Volume 16 Fall 2004 Issue No. 1

'Working Together, Unlimited Things Can Happen'
CDC, tribes, colleges strive to improve Native health

by Ron Selden

PIPELINES FOR STUDENTS. Tribal colleges introduce students such as Carol Gist and Cindy McCorison to health professions. Photo by Jonathan Chapman Photography, courtesy of Fond du Lac Tribal and Community College

Making positive changes in the overall health of American Indians and Alaska Natives must come from within the community, and "the more tribal members who become healthcare professionals, the better," says Pelagie "Mike" Snesrud, a Dakota Sioux working for the federal Centers for Disease Control and Prevention (CDC) in Atlanta.

Native people living on reservations and in urban areas face a broad array of health problems, Snesrud notes. There are many documented disparities in the health status and in the quality of health services Native people receive compared with other populations.

The CDC is committed to improving the health of Native Americans, according to Snesrud. The agency, she says, recognizes that substantial progress can be attained by expanding government-to-government consultation and developing stronger partnerships with tribes.

Snesrud is one of two full-time employees assigned to the "Indian desk" in the CDC's Office of Minority Health. She and Dr. Ralph Bryan, a medical epidemiologist, are helping to formulate a new tribal consultation policy for CDC, one of the agencies within the U.S. Department of Health and Human Services (DHHS). Snesrud is in Atlanta, and Bryan is based at the Indian Health Service National Programs office in Albuquerque.

DHHS Secretary Tommy Thompson and Deputy Secretary Claude Allen have visited more than 100 tribes across the nation to listen to the concerns of tribal leaders, Snesrud says. DHHS officials asked each agency to develop its own tribal consultation policy based on the department's policy to improve the working relationships between the federal government and tribes.

"The department has not only put consultation on the top of the stove; it's put it on the front burner," she explains. CDC officials met and talked with tribal leaders, tribal health directors, and tribal college presidents. Revisions to the draft policy should be completed and released for final comment in the next few months, Snesrud says. A primary goal of the pending policy, she notes, is "breaking down barriers and improving accessibility."

Snesrud says that direct consultation will further help identify unique health needs of Native communities and increase flexibility within programs, increasing the number of tribes receiving resources and technical assistance.

"Our tribal communities are different in so many ways," she says. "The needs change depending on what occurs in the day-to-day life of a tribal community."

The pending consultation policy and plan were developed through input from 266 representatives from tribes and tribal organizations. The CDC, working closely with the nonprofit National Indian Health Board and regional Native health boards, launched scoping meetings in the 12 Indian Health Service units to discuss the proposals in 2002. The CDC also has participated in regional tribal consultation sessions sponsored by DHHS in 2003 and 2004.

"It's exciting and challenging work," Snesrud says. In addition, the CDC/Office of Minority Health is working with the American Indian Higher Education Consortium (AIHEC) and its member colleges to encourage more minority students to enter the public health arena.

"We recognize that tribal colleges are real pipelines for tribal students," she says. "We're looking to expand and do more recruitment, as there simply is an inadequate workforce of Native public health professionals."

AIHEC has a five-year cooperative agreement with the CDC that's designed to both strengthen relationships with tribes and help tribally-controlled colleges increase the participation of American Indians and Alaska Natives in the health professions, enhance research, and improve the health status of Native peoples.

Edward Sekonde, MPH, is the project director at AIHEC. CDC leaders see tribal colleges and universities serving a crucial supporting role as they move toward further incorporating tribes into their operations. Sekonde is organizing four regional meetings of CDC liaisons at tribal colleges to explore curriculum development, partnering with mainstream universities and community-based organizations, grant writing, and federal budget process workshops.

The AIHEC cooperative agreement stems from a 1997 Executive Order from then-President Bill Clinton and a similar 2002 directive from President George W. Bush telling federal agencies to work with tribal colleges.

Dr. Ralph Bryan: "This policy will be a legacy that both Mike and I will be very proud of."

The CDC and the department's Agency for Toxic Substances and Disease Registry hosted a conference in Atlanta in July 2004 aimed at getting more American Indian and Alaska Native students enrolled in public health training programs and careers.

One reason that's important, Snesrud explains, is that Native providers understand the issues from their own life experiences, and they aren't seen as outsiders trying to foist foreign programs and beliefs on local communities. Native providers are often more able to develop a crucial bond of trust, she adds.

Pelagie "Mike" Snesrud: "True consultation is not agency employees telling indigenous peoples what they think is best for them."

"CDC has lots of tested knowledge and expertise. We have to find the bridges to exchange information and gain a mutual understanding with tribal leaders and colleges," she says.

Snesrud, 52, is a registered nurse from Shakopee, MN. She joined the CDC staff in 2001 after serving nearly 20 years as the public health nursing coordinator on the Fond du Lac Indian Reservation in Minnesota. She also previously worked as an ambulatory care nurse and a clinical instructor at Haskell Indian Junior College in Kansas (now Haskell Indian Nations University).

True consultation, Snesrud says, is not agencies telling indigenous peoples what they think is best for them. Instead, the CDC must encourage tribal collaboration from the ground up.

Bryan, 47, began working with the CDC in 1987. In 1994, he was assigned to oversee scientific field activities in the Four Corners area as part of the effort to better understand hantavirus pulmonary syndrome, a potentially fatal disease transmitted to humans from rodents. Bryan joined the agency's Office of Minority Health in 1999 and has been working solely on tribal issues ever since. He says the evolving consultation plan is designed to mesh with other internal changes being made within DHHS to increase public involvement.

"Establishment of a formal CDC tribal consultation policy will help ensure that a policy of open, two-way communication with tribes is institutionalized at the agency - a legacy that both Mike (Snesrud) and I will be very proud of," he adds.

Ron Selden is a freelance writer and photographer based in Helena, MT, and a frequent contributor to Tribal College Journal.