Department of Health and Human Services

Centers for Disease Control and Prevention 

Agency for Toxic Substances and Disease Registry

 Tribal Advisory Committee (TAC) Meeting 

January 31 – February 1, 2012

Executive Summary
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

Acronyms

ACA Affordable Care Act

AHRQ Agency for Healthcare Research and Quality 

AI/AN American Indian/Alaska Native 

AIMS American Indian Multi-State

ATSDR Agency for Toxic Substances and Disease Registry

BRFSS Behavioral Risk Factor Surveillance System

CDC Centers for Disease Control and Prevention 

CMS Centers for Medicare and Medicaid Services 

CORD CDC Online Resource Directory

CRIHB California Rural Indian Health Board

FOA Funding Opportunity Announcement

HHS Health and Human Services 

HRSPC Health Reform Strategy, Policy and Coordination

IHS Indian Health Service 

IHCIA Indian Health Care Improvement Act

IRB Institutional Review Board

ITCA Inter-Tribal Council of Arizona

LSPPP Laboratory Science, Policy, and Practice Program

MMWR Morbidity and Mortality Weekly Report

NCEH National Center for Environmental Health 

NDI National Death Index

NIHB National Indian Health Board 

NPHPSP National Public Health Performance Standards Program

NPIII National Public Health Improvement Initiative

OMHHE Office of Minority Health and Health Equity

OSTLTS Office of State, Tribal, Local, and Territorial Support

OTA Office of Tribal Affairs

PHAP Public Health Associate Program

PHLP Public Health Law Program

STAC Secretary’s Tribal Advisory Committee

STD Sexually Transmitted Disease

STIs Sexually Transmitted Infections

STLT State, Tribal, Local and Territorial

TAC Tribal Advisory Committee 

TB Tuberculosis

TSII Technical Assistance and Service Improvement Initiative

UNITY United National Indian Tribal Youth, Inc.

VFC Vaccines for Children

WHO World Health Organization
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

3

Department of Health and Human Services

Centers for Disease Control and Prevention 

Agency for Toxic Substances and Disease Registry

Tribal Advisory Committee (TAC) Meeting

January 31 – February 1, 2012

Executive Summary

The CDC/ATSDR Tribal Advisory Committee (TAC) Meeting was held January 31 – February 1, 

2012, in Atlanta, Georgia. The purpose of the TAC is to advise the Director of the Centers for 

Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Substances and 

Disease Registry (ATSDR) on policy issues and broad strategies that may affect American 

Indians/Alaska Natives (AI/ANs). The TAC assists CDC in fulfilling its mission—collaborating to 

create the expertise, information, and tools that people and communities need to protect their health 

– through health promotion, prevention of disease, injury and disability, and preparedness for new 

health threats. Specifically, TAC meetings provide a forum for CDC leadership, elected or 

appointed Tribal leaders (or their designees), and representatives of national Tribal organizations 

designated by Tribal leaders to act on their behalf, to exchange views, information and advice 

pertaining to the implementation and/or administration of CDC programs and policies concerning 

Indian Country. TAC meetings complement, not replace, Tribal Consultations between CDC and 

Tribes. This document provides a summary of the presentations and discussions made during the

TAC meeting; a detailed summary is provided under separate cover (See TAC Meeting January 31 –

February 1, 2012, Minutes of the Meeting). 

The meeting began with TAC Co-Chair Chester Antone, Tohono O’odham Nation, welcoming the 

participants and inviting Lester Secatero, Chairman, Albuquerque Area Indian Health Board, to give 

the opening blessing. Mr. Antone then asked that members of the Tribal Advisory Committee 

(TAC) provide a brief self-introduction, followed by the official calling of the roll by Kimberly 

Cantrell, Public Health Advisor-Tribal Support, Office for State, Tribal, Local and Territorial 

Support (OSTLTS), CDC. With a quorum being met (N=10), Mr. Antone proceeded to ask the 

audience members to introduce themselves. 

Judith Monroe, Deputy Director, CDC and Director, OSTLTS, extended welcoming remarks, 

reaffirming that the CDC recognizes its unique relationship with AI/ANs and remains committed to 

its relationship with Tribal governments. As an agency of the U.S. Department of Health and 

Human Services (HHS), Dr. Monroe said the CDC recognizes the complexities of relationships with 

Tribes and is committed to working on a government-to-government basis. After acknowledging the 

attendance of her colleagues Dr. Gregory Holzman, Associate Deputy Director for Tribal Support, 

Tribal Support Office, OSTLTS, CDC; and Delight Satter, Associate Director for Tribal Support, 

Tribal Support Office, OSTLTS, CDC, Dr. Monroe began her presentation on OSTLTS updates. 

She discussed CDC’s primary activities, discussed its organizational makeup, noted the 

responsibilities assigned to Ms. Satter, shared information on OSTLTS, and addressed how to take 

science and apply it to practice. Discussing the Public Health Associate Program (PHAP), Dr. 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

4

Monroe stated that three are associates in Indian Country: California, Montana, and Washington; and 

she indicated that the next application period opens February 1, 2012. She directed the group to the 

http://www.cdc.gov/phpr/ website for more information, and agreed to check and see if it is possible 

for Tribes to share an associate. Among the other topics covered during her presentation included 

CDC domestic staffs; the National Public Health Improvement Initiative (NPHII); CDC’s role in 

accreditation and quality improvement; the Technical Assistance and Service Improvement Initiative 

(TASII); the STLT Gateway; the CDC Online Resource Directory (CORD); and best practice 

approaches to diabetes prevention in Native communities. During the follow-up discussion after Dr. 

Monroe’s presentation, Dr. Holzman said an additional OSTLTS staff person was not in place 

because of budget cuts; and Dr. Monroe suggested doing focused calls with Tribes, due to their lack 

of participation on town hall conferences. Before moving to the next session, TAC Business 

Meeting, Ms. Cantrell asked non-TAC members to leave the room. 

