>>THANK YOU FOR JOINING US FOR
DAY TWO OF THE TAC.
FOR ANYONE LISTENING ONLINE,
THANK YOU FOR JOINING US.
WE STARTED THE MORNING SESSION
OVER AT -- WHERE WAS IT THIS
MORNING?
WE WERE AT THE CLINICAL CENTER
FOR A NICE TOUR.
DO YOU MIND DOING A ROLL CALL?
WE'LL DO INTRODUCTIONS STARTING
WITH YOU.
>>DEBBIE DANFORTH MEMBER AT
LARGE REPRESENTING THE ONEIDA
NATION.
>>MEMBER AT LARGE I LIVE IN
ALASKA AND REPRESENTING THE
ORGANIZATION OF MY TRIBE.
>>I'M A DELEGATE FOR THE TUCSON
AREA.
>>ALICIA MOUSSEAU FROM THE
GREAT PLAINS AREA.
>>STEVE KUTZ REPRESENTING THE
PORTLAND AREA.
>>
[SPEAKING NON-ENGLISH]
MY NAME IS BRITTANY JOCK
REPRESENTING THE NASHVILLE AREA
REPRESENTING THE SAINT REGIS
MOHAWK TRIBE.
>>HERMINIA: NEXT TIME WE'LL
TAKE INTO CONSIDERATION EAST
COAST AND WEST COAST BECAUSE
THAT'S REALLY IMPORTANT BECAUSE
IT'S A PACKED AGENDA AND WE HAVE
DIFFERENT TIME ZONES HERE.
ONE THING TO KEEP IN MIND.
THANK YOU FOR HANGING IN THERE.
THE GOOD THING IS I THINK WE ALL
STAYED WIDE AWAKE BECAUSE THE
PRESENTATIONS WERE SO
INTERESTING.
THEY WERE GOOD PRESENTATIONS AND
WE ALL LEARNED A LOT AND I THINK
THAT'S WHY WE WERE ALL ENGAGED.
AND WE HAD THE UPDATE BECAUSE WE
HAD A GOOD CONVERSATION TODAY
ALSO IN OUR CAUCUS AND
SUPPORTING ALE THE WORK YOU'VE
BEEN DOING IS CONSISTENT WITH
WHAT WE'VE BEEN TALKING ABOUT.
IT'S ALIGNED WITH WHAT WE'RE
DOING.
WE WANT TO CONTINUE TO SUPPORT
THAT AND WE ALSO WANT TO BE A
PART OF WHAT YOU'RE WORKING ON
AS YOU CONTINUE TO MOVE FORWARD
ON THE STRATEGY PLANNING.
THAT IS SOMETHING THAT WE'RE
LOOKING FORWARD TO DOING.
DO YOU WANT TO BRING UP ANYTHING
ELSE FOR THE WRAP UP FROM
YESTERDAY AND TODAY BECAUSE I
KNOW YOU DIDN'T REALLY HAVE A
CHANCE.
>>KARINA: THANK YOU VERY MUCH
AND GRATEFUL FOR OUR PANELIST TO
COME OUT AND SHARE THE AMAZING
WORK BEING DONE AT THE NIH BY
OUR NATIVE INVESTIGATORS.
GIVING THE TAC THE OPPORTUNITY
TO SEE THEM IN ACTION THE
COMMITTEE WORK THAT'S GOING ON
AND TODAY AT THE CLINICAL CENTER
IT'S THE FIRST TIME I'VE HAD A
CHANCE TO BE THERE AS WELL.
I FOUND IT REALLY INTERESTING
AND LOOK FORWARD TO HEARING WHAT
YOUR THOUGHTS ARE ON THAT AND
WAYS TO BETTER PARTNER
POTENTIALLY WITH THE CLINICAL
CENTER ACTIVITIES AND INTRAMURAL
PROGRAMS FOR OUR COMMUNITIES, SO
SERVICE OF THAT.
>>Herminia: WE TALKED TO
DR. TABAK AND ALSO HAD THOUGHT
ABOUT THE WORK ALL OF US BRING
TO THE TABLE AND THE PASSION WE
ALL BRING TO THE TABLE AND WE
HAVE REALLY GOOD AND GREAT
TECHNICAL ADVISORS AND PEOPLE IN
THE FIELD A LONG TIME.
WE REALLY WANT TO CONTRIBUTE TO
WHAT WE CAN HELP THROUGHOUT THE
COUNTRY AN INDIAN COUNTRY AND
AND SOMETIMES PROGRESS DOESN'T
HAPPEN AS QUICKLY AS OTHERS
MIGHT WANT TO SEE IT.
I THINK THAT'S BECAUSE IT'S
DIFFERENT AND WE'RE HAPPY TO SEE
YOU IN THIS POSITION AND YOU'VE
BEEN OUT WORKING IN THE
UNIVERSITY.
YOU'VE BEEN OUT WORKING WITH
YOUR TRIBE, YOU'VE BEEN OUT
WORKING WITH TRIBES AND YOU
REALLY DO UNDERSTAND THE DYNAMIC
AND SO IT'S REALLY HAVING YOU IN
THIS POSITION HAS -- WE ALREADY
SEE IT WHEN WE REPORT YESTERDAY
BUT WE SEE THE VALUE OF HAVING
YOU HERE AND BY YOU HIRING
SHEILA I THINK IT'S GOING TO BE
A GOOD FIT.
THAT'S ONE OF THE THINGS WE HAD
BEEN TALKING ABOUT IS HOW WE CAN
CONTINUE TO SUPPORT THAT BUT
ALSO THINKING ABOUT OUR WORK AS
WE WANT TO AS A TAC HOW DO WE
CONTINUE TO MOVE FORWARD AND
CONTINUE THAT MOMENTUM AS A
WORKING GROUP.
AS A REAL ACTIVE WORKING GROUP.
>>I ABSOLUTELY LOOK FORWARD TO
THAT AND A PRODUCTIVE FUTURE.
I HOPE TO BE ABLE TO BRING SOME
OF THE EXPERIENCE I HAVE FROM
THE FIELD BUT I'M ALSO STILL A
LEARNER AND LOOKING FORWARD TO
LEARNING FROM EACH OF EVERY ONE
OF YOU AND ADDRESS THE
CHALLENGES OUR COMMUNITIES OUR
FACING.
THANK YOU FOR THAT OPPORTUNITY.
NOW WE HAVE DR. TABAK HERE.
THANK YOU.
WE'LL MOVE FORWARD.
FIRST, THANK YOU DR. TABAK FOR
BEING HERE.
INTRODUCE YOURSELVES.
