i 

 

Annual Report of the 

American Indian/Alaska Native 

Health Research Advisory Council 

(HRAC) 

Fiscal Year 2014
TABLE OF CONTENTS

Introduction............................................................................................................................................... 1

Background ............................................................................................................................................... 1

Presidential Memoranda and Executive Orders......................................................................................................................1

Formation of the HRAC..........................................................................................................................................................2

HRAC History ........................................................................................................................................................................3

Fiscal Year 2014 Activities ....................................................................................................................... 4

Meetings..................................................................................................................................................................................4

Research Roundtable.............................................................................................................................................................10

Outreach Activities ...............................................................................................................................................................11

Annual Health Research Report............................................................................................................................................12

Recommendations to HHS ..................................................................................................................... 12

Tribal Epidemiology Centers Public Health Authority Status..............................................................................................12

National Children’s Study.....................................................................................................................................................13

General Research Recommendations....................................................................................................................................13

National Institutes of Health Tribal Consultation Policy ......................................................................................................15

Attachment A:......................................................................................................................................... 16

Member and Partner List for FY 2014–2015 ....................................................................................... 16

HRAC Co-Chairs..................................................................................................................................................................16

Members ...............................................................................................................................................................................17

Federal Partners ....................................................................................................................................................................20

 
INTRODUCTION

Each year the Office of Minority Health (OMH) produces an annual report that provides an overview of 

the American Indian/Alaska Native (AI/AN) Health Research Advisory Council (HRAC) and key 

activities and accomplishments. The fiscal year (FY) 2014 report includes summaries of FY 2014 

HRAC meetings, a summary of outreach activities, and recommendations that the HRAC submitted to 

the U.S. Department of Health and Human Services (HHS). A list of current HRAC members and 

federal partners is also included as an attachment. 

BACKGROUND

OMH was established in 1986, following the release of the 1985 Report of the Secretary’s Task Force 

on Black and Minority Health. The mission of OMH is to improve the health of racial and ethnic 

minority populations through the development of health policies and programs that will help eliminate 

health disparities. OMH advises the HHS Secretary, Assistant Secretary for Health, and other 

departmental leadership and works collaboratively with other HHS Operating and Staff Divisions, 

federal agencies, and with other organizations across the country on health-related matters affecting 

AI/AN, Asian American, Black/African American, Hispanic/Latino, Native Hawaiian, and Pacific 

Islander populations. 

OMH serves as the Executive Secretariat for the HRAC. In this role, OMH is responsible for the 

administrative and fiscal operation of the HRAC, solicitation and selection of tribal delegates to the 

HRAC, and for ensuring that delegates and alternates to the HRAC meet Federal Advisory Committee 

Act (FACA) exemption's requirements.

PRESIDENTIAL MEMORANDA AND EXECUTIVE ORDERS

Over the years, numerous Presidential Memoranda and Executive Orders have been directed at 

bolstering the relationship between tribal governments and the U.S. federal government. In 1970, 

President Richard M. Nixon set forth a new direction for Indian policy aimed towards Indian selfdetermination. He stated: 

“It is long past time that the Indian policies of the federal government began to recognize and build upon 

the capacities and insights of the Indian people.” 

An abbreviated timeline of memoranda and orders is presented below: 

April 29, 1994 » President William J. Clinton issued the Government-to-Government 

Relationship with Native American Tribal Governments memorandum to 

executive departments and agencies. It emphasized the special 

relationship between tribal governments and the federal government 

regarding tribal consultation and sovereignty. 

[Circa 1996] » The Domestic Policy Council Working Group on Indian Affairs requested 

that each department develop its own operational definition of 

“consultation” with Indian tribes to meet the requirements of the Indian 

Self-Determination and Educational Assistance Act. 

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August 7, 1997 » HHS created its formal Tribal Consultation Policy to strengthen the 

federal to tribal government-to-government relationship and ensure that 

tribes are consulted on matters affecting them. 

November 6, 

2000 

» President Clinton issued a revised Executive Order (13175) that 

reinforced his Administration’s commitment to tribal sovereignty and the 

unique government-to-government relationship that exists between the 

U.S. government and tribal governments; directed agencies to establish 

regular and meaningful consultation and collaboration between tribal

nations and the federal government; and directed all federal agencies to 

coordinate and consult with Indian tribal governments whose interests 

might be directly and substantially affected by activities on federally

administered lands. 

November 5, 

2009 

» President Barack Obama issued a Presidential Memorandum on tribal 

consultation that reaffirmed his Administration’s commitment to regular 

and meaningful consultation and collaboration with tribal officials 

through implementation of Executive Order 13175. 

December 12, 

2010 

» HHS, working with tribal leaders, developed and signed a revised Tribal

Consultation Policy that provided more opportunities for tribal input 

through the development of policies, regulations, and budgets. 

FORMATION OF THE HRAC

In November 2005, HHS solicited nominations from tribal leaders to develop the HRAC. The HRAC’s 

role is to facilitate communication between HHS and tribes regarding health research priorities and 

needs in AI/AN communities. Members of the Council are elected or appointed tribal officials, and 

include one delegate and one alternate from each of the 12 Indian Health Service (IHS) areas as well as 

four national at-large members. Federal partners representing HHS Operating and Staff Divisions also 

support the Council. 

The HRAC was established to fulfill three primary functions:

1. Obtain input from tribal leaders on health research priorities and needs for their communities;

2. Provide a forum through which HHS operating and staff divisions can better communicate 

and coordinate AI/AN health research activities; and 

3. Provide a conduit for disseminating information to tribes about research findings from 

studies on the health of AI/AN populations. 

The HRAC held its first meeting in May 2006 and elected two Co-Chairs, Councilwoman Cara Cowan 

Watts and President Cecilia Fire Thunder, to serve as the leaders and facilitators for meetings, outreach 

events, and general activities. HRAC members participated in numerous conference calls to plan for 

and organize activities. During these calls, they reviewed other HHS advisory models, discussed

solicitation of research priorities and needs, and planned for future meetings. 

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During the second meeting, held in November 2006, the HRAC reached a collective agreement to focus 

on three objectives: 

1. Establish the HRAC Charter (outlining the purpose, background, and structure of the Council 

and processes for voting, membership, and leadership); 

2. Develop a Discussion Guide (a survey to inquire about health research priorities and needs in 

Indian Country); and

3. Establish future meeting dates.

HRAC Members at April 2009 Meeting

HRAC’S HISTORY

From 2006 to 2014, the HRAC held quarterly conference calls and annual meetings. The topics of 

continued concern and interest included the National Children’s Study, National Institutes of Health 

(NIH) Tribal Consultation Policy, data sharing, scholarships for Native researchers, and a Native health 

research database. Based on the findings of these discussions, the HRAC developed and presented 

recommendations to HHS through letters to the Secretary and testimony at the annual HHS National 

Tribal Budget and Policy Consultation Sessions. 

