In 1996, the United States Congress took an important step in helping the Indian Healthcare Improvement Act to live up to its name. Congress established four Tribal Epidemiology Centers (TECs), which were charged with identifying and addressing risks to health and well-being among millions of American Indian and Alaska Native (AI/AN) people.
The legislation addressed a longstanding gap in the quality of healthcare available to AI/AN citizens, said Spero Manson, PhD, director of the Centers for American Indian & Alaska Native Health (CAIANH) at Colorado School of Public Health. He noted, for example, that disparities in care for tribal people contribute to high rates of diabetes, cardiovascular disease and behavioral health issues.
“Congress realized that tribal communities were at a significant disadvantage in terms of planning for and addressing the health needs of their respective members,” Manson said. “The role of the TECs is to provide data and ensure ongoing surveillance and trending analyses for these kinds of concerns so that tribes are better informed and in position to make the best possible investments in the resources that are available to them.”
The growth of TECs spurs need for more resources
There are now a dozen TECs serving the country’s Indian Health Service areas, including one in Seattle that represents urban health organizations across the nation. And since July 2022, they have received important support from the recently created Resource Center for Tribal Epidemiology Centers (RC-TEC) at the CAIANH.
The RC-TEC grew out of the idea advanced about 15 years ago by the National Institutes of Health (NIH) that TECs were “ideally situated” to pursue research that explores “the science of health disparities specific to America Indian and Alaska Native communities,” Manson explained. But funding for the initiative steadily decreased and the research flagged, he said.
That led Dr. Eliseo J. Pérez-Stable, director of the National Institute on Minority Health and Health Disparities (NIMHD) to seek ideas for a new direction. The NIMHD’s National Advisory Council offered a recommendation.
New funding and support for research
The idea was a resource center that provides TECs with discretionary funds to enhance their research capacity, while also supporting their efforts with a “full menu” of assistance with developing technical systems, providing training, and bolstering data infrastructure, Manson explained.
The NIMHD solicited nationwide applications to lead the new initiative. The CAIANH was ultimately the successful applicant and received funding to launch the initiative that is now the RC-TEC, led by Manson and his colleague, Joan O’Connell, PhD.
Manson said the RC-TEC provides support in four categories:
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Money supplied in “unfettered fashion” through the NIMHD to TECs to “enhance their research capacity.” For example, funds could support hardware and software purchases, data infrastructure improvements, staff training, and so on.
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Training opportunities. Manson said the RC-TEC works closely with ColoradoSPH’s Center for Innovative Design and Analysis (CIDA) and Debashis Ghosh, PhD, chair of the Department of Biostatistics and Informatics, to offer courses and training to TECs in areas such as using electronic health records and extracting data from them, as well as analyzing data and then communicating the findings that result from that work.
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Technical assistance for research design. This support helps TECs explore questions in specific areas of keen interest to AI/AN communities, such as maternal/child health. For example, TECs might get help in designing study questions, connecting with subject matter experts to dig for answers, and getting assistance with scientific editing of their research manuscripts.
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Training for grant writing. Manson said he and his colleagues at CAIANH have developed a series of research career development programs with a “heavy emphasis” on writing applications for NIH and other scientific research grants. The programs have been highly successful, he said, and helped to spawn a six-month grant-writing course for TECs with a two-day introductory workshop and a mentoring team that includes an NIH-sponsored investigator, a master’s level biostatistician and a science writer. RC-TEC held the first such workshop in February in Bethesda, Maryland, Manson said.
All of these initiatives aim to “improve the position of TECs to successfully pursue locally meaningful and beneficial research that will be of advantage to their constituencies, their tribal members and the tribes to which they are beholden,” Manson said. “The next step is, once you have that information, how can you use it to justify the continuation of existing programs or propose new programs, either by the tribes themselves or with state partners, departments of health, etc.?”
Judging the success of the RC-TEC
The success of the RC-TEC will be gauged by several metrics, Manson said. These include increasing the number of research grants for which TECs prepare, submit and ultimately receive funding; boosting the number of individuals who are exposed and receptive to and supportive of research; and increasing collaboration across TECs.
Ultimately, the need to bolster resources to the TECs is illustrated by a grim statistic, Manson said. Between 1970 and 2019, the average life expectancy of an American Indian male rose from 47.1 years to 71.3 years – five-and-a-half years less than for non-Hispanic Whites, but still a dramatic increase, he noted.
However, in the wake of the three-year COVID-19 pandemic, the life expectancy for AI/AN individuals dropped a full five years, he added. There were a variety of reasons that contributed to the decline: low socioeconomic status, barriers to accessing healthcare, emotional and psychological trauma, and high rates of comorbidities, Manson said.
“All of that contributed to a rapid and precipitous decline in life expectancy,” he said. “We are now seeking to recover that, and TECs have an important contribution to make in this regard.”