>>MY NAME IS DR. BRITTANY JOCK
AND I'M FROM THE SAINT REGIS
MOHAWK TRIBE AND EXCITED TO MEET
YOU AND HAVE THE SESSION.
>>HI, MY NAME IS STEPHEN KUTZ
FROM WASHINGTON STATE AND
REPRESENT THE PORTLAND AREA AND
COME PREDOMINANTLY FROM THE
PUBLIC HEALTH FIELD IN THE FIELD
ABOUT 33 YEARS.
>>I'M ALICIA MOUSSEAU.
>>I'M THE TRIBAL DELEGATE FOR
THE TUCSON AREA AND FOR THE
PASCUA TRIBE.
>>I'M A FAMILY PRACTICE DOCTOR
>>I'M DEBBIE DAN FORTH AND
MEMBER AT LARGE FOR THE TAC TEAM
ARE REPRESENTING THE ONEIDA
NATION AND MY BACKGROUND IS
PRIMARILY HEALTH DIRECTOR.
>>AND I WILL INTRODUCE
DR. TABAK.
HE IS THE ACTING DIRECTOR OF THE
NATIONAL INSTITUTES OF HEALTH
WHICH OFFICIALLY TOOK OFFICE ON
DECEMBER 20, 2021.
HE SERVED AS THE PRINCIPAL
DEPUTY DIRECTOR AND ETHICS
COUNSELOR OF NIH SINCE AUGUST
2010 AND ACTING PRINCIPAL DEPUTY
DIRECTOR OF NIH AND PART OF THE
DIRECTOR OF INTRACRANIAL AND
INTRAFACIAL RESEARCH.
>>WONDERFUL TO BE WITH YOU ALL
TODAY.
AS YOU HEARD I CAN'T KEEP A JOB
ANY PLACE.
BOUNCING AROUND NIH THE PAST 23
YEARS.
PRIOR TO THAT I WAS IN ACADEMICS
FOR 20 YEARS.
SO I'M IN MY 20th MONTH AS THE
ACTING DIRECTOR.
THAT JOB WAS SUPPOSED TO BE TWO
OR THREE MONTHS AND THEN A FUNNY
THING HAPPENED OR FUNNY THING
DIDN'T HAPPEN, I GUESS.
WE DO HAVE A NOMINEE DR. MONICA
BERTAGNOLLI CURRENTLY THE
DIRECTOR OF THE NATIONAL CANCER
INSTITUTE THE LARGEST INSTITUTE
AT NIH.
AND FOR HER TO SECURE
APPOINTMENT TWO THINGS NEED TO
HAPPEN.
FIRST, THE SENATE HEALTH
COMMITTEE NEEDS TO HOLD A
HEARING, A CONFIRMATION HEARING
AND ASSUMING SHE GETS THROUGH
THAT, WHICH I'M SURE SHE WILL,
WE'RE VERY CONFIDENT OF THAT,
THEN SHE HAS TO COME TO FULL
VOTE TO SENATE.
WE DON'T KNOW WHEN A HEARING
WILL BE HELD YET.
WE'RE STILL WAITING FOR THAT.
IT'S IN THE PRESS SENATOR
SANDERS EXPECTS THE
ADMINISTRATION TO COME UP WITH A
PLAN TO REDUCE DRUG PRICING
BEFORE HE'S WILLING TO BRING
ANYBODY TO COMMITTEE.
AS THEY SAY IN WASHINGTON,
THAT'S WAY ABOVE MY PAY GRADE
AND WE'LL LET THE ADMINISTRATION
AND SENATOR SANDERS WORK THIS
OUT.
IN THE INTERIM, YOU KNOW, WE ARE
CONTINUING TO DO ALL THE THINGS
THAT NEED TO BE DONE.
THE SECRETARY MADE IT CLEAR HE
WANTED ME TO DO THAT.
WE'VE POINTED -- IT WILL BE TWO
INSTITUTE DIRECTORS WE NEEDED TO
REPLACE.
AND ANOTHER FEW KEY POSITIONS
OVER THE NEXT WEEKS OR MONTHS.
SO, I WANT TO SAY WE'RE VERY
GRATEFUL TO ALL OF YOU.
WE KNOW YOU TRAVELED LONG
DISTANCES TO BE HERE AND WE
NEVER ASK PEOPLE WHO ARE NOT
INSANELY BUSY TO DO THESE JOBS
AND I'M SURE YOU ALL ARE IN THAT
CATEGORY.
SO WE DO APPRECIATE IT TAKES
TIME OUT OF YOUR SCHEDULES TO DO
THIS.
WE'RE PLEASED TO HAVE DR. KARINA
WALTERS JOIN US IN HER ROLE.
HAVING YOU AS PART OF THE NIH
FAMILY WILL ALLOW TO US ACHIEVE
GREATER THINGS GOING FORWARD.
OBVIOUSLY YOU HAVE UNIQUE
EXPERTISE AND INSIGHT AND WE
REALLY WANT TO THANK YOU, FIRST,
FOR TAKING ON THE ROLE BECAUSE
I'M SURE IT WAS A COMPLICATED
DECISION FOR YOU AND COURSE MOST
MULTIM
IMMEDIATELY GETTING THE WORK
WITH THE TAC.
I KNOW WE HAD PANELISTS AND
AMERICAN INDIAN/ALASKAN NATIVE
INVESTIGATORS.
THAT'S INVALUABLE TO US BECAUSE
THEY HAVE A UNIQUE PERSPECTIVE
NONE OF THE LEADERSHIP HAVE.
DR. WALTERS JOINING US THAT ADDS
TO OUR DEPTH.
AND INVESTIGATORS ARE ALREADY
PLAYING KEY ROLES OF TRAINING
THE NEXT GENERATION IN SOME
CASES.
AND I REPRESENT THE NIH AT THE
SECRETARY'S ADVISORY COMMITTEE
FOR THE LAST 13 YEARS BASICALLY.
AND OF COURSE OUR OWN TAC THE
GOAL IS TO EMPOWER TRIBAL NATION
TO DO RESEARCH THAT THEY ARE
INTERESTED IN DOING WITH NATIVE
INVESTIGATORS.
AND WE HOPE TO ACHIEVE THAT
COMPLETELY.
OBVIOUSLY SOME OF THAT IS
ALREADY GOING ON.
OUR GOAL IS TO ENABLE MORE OF
THAT.
ANY EFFORT TO ENHANCE THE
TRAINING AND I'LL GIVE A QUICK
OVERVIEW AND WE'LL TRY TO
ADDRESS ANY ISSUES YOU MAY HAVE.
WE HAVE BEEN DOING A FAIR AMOUNT
OF WORK THROUGHOUT THE YEAR.
