Appendix A: Tribal-Specific Resources and Considerations

As discussed throughout the public health assessment guidance manual, it is crucial to consider sensitive subpopulations when conducting your public health assessment. Developing an accurate understanding of exposure scenarios is a significant component in the health effects evaluation and is necessary for determining appropriate and beneficial public health recommendations.

The relationship Tribal populations' have with the environment is often different from that of other communities. Tribal lifestyle, cultural, ceremonial and religious practices are intertwined with the environment. These interactions can result in environmental exposure scenarios that are unique to individual tribes. This appendix provides some general information and resources for health assessors when working with tribal communities.

Information about ATSDR's Office of Tribal Affairs is presented first, followed by ATSDR's Policy on Government-to-Government Relations with Native American Tribal Governments, and ATSDR's Consultation and Coordination Policy with Indian Tribal Governments. In addition, Appendix D which provides a community checklist developed by ATSDR's Board of Scientific Counselors Community Tribal Subcommittee, should provide useful questions to consider when working with tribal communities.

ATSDR Office of Tribal Affairs

The United States has a unique legal relationship with American Indian/Alaska Native (AI/AN) governments as set forth in the Constitution of the United States, treaties, statutes, executive orders, and court decisions. The Department of Health and Human Services (DHHS) has established policy to work on a government-to-government basis with tribal governments to address issues concerning tribal self-determination, tribal trust resources, and tribal treaty rights. As a public health agency within the Department of Health and Human Services, the Agency for Toxic Substances and Disease Registry (ATSDR) has established a firm commitment to working with AI/AN governments and organizations.

ATSDR acknowledged that the U.S. government has a unique relationship with tribal governments, and established the Office of Tribal Affairs (OTA) to provide meaningful representation and discretion to plan, conduct, and administer programs, services, and functions that fulfill the agency mission and meet the needs of individual tribal communities. To facilitate an orderly transition from Federal to Tribal services, ATSDR helps AI/AN nations strengthen their capacity to preserve the environment, something at the core of cultural identity and health for tribal nations. ATSDR is the only agency within DHHS without a specific AI/AN mandate (such as Indian Health Services [IHS] and Administration for Native Americans [ANA]) that has a tribal office established to address specific AI/AN environmental health issues.

Currently, OTA is charged with developing agency tribal policy and programs, and responds to request from AI/AN governments, organizations and communities. OTA serves as a central conduit for Tribes to access agency programs and services, assist ATSDR in responding to presidential executive orders, and coordinate activities to support tribal-specific public health needs. Through different means, OTA provides oversight on several projects that include tribal subsistence, environmental health infrastructure, and self governance. OTA represents ATSDR on DHHS, U.S. Environmental Protection Agency (EPA), Centers for Disease Control and Prevention (CDC) and IHS working groups that focus on AI/AN health-related functions.

The office provides ATSDR staff members with training on working effectively with tribal governments. This training provides insights into appropriate protocols for working with Tribal governments and addresses special considerations that should be given when assessing the health of American Indian and Alaska Native people. In addition, an OTA representative often serves on the public health assessment team when a site has a tribal interest.

ATSDR tribal policies on government-to-government relations and tribal consultation, developed by OTA with appropriate tribal consultation, follow in this appendix.

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ATSDR Policy on Government-to-Government Relations with Native American Tribal Governments

This policy provides guidelines on the implementation of the government-to-government relationship with the tribes (in response to the 1994 Memorandum on Government-to-Government Relations with Native American Tribal Governments).

The mission of ATSDR is to prevent exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment. In carrying out its programs, ATSDR works with other Federal, State, and local government agencies, and tribal organizations to protect public health.

The U.S. Government has a unique government-to-government relationship with tribal governments as established by the U.S. Constitution, by treaties, by statute, by court decisions, and by Executive Orders. This relationship respects the U.S. Government's trust responsibility to American Indians and Alaskan Natives and their rights of self-government because of their sovereign status. ATSDR is strongly committed to building a more effective day-to-day working relationship with tribal governments.

In fulfilling the commitment to establish and maintain government-to-government relations with federally recognized tribal governments, ATSDR will be guided by:

1. Section 126 of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and the principles set forth in the President's "Memorandum for the Heads of Executive Departments and Agencies Regarding: Government-to-Government Relations with Native American Tribal Governments" (April 29, 1994). In particular, ATSDR will:
   
   • in a manner consistent with the protection of public health, consult with tribal governments to ensure that tribal rights and concerns are considered before ATSDR takes actions, makes decisions, or implements programs that may affect tribes; and
   • establish procedures to work directly and effectively with tribal governments;
     
2. The needs and culture of individual tribal governments;
3. ATSDR's prior and ongoing experience with tribal governments, and recognized organizations associated with such governments; and
4. The need to enhance coordination with other agencies with related areas of responsibility.

ATSDR Consultation and Coordination Policy with Indian Tribal Governments

The agency established the Office of Tribal Affairs and prepared this policy to ensure that regular and meaningful consultation and collaboration with tribal governments occur in the conduct of the agency's public health activities (in response to Consultation and Coordination With Indian Tribal Governments, EO13084).

ATSDR's mission is to prevent exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment. ATSDR is committed to assisting tribal governments in meeting the environmental health needs of their people. ATSDR continues to work to improve its communication and cooperation with tribes. This new policy is in response to the Presidential Executive Order 13084, Consultation and Coordination With Indian Tribal Governments, May 14, 1998, and affirms the current ATSDR Policy on Government-to-Government Relations with Native American Tribal Governments (61 FR 42255). The policy focuses on environmental health issues related to the release of hazardous substances into the environment. Consultations between ATSDR and tribal governments will continue to ensure effective collaboration in identifying, addressing, and satisfying the needs of tribal communities affected by hazardous substances. Consultation enables ATSDR staff and tribal members to interactively participate, exchange recommendations, and provide input on environmental health activities. As defined by ATSDR, the new policy supports:

1. a consultative process with tribal nations and their members to work together to address tribal environmental public health needs;
2. mutual trust, respect, and shared responsibilities between all participating parties; and
3. open communication of information and opinions leading to mutual interaction and understanding. ATSDR:
   
   • respects and honors the sovereignty of the tribes, the responsibilities and rights to self-governance, and the differences between tribal nations and individuals;
   • consults with tribal governments to ensure community concerns and impacts are carefully considered before the Agency takes action or makes decisions affecting tribal communities;
   • maintains government-to-government relationships with tribal governments;
   • ensures ongoing communication with tribal governments, communities, and individual tribal members to define concerns about possible health impacts from exposure to hazardous substances.

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Appendix B | List of Appendices