The HRAC developed a Discussion Guide to help ascertain health research priorities in Indian Country 

and constructed survey questions to examine health care delivery systems and the research that tribes 

were conducting. The HRAC members distributed the Discussion Guide to tribal leaders in their 

respective IHS areas from 2007 to 2009. During that time, the top health concerns reported (but not 

listed in priority order) were as follows: 

• Access to care and coordination of care; 

• Behavioral health issues, including domestic violence, substance abuse, suicide, and tobacco use; 

• Cancer, cardiovascular disease, diabetes, and obesity; 

• Health information technology and systems; 

• Lack of funding; and

• Recruitment/retention of highly qualified health care professionals/providers. 

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The Discussion Guide results provided valuable information to the HRAC from the tribes’ perspectives 

regarding health concerns, priorities, and the methodology by which future research should be 

conducted. 

HRAC members attended outreach events to educate and inform tribes of the HRAC’s mission and 

objectives. Events included the Annual Native Health Research Conference (2008, 2010, and 2011); 

National Indian Health Board (NIHB) Annual Consumer Conference (2008, 2011, and 2012); AI/AN 

Health Policy Conference (2009); IHS/Health Canada Maternal and Child Health Research Meeting 

(2009); Third National Leadership Summit on Eliminating Racial and Ethnic Disparities in Health 

(2009); NIHB Public Health Summit (2010); HHS Regional Consultations (2011, 2012, and 2013); 

Oklahoma City Area Indian Tribal Health Board Public Health Conference (2013); and an NIHB 

Quarterly Meeting (2013). These events provided an opportunity for tribes to collaborate and share their 

knowledge and experiences regarding the advancement of health research and its importance in Indian 

Country. 

In addition, the HRAC collaborated with the Administration for Children and Families (ACF); Agency 

for Healthcare Research and Quality (AHRQ); Assistant Secretary for Planning and Evaluation (ASPE); 

Centers for Disease Control and Prevention (CDC); Health Resources and Services Administration 

(HRSA); IHS; Intergovernmental and External Affairs (IEA); NIH; Substance Abuse and Mental Health 

Services Administration (SAMHSA); Tribal Epidemiology Center (TEC) staff; OMH; and external 

researchers and scientists to advance its knowledge of health care research and learn how to promote 

best practices in health research throughout Indian Country. 

FISCAL YEAR 2014 ACTIVITIES

MEETINGS (TELECONFERENCE AND IN-PERSON) 

February 7, 2014

The HRAC held its first teleconference for FY 2014 on February 7, 2014. HRAC Co-Chairs Cara 

Cowan Watts, Oklahoma Area Delegate, and Stephen Kutz, Portland Area Delegate, opened the 

call and welcomed participants. 

Commander (CDR) Tracy Branch, Public Health Advisor, OMH, announced that ACF is 

developing new research and data collection priorities and is seeking assistance from tribal

communities. 

Dr. Alan Trachtenberg, Research Director, IHS, shared that the National Children’s Study (NCS) 

advisory group met in January 2014 to update the framework that will be used for the study. The 

framework will define the higher-level functions of a normal 21-year-old and serve as a basis of 

comparison to evaluate outcomes for cohort members at the end of the study. Dr. Trachtenberg sent 

HRAC members a copy of the Request for Information that solicits feedback on the framework. He

asked HRAC members to review the framework and consider submitting comments regarding culturally

relevant or culturally specific areas of health for AI/ANs for the attention of the advisory group. 

Dr. Trachtenberg indicated that the researchers do not intend to stratify the hospital- or birth-unit-based 

samples. The random sample may or may not include Indian hospitals. 

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Councilman Kutz suggested that the HRAC ask the National Congress of American Indians to inform 

tribes that tribal citizens should identify themselves as AI/AN when they enter civilian hospitals to give 

birth. Dr. Trachtenberg suggested that the HRAC ask the NCS to do as much as possible to identify 

participants who are Native.

Councilwoman Cowan Watts said it was her understanding that the Affordable Care Act definition of 

AI/ANs might be changing again. She asked if the HRAC should recommend that the HHS and the 

NCS use a consistent definition. Councilman Kutz stated that it was important to ensure that the 

definition is clear. Hospitals and birthing centers are challenged in identifying AI/ANs, and the extent to 

which the study is diligent in identifying participants will be a factor in the study’s effectiveness. The 

performance standards for determining the identity of people in the study will be of great importance. 

Aaron Payment, Bemidji Area Delegate, stated that the current definition is based on membership in a 

federally recognized tribe, which is problematic for tribes that do not have lineal descent. There has 

been advocacy among tribes to base the definition of tribal membership on covering the two subsequent 

generations, so that a child and grandchild of a tribal member will receive coverage through the 

Affordable Care Act. Councilwoman Cowan Watts stated that the proposed definition described by 

Chairperson Payment will fit with the cultural affiliation among federally recognized tribes. 

Councilman Kutz said he believed the HRAC was advocating for the NCS to use the IHS definition and 

wondered how that will change the definition. 

Chairperson Payment reported that he spoke with Cathy Abramson, who chairs the NIHB. Ms. 

Abramson said there was no update about changing the definition of Indian for the Affordable Care Act, 

and she noted that the definition in the Affordable Care Act leaves out some Alaska Natives. The 

administrative fix had been reviewed and did not appear to resolve the problem; however, there is broad 

support for a legislative fix. Chairperson Payment stated that if the NCS uses the Affordable Care Act

definition, tribes without lineal descent will be left out. Dr. Trachtenberg replied that an epidemiologic 

study such as the NCS will not be bound to a definition that was developed to determine eligibility for 

medical care. The process for collecting information is still open to input. Chairperson Payment stated 

the Sault Ste. Marie Tribe is a lineal tribe, so the definition covers his people. If someone must be a 

tribal member, then a large number of Native children will be left out of the study. Participants agreed 

that erring on the side of counting study subjects as Native is preferable to using a definition that 

excludes them.

Dr. Trachtenberg suggested that a set of questions with yes/no or multiple-choice answers record the 

information in a way that allows analysis of data according to the definition the researcher wants to use. 