AND IN PARTICULAR OUR TRIBAL
CONSULTATION AND LISTENING
SESSIONS AND I KNOW THOSE ARE
DIFFERENT THINGS BUT WE'VE DONE
BOTH.
AND THEN OF COURSE A NUMBER OF
PROGRAMS THAT SUPPORT TRIBAL
COMMUNITIES IN CONDUCTING THEIR
LOCALLY PRIORITIZED RESEARCH.
BECAUSE AS I'VE COME TO LEARN, I
STILL HAVE MORE TO LEARN BUT AS
I'VE COME TO LEARN OVER THE
YEARS THAT'S AN IMPORTANT
ELEMENT TO WHAT WE SHOULD BE
DOING.
AND IT WORKS.
WE SEE THE RESULTS AND IT WORKS.
ULTIMATELY IT WILL BUILD A MUCH
MORE ROBUST CAPACITY TO CONDUCT
RESEARCH AND WE ALL LIKE TO
THINK THAT STEM CAREERS ARE
GREAT CAREERS FOR PEOPLE.
WE WANT AS MANY ENGAGED IN THAT
AS POSSIBLE.
SO IN TERMS OF THE CONSULTATIONS
AND LISTENING SESSIONS WE REMAIN
COMMITTED TO HONORING
SOVEREIGNTY AND
SELF-DETERMINATION AND WE HOPE
TO ENGAGE IN WHAT WE HOPE ARE
TIMELY CONSULTATIONS WANT TO
HEAR FROM TRIBAL LEADERS.
AS YOU ALL KNOW THERE'S MANY
CONCERNS.
THERE'S HISTORICAL CONSTRUCTS
THAT WE NEED TO LEARN FROM SO WE
NEED TO HEAR ABOUT THOSE.
THERE'S DIFFERENT CULTURAL NORMS
AND OBVIOUSLY EACH TRIBAL NATION
HAS ITS OWN UNIQUE SET OF EACH.
BUT BY CONTINUING THE DIALOGUE
WE CONTINUE TO BUILD OUR
KNOWLEDGE HERE AT THE AGENCY AND
HOPEFULLY THAT WILL DO WELL
GOING FORWARD.
IN MARCH OF 2022 WE IMPLEMENTED
A TRIBAL CONSULTATION POLICY.
EARLIER THIS YEAR THE TRIBAL
HEALTH RESEARCH OFFICE ISSUED AN
INTERNAL GUIDE TO OUR NIH STAFF
ON HOW TO IMPLEMENT THE TRIBAL
CONSULTATION POLICY.
WE HAVE -- WE'RE A VERY
DECENTRALIZED ORGANIZATION.
WE HAVE 27 INSTITUTES AND
CENTERS.
THEY EACH GET THEIR OWN
APPROPRIATION FROM THE CONGRESS
OF THE UNITED STATES AND THE
PHRASE HERDING CATS IS NOT
INAPPROPRIATE.
THEY HAVE THEIR OWN SHEETS, THEY
DON'T NEED MINE BECAUSE THEY
HAVE MORE THAN I DO BUT THAT
SAID FOR ISSUES OF THIS TYPE, WE
TRY VERY HARD TO HAVE AN
INTEGRATED AND STANDARD
APPROACH.
IN PARTICULAR, TRIBAL LEADER
INPUT HAS BEEN REALLY IMPORTANT
IN HELPING US IMPLEMENT PROGRAMS
AND THE "ALL OF US" PROGRAM HAD
FOUR LISTENING SESSIONS IN
ADVANCE OF THE CONSULTATION IN
NOVEMBER HELPING FRAME THINGS
THEY'VE BEEN ENGAGED IN.
BRIEFLY, A FEW EXAMPLES OF
PROGRAMS WE THINK SHOULD SERVE
AS AN EXEMPLARS FOR FUTURE WORK
IT, THE NATIVE AMERICAN RESEARCH
CENTERS NARCH PROGRAM AND THE
TURTLE PROGRAM.
IN 2021 THE NARCH PROGRAM WAS
EVALUATED CULMINATING IN A
CONSULTATION TO TEST THE
PROGRAM'S EFFECTIVENESS AND THE
GOALS ARE TO BUILD CAPACITY IN
HEALTH RESEARCH AND EDUCATION
AND TRAINING.
NIGMS, WHICH SPONSORS THE
PROGRAM, RELEASED THEIR FUNDING
OPPORTUNITY AND IN DIRECT
RESPONSE TO THE FEEDBACK THEY
RECEIVED.
SO THEY'RE STREAMLINING THE
PROCESS FOR APPLICANTS SHIFTING
TO A MUCH MORE STRAIGHTFORWARD
ANNUAL SUBMISSION CYCLE AND
INCREASING THE PROJECT PERIOD TO
FIVE YEARS SO YOU DON'T HAVE TO
KEEP WRITING GRANTS.
SOME PEOPLE LIKE TO WRITE GRANTS
BUT MOST PEOPLE WOULD PREFER A
LONGER INTERVAL.
THEY'VE INCREASED THE BUDGET UP
TO 1.3 MILLION IN DIRECT COSTS.
THE MAJORITY OF THE MONEY STAYS
WITH THE TRIBAL NATION.
THAT'S THE GOAL.
DEPENDING ON THE NATURE OF THE
APPLICATION, TRIBAL NATION MAY
HAVE TO ENGAGE WITH OTHER
PARTIES AND THAT'S THEIR
PREROGATIVE BUT THE REAL GOAL
STO GET AS MUCH AS THE MONEY
WITH THE TRIBAL NATIONS RATHER
THAN THE NON-AMERICAN INDIAN
NON-PARTNER ORGANIZATIONS.
THE INSTRUCTIONS HAVE BEEN
CLARIFIED.
WE ADOPTED MORE CULTURALLY
APPROPRIATE REVIEW GUIDELINE
LANGUAGE AMONG THE REVIEW
CRITERIA USED AND YOU CAN
CAPTURE PEOPLE EARLY IN THEIR
EDUCATIONAL PROCESS.
YOU MAY NOT BE SURPRISED BUT
HIGH SCHOOLERS IN ADDITION TO
BEING INTERESTING TEENAGERS
WHICH ARE A DIFFERENT SPECIES,
THEY'RE ALSO -- I JUST HAD MY
GRANDSON VISITED FROM OREGON AND
I WAS JUST REMINDED OF THIS, BUT
IN ADDITION TO THAT, WONDERFUL
PERIODS OF THEIR LIVES, THEY'RE
ALSO QUITE CAPABLE OF DOING COOL
THINGS IN A LAB AND RESEARCH
SETTING SO THAT'S WHAT WE WANT
TO CAPITALIZE.