TAC Co-Chairs Chester Antone and Brenda Nielson facilitated the TAC Business Meeting session. 

Mr. Antone confirmed with Ms. Cantrell that the roll called at the beginning of the meeting could 

also serve as the roll call for the TAC Business Meeting portion of the agenda. Ms. Cantrell noted 

that Rex Lee Jim, representing the Navajo Nation, was now present and therefore should be included 

in voting. Highlights from the session include the following: 

 A motion to approve the agenda for the CDC/ATSDR TAC was unanimously approved. 

 Corrections to TAC Meeting Minutes dated August 22-23, 2011, were noted: a spelling error 

on the name Dee Sabattus on Page 17; and a spelling error on the acronym IHS on Page 9. 

Subsequently, a motioned to approve the meeting minutes from August 22-23, 2011, was 

unanimously approved. 

 A motion to have the TAC summer 2012 meeting in Wisconsin was unanimously approved. 

Subsequently, Mr. Antone requested that Ms. Bohlen gather information on contacts in 

Wisconsin and forward the information to Ms. Cantrell. The group was informed that the 

summer meeting typically occurs in July or August. 

 A motion was made and unanimously approved to have the three issues previously identified 

as “Items to Raise to the STAC” in the TAC’s August 22-23, 2011, meeting minutes as those 

that would be raised to the STAC and presented at the Annual HHS Tribal Consultation 

Session in March 2012. It was noted that the first bullet on collaboration will be expanded 

to address a focus on coordination with States regarding collaboration related to public heath 

accreditation. The second bullet on data will be expanded to address access to data at the 

State level and open dialogue between States and Tribes. The third bullet will be changed to 

read, “Issues related to CDC reorganization” and the first sub-bullet therein reworded. The 

issue of sequestration and holding Indian programs harmless will be added as a new item to 

raise to the STAC. 

Prior to beginning the next session, TAC Charter Discussion, Ms. Cantrell welcomed back the nonTAC participants to the meeting. She provided an overview of the last year’s activities and 

addressed next steps. She reminded the group that at the last TAC meeting there was an update on 

the CDC Tribal Consultation Policy. At that time, she said, Dee Sabattus did a comparison of the 

CDC and HHS policies and revisions were made. A revised version of the CDC policy, with 

suggestions and comments incorporated, was subsequently sent to the CDC Centers for review. 

Centers’ comments have yet to be incorporated; and Ms. Satter has not had an opportunity to read 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

5

the document. She also indicated that the TAC’s charter was last updated in 2009, noting the 

importance of reviewing it to ensure it reflects the direction the group wants to go in. She suggested 

that the TAC Co-Chairs invite individuals to work on an interim committee to assist with the work 

that needed to be done. The following individuals volunteered to serve on a committee to assist with 

finalizing the CDC Tribal Consultation Policy and the TAC Charter: J.T. Petherick, Stacy Bohlen (as 

a technical support person to Cathy Abramson), Chester Antone, Dee Sabattus (per Connie Hilbert’s 

instruction), Joe Finkbonner, and Vice President Jim. Ms. Cantrell agreed to contact the volunteers 

regarding setting up a meeting time to begin the work. She also indicated that updates on their 

progress would be provided to the TAC during planning calls. 

Lester Secatero began the Area/Organizational Updates by providing an update for the Albuquerque

Area. Highlights from his remarks are provided below: 

 Increase in diabetes among adults. 

 Navajo Nation supplied trucks for getting medicine and wood to persons in need during 

periods of heavy snow; and the county provided helicopters.

 Navajo Nation gave $200,000 to buy medical equipment. 

 Working on cross deputizing law enforcement officers with the county and the State. 

 County provides assistance to the fire department and ambulances. 

 Raised money to build a clinic, but needs additional staffing. 

 Will bring in a water line from Albuquerque. 

 A gas company that wants to run a gas line through the reservation. 

 Immunizations are occurring late, around January. 

 Johns Hopkins is doing a survey on Native foods. 

 Uranium mine will open on nearby private land. 

 Some people bothered by President Obama’s use of the code name “Geronimo” [in reference 

to Osama Bin Laden].

The Nashville Area representative, Connie Hilbert said she tried to gather information from Tribes in 

her area for the last 6 months. She apologized to Ms. Cantrell for the brevity of her report, stating 

that many Tribes were very busy with their day-to-day issues and therefore they were unable to 

respond to her inquiry. Among the information she was able to glean includes the following: 

 Tribes are committed to the work they do with the United South and Eastern Tribes, Inc. 

 Some Tribes are concerned about data collection, diabetes, prescription drugs, bath salts, and 

substance abuse. 

 Tribes are working hard on dealing with alcohol and substance abuse issues. 

 A lot of Tribes are working on the SDPI grant and related reporting requirements.

Mr. Petherick’s update on the Oklahoma City Area focused on: 

 Work with Inter-Tribal Health Board and Epidemiology Center to get CDC information 

disseminated. 

 Epidemiology Center Director position now stable. 

 Developing Tribal community health profiles.
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

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 Assisting Tribes with navigating through the public health accreditation. 

 Working on collaboration, e.g., the Oklahoma State Department of Health has established a 

Tribal Office. Now a full-time Tribal staff person is dedicated to working on public health 

issues. They are also working on inter-jurisdictional issues. 

 Working well with counterparts at the State level to address emergency management issues. 

Mr. Finkbonner cited the following updates for Portland Area: 

 There is a weekly mail out to disseminate CDC information.

 Quality and performance improvement will be important to Tribes, especially as they 

consider if accreditation is appropriate for them. 

 HIV/STD programs use media sources to contact teens to get them health information. 

 Continue to work on provider development through the Cancer Control program. 

 Working with Fred Hutch on the AIMS [American Indian Multi-State] Project—looking at 

cancer survivors’ outcomes. 

 Moving forward with the BRFSS [Behavioral Risk Factor Surveillance System] project.

