Public Health Practices

By law, tribal governments are sovereign and operate independently of state governments. During a public health emergency, however, overriding authority resides with the state governor. To build the relationship between tribal and state governments and better understand government roles during emergency preparedness planning and response, Arizona organized an executive committee consisting of eight tribal representatives and one state representative.

The Nevada State Health Division's collaborative relationship with area American Indian tribes and the addition of a tribal liaison position led to a successful H1N1 response in this population. As the H1N1 virus started to affect local populations, the Nevada State Health Division took an aggressive approach to working with the state's health authorities and tribes.

In October of 2009, the Arizona Department of Health Services (ADHS) noticed a disproportionate number of H1N1 hospitalizations and deaths among American Indians (AI). Similar findings in other states led to the formation of a multidisciplinary workgroup that compiled surveillance data from 12 states. The preliminary results indicated that AI were twice as likely as the general population to be hospitalized with severe complications or die from novel H1N1 flu.