Delight Satter, Associate Director for Tribal Support, CDC, stated that the California Health Interview 

Survey (CHIS) used that approach. She said investigators asked whether the participant was American 

Indian, enrolled in a tribe, in which tribe they were enrolled, and so on. This methodology has been 

used for more than 10 years and works very well; and the material is available for public access. The 

approach does not address the problem of whether the sample is large enough for each sub-population to 

be generalizable, but it will be the most useful way to gather the data.

Councilwoman Cowan Watts summarized that the key issues for the HRAC are sampling and 

oversampling, and how the NCS will identify AI/ANs. She proposed including a discussion of the CHIS 

methodology on the agenda for the next quarterly conference call. Ms. Satter offered to make a 

presentation on the approach to developing the methodology described by Dr. Trachtenberg. She noted 

that the University of California, Los Angeles (UCLA) validated the items with many cultural groups in 

California, including tribes, and across six languages. 

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March 21, 2014

The HRAC teleconference call on March 21, 2014, began with Councilwoman Cowan Watts calling the 

meeting to order once a quorum was reached. 

Dr. J. Nadine Gracia, Deputy Assistant Secretary for Minority Health, and OMH Director, noted that 

nominations were currently under review for the HRAC’s vacant seats. The goal is to appoint the new 

members prior to the annual meeting in June. She also reported that: 

• Mayra Alvarez has joined OMH as the new Associate Director, after serving at the HHS Office 

of Health Reform. She will now be leading OMH initiatives related to the Affordable Care Act; 

• OMH has developed four infocards featuring young adults of color to increase young adult 

awareness and enrollment in the Health Insurance Marketplace. The infocards are available on 

the OMH website, and they feature young adults who are Native American, African American, 

Latino, and Asian American;

• Some of the Regional Health Equity Councils (RHECs) of the National Partnership for Action to 

End Health Disparities (NPA) have identified Affordable Care Act outreach as a priority area 

and have been holding community education sessions to help inform community members about 

provisions of the Affordable Care Act. The Southeastern Health Equity Council conducted 

Affordable Care Act enrollment outreach at the North Carolina Indian Unity Conference;

• A member of the Region VI RHEC is working to establish a work group of AI/AN

representatives from all of the RHECs. The goal is to identify and work across RHECs to 

address key concerns of Native communities and to increase their membership and participation 

in the RHECs; and 

• The OMH Resource Center is establishing a technical assistance resource center for institutions 

of higher education, in particular, minority-serving institutions, to include Tribal Colleges and 

Universities and American Indian and Alaska Native Serving Institutions. 

Councilwoman Cowan Watts called for a motion to approve the minutes of the September 2013 and 

February 2014 meetings. Chairperson Payment moved to approve the minutes of both meetings. Dr. 

Jay Butler, Alaska Area Alternate, seconded the motion. Councilwoman Cowan Watts called for 

questions, concerns, or amendments. Hearing none, she called for a vote. The motion passed 

unanimously. 

Councilman Chester Antone, Tucson Area Delegate, and Chairperson Payment provided an update from 

the Secretary’s Tribal Advisory Committee (STAC). Councilman Antone stated that contract support 

costs were one of the main issues discussed at the February 2014 meeting. Chairperson Payment noted 

that Secretary Sebelius informed the STAC that Dr. Yvette Roubideaux, Acting Director, IHS, had 

advocated against the recommendations to cap contract support costs. Chairperson Payment reported 

that he reminded the Secretary of the trust obligations and reviewed the shortfall in funding for members 

that are exempted from the Affordable Care Act but do not live near an IHS facility. The Secretary 

stated that Medicaid was an option for those individuals. Chairperson Payment noted that many states 

are not participating in the Medicaid expansion, and Medicaid is predicated on income eligibility, which 

is not the case for IHS. Chairperson Payment stated that the definition of Indian has not been corrected 

in the Affordable Care Act. This affects individuals who are descendant members and not enrolled 

members. HHS suggested a legislative fix. The STAC felt that HHS should have the administrative 

authority to adopt the Medicare definition of Indian, which applies to a tribal member and the two 

generations that are born after that tribal member. Chairperson Payment stated that the STAC reiterated 

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its requests for forward funding for veterans health and non-discretionary funding for IHS. The STAC 

has some momentum on this issue and should continue to make those requests. 

Councilwoman Cowan Watts asked if HRAC members wished to remove, elevate, or add anything to 

the HRAC priorities list. Violet Mitchell-Enos, Director of Health and Human Services for the Salt 

River Pima-Maricopa Indian Community in the Phoenix Area, noted that caring for members who have 

dementia or Alzheimer’s disease is a challenge within the Salt River Tribe. The relationship between 

those conditions and diabetes or other types of chronic illness is not known. If managing these 

conditions is a challenge for other tribes, Ms. Mitchell-Enos said she would like to see the issue included 

in the research priorities. Councilman Kutz expressed interest in discussing dementia and Alzheimer’s 

disease at a future meeting. He suggested that the HRAC members determine whether this is an issue in 

their communities.

June 23, 2014

The HRAC held its annual in-person meeting for FY 2014 on June 23, 2014, in Rockville, Maryland. 

Councilwoman Cara Cowan Watts opened the meeting and confirmed a quorum, after which time 

Chairperson Payment provided an opening blessing. Following welcoming remarks from Co-Chairs 

Cowan Watts and Kutz, Councilwoman Cowan Watts reviewed the provisions and exemptions of 

FACA, as the HRAC operates under an exemption from the FACA identified in the Unfunded Mandates 

Reform Act of 1995. 

Dr. Gracia reminded the group of the two vacancies on the Council for which OMH was actively 

pursuing nominations; and she announced that Rick Haverkate recently joined OMH as a Public Health 

Advisor and AI/AN Health Policy Lead. He will serve as Executive Secretary of the HRAC and as staff 

liaison to the White House Initiative on AI/AN Education. Mr. Haverkate will also support Dr. Gracia 

on intradepartmental tribal committees and councils and other initiatives. 

Dr. Gracia assured council members that the HRAC remains a priority for OMH. To that end, Dr. 

Gracia requested the Council’s input on strengthening communications to ensure that Council members 

have access to information disseminated by OMH and can inform OMH of opportunities for 

collaboration. 

Dr. Roubideaux addressed the Council by video, expressing IHS's belief that tribal consultation and 

partnerships are an integral part of research efforts in Indian Country. Stating that IHS is not authorized 

or funded to do research, she indicated that research and evaluation help IHS deliver high-quality, 

evidence-based care and help IHS see the impact of their programs. She commented on IHS’s 

Institutional Review Board (IRB), work with TECs, and support of the Native American Research 

Centers for Health (NARCH) initiative. Dr. Roubideaux also stated that IHS is continuing to look for 

opportunities to work with academic and research institutions in formal, research-related arrangements, 

noting existing memoranda of understanding. 