 Would like CDC to continue to foster relationships between Tribal public health systems and 

States/locals. 

 Received feedback that HIV block grants are not making it to Tribal levels. 

Ms. Bohlen provided an update on the National Indian Health Board (NIHB). Highlights from her 

presentation included the following: 

 Continues to develop and refine a national list of Tribal health directors and public health 

directors to disseminate information from CDC, as well as other information relevant to 

public health. 

 Public Health Summit will be May 30 – June 1, 2012, in Tulsa Oklahoma. Hoping for CDC 

support. 

 Will form a National Tribal Technical Health Tribal Advisory Committee to help in 

developing policy, providing analysis, and looking at public health impacts.

 Developed a proposal for CDC to support the development of a Tribal Public Health 

Workgroup to act as an advisory group to the TAC. 

 Working with the Tribal Epidemiology Centers Directors Workgroup and will develop a web 

based fact sheet and will post on NIHB website a list of Tribal Epidemiology Centers with 

contact information and links. 

 Collaborating on two research initiatives: Public Health Systems and Services Research and 

Health Professions Opportunities grants. 

 Working with IHS and the Native American AIDS Prevention Center to develop additional 

outreach efforts and media campaigns for HIV/AIDS prevention initiatives. 

 Board of Directors developed and passed a resolution to create a Tribal Youth Health 

Advisory Committee. 

 Partnering with UNITY [United National Indian Tribal Youth] Inc., to host a luncheon for 

youth participating in the UNITY mid-year conference next week. 

 NIHB continues to serve on various health committees and advisory boards.
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

7

 The 40th anniversary of NIHB will be marked by an annual conference in Denver, Colorado 

the last week in September. 

Alicia Reft invited Mr. Butler to present the updates for the Alaska Area: 

 

 Two of the Tribal recipients of the National Public Health Improvement Initiative are in 

Alaska.

 Has a project looking at grants management. 

 Moving forward with community health assessments. 

 Production of Traditional Foods, Contemporary Chef continues, with episodes available on 

the internet. 

 The I Want the Kit project, a computer based self-testing opportunity for STIs [sexually 

transmitted infections], has about a 25% return rate. 

 Thanked CDC for support of the Universal Vaccine Program in Alaska, which has now gone 

away. Expressed appreciation for the Art of Investigations Program. 

 Acknowledged the Did You Know? and Have You Heard? initiatives.

 Hosted the NIHB Consumer Conference, which yielded a follow-up activity related to 

looking at data from the Adverse Childhood Events Study to see how it might apply in Indian 

Country. Leadership has been looking at data and seeing how it might affect Indian 

Country. Suggested that Dr. Rob Anda (sp), one of the co-principal investigators of the 

original study to address the TAC.

 Acknowledged CDC grants for colon/rectal cancer screening. 

 Last week there was a briefing for State health officers pertaining to the Strategic National 

Stockpile and there is a concern if the distribution model will reduce the assets available to 

the most remote parts of Indian Country. 

Vice President Jim shared updates from the Navajo Nation. Among the highlights from his 

presentation included the following items: 

 Navajo Nation disseminates information on CDC to the Navajo Nation Council, as well as 

various committees, divisions, programs, organizations and through the Navajo Nation State

Address. Also started a newsletter and distributes information through conferences. 

 Public health issues include: need for Tribes to have the option to receive direct funding from 

CDC; need for Tribes to have direct access to Tribal health data (federal, State, and local 

sources); Epidemiology centers need to establish technological data infrastructures to store, 

retrieve, and analyze data regarding the local health status of AI/ANs; need for AI/AN 

surveillance systems; need more effective collaboration across Tribal federal agencies and 

States; and need for more effective Tribal consultations.

 Funded with a cooperative agreement with the National Public Health Improvement Initiative 

for Performance Improvement to prepare for the public health accreditation board.

 Developing a Navajo Cancer Control Plan to address cancer concerns. 

 Advocating for research on uranium expose. 

 Seeks additional funds to address health disparities. 

 Vaccinations needed for high risk groups. 

 Need funding to build staffing capacities. 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

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 Breast and Cervical Cancer Prevention Program is taking a mammography unit to remote 

areas. Started a partnership with a professional golfer to raise awareness on physical activity

and build more soccer fields. 

 Addressing oral health through mobile units and hoping some dentists will do volunteer work 

on Navajo. 

 Collaborates with spiritual leaders on public health outreach and asking them to serve 

healthier foods at ceremonies. 

 CDC should be aware of: Navajo Nation’s desire for direct funding whenever possible; CDC 

public health preparedness is not distributed adequately to benefit the entire Navajo Nation; 

want to meet on stockpiles; and needs funding and technical for the Medicaid Feasibility 

Study

 Navajo Nation wants to build effective policies to build its workforce capacity; health data 

management infrastructure, and surveillance systems.

 Requests technical support in the form of a special assignment of a public health advisor to 

assist with addressing environmental and infectious disease concerns on the Navajo Nation. 

Following Vice President Jim’s presentation, Dr. Holzman asked specifically what the Navajo 

Nation was requesting in terms of the technical assistance for the Medicaid Feasibility Study. A 

member of Vice President Jim’s staff responded that technical assistance was being requested for the 

design of the feasibility study and in developing a timeline to implement the study. She also said the 

Navajo Nation wanted to be involved in determining where the study will be conducted. Dr. 

Holzman asked if the study was intended to see if the Navajo Nation could have its own Medicaid 

system. He was told, “Yes, it’s to take on all CMS [Centers for Medicare and Medicaid Services] 

services. The federal government doesn’t understand that we don’t recognize State lines. We have 

families that are mobile and it’s important to have accessibility to Medicaid and Medicare in all three 

States.” 

Although the remainder of the updates occurred later in the day, they are presented below in this 

document. 

Sherrilla McKinley provided the update for the Phoenix Area:

 IHCIA Section 214 says CDC shall give technical assistance Tribal Epidemiology Centers. 

