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Upcoming Events

IHS Influenza Update

December 17, 2014

11:00 am AKT/12:00 pm PT/1:00 pm MT/2:00 pm CT/3:00 pm ET



IHS Webinar on School Violence

December 17, 2014

12:00 pm AKT/1:00 pm PT/2:00 pm MT/3:00 pm CT/4:00 pm ET

Passcode: child



IHS Ebola Update #8

December 18, 2014

9:00 am AKT/10:00 am PT/11:00 am MT/12:00 pm CT/1:00 pm ET

Passcode: rounds



CDC Tribal Advisory Committee Meeting and Tribal Consultation

February 10-11, 2015

Atlanta, GA



National Network of Public Health Institutes Open Forum for Quality Improvement in Public Health

March 19-20, 2015

San Antonio, TX



National Indian Health Board Tribal Public Health Summit

April 7-9, 2015

Palm Springs, CA

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Funding Opportunities

NIHB Announces a Funding Opportunity for Tribes


NIHB and the CDC are pleased to announce new funding initiative that will provide funds to Tribes to support activities and efforts towards achieving public health accreditation.  This funding program, titled the Tribal Accreditation Support Initiatives (Tribal ASI) will fund 5-10 Tribes at amounts ranging from $5,000 to $10,500 to work in one or more categories related to strengthening the Tribal Health Department and working towards accreditation as defined by the Public Health Accreditation Board. Funds can be used for (but not limited to): completing pre-requisites activities, compiling documentation aligning with standards and measures, engaging in quality improvement activities, and supporting accreditation application fees.  NIHB has created a short application that asks for details on how the funds will be used and a statement of commitment from the Tribe to work towards accreditation.  The request for applications (RFA) is downloadable from here.  It can be downloaded, completed as a Word document, then turned into a PDF for submission. Completed applications are due to NIHB via email by Wednesday, January 7, 2015, by 11:59pm EST.


NIHB and CDC staff will host a conference call with all interested parties on December 16, 2014 at 1:00 PM EST (1-866-303-3137, passcode: 702869#) to answer questions about this RFA and application process.

Additional questions about this RFA or the Tribal Accreditation Support
Initiative (Tribal ASI) may be directed to Robert Foley, 

Public Health Digest 
A Publication of the National Indian Health Board 
Mission of the National Indian Health Board

One Voice affirming and empowering American Indian and Alaska Native peoples to protect and improve health and reduce health disparities.

This Publication
The National Indian Health Board (NIHB) invites you to learn more about the latest developments in Tribal public health, including updates on NIHB's current projects.  We also invite you to share your news items, comments or questions. 
Ebola Update

The Ebola virus disease has captivated the attention of most Americans since late spring of 2014. The current outbreak in West Africa is the largest outbreak of Ebola in history, and the world's first Ebola epidemic. The rarity and deadliness of the disease, combined with misconceptions about risk has led to widespread fear and confusion. In fact, a recent Rutgers-Eagleton Poll indicated that approximately 69% of polled New Jersey residents were somewhat or more concerned about a possible Ebola outbreak in the United States.[1] It is clear Ebola has quickly skyrocketed from obscurity to a serious domestic public health concern. In order to tackle the concerns of outbreak, it is important to first understand basic information about Ebola.


What is Ebola?

Previously called the Ebola hemorrhagic fever, Ebola is a rare and deadly disease that can be caused in humans by four virus species: Ebola virus, Sudan virus, Taļ Forest virus, and Bundibugyo virus.[2] The virus was first discovered in a small village in the Democratic Republic of the Congo (formerly known as Zaire) in 1976. Since then there have been scattered outbreaks isolated to Africa.


There are several symptoms indicative of Ebola infections:

  • fever greater than 101.5° F
  • muscle pain
  • vomiting
  • fatigue
  • diarrhea
  • abdominal pain
  • unexplained bleeding

It's important to note, however, many of these symptoms are also closely associated with influenza.[3] As the flu season arrives, it's imperative to distinguish the difference between the flu and Ebola. While both the flu and Ebola cause fever, headaches, muscle pain, and fatigue, the flu is also frequently accompanied by a cough, sore throat, and runny nose.  Influenza symptoms are much quicker to present, and, more often than not, the symptoms arrive together. The Ebola virus, on the other hand, develops over a longer period of time and becomes progressively worse as time goes on. The Centers for Disease Control and Prevention (CDC) has put together an informational poster to illustrate the difference between influenza and Ebola.[4] A significant difference between influenza and Ebola is the susceptibility of the general population here in the United States.