NIGMS IS THE PROCESS OF
ADDITIONAL PROGRAMS TO
SUPPLEMENT THE NARCH IN AREAS
THAT HAVE BEEN HIGHLIGHTED BY
THE TRIBAL CONSULTATIONS.
THIS INCLUDES THINGS LIKE
PLANNING GRANTS AND PLANNING
GRANTS TO SUPPORT WHO WANT A
NARCH AND INSPIRE THEM TO GET
SEED MONEY TO GET THE THIS
MOVING.
IRB GRANTS WILL BE PROVIDED TO
SUPPORT TRIBAL ORGANIZATIONS AND
ESTABLISHING OR ENHANCING THEIR
IRBs WHICH OBVIOUSLY IS A BIG
DEAL.
AND EVERYTHING HAS AN ACRONYM AT
THE NIH, TRIBAL UNDERGRADUATE TO
GRADUATE RESEARCH TRAINING AND
LEADERSHIP EXPERIENCES.
OKAY, THAT DOES SPELL TURTLE I
GUESS.
IT WILL PROVIDE INSTITUTIONAL
TRAINING GRANTS TO TRIBES AND
TRIBAL ORGANIZATIONS TO SUPPORT
UNDERGRADUATE AND GRADUATE
STUDENTS.
AGAIN, KEY PART OF THE PATHWAY
FOR CAREER DEVELOPMENT.
THE CAPACITY DEVELOPMENT STAGE
TO BUILD THE ADMINISTRATIVE
INFRASTRUCTURE NEEDED AND THE
TRAINING GRANT PHASE TO PROVIDE
STIPENDS, TUITION REMISSION AND
MENTORING.
THESE ARE ALL EXCITING AND CAME
DIRECTLY BECAUSE OF THE FEEDBACK
WE WERE PLEASED TO RECEIVE.
YOU HEARD YESTERDAY ABOUT
ANOTHER NEW PROGRAM IN DIRECT
RESPONSE IDENTIFIED IN TRIBAL
CONSULTATIONS THAT IS THE N CREW
PROGRAM.
THE NATIVE COLLECTION RESEARCH
EFFORT TO ENHANCE WELLNESS.
THIS IS A COLLABORATIVE
PARTNERSHIP AMONG NIH AND
AMERICAN INDIAN/ALASKAN NATIVE
ORGANIZATIONS TO RESPOND TO THE
OPIOID OVERDOSE AND ADDICTION
PUBLIC HEALTH EMERGENCY.
MANY OF THE THEMES WHICH EMERGED
FROM THE 2018 AND 2022
CONSULTATIONS INCLUDING THE
IMPORTANCE OF INDIGENOUS
KNOWLEDGE AND LOCAL EXPERTISE
AND THE NEED TO INVEST IN
RESEARCH AND DATA LED BY THE
TRIBAL NATIONS THEMSELVES AND IT
WILL BE FACTORED IN.
I HAVE BEEN IMPRESSED AND HAVE
VISITED SOME TRIBAL NATIONS
WHERE LOCAL CUSTOMS ARE BEING
USED TO DEAL WITH OPIOID MISUSE
IN A VERY EFFECTIVE WAY.
IT'S NOT WESTERN MEDICINE BUT IT
WORKS AND SO WE NEED TO EMBRACE
THAT AND AGAIN EACH TRIBAL
NATION HAS THEIR OWN APPROACH TO
THIS AND THAT'S FINE BUT THESE
ARE SOME OF THE THINGS.
THERE'S TWO RESEARCH RESEARCH
OPPORTUNITY ANNOUNCEMENTS
ACCEPTING APPLICATIONS AND GET
THE THAT FROM COLLEAGUES.
THERE'S AN NIH FUNDED AMERICAN
INDIAN/ALASKAN NATIVE EXTRAMURAL
RESEARCH PROGRAM TO HELP BUILD
THE INFRASTRUCTURE TO GET MORE
COMMUNITIES ENGAGED IN RESEARCH
AND WE'VE ALSO SINCE 2011
SUPPORTED SOMETHING KNOWN AS THE
INTERVENTION RESEARCH TO IMPROVE
NATIVE AMERICAN HEALTH AND WON'T
DARE TO PRONOUNCE THAT ACRONYM.
THIS IS DESIGN TO TEST THE
EFFECTIVENESS OF CULTURALLY
BASED HEALTH PROMOTION AND
DISEASE PREVENTION INTERVENTIONS
IN COLLABORATION WITH YOUR
COMMUNITIES.
THERE'S OVER 50 GRANTS AWARDED
FROM AMONG THE DIFFERENT
INSTITUTES AND CENTERS AT NIH.
FOR EXAMPLE, A RANDOMIZED
CONTROL TRIAL OF STOOL DNA TEST
TO IMPROVE COLORECTAL SCREENING.
THE QUOTE WEAVING HEALTHY
PROGRAMS FOR WAYS TO PREVENT
ALCOHOL AND DRUG MISUSE AND
VIOLENCE.
A YOUTH LEADERSHIP PROGRAM THAT
CENTERS ON TRADITIONAL
ECOLOGICAL KNOWLEDGE OF THE
TRIBE AND LAND BASED HEALING AND
HEALING STRATEGIES TO PREVENT
SUBSTANCE USE AND IMPROVE
PHYSICAL ACTIVITY.
A COUPLE MORE, WE HAD A
PARTICULAR PROGRAM REACHING OUT
DIRECTLY TO TRIBAL NATIONS IN
THE COMMUNITY ENGAGEMENT
ALLIANCE OR SEAL PROGRAM.
WE STARTED THIS DURING THE
PANDEMIC AS A WAY OF CONNECTING
WITH COMMUNITIES TYPICALLY
MARGINALIZED AND FORGOTTEN.
WE WANTED THE TRIALS TO LOOK
LIKE THE NATION THAT WE WERE
TRYING TO TREAT.
ALL MEME NOT JUST CONVENIENCE
POPULATIONS OF YOUNG WHITE MEN
WHICH IS TYPICALLY WHAT IS IN
MANY CLINICAL TRIALS.
SO THESE ENGAGEMENTS ARE AT THE
COMMUNITY LEVEL.
MY COLLEAGUE GARY GIBBONS TALKS
ABOUT PROCEEDING AT THE SPEED OF
TRUST AND I THINK THAT
SUMMARIZES A LOT OF THIS.
TO ENGAGE LOCALLY, NOT JUST
PARACHUTING IN AND MAKING
PROCLAMATIONS AND TRYING TO WORK
CLOSELY WITH COMMUNITY LEADERS
AND PEOPLE RESPECTED BY THE
COMMUNITY.