During the Business Items portion of the agenda, a motion was unanimously passed to approve the 

minutes of the March 31, 2014, quarterly conference call; nominations for the Co-Chair positions were 

called and resulted in a unanimous vote that elected Councilman Kutz and Chairperson Payment as new 

Co-Chairs of the HRAC. 

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Sheila Cooper, Senior Advisor for Tribal Affairs, SAMHSA, presented on SAMHSA’s challenges in 

obtaining data specific to AI/ANs. She discussed its tribal discretionary grant portfolio and provided 

other highlights related to SAMHSA activities concerning AI/AN populations. She also indicated that 

SAMHSA’s Tribal Technical Advisory Committee (TTAC) was revising its charter and SAMHSA’s 

Tribal Consultation Policy. Following the presentation, various council members echoed the need for 

AI/AN-specific data and increased access to tribal data. The group discussed the prevalence and impact 

of suicide on tribal communities. Other topics included the use of wrap-around services and racial 

misclassification on death certificates.

Ms. Mitchell-Enos and Councilman Kutz provided information supporting the need for research in the 

area of dementia/Alzheimer’s disease in AI/AN communities. Councilwoman Cowan Watts proposed 

adding this issue to the list of HRAC research priorities.

Councilman Kutz provided an update on the STAC, reporting that the Committee is currently working 

on revising its by-laws and identifying priorities that it would like Secretary Burwell to address. He and 

Chairperson Payment highlighted several STAC priorities, including the Indian Child Welfare Act 

compliance; SAMHSA funding; HRSA (concerning needed support for mid-level oral health providers); 

expansion of tribal self-governance; the Affordable Care Act definition of Indian; and support for the 

use of priority points for AI/AN HHS grant applicants. They welcomed the HRAC’s input on the list of 

items; and they suggested that the new Secretary’s previous experience working with the Office of 

Management and Budget and the Bill and Melinda Gates Foundation would inform her approach to 

working with tribal communities. It was suggested in follow-up discussions that a more formal process 

be established for communications between the HRAC and STAC. 

Councilwoman Cowan Watts asked HRAC members to identify two or three research projects that 

would have the greatest impact on Indian Country if funds were available at the end of the fiscal year. 

The group agreed on the following: (1) funding for a Native research database/clearinghouse; (2) 

funding for the Navajo TEC survey; and (3) review of tribal applications that were approved but not 

funded due to lack of data and then working with the tribe and/or a TEC to collect qualitative data. 

After reviewing the HRAC’s FY 2014 priorities and activities for the upcoming year, participants 

decided that it would be beneficial for the new leadership at both HHS and the HRAC to have a table 

that lists: (1) the HRAC priorities; (2) what has been done to request action on each priority, and when; 

(3) what response was received; and (4) contact information at the relevant HHS agency. 

CDR Tracy Branch (OMH) led a discussion on HRAC charter revisions, noting that the HRAC and the 

other advisory committees have been asked to revise their charters to align with the STAC charter. A 

work group will be making revisions for the HRAC to review. 

The balance of the day comprised updates from numerous federal partners: AHRQ, CDC, HRSA, IHS, 

and NIH. In addition, Councilwoman Cowan Watts stated that she would report back to the HRAC 

regarding how the Cherokee Nation handles the issue of an NIH-funded researcher who claimed to be 

Cherokee conducting research with the Cherokee Nation and Choctaw Nation. 

The meeting ended with Councilwoman Cowan Watts confirming that the agenda items had been 

addressed and indicating that the next steps included the Research Roundtable on June 24, 2014; 

quarterly conference calls for the full HRAC; and monthly meetings for the charter revision work group. 

The meeting adjourned with Chairperson Payment offering a closing prayer.

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HRAC Members at June 2014 Meeting

September 12, 2014 

The HRAC teleconference call on September 12, 2014, began with Chairperson Payment and Mr. 

Haverkate calling the meeting to order. 

Dr. Gracia welcomed the attendees on behalf of OMH and noted that the HRAC contributions to AI/AN 

health research priorities provide the Department with more meaningful insight into tribal communities. 

She noted that the HRAC charter is an important part of the HRAC, and a work group will review the 

charter and make recommendations to OMH. She stated that she is looking forward to working with the 

work group and the HRAC to complete the charter. 

Mr. Haverkate stated that he has been meeting with Dr. Gracia on a regular basis. Dr. Gracia and OMH

are committed to supporting health research for AI/AN communities. OMH has reviewed the priorities 

identified by the HRAC and will be working to help support these priorities. He would like to work 

with the Co-Chairs and HRAC members to develop a logic model for the HRAC. 

Chairperson Payment reminded the HRAC that there is a current list of priorities and then additional 

suggestions identified during the Research Roundtable. He commented that some of the priorities 

overlap and that the group should develop a way to merge them into one list. He added that he 

supported the idea of a logic model for identifying tasks and timelines.

Dr. Yvonne Maddox, Acting Director, National Institute of Minority Health and Health Disparities, 

NIH, reported that NIH has had several meetings with AI/AN scientific leaders and physicians. She 

noted that NIH will hold an AI/AN Research Symposium in November during Native American 

Heritage Month. Scientists will be invited to discuss the challenges of being an AI/AN researcher. She 

stated that they would like for the HRAC to be represented at the event. 

Chairperson Payment commented that one of the HRAC priorities is the Native research 

database/clearinghouse. He noted that a lot of current work relates to studying American Indians as well 

as studies conducted by American Indians. 

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Chairperson Payment stated that it sounded like HRAC has a ready subcommittee in the formation with 

a focus on data collection. He asked Dr. Malia Villegas, National At-Large Member Alternate, if she 

would be willing to facilitate a process with partners to consolidate the different data points. He will 

also be involved in the process to help achieve this goal. Dr. Villegas agreed and indicated that the 

starting place would be looking at the Westat report from 2007 where extensive data were compiled on 

all the existing AI/AN data sets. 

Dr. Villegas also suggested that the HRAC begin developing one-pagers related to some of the HRAC 

priorities as a way to move forward with identifying existing resources and policy recommendations.

Ms. Mitchell-Enos commented that there has been a lot of discussion on genetics data and biobanking. 

