Public Health Model in Tribal Communities

Public Health Model

The Centers for Disease Control state, “the focus of public health is on the health, safety,

and well-being of entire populations. A unique aspect of the field is that it strives to 

provide the maximum benefit for the largest number of people.” The public health 

approach to prevention is based on the Public Health Model. There are multiple steps in 

the public health approach, with each step informing the next. Many people, 

organizations, and systems are involved at each step along the way. This approach is 

shown in Figure 1.

Figure 1. Public Health Approach

1

 

1 1 CDC. The Public Health Approach to Violence Prevention. Retrieved 3/17/17 from: 

https://www.cdc.gov/violenceprevention/overview/publichealthapproach.html

Define the 

problem

Identify risk and 

protective factors

Develop and test 

prevention strategies

Assure widespread 

adoption

., 

-

------ -- -- -- -- -- -- -- -- -- -- -- -~ -~ -~ -~ -~ -~ -~ -~ -~ -~ --=--~ -=--------:---- \. • / Substance Abuse and Mental Health Services Administration ~.......................................... t-.sAMH§A 

~ www.samhsa.gov • 1-877-SAMHSA-7 (1-877-726-47271 
2

Considerations for Public Health Models in Tribal 

Communities

Although this seems straightforward, mainstream models for public health don’t 

always meet the needs of tribes. As tribes take control of their health care services, 

developing cultural frameworks for public health becomes more and more important. 

The National Indian Health Board states, “Now more than ever, focused efforts are 

needed to create a tribal public health system that is functioning proactively, rather than 

reactively, to address the health needs of our communities.”

2

 

What does it mean to create a tribal public health system? Academic literature suggests 

a public health model for tribal communities should consider the importance of culture, 

language, issues of identity and place, and the need for tribal people to operate in both 

traditional and dominant cultures.3 A public health model for tribal communities will 

look different from one community to the next because it should be based on the 

specific cultural realities of the community. Practically, what this might mean in one 

community is that translators are available if needed, cultural practitioners are available 

if requested, and referrals to both traditional and mainstream services are made. In 

another community, it might mean that neither Christian or traditional beliefs are given 

preference, but that both are respected.

Some tribal models don’t just look at objective measurements, but also look at the 

importance of direct experience, interconnectedness, relationship, and value. These and 

other cultural values such as importance of place, community, and culture can inform 

our Strategic Action Plans as well as research.

The public health model for tribal communities should also include capacity building.

This has been shown to have value in the long term, but is sometimes difficult for tribal

 

2 2010 Tribal Public Health Profile: Exploring Public Health Capacity in Indian Country: National Indian 

Health Board, Retrieved 3/17/2017 from 

http://www.nihb.org/docs/07012010/NIHB_HealthProfile%202010.pdf

3 Building True Capacity: Indigenous Models for Indigenous Communities. Michelle Chino, PhD and 

Lemyra DeBruyn, PhD.

flQtive CONNECTIONS 
3

communities to embrace when faced with immediate need or with the grief and other 

consequences of unresolved current and historical trauma.4

Cultural Framework for Public Health Model

One public health model based on a cultural framework was developed by Joyce 

Naseyowma, Michelle Chino, and Connie Garcia working for a tribal consortium in the 

Southwest, the Community Involvement to Renew Commitment, Leadership, and 

Effectiveness (CIRCLE). The CIRCLE model was based on the GONA, a national 

curriculum developed by prevention and health professionals based on indigenous 

thought that emphasizes hope, skills transfer, and traditional values as a basis for 

community action. The theory underlying the CIRCLE model suggests as personal and 

professional relationships develop, they lead to the development of individual and 

group skills. These skills in turn lead to effective working partnerships, ultimately 

promoting a commitment to the issue, the group, and the process. This process creates 

an interest in new relationships, the need for new skills, and new opportunities for 

collaboration and a long-term commitment to positive change. Rooted in indigenous 

ideology, this model is an example of the type of capacity-building framework that can 

work well in tribal communities.5

Example of Cultural Public Health Programming 

Effective, comprehensive suicide prevention programs focus on risk and protective 

factors, including coping skills, access to mental health treatment, substance misuse, 

and social support. An example of a comprehensive prevention program that was

reported to reduce suicidal behavior within an American Indian/Alaska Native

community is the Natural Helpers Program. This program involves personnel who are 

trained to respond to adolescents and young adults in crisis, notify mental health 

professionals in the event of a crisis, and provide health education in the schools and 

community. Other program components include outreach to families after a suicide or 

other traumatic death, immediate response and follow-up for youths reported to be at 

 

4 Chino, M. and DeBruyn, L., Building True Capacity: Indigenous Models for Indigenous Communities, American 

Journal of Public Health 96(4): 596-9 · May 2006

5

Ibid.

flQtive CONNECTIONS 
4

risk, alcohol and substance abuse programs, community education about suicide 

prevention, and suicide-risk screening in mental health and social service programs.6

Applying Theory to Native Connections Grantees

The Native Connections Approach is based on the Public Health Model. As grantees 

work through the stages of the Approach, 1) Community System Analysis, 2) 

Community Readiness Model assessments, 3) Strategic Action Planning and, 4) 

Implementing the Strategic Action Plan, they will have the opportunity to customize 

their grant activities to fit their communities. This will look different for each grantee 

based on the community’s needs assessment, cultural and tribal realities, personnel 

capacity, and existing community resources. See Figure 2 for a graphic to the NC 

Approach.

Figure 2. Native Connections Approach

 

6 Crosby, A.E., Ortega, L., Stevens, M.R.: National Center for Injury Prevention and Control, January 14, 2011, Centers 

for Disease Control and Prevention, retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/su6001a11.htm

3/20/2017.

flQtive CONNECTIONS 

Native Connections Approach 

Promote 

Mental Health St P 

Ob •• 

M•• ,la 

Disseminate 

Best Practices 

G'•11i 

SAP "> :00 .. ,,. 

<-~ 

• Wllat to Mwu11 • Data r.ollectian & Metlloa 

• s11111111ary, Aaal'fSIS. Reporona - ~ rer11 Ptann1na 

Reduce Suicidal 

,..iiiiiiiiiiiiiiii,,--11 CSA Behavior 

• Identify oroalzatillll$, ,ei,arnMnlS, IJIOtll1ms, services, 

aad traCitienal ,nctices/t:1Stm • SNsystem Ecw,s 

• Lewels ol Clllabt11tioes • Impact wlysis • Baseline DatJ 

Reduce Substance 

Use and Misuse CIOH Gap1 
5

As grantees progress through the steps of the Native Connections Approach, they 

should rely on the community through consulting with the advisory panel, elders, 

youth, and tribal leaders to help look at what is important to the Tribe in terms of 

cultural values and community norms and traditions. With these cultural factors in 

mind, as well as information gained through the community needs assessment, 

grantees can develop effective, comprehensive prevention programs that are based in 

community strengths, consider the importance of culture, and address the specific 

needs of youth in communities.

flQtive CONNECTIONS