease control and prevention programs. Some
existing centers provide additional assistance to tribal-participants in
such areas as sexually transmitted disease control and cancer
prevention. They also assist tribes in activities such as conducting
Behavioral Risk Factor Surveys in order to establish baseline data for
successfully evaluating intervention and prevention activities.

In FY 2003 and FY 2004, this program will continue to enhance the
ability of the Indian health system to collect and manage data more
effectively to better understand and develop the link between public
health problems and behavior, socioeconomic conditions, and geography.
The Tribal Epidemiology Program will also support tribal communities by
providing technical training in public health practice and
prevention-oriented research and promoting public health career pathways
for tribal members. Efforts to implement the Tribal Epidemiology Program
will be coordinated with the Centers for Disease Control and Prevention
(CDC) to optimize federal resource utilization, create stronger
interagency partnerships, and prevent costly duplication of effort.

**[Program Needs]{.underline}**

The six Epidemiology Centers are funded at approximately \$200,000 each.
This is not adequate for more than a very basic operation, so all of the
centers have to write other grants and attract funds from a variety of
sources to accomplish their mission. Approximately \$500,000 is needed
for each center.

+--------------------------------------------------------+-------------+
| # **Cooperative Agreements Funded**                    | **Amount**  |
+--------------------------------------------------------+-------------+
| Alaska Native Health Board, Anchorage, AK              | \$385,000   |
+--------------------------------------------------------+-------------+
| Great Lakes Inter-tribal Council, Lac du Flambeau, WI  | \$385,000   |
+--------------------------------------------------------+-------------+
| Inter-tribal Council of Arizona, Phoenix, AZ           | \$385,000   |
+--------------------------------------------------------+-------------+
| Northwest Portland Area Indian Health Board, Portland, | \$380,000   |
| OR                                                     |             |
+--------------------------------------------------------+-------------+
| Seattle Indian Health Board, Seattle, WA               | \$350,000   |
+--------------------------------------------------------+-------------+
| United South and Eastern Tribes, Nashville, TN         | \$385,000   |
+--------------------------------------------------------+-------------+
| Proposed new center, location TBD                      | \$300,000   |
+--------------------------------------------------------+-------------+
| IHS National Epidemiology Center, Coordinating Center, | \$380,000   |
| Albuquerque, NM                                        |             |
+--------------------------------------------------------+-------------+
| ## **TOTAL**                                           | **\$2,9     |
|                                                        | 50,000.00** |
+--------------------------------------------------------+-------------+

The six existing Epidemiology Centers serve less than half of the
American Indian and Alaska Native population. To achieve full coverage,
an additional four to five centers should be established.

The Epidemiology Centers provide a valuable service to IHS and the
Department of Health and Human Services by assisting with GPRA data
collection and reporting. Since Self-Governed Tribes are not required to
submit GPRA reports, the Epidemiology Centers can serve an important
role by working with tribally operated health programs to include their
health statistics in the IHS GPRA report.

Following are the funding levels for the past five fiscal years (without
accrued):

+----------------------+------------------------------+----------------+
| # **Year**           | **[Funding]{.underline}**    | **[FTE]        |
|                      |                              | {.underline}** |
+----------------------+------------------------------+----------------+
| 1999                 | \$750,000                    | 0              |
+----------------------+------------------------------+----------------+
| 2000                 | \$950,000                    | 0              |
+----------------------+------------------------------+----------------+
| 2001                 | \$1,450,000                  | 0              |
+----------------------+------------------------------+----------------+
| 2002                 | \$1,450,000                  | 0              |
+----------------------+------------------------------+----------------+
| 2003                 | \$2,950,000                  | 0              |
+----------------------+------------------------------+----------------+

We estimate that all Areas could be served by Epi Centers with a budget
of \$4,450,000.

**[RATIONALE FOR BUDGET REQUEST]{.underline}**

**[TOTAL REQUEST]{.underline}** -- No additional funds requested.

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