Chairperson Payment reported that at a CDC consultation session the issue of human samples and 

appropriate use and disposition of samples were discussed. He noted that one item to be considered is 

the cultural perspective. For example, in the Anishinaabe culture, a person’s hair should be protected 

and bodily fluids should be handled in an appropriate and culturally sensitive manner. Ms. MitchellEnos stated that she did not see allowance for Native researchers. In the past it has been primarily nonNative researchers looking to do genetic research. She noted that tribes can develop an agreement on 

how samples will be handled for research, but the challenge is for tribes to get federal agencies to agree 

that the tribes maintain data ownership when federal funding is secured. She suggested that the HRAC 

relook at the issue of human sampling and research. 

RESEARCH ROUNDTABLE

The HRAC Research Roundtable, held on June 24, 2014, in Rockville, MD, brought together HRAC 

members, Native health researchers, TEC representatives, and federal partners to discuss research 

priorities in Indian Country. Councilwoman Cowan Watts welcomed attendees and then introduced 

Councilman Kutz. Councilman Kutz offered an opening blessing, followed by participants’ selfintroductions. On behalf of OMH, Dr. Gracia and Mr. Haverkate gave opening remarks. 

Mr. Haverkate provided an overview of OMH activities, followed by an overview of the history and 

purpose of the HRAC. 

Robert McSwain, Deputy Director, IHS, welcomed tribal leaders, tribal researchers, and federal partners 

to the meeting and IHS. He emphasized the importance of updating tribal leaders on research, 

acknowledged that research in the field entails challenges, and highlighted IHS collaborations with 

agencies throughout HHS that conduct research on issues important to Indian Country.

Concerning the issue of data sharing/ownership facing tribes, the HRAC heard brief presentations from 

representatives of TECs, Native researchers, and HRAC members. The presentations identified a range 

of current issues that could be presented to Secretary Burwell, as well as be used to further the HRAC’s 

priorities. Among the challenges cited included explaining the difference between research data and 

public health data to tribal councils; getting state legislatures to recognize tribal organizations; states not 

recognizing TECs as public health authorities; racial misclassification; timeliness of HHS responses to 

questions from the HRAC; data gaps due to states upgrading electronic infrastructures; inconsistencies 

in the way that states collect data that result in persistent discrepancies; TECs’ lack of infrastructure, 

capacity, and funding; the federal government’s lack of a research policy and research infrastructure for 

tribes; and the need for local-level data. Appreciation was expressed to Dr. Roubideaux for developing 

the template that TECs can use to enter into a data-sharing contract with IHS; and Councilwoman 

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Cowan Watts noted that HRAC advocacy for basic research infrastructure had emerged as a new issue 

during this discussion. 

Delight Satter (CDC) and Teshia Solomon, PhD, University of Arizona, Arizona Study Center, served as 

presenters for the National Children’s Study (NCS) session. Noting the HRAC’s concerns about the 

lack of quality survey data on AI/AN populations, Ms. Satter presented the methodology used in the 

California Health Interview Survey (CHIS), which is a collaborative project of the UCLA Center for 

Health Policy Research, the California Department of Health Services, and the Public Health Institute. 

The CHIS surveys 55,000 households every two years, with high participation rates from AI/ANs. This 

is the only survey in the country that captures subpopulations of AI/ANs and Asians. 

For her portion of the presentation, Dr. Solomon first noted that the National Academy of Sciences had 

recently released a report with concerns about the NCS that resulted in NIH putting the main study on 

hold, and she suggested that the HRAC may want to advocate for a role in the planning efforts for 

moving forward. Dr. Solomon reported on work the Arizona Study Center performed under the NCS, a 

geographic sampling of three counties for the NCS—Maricopa County, Apache County (Navajo 

Nation), and Pinal County—and the challenges they faced in trying to develop a subsequent toolkit to 

enhance the recruitment and retention of AI/AN participants. Dr. Solomon agreed to send a copy of the 

toolkit to the HRAC.

Next, Councilwoman Cowan Watts invited Native researchers and TEC representatives to propose 

research topics that the HRAC could consider recommending to HHS. Topics ranged from having a 

Native research database/clearinghouse, to environmental justice, to the need for basic research 

infrastructure for Indian Country, to the social determinants of health, among others. Councilwoman 

Cowan Watts also asked researchers to identify “shovel-ready” projects that end-of-year funds could 

support. That discussion resulted in the identification of various projects, including completion of the 

NCS toolkit, supplemental funding for the NARCH to enhance existing training/projects; projects that 

support indigenous healing and nutrition; establishing a field-based public health education and training 

center; and reinstatement of the NIH Science Education Partnership Award. Councilwoman Cowan 

Watts proposed to add the totality of suggestions researchers offered to the HRAC’s list of potential 

projects and have the Council prioritize the list during subsequent conference calls. 

After discussing the issue of an NIH-funded researcher who claimed to be a Cherokee Nation citizen and 

conducted a study without IRB approval, the group shifted its discussion to the problem of prescription 

drug use/abuse among children and adults in Indian Country. The latter discussion resulted in 

Councilwoman Cowan Watts proposing to add the following items to the HRAC priorities: (1) research 

on the prevalence of prescribing behavior-modifying medications for children and adults; and (2) 

research on abuse of prescription medications. 

The meeting closed with Councilwoman Cowan Watts thanking HRAC members, researchers, and staff 

for a productive meeting. 

OUTREACH ACTIVITIES

The HRAC members conducted outreach throughout the year to share its priorities and 

recommendations, provide updates to tribes on HRAC activities, and to gather feedback and input from 

tribes and tribal communities regarding research issues, concerns, and priorities. An HRAC update was 

provided at the Oklahoma City Area Indian Health Board Quarterly Meeting in Shawnee, Oklahoma, on 

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January 14, 2014. Councilman Antone attended the 16th HHS Annual National Tribal Budget 

Consultation Session on March 7, 2014, in Washington, D.C. and presented testimony on behalf of the 

HRAC. Updates on the HRAC were also provided during HHS Regional Tribal Consultations in the 

spring of 2014. 

ANNUAL HEALTH RESEARCH REPORT

The HRAC produced its Annual Health Research Report, a compilation of findings related to important 

health research topics in AI/AN communities. This report is utilized as a resource to share research 

findings, topics, and available federal programs with tribes. 

RECOMMENDATIONS TO HHS

The HRAC submitted recommendations to HHS via testimony on March 7, 2014, on issues of concern 

from the tribal communities that the HRAC represents. The recommendations that were submitted are 

provided below. 

TRIBAL EPIDEMIOLOGY CENTERS’ PUBLIC HEALTH AUTHORITY STATUS

TECs are having difficulty gaining access to data sets held by state governments even though the 

Affordable Care Act established TECs as “public health authorities” as that term is defined in the Health 

Insurance Portability and Accountability Act of 1996 (HIPAA). The Affordable Care Act also provided 

new statutory authority for IHS-funded TECs to access “data, data sets, monitoring systems, delivery 

systems, and other protected health information in possession of the Secretary.”