Will Ebola Effect My community?

Influenza is a contagious respiratory illness caused by influenza viruses. An estimated 5-20% of Americans get the flu each year. The flu is frequently spread by infected people when they cough, sneeze, or talk. It's very easy to get the flu in comparison to Ebola.


The Ebola virus is spread through direct contact with an Ebola-infected person's blood, urine, saliva, sweat, feces, vomit, breast milk, and semen; and contaminated objects, including bedding, needles, syringes, or infected animals. The virus only spreads via direct contact though broken skin, or unprotected mucous membranes (these membranes line your internal organs, nostrils, lips, eyelids, ears, genitals, and anus). As Ebola is not airborne, the only method of transmission is through direct contact with the aforementioned bodily fluids of either an infected person or animal and contaminated objects. According the CDC, "Ebola poses no substantial risk to the U.S. general population." The people at risk most are healthcare workers caring for Ebola patients, as they are the people most likely to have direct contact with a sick person's bodily fluids and contaminated objects.


The American Psychological Association believes that the news coverage of Ebola has raised awareness, while also obscuring some of the most important information.[5] While Ebola is a serious public health concern worldwide, it is not presently a concern for the United States. In comparison, there have been over 14,000 Ebola cases in West Africa, and only 4 people diagnosed with Ebola have set foot on U.S. soil.  If you find yourself or someone in your community still concerned about the prospect of an outbreak, please consider the following steps to take to managing fear regarding Ebola:

  • Keep things in perspective: decrease time spent watching or listening to media coverage.
  • Get the facts: obtain information from credible sources, including your provider, Tribal, local, or state public health agencies, the CDC, or the World Health Organization.
  • Stay healthy: living a healthy life is the best way to combat any illness. Proper diet, exercise, and avoiding alcohol and drugs can help with keeping anxiety and stress at bay.
  • Share openly: Talk honestly with the young people in your family about diseases and their risk of contracting an illness.

For updated information on the Ebola virus disease, please visit the CDC's dedicated Ebola page.



 [1] Eagleton Institute of Politics. (2014). New Jerseyans Concerned About Possiblity of U.S. Ebola Outbreak. Retrieved from

[2] Centers for Disease Control and Prevention. (2014). Ebola (Ebola Virus Disease). Retrieved from

[3] Centers for Disease Control and Prevention. (2014). Influenza (Flu). Retrieved from

[4] Centers for Disease Control and Prevention. (2014). Is it Flue or Ebola?. Retrieved from

[5] American Psychological Association. (2014). Managing Your Fear about Ebola. Retrieved from

Understanding the Differences Between Risk and Harm Reduction

Health providers and professionals are often faced with clients that are unable or unwilling to change potentially high-risk or harmful behaviors - like drinking, using drugs, or having unprotected sex. Abstinence from these behaviors isn't always a viable option. Risk reduction and harm reduction are two approaches that have been employed to address high-risk behaviors and seek to reduce potential harm that may come to the client. It's easy to confuse harm reduction and risk reduction as they have similar objectives. Risk reduction seeks to minimize risk behaviors, while harm reduction seeks to minimize the harms that can come by engaging in a risk behavior.


The principles of risk reduction include finding a health issue in a community and determining methods to reduce or eliminate the high-risk behaviors. For example, if teen pregnancy is a prevalent issue in your community, then this indicates that unprotected sex is occurring; risk reduction for this issue would focus on reducing the number of unprotected sex acts by promoting condom use.  If drunkenness is a prevalent risk behavior in a community, then risk reduction strategies would promote reducing the number of drinks consumed, reducing the amount of alcohol consumed, consuming water drinking between drinks or eating before going out. Harm reduction would say if this person is going to be get drunk how can you minimize the harms that could come from that? This could include making sure he/she doesn't drive, that they have sober friends with them throughout the night, or that he/she has a prepaid taxi to take him/her home, or not drinking drinks with incredibly high alcohol content.