Wants assurance from CDC that Tribal data will be transmitted to the Epidemiology Centers 

and coordinated with IHS.

 Public health activities include: the Southwest Indian Collaborative Network is developing a 

2-day web based Patient Navigator Certified Trainer Program. 

 ITCA [Inter Tribal Council of Arizona] Dental Prevention and Clinical Support Center 

provides continuing education and training for dental program staff. 

 ITCA Tribal Epidemiology Center is preparing community health profiles to evaluate 

community health status of Tribes. 

 CDC should be aware of public health issues such as chronic pain management, patient 

education on prescription medication, diabetes care management, home health services for 

elders, women’s health care service enhancements, and the need for adult male residential 

treatment services for alcohol and substance abuse. 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

9

 Fort Yuma Ambulatory Health Care facility has been declared unsafe and process is 

underway to relocate services.

 Recommended that TAC members through support from CDC’s OSTLTS be present at HHS 

Regional Tribal Consultation Sessions to obtain advisement from Tribal leaders on policy 

concerns, budgetary matters, and public health collaborations.

Gayline Hunter shared updates from the California Area. Among the highlights of her presentation 

included the following: 

 CRIHB [California Rural Indian Health Board] disseminates information via list servs, 

presentations, newsletters, board meetings, conferences, and community health events, 

among other vehicles. 

 Engaged in nationwide tobacco surveillance and monitoring project. 

 Public health issues include a need for more funding for public health programs and services 

(tobacco, substance and alcohol abuse, HIV/AIDS, suicide, injuries, and elder falls). Other 

areas of concern are social determinants of health especially in babies and children, maternal 

and child health services, home visiting resources, services for youth, and public health 

accreditation (related to capacity of small Tribes to engage in work and achieve 

accreditation). 

 Public health activities being planned include injury prevention activities for children, e.g., 

car seat installation, home safety, and bike and recreation safety. 

 As a result of a Tribal Motor Vehicle Injury Prevention Program grant, Yurok Tribal police 

have been trained in the National Highway Traffic Safety Administration’s Child Passenger 

Certification course. The grant also enabled the production of a media campaign on road 

safety.

 CRIHB is engaged in ongoing consultations and nutritional health assistance with Tribal

Head Start programs.

 PHAP fellow was awarded in California.

 Tribal consultation is still a priority. 

Mr. Antone provided the update for the Tucson Area. Highlights are as follows: 

 Mode of communication is through the CDC list serv, and via radio stations.

 There is a Rocky Mountain Spotted Fever outbreak on Tohono O’odham Nation, with 11 

confirmed cases. (Meeting scheduled on February 17th for all Arizona Tribes to discuss the 

issue.)

 A CDC H1N1 study is being conducted. 

 Public health activities: Tough Enough to Wear Pink at the rodeo; half marathons; and other 

year-round activities. 

 Held a Research Review Process meeting to work towards getting an IRB [Institutional 

Review Board] for nations without one. 

 Need additional research related to cancer, cardiovascular disease, and diabetes.

 Should begin to look at social determinants of health in conjunction with the National Plan of 

Action and the Secretary’s Strategic Plan to Eliminate Health Disparities. 

 Should scrutinize budgets to protect funds most used by AI/ANs. 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

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 Would like insight into current financial information compiled by Ms. Satter’s office using 

financial information retrieved from the Financial Office.

Joe Bray conveyed Tribal Self-Governance support of this meeting. 

Lydia Ogden, Director, Health Reform Strategy, Policy, and Coordination Office (HRSPC), Office 

of the Associate Director for Policy, CDC, served as the presenter for the Health Care Reform –

CDC Perspective session. She indicated that the Office for Health Reform Strategy, Policy, and 

Coordination (HRSPC) was created in August 2011, stating that she is its Director. She said the 

Office deals with anything that has to do with the ACA or health reform, more largely. She also 

noted that her complementary office is the Office of Prevention through Health Care, which is 

responsible for working to integrate prevention into the health care system. She said the U.S. is 

experiencing rising health care costs, demographic changes, and mounting fiscal woes. With that in 

mind, her presentation focused on addressing, 1) what is the problem we are trying to fix; 2) an 

overview of the ACA and how it addresses that problem(s); and 3) opportunities for public health 

vis-à-vis the ACA. 

Dr. Ogden showed the per capita U.S. health expenditures in 2009, noting that on average $7960 was 

spent per person as compared to $3032 per person in other industrialized countries. With the U.S. 

spending more than twice as much as others, she questioned the value of what is being spent when 

the U.S. is not doing well as those other systems in many areas, e.g., low birth weight, hypertension 

under control, diabetes under control. In 2011, she said, $2.7 trillion was spent on health in the U.S. 

(with 3% spent on government public health activities and the bulk of the resources going towards 

restorative health). In terms of the current situation, she said we are on an unsustainable path. With 

that in mind, the ACA was designed to deliver better health, better care, and lower costs. She said 

opportunities for public health include expanded insurance coverage and access; policy and 

regulations looking at structural interventions to promote healthy choices; essential health benefits 

packages; immunizations; screenings; smoking cessation; ongoing interventions; medication 

adherence; and personalized behavioral interventions. 

She shared example provisions in the ACA; and she talked about parts of the Act intended to 

increase individual health and well being, e.g., preventive care with no cost sharing; and preventive 

guidelines for children, adolescents, and women. Dr. Ogden also mentioned that the CDC is funding 

technical assistance and capacity building for workplace wellness provisions, to ensure they are 

evidence based. For communities and States, the Community Transformation Grants build on the 

Communities Putting Prevention to Work initiatives (and of that money $6 million went to Tribes). 

Dr. Ogden said the ACA permanently reauthorizes the Indian Health Care Improvement Act 

(IHCIA), authorizes new programs and services with IHS, and provides AI/ANs with more choices. 