Access to state-maintained data sets is particularly important given the high rates of misidentification of 

AI/ANs in most state data and resulting publications and use of misinformation concerning AI/AN 

health status and access to health services. Access to state data sets, such as vital statistics records and 

Pregnancy Risk Assessment Monitoring System, is important because access to IHS-provided services 

varies greatly within the IHS delivery system and many service areas do not have access to IHSoperated hospitals or IHS specialty providers. This means IHS data alone is incapable of reflecting an 

accurate picture of AI/AN service utilization and health status in those states.

The HRAC recommends that the Secretary send a letter to the governor of each state identified as failing 

to comply with Affordable Care Act and HIPPA regulations and their departments of health requesting 

that they facilitate TECs’ access to state data and data sets for the purposes of assessing and reporting 

the health status of AI/ANs in each state for health program and facility planning. Furthermore, when 

TECs access state data, fees charged should not be higher than those paid by other governmental 

entities. The HRAC respectfully requests that states be encouraged to work with the TECs to provide 

comparable data on health status of the general population for benchmarking and to track progress in 

eliminating health disparities. The HRAC also asks that TECs have a place, such as the Office of the 

Secretary, where they can report any further difficulties in accessing the data and that states be made 

aware of this reporting mechanism.

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NATIONAL CHILDREN’S STUDY 

While the HRAC fully supports the intent and purpose of the NCS, the study could have more 

meaningfully included the participation of tribal nations and the AI/AN community. Tribal consultation 

should have been required before the study was planned and funding committed in a manner consistent 

with longstanding federal policy. Consultation should also be utilized at each new stage of the study so 

that local tribes are consulted during the planning phase. 

The HRAC believes there is still an opportunity at this stage of the NCS to implement the following 

recommendations: 

• Health research participants defined as AI/AN must present proof of enrollment from a federally

recognized tribe as provided in the current “Indian Entities Recognized and Eligible to Receive 

Services from the United States Bureau of Indian Affairs” or meet the Bureau of Indian Affairs 

(BIA) definition of AI/AN as provided by a “Certificate of Degree of Indian Blood.” Selfidentification is not adequate; 

• Oversampling of AI/AN populations should be done through the inclusion of AI/AN majority 

hospitals and clinics in any data set to improve understanding of disparate infant mortality rates 

and childhood death and disability. Data are needed to determine the root causes of these 

disparities and to develop effective intervention strategies and programs; 

• Sampling protocols promised by the NCS, including preservation of DNA and tissue samples, 

must be followed and tribes must be consulted before, during, and after as ongoing partners;

• Commitment to tribal sovereignty must be kept; 

• De-identification of data must be reviewed with tribes; and

• A data-sharing agreement with tribes must be established before the local study commences.

GENERAL RESEARCH RECOMMENDATIONS

The HRAC is acutely aware of the high and disproportionate rates of morbidity and mortality 

experienced by AI/ANs; therefore, many of the recommendations focus on addressing the health 

disparities that continue to plague Indian Country. Additionally, the HRAC would like to recommend 

that HHS increase its activities to address the suicide epidemic in AI/AN communities, including 

research of the root causes of the epidemic. 

To address the health concerns identified by the HRAC, research should focus on: data quality and 

accuracy to address under-representation of AI/ANs in population health data; the lack of access to 

health care services for AI/ANs in both rural and urban settings; lack of incorporation of traditional 

health care practices and traditional diets; the efficacy of health promotion/disease prevention activities;

and the lack of health insurance coverage for AI/ANs. The HRAC has identified and recommends 

several research priorities (list is not prioritized), including:

• Quantification of chronic disease prevalence (e.g., cancer, heart disease, diabetes) and associated 

risk factors (e.g., obesity, diet, physical activity) through sustained support of prospective studies 

among AI/AN populations; 

• Chronic disease risk factor reduction; 

• Intentional and unintentional injuries reduction; 

• Hypertension – evaluating methods to improve awareness and treatment of hypertension; 

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• Stroke prevalence/prevention; 

• Methamphetamine prevalence/prevention; 

• Evaluation of the use of emerging technology (such as telemedicine, electronic health records, 

health information exchange, etc.) for the provision of care; 

• Health services research (such as utilization of prenatal care; preventable hospitalizations; 

emergency room utilization, etc.); 

• Autoimmune disorders research;

• Suicide prevention; 

• Readiness of tribal governments for public health accreditation; and

• Health care reform impact and effectiveness evaluation. 

In addition, efforts should be made to support research aims that attempt to understand exposure to risk 

and vulnerability over the entire lifespan due to social determinants such as social exclusion, 

marginalization, and inequality. Research should address the complex interactions between health 

determinants and long-term exposure to risk unique to AI/ANs as an indigenous population resulting 

from misguided federal Indian policy. 

It is important to stress that all research conducted should be evidence-based, and to the extent possible, 

community-based participatory research. Tribal governments are the rightful owners of their respective 

data, and therefore, all efforts should be undertaken to ensure tribal governments are consulted before 

such data are shared with any entity. In addition to health concerns and research priorities, many 

barriers exist regarding research activities in Indian Country. These barriers could be addressed by:

• Increasing cultural sensitivity among researchers; 

• Increasing the number of AI/AN researchers (possible avenue is through additional funding 

through the IHS Health Professions Scholarship Program and Loan Repayment Program, and 

CDC and NIH, specifically, for research positions);

• Improving the accuracy of data related to AI/ANs and the interoperability of data among HHS 

operating and staff divisions; 

• Increasing the amount of available comparative data. (When research includes a comparison of 

racial or ethnic data that does not include AI/ANs, the HRAC recommends that HHS make 

oversampling a priority to provide these data for comparison);

• Improving infrastructure among tribal governments to increase tribal capacity to carry out 

research and/or implement recommendations identified through research; 

• Increasing the amount of community-driven research; 

• Providing IHS with a research funding line item to support research by and for AI/ANs; and

• Holding a consultation with tribes for the purpose of developing a department-wide policy on 

data management in Indian Country. 

Additionally, one of the most beneficial improvements would be to establish single data sources. As an 

example, the federal government maintains several AI/AN data sources through IHS, BIA, Centers for 

Medicare & Medicaid Services, CDC, NIH, SAMHSA, U.S. Census Bureau, and others. A single, 

integrated Internet accessible website with data available to calculate simple statistics, such as incidence 

and prevalence rates, would assist in identifying areas of focus within AI/AN communities. 