SO THEY ESTABLISHED THE
INITIATIVE SPECIFICALLY FOR
AMERICAN INDIAN/ALASKAN NATIVE
ENRICHMENT TO SUPPORT ENGAGEMENT
ABOUT BIOMEDICAL RESEARCH TO TRY
TO LESSEN THE MISTRUST AND
PROMOTE INCLUSION OF THESE
GROUPS IN OUR VARIOUS EFFORTS.
I CAN GO ON FOR A LONG TIME BUT
I'M GOING TO WIND UP HERE.
WE HAVE EFFORTS RELATED TO
RESPONSIBLE MANAGEMENT AND
SHARING OF RESEARCH PARTICIPANT
DATA.
SOMETHING I KNOW IS VERY
IMPORTANT TO TRIBAL NATIONS IN
CONTEXT OF THE ALL OF US PROGRAM
BUT REQUIRED DELIBERATION ON ALL
OF OUR PROGRAMS WE TALKED ABOUT
DATA MANAGEMENT AND POLICIES AND
GUIDELINES IN PARTICULAR AND WE
CONTINUE TO WORK WITH YOU TO
WORK AND CLARIFY AND MAKE THE
PROGRAMS EASIER TO IMPLEMENT.
SMALL BUSINESS INNOVATION
RESEARCH WITH THE NATIVE
SPECIFIC FOCUS FOR NATIVE-OWNED
SMALL BUSINESSES, NIMHD,
ENCOURAGES SPECIFICALLY
APPLICATIONS FROM NATIVE-OWNED
SMALL BUSINESSES AND PROVIDES
PROGRAM FUNDS LOOKING TO EMPOWER
COMMUNITY THROUGH RESEARCH OR
DISEASE PREVENTION OR
COMMUNITY-BASED SOLUTIONS AND SO
FORTH.
I KNOW THERE'S A TREMENDOUS
INTEREST IN INDIGENOUS KNOWLEDGE
AND DR. WALTERS REPRESENTS THE
NIH ON THE WHITE HOUSE COUNCIL
SUBCOMMITTEE ON INDIGENOUS
KNOWLEDGE.
THIS SUBCOMMITTEE IS CHARTERED
TO IMPLEMENT VARIOUS GUIDELINES
THAT RELATE TO THIS.
I HAVEN'T DONE COMPLETE JUSTICE
TO ALL THE PROGRAMS BUT I DID
PROMISE TO HAVE TIME TO CHAT.
BUT I HOPE YOU APPRECIATE WE
HAVE A NUMBER OF THINGS ONGOING.
MANY IN DIRECT RESPONSE TO
CONSULTATIONS AND OTHER MEETINGS
WITH TRIBAL LEADERS AND THEIR
RESPECTIVE TEAMS.
I KNOW THAT UNDER DR. WALTER'S
LEADERSHIP THE TRIBAL HEALTH
RESEARCH OFFICE WILL CONTINUE TO
BUILD PARTNERSHIPS AND WORK
COLLABORATIVELY ACROSS THE
NATIONS AND WE LOOK FORWARD TO
DEVELOPING APPROACHES WHERE WE
UPHOLD TRIBAL SOVEREIGNTY AND
YET LOOK TO MOVE FORWARD WITH
THE COMMUNITY AND WITH THAT I'M
HAPPY TO ANSWER QUESTIONS OR
LISTEN TO ANY COMMENT YOU HAVE
TO OFFER.
>>
>>Herminia: THANK YOU FOR
TAKING THE TIME TO MEET WITH US,
DR. TABAK.
WE KNOW YOUR TIME IS VERY BUSY
SO YOUR TIME IS VERY VALUABLE TO
US TO SHARE THAT TIME.
I WANTED TO START OFF BY
THANKING YOU ALSO FOR HIRING
DR. WALTERS.
SHE'S ONLY BEEN HERE THREE
MONTHS AND SEEN THE IMPACT AND
SHE DID A REPORT AND SOME THINGS
SHE'S WORKING ON AND ONE THING
THE TAC WAS HAPPY TO SEE IS WHAT
SHE SHARED WITH US WAS
CONSISTENT TO THE POINTS OF THE
AREAS WE JUST TALKED ABOUT.
WE ARE ALIGNED IN THOSE AREAS
AND WOULD LIKE TO SEE YOU
SUPPORT HER THRO OFFICE AND TO
THE HIRING MADE WITH HER TEAM
AND THE OFFICE IS VERY SMALL.
SHE'LL NEED MORE SUPPORT IN THAT
OFFICE.
TO BE ABLE TO SUPPORT THAT
OFFICE WOULD BE VERY BENEFICIAL
TO THE THRO OFFICE.
WE WOULD LIKE THAT TOO.
THERE'S A LOT OF WORK THAT NEEDS
TO BE DONE SO WE CAN CONTINUE TO
HAVE THE RESOURCES THAT WE NEED
IN THE THRO OFFICE.
THERE'S BEEN CHALLENGES WITH US
MOVING FORWARD IN THE THRO AND
WE'D LIKE TO GET OVER THAT.
ONE OF THE THINGS THAT MOVING
FORWARD ON THE STRATEGY PLANNING
ONE OF THE THINGS WE TALKED
ABOUT TOO WAS US BEING ENGAGED
WITH DR. WALTERS AND TO HELP HER
AS THE THRO DID IN THE PAST WHEN
THE OFFICE WAS FIRST PUT
TOGETHER AND BE ABLE TO PROVIDE
THAT FEEDBACK WITH HER AND
BECAUSE INDIAN COUNTRY IS VERY
DIVERSE AND HAVE A GROUP HERE
WITH THE TAC WILLING TO ROLL UP
THEIR SLEEVES AND WITH OUR
TECHNICAL ADVISORS TOO WILLING
TO HELP PROVIDE THAT FEEDBACK
AND WILLING TO HELP AND ALSO
WITH THE WORK WE HAVE PUT IN
WITH OUR GOALS AND OBJECTIVES
AND PRIORITIES TO SAY THIS IS
HOW WE CAN HELP.
WE UNDERSTAND WORK NEEDS TO BE
DONE BUT WE KNOW WE WANT TO SEE
THE CHANGES.
YESTERDAY TO SIT HERE AND HEAR
FROM THE PEOPLE THAT PRESENTED
THEIR PROJECT AND THE WORK
THEY'RE DOING WAS VERY INSPIRING
BECAUSE WE'RE SEEING THESE ARE
HAPPENING IN INDIAN COUNTRY AND
MAKING A DIFFERENCE.