During the follow-up discussion, Dr. Ogden addressed CDC’s role in the health insurance “game;” 

expected benefits for AI/ANs; the need to educate providers on new populations; the pending release 

of a special supplement to the MMWR [Morbidity and Mortality Weekly Report] that looks at 

surveillance at core clinical services and health outcome metrics to get a baseline measure before the 

implementation of health reform; the evolution of the Prevention fund and its uncertain financial 

future; and the potential for Federal based Exchanges.
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

11

Carol J. McElroy, Acting Deputy Director/Budget Officer, Financial Management Office, CDC, 

began the CDC/ATSDR Budget presentation by sharing FY 2011 resource allocations for programs 

that benefit AI/AN populations, noting that reports on awarded contracts were pulled to collect the 

information. She also clarified that all of information was pulled from financial data systems. 

Overall funding to AI/AN programs (as of September 30, 2011) was slightly over $226 million, of 

which the majority (69%) was Vaccines for Children (VFC) funding. This reflected a 16 percent 

total increase over FY 2010 funds, with the largest percentage of growth occurring in contract 

funding. Ms. McElroy provided comparison data on funding as distributed among AI/AN 

tribes/organizations for FY 2010 and FY 2011, as well as by specific disease areas. During the 

follow-up discussion, the following items were noted: 

 The VFC program is a $4 billion program. The estimated VFC population is almost 41 

million, with the AI/AN population being 1.6 million of that (3.95%). 

 What is not included in that [data] is the vaccines which the providers purchase through the 

CDC purchasing system. Each provider in the States order vaccines which are then provided 

to patients. Those numbers are actually not captured here. Those are considered supplies as 

opposed to contracts. 

 CDC took a 0.189% cut, which should not affect grants and cooperative agreements. It 

doesn’t mean money has to go to the same grantees. Cuts are targeted for intramural 

programs (administrative expenses, travel, space), not external customers. 

During a surprise presentation, Dr. Melanie Duckworth was honored with a special “thank you” for 

her work. Ms. Satter shared slides about Dr. Duckworth and Mr. Antone presented her with a gift on 

behalf of the Tribes and the CDC. 

Ms. Satter provided an update on the OSTLTS. Specifically, she shared responsibilities of the 

Office and noted its current activities. Items of particular interest included: 

 Tribal Consultation Report (provided in binder).

 Improved communication with the TAC and CDC.

 Completed report to Congress on the Social and Economic Conditions of Native Americans.

 Completed OMHHE [Office of Minority Health and Health Equity] Tribal Colleges and 

Universities Investment reports. 

 Pending FOA [Funding Opportunity Announcement] release (on infrastructure and winnable 

battles). 

As part of her remarks, Ms. Satter also discussed cross-CDC activities such as the Public Health Law 

Program (PHLP)/OSTLTS, Tribal Judiciary Public Health pilot; ATSDR National Tribal

Environmental Think Tank; and a Tribal and State Collaborative Roundtable scheduled for the 

coming Friday. 

Matthew Penn, Director, Public Health Law Program, OSTLTS, CDC, provided information on the 

Public Health Law Program. He indicated that the program has ten attorneys working in three areas: 

 Serving as a resource within CDC for programs that touch on State, Tribal, and territorial 

laws to make sure the laws are appropriately integrated into program initiatives.
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

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 Providing legally-based technical assistance, working with State, local, and Tribal health 

departments as they grapple with issues. 

 Providing public health law training and developing curriculum to give the national public 

health community an understanding of public health law. 

Mr. Penn said the second area was probably most relevant to the group, giving an example of a 

project in Alaska where they helped a consortium of hospitals that was wrestling with trying to make 

their employee health immunization policies consistent across the hospitals. He also cited examples 

of work such as providing legal work to the Cherokee Nation and Navajo Nation; and work with the 

University of Pittsburg on public health training for the judiciary and how it can be adapted for 

Tribal Nations. Mr. Penn also noted a recent request for technical assistance from the Umatilla Tribe

in the Northwest as they attempt to go for accreditation, as one of the criteria for the accreditation is 

to conduct a legal review. Because the program did similar work with the city of New Orleans, it 

hopes that the information will be useful to the Umatilla Tribe. In closing, Mr. Penn’s colleague 

Montrece Ransom, PHLP, OSTLTS, CDC, said the Public Law Program was in the mist of 

launching a needs assessment for training and technical assistance in the field and wanted to make 

sure that Tribes were included. She encouraged them to subscribe to CDC Public Health Law News, 

stating that she had copies of the November 2011 issue that focused on Tribal law for review. Mr. 

Penn added that the upcoming February edition would include a Tribal interview with Michael Byrd. 

During the follow-up discussion, Mr. Penn said the office is working with the Injury Center to 

provide technical assistance for policy related injuries; and it can help Tribes with developing traffic 

safety laws. Ms. Bohlen extended an invitation to Mr. Penn to present a public health law mini 

seminar at the NIHB-hosted Public Health Summit in Tulsa, Oklahoma at the end of May/beginning 

of June.

Annabelle M. Allison, Tribal Liaison, Office of Tribal Affairs, National Center for Environmental 

Health (NCEH)/ATSDR, served as the presenter for the ATSDR Updates session. She said the 

Office of Tribal Affairs (OTA), NCEH/ATSDR, underwent an exercise last year to consider the 

strategic direction the office should take in terms of environmental health in both the short and longterm. She said as they went through the exercise, they found that there were many definitions of 

environmental health and many crossroads between environmental health and public health. The 

Think Tank Initiative was established to develop a 3 to 5 year plan in terms of the vision of the 

OTA. Twelve Tribal professionals were recruited to serve as members of the Think Tank and NIHB 

served as their contractor. The first three meetings focused on creating a strategic analysis and

setting the foundation for the Think Tank, discussing major environmental concerns of Tribes, and 

developing a strategic plan to address the issues, respectively. To guide its work, the Think Tank set 

seven guiding principles and established guiding pillars for its strategic plan. The group identified 

training, education, and mentorship as priority activities; and it noted the importance of doing more 

work with urban Indians, using Tribal Epidemiology Centers, including representation from the 

Pacific Island region and the Navajo Nation in its membership, getting leadership buy-in, and 

keeping its efforts going. Ms. Allison said the Think Tank is now in the process of drafting its 

strategic plan and hopes to have it completed by the spring of this year. After acknowledging the 

work of Ms. Ransom and Chinyere Ekechi, Ms. Allison also noted that the Think Tank will look at 

public health topics, not just environmental health. The discussion following Ms. Allison’s 

presentation centered on environmental issues in Montana. Ms. Allison stated that in July of 2010, 

some TAC members took a tour of a mine that is said to have environmental health impacts and is 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

13

not getting visibility in terms of remediation. Noting a request that ATSDR look at the data, she said 

they have been going back and forth with the Tribe in terms of accessing data. 