Additionally, the resource could provide access to published data as well. 

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While the HRAC would like to see more grants awarded directly to tribal governments, the HRAC

realizes that academic institutions and research organizations are often the most suitable awardees for 

certain highly technical and advanced research grants. Unfortunately, when academic institutions and 

research organizations are awarded grants for research affecting AI/AN communities, no uniformity or 

requirements exist for collaboration and cooperation with tribal governments. The HRAC recommends 

that grant requirements include demonstrated cooperation and collaboration with tribal governments, 

such as with the submission of a tribal resolution. While some grant awardees may consider such a 

requirement too burdensome, numerous resources are available to reduce any burdens on grant 

awardees. Resources that are readily available to assist include the HRAC, other AI/AN federal 

advisory bodies, intertribal organizations, area Indian health boards, TECs, and numerous others. The 

HRAC offers this recommendation, not only because it is the right thing to do, but also because too 

many times a research project has been rendered useless by the AI/AN community because it was 

conducted without adequate collaboration or had relied on invalid AI/AN expertise.

The HRAC recommends that agencies allow more time between when the funding opportunity 

announcement is released and the application deadline. Tribes and tribal organizations typically have 

internal requirements, such as tribal council approval through a resolution, to meet before developing 

and submitting a proposal. Tribal Council meetings may only be held monthly, so a 30-day response 

period to a funding announcement is not enough time. The HRAC also recommends that a “Dear Tribal 

Leader” letter be sent out as an early announcement before a funding announcement is released to allow 

additional preparation time.

In addition to requiring tribal collaboration and cooperation as part of grant funding requirements, it is 

important to use grant reviewers that have demonstrated experience with tribal governments and who are 

culturally sensitive. Such reviewers can ensure that grant applications include adequate collaboration 

and cooperation components, as well as evaluate grant applications from the AI/AN community that

may have extensive subject matter experience but fewer academic credentials and degrees. The HRAC

recommends developing a training module to assist non-Native reviewers.

NATIONAL INSTITUTES OF HEALTH TRIBAL CONSULTATION POLICY

The HRAC is encouraged that the NIH has started to address tribal consultation with the Guidance on 

the Implementation of the HHS Tribal Consultation Policy. However, the HRAC is concerned about the 

delays in implementation. It is recommended that all tribal leaders be informed of NIH’s efforts and 

receive a copy of the guidance for their review as well as any upcoming consultation opportunities. 

In addition, more focus should be placed on putting AI/AN leadership throughout the NIH to provide 

advice on issues of importance to Native communities and to ensure tribes are consulted on priorities, 

research design, and community-based research.

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ATTACHMENT A: 

MEMBER AND PARTNER LIST FOR FY 2014–2015 

HRAC CO-CHAIRS

Stephen Kutz

Councilman, Cowlitz Indian Tribe 

1055 9th Ave, Ste. A 

Longview, WA 98632 

Phone: (360) 508-6347 

Fax: (360) 575-1948 

Email: skutz.health@cowlitz.org

Aaron Payment 

Tribal Chairperson, Sault Ste. Marie Tribe of Chippewa Indians 

523 Ashmun Street 

 Sault Ste. Marie, MI 49783 

 Phone: (906) 632-6829 

 Fax: (906) 440-5937 

Email: aaronpayment@saulttribe.net

HRAC Co-Chairs Stephen Kutz and Aaron Payment

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MEMBERS

2014 Area Representatives

Great Plains Area (formally the Aberdeen Area)

Delegate: Patrick Marcellais

Councilman, Turtle Mountain Band of Chippewa 

Indians 

Alternate: John Black Hawk

Chairman, Winnebago Tribe of Nebraska 

Alaska Area

Delegate: Ileen Sylvester

Vice President of Executive & Tribal Services, 

Southcentral Foundation 

Alternate: Jay Clarence Butler

Senior Director, Division of Community Health 

Services, Alaska Native Tribal Health Consortium

Albuquerque Area

Delegate: Vacant

Alternate: Vacant

Bemidji Area

Delegate: Aaron Payment 

Tribal Chairperson, Sault Ste. Marie Tribe of 

Chippewa Indians

Alternate: Vacant

Billings Area 

Delegate: Patty Quisno

Councilwoman, Fort Belknap Indian Community 

Alternate: Darrin Old Coyote 

Chairman, Crow Nation 

California Area 

Delegate: Daniel Calac 

Chief Medical Officer, Indian Health Council

Alternate: Vacant

2015 Area Representatives

Great Plains Area (formally the Aberdeen Area)

Delegate: Patrick Marcellais 

Councilman, Turtle Mountain Band of Chippewa 

Indians 

Alternate: John Black Hawk

Chairman, Winnebago Tribe of Nebraska 

Alaska Area

Delegate: Ileen Sylvester

Vice President of Executive & Tribal Services, 

Southcentral Foundation 

Alternate: Jay Clarence Butler

Senior Director, Division of Community Health 

Services, Alaska Native Tribal Health Consortium

Albuquerque Area

Delegate: Michelle Gomez

Director, Jicarilla Apache Community Health and 

Fitness Center

Alternate: Pamela Cordova

Councilwoman, Mescalero Apache Tribe 

Bemidji Area

Delegate: Aaron Payment 

Tribal Chairperson, Sault Ste. Marie Tribe of 

Chippewa Indians

Alternate: Vacant

Billings Area 

Delegate: Patty Quisno

Councilwoman, Fort Belknap Indian Community 

Alternate: Darrin Old Coyote 

Chairman, Crow Nation 

California Area 

Delegate: Daniel Calac 

Chief Medical Officer, Indian Health Council

Alternate: Vacant

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2014 Area Representatives

Nashville Area 

Delegate: Sandra Yarmal 

Health Director, Passamaquoddy Tribe Pleasant 

Point 

Alternate: Tihtiyas (“Dee”) Sabattus

Health Policy Analyst, United South and Eastern 

Tribes, Inc.

Navajo Area 

Delegate: Rex Lee Jim

Vice President, Navajo Nation

Alternate: Larry Curley

Executive Director, Navajo National Division of 

Health

Oklahoma Area 

Delegate: Cara Cowan Watts

Tribal Council Representative, Cherokee Nation 

Alternate: Tom Anderson 

Tribal EpiCenter Manager, Oklahoma City Area 

Inter-Tribal Health Board

Phoenix Area

Delegate: Diane Enos

President, Salt River Pima-Maricopa Indian 

Community 

Alternate: Violet Mitchell-Enos 

Director, Health and Human Services, Salt River 

Pima-Maricopa Indian Community 

Portland Area 

Delegate: Stephen Kutz 

Councilman, Cowlitz Indian Tribe 

Alternate: Vacant

Tucson Area

Delegate: Chester Antone

Councilman, Tohono O’odham Nation 

Alternate: Vacant

2015 Area Representatives

Nashville Area 

Delegate: Vacant

Alternate: Tihtiyas (“Dee”) Sabattus

Health Policy Analyst, United South and Eastern 

Tribes, Inc.