THAT'S WHAT WE WANT TO SEE.
WE WANTED TO SHARE THAT BECAUSE
WE NEED TO CONTINUE TO
STRENGTHEN THE OFFICE OF THRO
AND CONTINUE TO PUT MONEY INTO
THE OFFICE OF THRO AND THE TAC
THAT IS HERE AND THE TAC THAT
UNFORTUNATELY COULDN'T BE HERE
IS WILLING TO DO THE WORK AND
SHARE AREAS WE'VE BEEN TALKING
ABOUT THAT THE FOUR MAJOR AREAS
WE WANTED TO HIGHLIGHT AROUND
INTERVENTION BASED RESEARCH WITH
THE FOCUS ON WELLNESS AND SOCIAL
DETERMINATES OF HEALTH.
THIS MORNING WE HAD A TOWER BY
ONE OF THE DOCTORS WHO SHE
SHARED ABOUT SOCIAL DETERMINATES
OF HEALTH AND CARDIOVASCULAR
HEALTH AND THE IMPACT ON
NEIGHBORHOOD AND STRESS AND
BLOOD AND THE RESEARCH IT DOES.
SOCIAL DETERMINATES OF HEALTH IS
VERY IMPORTANT.
WE TALK ABOUT IT BUT THE
RESEARCH AROUND IT IS VERY
IMPORTANT AND FOR US TO BE ABLE
TO HAVE OPPORTUNITIES TO START
TO DO THAT TYPE OF RESEARCH.
SO WE NEED TO BE ABLE TO FOCUS
ON THAT AND ALSO THE ORDINANCE
OF METHODOLOGIES ABOUT
INDIGENOUS KNOWLEDGE WITH
INDIGENOUS KNOWLEDGE AND
SUPPORTING THOSE METHODOLOGIES
AND TRIBAL SOVEREIGNTY AND
TRIBAL NATION AND OWNERSHIP.
THAT'S COME UP AROUND THE ALL OF
US STUDY.
I KNOW WE'RE GOING TO GO BACK
AND TALK ABOUT HOW WE'LL WORK
THAT OUT BUT WE HAVE A GROUP
HERE WILLING TO HAVE THE
CONVERSATION AND DATA
SOVEREIGNTY IS VERY IMPORTANT
AND WE'LL HAVE MORE CONVERSATION
ABOUT THAT AND THE CAPACITY
BUILDING AROUND INDIAN COUNTRY
AND AROUND OUR PEOPLE THAT'S THE
BOTTOM LINE IS BUILDING CAPACITY
AND IS THE RESOURCES ARE THE
FOUR POINTS I WANTED TO BRING UP
TOO.
>>WELL, THANK YOU.
>>DR. TABAK: LOTS OF HARD WORK
TO DO SO I'M HAPPY WE'RE IN
ALIGNMENT.
I'LL OFFER A FRIENDLY AMENDMENT
IN THE ISSUE TO GETTING THE THRO
OFFICE TO THE RIGHT CAPACITY.
WE'RE GOING TO NEED YOUR HELP IN
IDENTIFYING PEOPLE TO HELP STAFF
THAT OFFICE.
AND WHAT THAT MEANS, HERE'S THE
HARD PART, SOME OF YOUR BEST
PEOPLE YOU MAY HAVE TO ENCOURAGE
TO APPLY EVEN IF IT'S FOR A
SHORT TERM WHICH IS POSSIBLE IN
THE GOVERNMENT.
FOR SOME OF YOU THE BENCH
STRENGTH IS NOT GREAT AND YOU
CAN'T LET THAT PERSON GO BUT
THAT'S WHAT'S GOING TO BE REALLY
NEEDED.
WE'LL SUPPORT HER TO GET HER
RIGHT SIZED BUT YOU ALL KNOW THE
RIGHT PERSON IS FAR GREATER THAN
THE NUMBER OF PEOPLE.
THAT'S WHERE WE'LL NEED YOUR
HELP.
YOU ALL KNOW WHERE THE TALENT
LIES AND I KNOW YOU'RE HIDING
SOME OF IT BECAUSE WE ALL DO
THAT BUT WE WILL HOPEFULLY
ENCOURAGE YOU TO ENCOURAGE SOME
OF YOUR TEAMS TO APPLY FOR THESE
TYPES OF POSITIONS AND NOT
FOREVER BUT FOR SOME PERIOD OF
TIME AND THEN THEY GO BACK AND
HAVE A BETTER INSIGHT ABOUT WHAT
NIH IS ALL ABOUT AND THEY BECOME
INVALUABLE, QUITE FRANKLY.
ANYWAY, THAT ONE LITTLE FRIENDLY
AMENDMENT.
>>
>>Herminia: ANY OTHER COMMENTS?
QUESTIONS FROM THE TAC?
>>STEPHEN: THANK YOU FOR
SPENDING THE TIME WITH US TODAY.
YOU WERE TALKING ABOUT THE NARCH
PROGRAM AND THE GRADUATE
FELLOWSHIP PROGRAM IS
INVALUABLE.
IT'S A LOT OF THE GRADUATES ARE
FINISHING THEIR DEGREES AND
GETTING JOBS.
APPROXIMATELY 200 NEW Ph.D.s AND
MASTER'S PROGRAMS HAVE RESULTED,
I THINK PROBABLY FROM THAT WORK.
AND ABOUT 1200 PEOPLE HAVE BEEN
TRAINED.
SO CONTINUING THAT IS IMPORTANT
BECAUSE THAT'S THE PIPELINE THAT
YOUR TALKING ABOUT.
SOME OF THEM HOPEFULLY WILL COME
AND DO SOME OF THE WORK HERE
THAT NEEDS TO BE DONE.
IF SOMEONE PROPOSES TO DO
TRIBAL RESEARCH THERE SHOULD BE
A TRIBAL PERSON INVOLVED IN THE
RESEARCH.
IT'S NOT JUST RESEARCH BEING
DONE ON INDIAN COUNTRY BUT
PARTICIPATING WITH INDIAN
COUNTRY.
I WANTED TO SAY THOSE FEW
THINGS.
THE OTHER THING IS I AM
ENCOURAGED WITH WHO IS WORKING
ON THE HEAL PROGRAM RIGHT NOW.
I'M HOPING THAT WE'RE GOING TO
BE ABLE TO RECRUIT ADEQUATE
REPRESENTATION OF TRIBAL PEOPLE
IN THAT PROJECT.