Ms. Satter asked for and received permission from Mr. Antone to have a demonstration of the CDC 

Gateway. Chelsea Payne, Lead Health Communications Specialist, OSTLTS, CDC, led the 

demonstration. She stated that the Gateway was intended to be a one-stop-shop to locate CDC 

information that individuals needed to better do their jobs. She noted that the homepage contained 

constantly changing information, as well as a “What’s New” section. She provided an overview of 

the site, highlighting products on the homepage and the CDC online resource directory. She 

commented that the site is still under revision. Notably, she said the Tribal Support section was 

outdated; and she welcomed input to improve it. During the follow-up discussion a request was 

made for more information on Native Americans; a listing of personnel was requested; and a 

recommendation was offered to have some type of warning system to say an email or phone call is a 

priority. Following the discussion, Ms. Hilbert and Mr. Butler volunteered to assist Ms. Allison by 

providing feedback on the site. Mr. Petherick also agreed to volunteer one of his staff to help. 

The first day of the meeting ended with Ms. Satter recapping the events of the day and thanking the 

Tribal leaders for their updates and the presenters for their presentations. Lester Secatero provided 

the closing blessing. 

The second day of the CDC/ATSDR TAC meeting started with TAC Co-Chair Brenda Nielson 

welcoming the group back and inviting her fellow Co-Chair Chester Antone to provide the opening 

blessing. After offering welcoming remarks to the TAC, Ms. Satter provided a brief introduction of 

herself. Dr. Holzman next shared information about himself and his work, expressing his 

commitment to improving health for all, including Indians. Remarking that she too had a similar 

childhood as that one described by Ms. Satter, Ms. Nielson proceeded to ask for brief introductions 

from the TAC members. The Committee’s introductions were followed by introductions by 

members of the audience. 

A staff member in Laboratory Science, Policy, and Practice Program (LSPPP) Office, Caryln Collins 

began the Work Together on Laboratory Issues session by stating that laboratories are a central part 

of health care efforts. Laboratory testing is done in a variety of settings, from hospitals to small 

clinics. Dr. Collins said some entities even contract with larger labs and/or use State public health 

laboratories. Despite estimates that say 70% of decisions in health care are made based on a lab 

tests, Dr. Collins said laboratories sometimes get overlooked. In earlier days, she said there was a 

Bureau of Laboratories at CDC and they all worked together. Now, CDC labs sit with their 

programs and are therefore fragmented. Dr. Collins showed an organizational chart and shared the 

directive of the LSPPP, part of which is to connect CDC with various stakeholders (including 

Tribes) on cross-cutting laboratories issues. She shared some of LSPPP’s activities; discussed what 

may be useful to laboratories that serve Native health systems; and asked the following questions: 

 Are the services I described something that would be useful to Tribes?

 What are the best ways to go about the effort?

 Whom should we speak to? 

In response to Dr. Collin’s questions, the following items were noted: 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

14

 Most of our lab work in Indian Country is tied to IHS. Most of the communications would 

be with them. 

 Tribes typically don’t have any capacity when it comes to an outbreak; they would have to go 

to State and/or local partners. 

 It would be useful to use communication tools such as “Do You Know?” and “Have You 

Heard?” and have trainings archived online or available on CD.

Mark Miller, National Center for Environmental Health, discussed Rocky Mountain Spotted Fever, a 

bacteria that is transmitted by a tick (dog or wood) bite. Mr. Miller said the disease can be severe 

and difficult to diagnose. He also indicated that the rash often shows late and therefore it is 

important to get an early diagnosis and apply mediation. Deaths do occur, as well as organ failure; 

and a high number of cases have been reported in eastern parts of the U.S. Additionally, he said 

there is a band of counties in Arizona that are Tribal areas with high rates. He emphasized the need 

for animal control and veterinary care. Mr. Miller discussed an upcoming effort, the Neighborhood 

Pilot Project, where one community will allow removal of unwanted dogs, be provided collars, have 

dogs and homes treated on a regular basis, receive education for homeowners, and get monitored for 

changes in Rocky Mountain Spotted Fever. The goal of the project, Mr. Miller said, is to improve 

human health by improving the health of the pet population. Highlights from the discussion points 

include the following: 

 A campaign will start in March 2012 to advertise the pilot project.

 On February 17, 2012, there will be a statewide meeting on RMSF in Chandler, Arizona.

 RMSF can be treated with an antibiotic, Doxycycline. 

 The Humane Society is a great partner and heavily involved with animal control services. 

 An Integrated Pest Management Training will be held February 13-15, 2012. There will be a 

full day’s agenda on animal control. 

Rachael Johnson, Public Health Associate Program, explained during the Public Health Associate 

Program (PHAP) session that the PHAP takes recent bachelors graduates and places them for 2 years 

at public health agencies. First piloted in 2007, in 2010 the PHAP became a nationwide program. 

Ms. Johnson informed the TAC that the program currently has 119 associates that cover 26 States, 3 

Tribes, 1 territory, and the District of Columbia. Sample program areas in which associates work 

include STD/TB and/or HIV; chronic disease; environmental health; and public health preparedness. 

