New Leadership for CDC Tribal Support

4/23/2012

As a federal agency, CDC recognizes its special obligations to, and unique relationship with, the American Indian and Alaska Native (AI/AN) population. CDC tribal support activities are already well underway in the 2012. Most notably, CDC welcomed its new Associate Director for Tribal Support, Delight Satter, MPH, within the Office for State, Tribal, Local and Territorial Support (OSTLTS).

Satter joined the agency on December 4, 2011. In her role, she acts as the principal contact for all tribal-related public health activities in the agency and serves as CDC's principal advisor to and main liaison with policy-level officials. She also coordinates CDC programs and policies that benefit or affect AI/AN populations.

"We are truly fortunate to have Ms. Satter with us, bringing with her an impressive resume of work, which shows her deep commitment to the health of the Indian nation," said Judith Monroe, MD, FAAFP, OSTLTS director.

Satter has worked on numerous research, programmatic, and policy efforts from a local, state, and national perspective. Prior to joining CDC, she directed the American Indian Research Program, which she founded in 1998 at the University of California, Los Angeles Center for Health Policy Research, one of the nation's preeminent policy research centers.

"It is my honor to serve CDC and native communities in my role as Associate Director for Tribal Support. It is a dream opportunity to utilize my academic and community-based experiences in a structural way for native public health," said Satter.

Support Activities

Various tribal public health support activities have already taken place under Satter's leadership, including the Tribal Advisory Committee (TAC) Meeting and the 8th Bi-annual Tribal Consultation Session, held on January 31–February 2, 2012. This CDC Tribal Consultation Session for all elected tribal leaders is one of two sessions held yearly—one in Atlanta hosted by CDC in the winter and a second hosted by a tribe or area tribal health board in late summer.

The elected tribal leaders, or their official designates, make up the TAC, which advises the CDC director and administrator of ATSDR on policy issues and broad strategies that may affect AI/AN tribes and people. The Tribal Consultation Policy requires all agency programs to consult with tribal governments when developing programs and activities that will affect Native populations (see sidebar).

CDC representatives from across the agency presented on various topics and held dialogue with TAC members. Also in attendance was CDC Director, Tom Frieden, MD, MPH, who assured participants that CDC remained committed to the government-to-government relationship with tribal governments and recognized the sovereignty of tribes (see sidebar). He presented on eliminating health disparities among AI/AN populations, touching on the CDC budget, the Million Hearts initiative, prescription drug abuse, and immunization.

Voicing Opinions

TAC members voiced their opinions on multiple CDC activities, such as the Rocky Mountain spotted fever epidemiological investigation in Tohono O'odham Nation and future funding directions for the Traditional Foods Program. TAC members also requested strengthening communications, including implementation of a TAC issues tracking tool, and further CDC engagement in tribal settings.

TAC members expressed strong interest in CDC's Public Health Associate Program (PHAP), in which CDC-funded, entry-level PHAP associates are assigned to a state, tribal, local, or territorial public health agencies to work for two years.

Multiple TAC members already expressed they were partnering to promote the program to tribes and young native professionals, and stated they would submit applications for hosting the PHAP associates. The PHAP program has already gained high praise from the Shoalwater Bay Indian Tribe, which hosts current associate, Caroline Sedano.

"PHAP represents a unique and valuable opportunity for us to partner with CDC," said F. Scott Powell, health director. "Not only do we acquire access to CDC resources and subject matter expertise, but our associate, Ms. Sedano, has impressed us immensely with her talent and drive. She continues to ask great questions, has begun formulating new answers to old problems, and is always willing to jump in and help out wherever she's needed.

Powell continued, "In addition to her work duties, she is able to navigate the cultural aspects of the position and has conducted herself extremely well in her meetings with the tribal council, elders, and members. Ms. Sedano has involved herself in various groups and activities, such as drumming classes, to improve her knowledge and gain foresight into what is needed in the community."

Unique Opportunity to Interact with Tribal Leaders

The second tribal consultation session for summer 2012 will be hosted by the Mohegan Tribe in Uncasville, Connecticut. All CDC CIOs are invited to participate.

"We encourage CDC staff to join us in Indian Country and participate in this upcoming summer session. This is really a unique opportunity for one-on-one interaction with tribal leaders and community members and to see firsthand what goes on in the field, since this session will take place in a Native community," said Satter.

A History of Promising Collaborations

Satter was also central in planning the Association of State and Territorial Health Officials' Tribal and State Health Collaborative Roundtable that took place February 2–3 in Atlanta. Other partners included the National Indian Health Board and the Northwest Portland Area Indian Health Board.

The event highlighted promising collaborations between tribal health groups, state health agencies, and Medicaid; identified opportunities to improve quality and access across health systems; and reaffirmed the importance of resource alignment through coordinated efforts, policy initiatives, and programs.

The primary groups at the roundtable included representatives from the CDC Tribal Advisory Committee, the Centers for Medicare and Medicaid Services' analogue committee called the Tribal Technical Advisory Group, state public health officials, and state Medicaid directors.

Building Relationships

Satter's primary focus remains enhancing the relationship building with and liaison role between CDC and tribes, including developing communications strategies, leveraging existing cooperative agreements, and maximizing visibility through speaking engagements, among other efforts. Under Satter's purview, a funding opportunity announcement (FOA) for tribal capacity building has just been released for 2012, with another soon to be released for 2013.

Satter expressed her anticipation about the myriad of opportunities to come. "I am excited about the upcoming slate of activities within Tribal Support, including updating the policies which guide CDC in its government-to-government relationship with tribes, implementing a new TAC Issues Tracking Tool to monitor our communications with TAC members, and our summer CDC/ATSDR Tribal Advisory Committee meeting and 9th Bi-annual Tribal Consultation Session meeting kindly hosted by the Mohegan Tribe in Connecticut this August.

Satter continued, "We are centralizing and modernizing CDC's American Indian and Alaska Native communications strategy, using existing CDC infrastructure. We have an FOA on the streets and look forward to supporting AI/AN Winnable Battles and capacity building applications. We are partnering across CDC on multiple efforts, like the OSTLTS Public Health Law Program's tribal judges public health training."

For more information visit the CDC tribal public health activities online.

Did You Know? CDC's Unique Government-to-Government Relationship with Tribal Governments The United States has a unique legal and political relationship with Indian tribes and a special relationship with Alaska Native entities as provided in the Constitution of the United States, treaties, and federal statutes. CDC, as an agency of HHS, recognizes the complexity of the federal-tribal intergovernmental relationships resulting from treaties, statutes, executive orders, and court decisions. CDC is committed to continuing to work with federally recognized tribal governments on a government-to-government basis and strongly supports and respects tribal sovereignty and self-determination for tribal governments in the United States. More information: Presidential Memorandum and Executive Orders Tribal Consultation