Navajo Area 

Delegate: Rex Lee Jim

Vice President, Navajo Nation

Alternate: Vacant

Oklahoma Area 

Delegate: Cara Cowan Watts

Tribal Council Representative, Cherokee Nation 

Alternate: Tom Anderson 

Tribal EpiCenter Manager, Oklahoma City Area 

Inter-Tribal Health Board

Phoenix Area

Delegate: Vacant

Alternate: Violet Mitchell-Enos 

Director, Health and Human Services, Salt River 

Pima-Maricopa Indian Community 

Portland Area 

Delegate: Stephen Kutz 

Councilman, Cowlitz Indian Tribe 

Alternate: Vacant

Tucson Area

Delegate: Chester Antone

Councilman, Tohono O’odham Nation 

Alternate: Vacant

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2014 National At-Large Members

Delegate: Jefferson Keel

Lt. Governor, Chickasaw Nation

Alternate: Malia Villegas

Director, Policy Research Center, National 

Congress of American Indians 

Delegate: H. Sally Smith

Chair of the Board of Directors, Bristol Bay Area 

Health Corporation and Alaska Representative of 

National Indian Health Board 

Alternate: Stacy Bohlen 

Executive Director, National Indian Health Board

Delegate: Michael Peercy

Epidemiologist, Choctaw Nation Health Services 

Authority/Chickasaw Nation

Alternate: Mickey Peercy

Executive Director of Health Services, Choctaw 

Nation of Oklahoma 

Delegate: Vacant 

Alternate: Vacant

2015 National At-Large Members

Delegate: Jefferson Keel

Lt. Governor, Chickasaw Nation

Alternate: Malia Villegas

Director, Policy Research Center, National 

Congress of American Indians

Delegate: H. Sally Smith

Chair of the Board of Directors, Bristol Bay Area 

Health Corporation and Alaska Representative of 

National Indian Health Board 

Alternate: Stacy Bohlen 

Executive Director, National Indian Health Board

Delegate: Michael Peercy

Epidemiologist, Choctaw Nation Health Services 

Authority/Chickasaw Nation

Alternate: Mickey Peercy

Executive Director of Health Services, Choctaw 

Nation of Oklahoma 

Delegate: Vacant 

Alternate: Vacant

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FEDERAL PARTNERS

2014 Federal Partners

Administration for Children and Families

Delegate: Anne Bergan

Office of Planning, Research and Evaluation 

Alternate: Hilary Forster

Office of Planning, Research and Evaluation 

Agency for Healthcare Research and Quality 

Delegate: Kishena C. Wadhwani 

Director, Division of Scientific Review

Alternate: Vacant 

Assistant Secretary for Planning and Evaluation 

Delegate: Sue Clain

Indian Health Desk Officer

Alternate: Ansalan Stewart

Program Analyst

Centers for Disease Control and Prevention 

Delegate: Delight Satter

Associate Director Tribal Support

Alternate: Kimberly Cantrell

Deputy Associate Director Tribal Support 

Health Resources and Services Administration

Delegate: Michelle Allender-Smith

Director, Office of Health Equity 

Alternate: Chrisp Perry

Public Health Analyst, Office of Health Equity 

Indian Health Service

Delegate: Alan Trachtenberg

Research Director, United States Public Health 

Service

Alternate: Mose A. Herne 

Director, Division of Planning, Evaluation, and 

Research

2015 Federal Partners

Administration for Children and Families

Delegate: Anne Bergan

Office of Planning, Research and Evaluation 

Alternate: Hilary Forster

Office of Planning, Research and Evaluation 

Agency for Healthcare Research and Quality 

Delegate: Kishena C. Wadhwani 

Director, Division of Scientific Review

Alternate: Vacant 

Assistant Secretary for Planning and Evaluation 

Delegate: Adelle Simmons

Senior Program Analyst 

Alternate: Vacant

Centers for Disease Control and Prevention 

Delegate: Delight Satter

Associate Director Tribal Support

Alternate: Kimberly Cantrell

Deputy Associate Director Tribal Support 

Health Resources and Services Administration

Delegate: Michelle Allender-Smith

Director, Office of Health Equity 

Alternates: Chrisp Perry and LCDR Gwenivere 

Rose 

Public Health Analysts, Office of Health Equity 

Indian Health Service

Delegate: Mose A. Herne

Director, Division of Planning, Evaluation, and 

Research

Alternate: Vacant

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2014 Federal Partners

National Institutes of Health 

Delegate: Yvonne Maddox 

Acting Director, National Institute on Minority 

Health and Health Disparities

Alternate: Joyce A. Hunter

Deputy Director, National Institute on Minority 

Health and Health Disparities

Office of Minority Health* 

Delegate: J. Nadine Gracia

Deputy Assistant Secretary for Minority Health 

and Director

Alternate: CDR Tracy Branch and Rick Haverkate

Public Health Advisor 

Substance Abuse and Mental Health Services 

Administration

Delegate: Sheila Cooper 

Senior Advisor for Tribal Affairs

Alternate: Vacant

2015 Federal Partners

National Institutes of Health 

Delegate: Yvonne Maddox 

Acting Director, National Institute on Minority 

Health and Health Disparities

Alternate: Joyce A. Hunter

Deputy Director, National Institute on Minority 

Health and Health Disparities

Office of Minority Health* 

Delegate: J. Nadine Gracia

Deputy Assistant Secretary for Minority Health 

and Director

Alternate: Rick Haverkate

Public Health Advisor, AI/AN Health Policy Lead

Substance Abuse and Mental Health Services 

Administration

Delegate: Sheila Cooper 

Senior Advisor for Tribal Affairs

Alternate: Vacant

*HRAC Executive Secretariat

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For Additional Information on the HRAC:

Please Contact:

Rick Haverkate, MPH 

Public Health Advisor

American Indian/Alaska Native Health Policy Lead

Office of Minority Health 

1101 Wootton Parkway, Suite 600

Rockville, MD 20852

Phone: (240) 453-2882 

Email: Richard.Haverkate@hhs.gov 

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