I THINK THAT THE DIRECTOR IS
SUPPORTIVE OF THAT AND WE'RE
LOOKING FORWARD TO ANY WAY WE
CAN ENSURE TRIBAL REPRESENTATION
ACROSS THE COUNTRY AND NOT JUST
IN POCKETS THAT DOESN'T
REPRESENT REALLY ALL OF INDIAN
COUNTRY IS IMPORTANT FOR THAT TO
HAPPEN.
I MEANT THE "ALL OF US" NOT THE
HEAL.
AND THE HEAL INITIATIVE IS GOING
TO BE REALLY IMPORTANT TO US
BECAUSE TRIBAL HEME HAVE THE
HIGHEST IMPACT OF THE OPIOID
EPIDEMIC BEYOND THE SHADOW OF A
DOUBT.
SO THIS RESEARCH IS GOING TO BE
SO IMPORTANT TO US WE GET GOOD
INFORMATION AND PROGRAMMING TO
HELP US MAKE A DIFFERENCE AT
HOME.
THOSE ARE A FEW THINGS I WANTED
TO SAY.
>>DR. TABAK: THANK YOU FOR
RAISING THOSE ISSUES.
THE TRAINING PROGRAMS ARE
CRUCIAL.
THEY CEDE EVERYTHING ELSE WE
HAVE SHARED GOALS FOR.
THE "ALL OF US" PROGRAM, WE
LEARNED A LOT TOGETHER FRANKLY.
WE HAVE MORE TO LEARN AS WE GO
FORWARD BUT I HOPE EVERYBODY
APPRECIATES THAT THE
INVESTIGATORS ARE TRYING TO DO
THIS IN THE RIGHT WAY TO
MAXIMIZE THE VALUE TO
PARTICIPANTS OF COURSE INCLUDING
THOSE WHO ARE AMONG YOUR
COMMUNITIES.
AND LIKE HEAL, I KEEP A CLOSE
EYE ON.
WE THOUGHT IT WAS VERY IMPORTANT
TO GET AN AIAN CENTRIC FOCUS ON
THE HEAL RESOURCES.
BUT FOR THE REASONS YOU SAID TO
COME UP WITH RESEARCH THAT WILL
DIRECTLY HAVE THE BEST
OPPORTUNITIES TO POSSIBLY AFFECT
PREVENTION AND/OR TREATMENT
AMONG THE TRIBAL NATIONS.
SO AGAIN, GOOD WE'RE IN
ALIGNMENT BUT WE ALL APPRECIATE
THERE'S STILL A LOT TO DO.
THANK YOU.
>>DR. JOCK.
>>DR. JOCK: I WANTED TO
RECOGNIZE THE HIERARCHY OF
EVIDENCE WHEN IT COMES TO
INDIGENOUS DATA AND WHEN
PARTICULARLY DISTINGUISHING
BETWEEN RECRUITMENT OF
COMMUNITIES AND INCORPORATING
COMMUNITY-INFORMED CONSENT AND
DIFFERENTIATING THAT FROM
RECRUITING INDIVIDUALS WHICH
OFTEN TIMES MEANS SELF-REPORT OF
INDIGENOUS OR AMERICAN
INDIAN/ALASKAN NATIVE IDENTITY.
AND TO ME I THINK THE GOLD
STANDARD THAT THE NIH SHOULD
CONSIDER IS IS RECRUITMENT OF
COMMUNITIES WHERE IT'S
PARTNERSHIP WITH COMMUNITIES,
WORKING WITH COMMUNITIES TO
RECRUIT PARTICIPANTS FOR SAMPLES
AND THAT BEING A CONSIDERED A
HIGHER QUALITY EVIDENCE COMPARED
TO SELF-REPORT BECAUSE THERE'S
PERVASIVE ISSUES OF
SELF-IDENTIFICATION NOT BEING
ACCURATE ESPECIALLY ACROSS THE
COUNTRY.
AND ONE OF THE QUESTIONS THAT I
HAD IS GOING BACK TO THE
IMPORTANCE OF INTERVENTION-BASED
RESEARCH AND A WELLNESS FOCUS
OPPOSED TO A DISEASE MODEL.
ONE CHALLENGE BECOMES BECAUSE OF
THE WAY THE INSTITUTES ARE
STRUCTURED, THEY'RE FOCUSSING ON
THE SPECIFIC ILLNESSES, WHAT IS
OF INTEREST ACROSS INDIAN
COUNTRY IS WELLNESS AND HEALTH
PROMOTION APPROACHES.
CULTURAL REVITALIZATION PROGRAMS
AND HOW THEY CAN HAVE HUGE
IMPACTS ON HEALTH.
ONE OF THE THINGS THAT I'M
CURIOUS ABOUT IS IF IT'S
POSSIBLE WITHIN THESE PRIORITIES
WHICH ALIGN WITH THE NIH TAC AND
THE DIRECTION DR. WALTERS HAS
OUTLINED IS IF IT'S POSSIBLE FOR
THRO AS AN OFFICE WITHIN NIH TO
COLLABORATE ON SPECIFIC FUNDING
ANNOUNCEMENTS WITH THIS BROADER
FOCUS.
THANK YOU.
>>DR. TABAK: THANK YOU.
THOSE ARE TWO IMPORTANT POINTS
YOU RAISED.
THE ISSUE OF -- AND I LIKE VERY
MUCH THE WAY YOU FRAMED
INDIVIDUAL VERSUS
COMMUNITY-BASED CONSENT, IF YOU
WILL.
AND OF COURSE COMMUNITY-BASED
CONSENT IS NOT TYPICAL OF
EVERYONE IN THE U.S. BUT
PARAMOUNT TO TRIBAL NATIONS.
FRANKLY, WE HAVE BUMPS AND
BRUISES BECAUSE WE DIDN'T QUITE
GET THAT EARLY ON.
BUT HOPEFULLY WE'VE LEARNED FROM
THAT EXPERIENCE AND HAS JOSH
COME TO SPEAK TO THE GROUP YET
OR IS HE COMING -- YESTERDAY?
OKAY.
HOPEFULLY HE REFLECTED THE
COMMITMENT GOING FORWARD TO
DOING THIS IN THE PROPER WAY AND
THAT'S FINE BECAUSE YOU ARE IN
DEAL SORCHB --
YOU ARE INDEED SOVEREIGN NATIONS
SO WE HAVE TO ABIDE BY THAT.
IN TERMS OF YOUR SECOND POINT,
FRANKLY, AND WE SPEND TOO MUCH
TIME ON DISEASE INSTEAD OF
WELLNESS AND MANY DIRECTORS SAY
THE SAME THING.
IT CAN BE A CATALYST.
THE REAL MONEY'S IN THE
INSTITUTES AND CENTERS BECAUSE
THAT'S WHERE CONGRESS PUTS IT
BUT INDEED THEY ARE REAL MONEY.