Using protective factors to promote risk reduction has been found to be a successful combination approach. According to the Kansas University's Community Toolbox, protective factors are, "those things that keep whatever it is you're trying to prevent from occurring."[1] Protective factors usually help reduce or counteract risks. The Oglala Sioux Tribe in South Dakota operates CHOICES, a program that seeks to reduce the risk of alcohol-exposed pregnancy.[2] The program meets with women ages 18-44 that are not pregnant or taking any form of consistent birth control and are also drinking at risky levels. The women participate in four sessions, including one birth control session with a Health Provider. During these sessions, women are taught about making healthier life choices, including reducing drinking, or increasing the usage of birth control. Protective factors are also discussed, but not forced upon participants. Some protective factors for alcohol-exposed pregnancy include healthy relationships, surrounding yourself with friends that do not drink or engage in other problem behaviors (including drug usage), steady employment, and community involvement.


The concept of reducing a drug user's harm with protections is not a new concept and has been practiced historically. Formally developed in the mid-1980s in the United Kingdom to address HIV transmission via intravenous drug usage, harm reduction's primary objective is to decrease the potentially negative consequences of drug usage. In the United States, harm reduction organizations frequently focus on providing syringe exchange programs, safer injection supplies, and health education. Harm reduction notably does not advocate for complete abstinence from drug usage. Instead it is famously known for meeting a client "where they are at." This also means the movement is well known for not judging individuals or their behavior. The spectrum of services and education varies from providing new syringes to supporting a client in seeking rehabilitation, should they request it. While harm reduction started as a prevention approach, it has now evolved into an activist movement for the rights of underprivileged or underpowered populations, including drug users, commercial sex workers, the gay community, and tobacco users.


When considering which approach to adopt, it's important to understand the risk trends in your community, the feasibility with the risk population, and the political will of your community. Both risk and harm reduction have seen successes, but only local providers and case workers will know which approach will best work for individual Tribal communities.


[1] Kansas University Community Tool Box. 2014. Section 3. Identifying Strategies and Tactics for Reducing Risks. Retrieved from

[2] Oglala Lakota Nation. CHOICES - OST Health Administration. 2014. Retrieved from


Oral Health and Native American Youth

 The Center for Native American Youth (CNAY) at the Aspen Institute, founded by former US Senator Byron Dorgan, is dedicated to improving the health, safety and overall well-being of Native American youth through communication, policy development, and advocacy. In our outreach to over 3,500 Native youth, CNAY consistently hears that lack of access to health care, including oral health care needs is a serious issue for Indian Country. As part of a collaborative initiative to address the dental care needs of Native youth and their communities, CNAY is highlighting youth voices about access to care and the power of tribally-driven solutions.


Native Youth Oral Health Status

  • Tooth decay is five times the national average among American Indian Alaska Native (AI/AN) children ages 2 to 4 (US Agency for Healthcare Research and Quality).
  • 72% of AI/AN children have untreated tooth decay - more than twice the rate of the general US population (US Department of Health and Human Services).
  • 91% of AI/AN teens have experienced tooth decay (Association of Schools of Public Health).
  • AI/AN teens have three times the amount of untreated tooth decay than the general US population (Health Policy Institute at Georgetown University).
  • Recent tribal-specific studies further underscore the need for increased access to dental care:
    • Untreated tooth decay is present in nearly 50% of Santo Domingo Pueblo children, 70% of Navajo children, and 84% of Oglala children (The Center for Native Oral Health Research - University of Colorado).  
    • In Fiscal Year 2013, 1,316 AI/AN children in South Dakota had to be treated under general anesthesia because of severe tooth decay (Delta Dental). 

Native Youth and Access to Dental Care

US Health Resources and Services Administration Dental Care Shortage Areas (as of September 2014, in green)


Tribal Solutions

In response to oral health disparities, Alaska Native leaders and the Alaska Native Tribal Health Consortium created a mid-level dental therapy program to serve their people. Over the last decade, they trained 27 dental therapists expanding dental care access for 45,000 people in 81 remote villages.

  • global literature review finds dental therapists, the most researched dental provider, safely perform preventative and routine care such as filling cavities and simple extractions.
  • The Alaska, tribal dental therapy requires a post-secondary two-year education and is an educational opportunity for Native youth.
  • More than 90 tribal governments publicly support the use of mid-level dental providers like dental therapists (W.K. Kellogg Foundation).
  • The Alaska Native Tribal Health Consortium reports Alaska Native communities with dental therapists now see cavity-free children for the first time since the early 1900's.