Ms. Johnson noted the three associates placed with Tribes: Allysa Llamas in Billings, Montana; Lan 

Lee in Sacramento, California; and Caroline Sedano in Tokeland, Washington. Ms. Johnson 

identified two gaps in the program. First, she said, there is no strong representation of Indian Tribes 

as host sites. Secondly, there is only 1% Native American participation as associates. To encourage 

Tribes’ participation, Ms. Johnson explained some of the benefits of being a host site and shared 

eligibility criteria. She also discussed core competencies needed by associates and provided an 

overview of the process from recruitment through placement. In closing, Ms. Johnson said the 

applications for associates and host sites open that day and would remain open for 6 weeks. In the 

follow-up discussion, Ms. Johnson described the work being done by associates in Indian Country; 

and she outlined CDC vs. host site vs. associate responsibilities. 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

15

Rear Admiral Scott Deitchman, Associate Director for Terrorism Preparedness and Emergency 

Response, NCEH and ATSDR, explained during the Introduction and Overview of Preparedness & 

Response Activities at NCEH/ATSDR and Collaboration with Tribal Communities session that his 

office addresses environmental health emergencies, e.g., chemical, radiological, and natural 

disasters. Specifically, he said the office has two responsibilities: to develop guidance and 

recommendations for health departments to prepare for events and coordinate response to actual 

events; and to provide epidemiologic support to providing health interpretation data to providing 

public guidance. With regard to Tribal issues, he said he has been in a growth phase. Initially 

thinking that Tribes were connected to State health departments in times of disaster, Dr. Deitchman 

said he now realizes that is not always the case. He welcomed suggestions on how to make 

communications more efficient. “Disaster risk reduction says disaster is caused by a hazard or 

vulnerability to the hazard. If you can reduce vulnerability, then you wouldn’t have the disaster.” 

Dr. Deitchman indicated that disaster risk reduction is the next “big thing,” and he looked forward to 

exploring it in terms of Tribal communities in future meetings. To that end, he said he would be 

happy to attend the TAC’s next meeting in Wisconsin. During the follow-up discussion, Dr. 

Deitchman (along with Mr. Greg Smith) described a typical response protocol to a disaster.

Matthew Murphy, NCEH/Health Studies Branch (HSB), CDC, presented for the Unregulated Water 

Sources in Tribal Communities: Background and Feedback for Potential Funding Opportunity 

session. He began his presentation by sharing background information on the Health Studies 

Branch, stating that it conducts environmental health research, conducts outbreak investigations, 

prepares for and responds to disasters, provides technical assistance and expertise to public health 

partners, and runs the Clean Water for Health Program. He said the latter focuses on identifying and 

evaluating non-infections contamination of unregulated drinking water sources, e.g., private wells, 

natural springs, rainwater, and surface water, as well as evaluating potential contamination risks due 

to drinking water hauling and water storage, developing interventions and educational materials to 

decrease community risk for harmful drinking water exposures, and providing grant funding. As 

part of his presentation, Dr. Murphy discussed previous HSB collaborations with Tribal groups. 

Specifically, he discussed water hauling on the Navajo Nation; and investigating unregulated 

drinking water use, water hauling, and water storage in Alaskan villages. Dr. Murphy also discussed 

Clean Water for Health federal grants, i.e., Enhancing Capacity for Environmental and Public Health 

Surveillance of Unregulated Drinking Water grants. 

Donna McCree, Associate Director for Health Equity, Division of HIV/AIDS Prevention, National 

Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, began the presentation on Social 

Determinants of Health by stating that access to medical care, economics, housing, and incarceration 

are all social determinants of health. She called social determinants of health “complex, integrated, 

and overlapping social structures and economic systems that influence health status.” Dr. McCree 

proceeded to show the basic framework used by the World Health Organization (WHO), noting that 

health equity is the achievement of the highest level of health for all people. She discussed factors 

that influence health and specifically addressed social determinants and contributing factors as 

related to HIV. 

Leandris C. Liburd, Director, Office of Minority Health and Health Equity (OMHHE), CDC,

contented that we’ve always known that there was an influence of the social environment on health, 

yet it has taken years to build a political will and come to a tipping point about the issues in public 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

16

health. She quoted a poster on the WHO website that asks, “Why treat people and not change what 

makes them sick?” Dr. Liburd focused her portion of the presentation on Healthy People, saying 

Healthy People 2020 is the national agenda to improve health in the country and achieve health 

equity. It provides a set of specific measurable objectives over a 10-year period. Reminding 

everyone that last December the findings from Healthy People 2010 were released, Dr. Liburd said 

the number of objectives has increased. Led by HHS and other stakeholders, Healthy People 2020 

builds on previous decades of work, is grounded in science, and is guided by public input. To that 

end, she said they want to increase awareness of social determinants of health. During the followup discussion, it was suggested that Tribal governments be specifically identified as being able to 

provide input as a government body; Dr. Liburd and Dr. McCree discussed the issue of “evidence 

based;” and a member of the audience shared information on the Commissioned Corps Officer 

Student Training and Extern Program.

Amy Burnett Heldman, Electronic Media Branch, Division of News and Electronic Media, Office of 

the Associate Director for Communication, Office of the Director, CDC, discussed social media at 

CDC. She began her presentation defining social media outlining its core tenets. She explained that 

social media allows CDC to tailor health messages to diverse audiences, as well as increase user 

engagement, share health information in new spaces, listen to audiences, and educate people 

worldwide about the CDC. Among the CDC’s social media strategic objectives include integrating 

social media in health communications strategies and plans; increasing social media research, 

monitoring and evaluation; and engaging and interacting with its users. The CDC’s social media 

reach includes Facebook (including an OSTLTS page launched last year), Twitter, Blogs, Text 

messaging, YouTube, and other tools. Ms. Heldman said that a priority of her branch is content 

syndication—sharing CDC content with partner websites; and she said mobile/portable content will 

be a big priority for 2012, with CDC now having an application for iPads and iPhones. After 

sharing various examples of CDC’s social media initiatives, Ms. Heldman discussed the steps to 

developing a social media strategy; and she said the Health Communicators Social Media Toolkit 

and other documents are available on the CDC website. 

Melissa Jim, National Comprehensive Cancer Control Program, National Center for Chronic Disease 

Prevention and Health Promotion, CDC gave a presentation on improving cancer surveillance and 

mortality data for AI/AN populations. Noting that race misclassifications too often occur in cancer 

surveillance, she said her work involves indentifying cases as non-natives and links administrative 

records from IHS with records from central cancer registries. Among the highlights of her 

presentation included how National Death Index (NDI) and IHS information was used to create two 

new databases; a discussion on OK2Share; working with the Great Plains Tribal Chairmen’s Health 

Board; the cancer among the Navajo Nation report; and linking Tribal enrollment data to produce 

Tribal cancer summaries. Ms. Jim also discussed various trainings, including work with CRIHB on 

2009 Influenza data; and the Summer Research Training Institute for AI/AN Health Professionals, 

among others. Finally, she talked about the importance of data confidentiality and she concluded 

that racial misclassifications can be addressed through data linkages. 

Native Diabetes Wellness Program, Division of Diabetes Translation, National Center for Chronic 

Disease Prevention and Public Health Promotion staff members Dawn Satterfield and Larry Alonso 

co-presented for the Native Diabetes Wellness Program session. Dr. Satterfield shared statistics on 

diabetes in the U.S. A disease once rare in Indian Country, Dr. Satterfield said AI/ANs now have 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

17

over twice the rates of non-Hispanic Whites (perhaps one in two for Native children). Dr. Satterfield 

shared highlights of “River of Hope,” which outlines the course of the Native Diabetes Wellness 

Program. Noting that the balanced budget amendment of 1997 established the Special Diabetes 

Program for Indians (SPDI), Dr. Satterfield called IHS a strong partner in the effort and told how the 

program spawned the Eagle book series and related Eagle projects.

Larry Alonso discussed the Traditional Foods Project, emphasizing the need for social support and 

the sharing of knowledge through stories. He said the Traditional Food Project has three domains: 

traditional foods, traditional forms of exercise, and social support (specifying that social support 

needs to be culturally relevant). Mr. Alonso said stories were being collected from 17 Tribes; and he 

shared a video from the Eastern Band of Cherokee Indians that addressed diabetes and obesity. He 

said the Traditional Foods Project would conclude in 2013; and he directed the group’s attention to a 

poster on the back wall which highlighted the project, noting that existing data demonstrated the 

transformation of various communities. After his presentation, he agreed to provide contact 

information for the Eastern Band of Cherokee Indians for individuals wishing to obtain a copy of the 

video he showed. 

The second day of the TAC meeting ended with Dr. Holzman thanking the meeting participants for 

what he called a fantastic couple of days. Noting that progress had been made on some items, he 

said there is still much to do. Through collaboration, and with help from Tribal leaders in 

prioritizing issues, he said items could be moved forward. The meeting ended with Ms. Nielson 

thanking the group for being patient with her as she served as Co-Chair for the first time, and Mr. 

Antone providing the closing blessing. 
Tribal Advisory Committee (TAC) Executive Summary January 31 – February 1, 2012

18

Appendix A: Participant Roster

Tribal Advisory Committee (TAC) Members 

Chester Antone, Tohono O’odham Nation

Stacy A. Bohlen, Sault Ste. Marie Chippewa; National Indian Health Board

Joe Bray, Choctaw Nation, Special Project Coordinator

Jay Butler, MD, Alaska Native Tribal Health Consortium

Connie Hilbert, MS, RS, Mohegan Tribe

Gayline Hunter, California Rural Indian Health Board

Rex Lee Jim, Navajo Nation

Sherrilla McKinley, Inter Tribal Council of Arizona, Inc.

Brenda Nielson, Northwest Portland Area Indian Health Board, Quileute Tribe

J.T. Petherick, JD, MPH, Cherokee Nation

Lester Secataro, Albuquerque Area Indian Health Board, Inc.

Centers for Disease Control and Prevention

Annabelle M. Allison, National Center for Environmental Health and the Agency for Toxic 

Substances and Disease Registry

Larry Alonso, FNP, Division of Diabetes Translation

Kimberly Cantrell, Office for State, Tribal, Local, and Territorial Support

Carlyn Collins, MD, MPH, Laboratory Science, Policy, and Practice Program Office, Office of 

Surveillance, Epidemiology and Laboratory Services

Rear Admiral Scott Deitchman, MD, MHP, National Center for Environmental Health and Agency 

for Toxic Substances and Disease Registry

Michael Franklin, Financial Management Office

Amy Burnett Heldman, MPH, Office of the Associate Director for Communication, 

Office of the Director 

Gregory S. Holzman, MD, MPH, Office for State, Tribal, Local, and Territorial Support

Melissa Jim, MPH, National Center for Chronic Disease Prevention and Health Promotion

Rachael Johnson, Public Health Associate Program

Leandris C. Liburd, PhD, MPH, MA, Office of Minority Health and Health Equity 

Donna McCree, PhD, MPH, RPh, Division of HIV/AIDS Prevention

Carol J. McElroy, Financial Management Office 

Mark Miller, National Center for Environmental Health

Judith Monroe, MD, FAAFP, Office for State, Tribal, Local, and Territorial Support

Matthew Murphy, PhD, MS, National Center for Environmental Health

Lydia Ogden, PhD, MPP, MA, Health Reform Strategy, Policy, and Coordination Office, Office of 

the Associate Director for Policy

Matthew Penn, JD, MLIS, Public Law Program, Office for State Tribal, Local and 

Territorial Support

Delight Satter, MPH, Office of State, Tribal, Local and Territorial Support

Dawn Satterfield, RN, PhD, National Center for Chronic Disease Prevention and

Public Health Promotion