The National Indian Health Board is working with CNAY and other oral healthcare advocates to promote oral hygiene and health care in Tribal communities by increasing education and awareness efforts, and increasing access to services by developing mid-level provider programs specifically for Tribal communities. 

Save the Date: Tribal Public Health Summit



Please plan on reserving April 7-9, 2015 to join public health professionals, Tribal leaders, federal and academic partners, and community advocates from across Indian Country in warm and beautiful Palm Springs, California for the National Indian Health Board's Tribal Public Health Summit, hosted by the California Area. 


This year's Summit will feature:

  • Longer workshop times to allow for more skills-building and networking opportunities;
  • Listening sessions with federal agencies
  • A dynamic and resource-filled exhibit hall 
  • New and refreshing panel plenary presentations

Stay tuned, as NIHB will be releasing additional information on the following in the coming weeks:

  • Registration
  • Call for Proposals
  • Hotel and Lodging Information
  • Sponsorship Information
  • Exhibitor Prospectus


The Growing Concern of the Intersection Between Intimate Partner Violence Against Native Women and HIV

Michaela Grey, MPH


Young American Indian/Alaska Native (AI/AN) women are often overlooked when it comes to HIV prevention efforts.  To date, HIV prevention campaigns focus on men.  AI/AN women, herein Native women, are more likely to be physically and/or sexually assaulted before the age of 20 by partners who may or may not be Native. 


According to the Full Report of Prevalence, Incidence and Consequences of Violence Against Women issued by the US Department Justice, American Indian/Alaska Native women are significantly more likely to have experienced rape, stalking and/or physical violence in their lifetime compared to women of other races and ethnicities.  

Furthermore, the CDC factsheet titled "Intersection of Intimate Partner Violence and HIV in Women" states that nearly 1 in 2 women have experienced other forms of sexual violence in their lifetime (i.e. unwanted sexual contact, sexual coercion).  In addition, women exposed to intimate partner violence (IPV) elevates her risk of HIV infection via forced sex with an infected partner, limited or compromised safe sex negotiation skills and increased sexual risk-taking behaviors (CDC Factsheet, February 2014).  Also, of the latest HIV infections reported for Native women, approximately 75% are attributed to having sexual intercourse with an infected male partner.  There is a growing concern among public health programs that link intimate partner violence against women with HIV infection.  


The epidemiological overview paints a stark picture for women of the general population and an even darker picture for Native women.  We can infer, based upon previously gathered data, that a Native woman's risk for HIV infection due to IPV is higher.  Here are a couple indicators that confirm the link between IPV against women and HIV.  Among Native women who report a history of IPV also report participating in behaviors known to increase HIV risk, such as injection drug use, exchanging sex for money or drugs and unprotected sexual intercourse. 


"To get over what happened to me (IPV), I party ..."


Another indicator is that women involved in violent - physical, mental or sexual - relationships have four times the risk of contracting HIV and/or a sexually transmitted infection.  The fear of enduring another traumatic attack impacts a Native woman's ability to safely negotiate condom use with a male partner. 


Yet another indicator that directly pertains to Native women is childhood sexual abuse and forced sexual initiation in adolescence are associated with increased HIV risk-taking behaviors that include multiple partners, sex with older partners, alcohol-related sex and engaging in unprotected sex.  Native women living on reservations endure unique challenges that include childhood sexual abuse by an older male relative, typically.  Native-serving public health programs need to develop programs that address intimate partner violence as a risk of HIV acquisition among Native women.


Native-serving public health programs need to address IPV as a significant risk factor for HIV infections among Native women.  This process begins with defining and increasing awareness of IPV and enhancing the competency to discuss IPV among health care providers and public health program staff working with Native women.  No longer can the focus of such programs be HIV, solely.  Thereafter, the team could build Native-specific training materials or adapt previous trainings to include the risks associated with IPV.  In response, NNAAPC developed the "Native Women Speaking: Keeping Our Communities and Ourselves Strong" curriculum that is offered in retreat style formats by partner sites located in North Carolina, Minnesota, North Dakota, Oklahoma and New Mexico.  Native Women Speaking is an HIV Wellness Project for Native women, their families and their communities.  Additional information about Native Women Speaking is available at


The National Indian Health Board welcomes your input!  If you would like to submit materials for consideration, please contact the NIHB Public Health Department through the Acting Director of Public Health Programs and Policy,  Robert Foley at or (202)355-5494.

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