PERHAPS TAKING ADVANTAGE OF WHAT
IS SORT OF BUILDING INTEREST
AMONG THE INSTITUTES AND CENTERS
ABOUT WELLNESS OPPOSED TO FIXING
IT AFTER THE FACT MAYBE THERE'S
AN OPPORTUNITY THERE TO CATALYZE
THE TYPES OF THINGS THAT YOU'RE
REFERRING TO BECAUSE WE ALL KNOW
THAT IF YOU PREVENT TYPE II
DIABETES OR OBESITY SO I THINK
YOU RAISE A GOOD TACTICAL A.
FOR THE TRIBAL HEALTH AND WE'RE
INTERESTED IN THIS APPROACH.
AND THERE'S A SIGNAL.
THEY GET IT.
AND SO I THINK BOTH OF THOSE
POINTS ARE VERY HELPFUL.
THANK YOU.
>>HERMINIA: ANY OTHER
QUESTIONS?
WE HAVE A COUPLE MORE MINUTES.
YES, STEPHEN.
>>STEPHEN: ONE OTHER ISSUE IT
WAS SO REFRESHING TO HAVE THE
RESEARCH BROUGHT INTO US AND
WE'LL GET MORE TODAY FROM
DR. WARREN AND -- DR. WARNE AND
IN THAT SMALL AMOUNT OF TIME OF
HEARING THE RESEARCH IN THE
COMMUNITIES AND HOW IMPACTFUL IT
WAS WAS HEARTWARMING.
WE'RE ASKING IF THRO -- AND THIS
GOES ALL THE WAY BACK YEARS AND
WE WERE ASKING TO CATALOG THE
RESEARCH DONE IN INDIAN COUNTRY
SO WE -- IF WE COULD BEGIN TO
UNDERSTAND ALL OF THE RESEARCH
THAT'S GONE ON AND BE ABLE TO
READ ON THE THINGS PER
PERTINENT TO US AND HEARING AND
BEING ABLE TO UNDERSTAND WHERE
THE RESEARCH HAS ALREADY
OCCURRED SO WE'RE NOT GOING OVER
THE SAME PATH ALWAYS ALL THE
TIME IS HELPFUL.
RESEARCH IS GOING ON IN INDIAN
COUNTRY AND IF NIH IS KEEPING
TRAM AS MUCH AS POSSIBLE THAT'S
HELPFUL.
>>DR. TABAK: THAT'S AN
OPPORTUNITY FOR A COLLABORATION
WITH OTHER PARTS OF PCIPSI TO DO
DEEP DIVES OF WHAT WE'VE DONE IN
THE PAST AND I ENCOURAGE YOU TO
TAKE ADVANTAGE OF THEIR
EXPERTISE.
I THINK THAT'S A REASONABLE
REQUEST AND WE SHOULD TRY TO
TAKE ADVANTAGE OF THAT.
>>I THINK BRITTANY HAD A
COMMENT.
>>BRITTANY: I HAD ANOTHER
COMMENT, THANK YOU VERY MUCH.
ONE OTHER SUGGESTION AND THINGS
I THINK IS IMPORTANT IN TERMS OF
SUPPORTING INFRASTRUCTURE FOR
OUR COMMUNITIES IS IN I AGREE IN
CATALOGING THE INFORMATION.
I'M GLAD YOU MENTIONS THE
PIPELINE FOR HIGH SCHOOL
STUDENTS IS IMPORTANT AND TO
BUILD ON THAT INCORPORATING
THINGS LIKE THE OCAP PRINCIPLES
WHICH WERE ESTABLISHED ON THE
NORTHERN END OF TURTLE ISLAND
AND INCORPORATING THAT TO NIH
POLICY AS WELL AS SUPPORTING
INFRASTRUCTURE WITHIN
COMMUNITIES AND FUNDING DIRECTLY
TRIBAL EPICENTERS AS AN
IMPORTANT PART.
>>DR. TABAK: HOPEFULLY OVER
TIME THEY'RE ONE OF THE
STRENGTHS YOU COULD CURRENTLY
DRAW UPON BUT I DON'T WANT TO
STOP JUST WITH THE EPICENTERS.
I'M AN EPIDEMIOLOGIST BY
TRAINING BUT I DON'T WANT THAT
TO BE THE ONLY LOCUS OF STRENGTH
BUT CERTAINLY SHOULD BE AMONG
THEM.
>>HERMINIA: I LIKE TO MAKE A
COMMENT AND I KNOW WE'RE ALMOST
OUT OF TIME BUT ABOUT TECHNOLOGY
AND THE DIVERSITY WITH ALL THE
TRIBES THAT WE HAVE THAT WE
REPRESENT WITHIN ALL OF OUR
DIFFERENT REGIONS.
I'M IN THE TUCSON AREA WHERE
IT'S HOT.
TUCSON AND PHOENIX ARIZONA WE
JUST HAD THE MAJOR EXTREME HEAT.
WE HAVE ALASKA REPRESENTATION
AND WE HAVE NORTHWEST AND IT'S
VERY DIVERSE.
SOMETIMES WE FORGET ABOUT THE
DIVERSITY AND EVEN I FORGET
ABOUT THE DIVERSITY.
AND ONE OF THE CHALLENGES WITH
THE DIVERSITY IS THE TECHNOLOGY
AND ACCESS TO TECHNOLOGY.
WHEN I MENTIONED EARLIER ABOUT
HOW US AS THE TAC WE'RE READY TO
WORK WITH THE THRO OFFICE TO
REALLY START HELP IING TO HELP E
OFFICE WE AS DELEGATES A LOT OF
PEOPLE AND IT'S SCARY AND WE'RE
WILLING TO STEP UP AND BE A PART
OF THIS TO UNDERSTAND AND TO
GAIN THAT KNOWLEDGE AND BUILD
CAPACITY AND TECHNOLOGY IS
SOMETHING THAT A LOT OF OUR
TRIBAL NATIONS HAVE NOT HAD THE
ADVANTAGE OF AND ONE OF THE
ADVANTAGE THE REST OF THE
COUNTRY HAS HAD AN ADVANTAGE
THAT INDIAN COUNTRY HASN'T IS
THE INTERNET AND BROADBAND.
THAT'S INHIBITED US FROM
RESEARCH AND EPIDEMIOLOGY AND
GATHERING THE DATA AND GATHERING
WHAT IT IS THAT HAS PREVENTED US
FROM ELECTRONIC HEALTH RECORDS
AND FROM GETTING THIS KIND OF
INFORMATION SO I WANTED TO BRING
THAT UP SOMETIMES I EVEN FORGET
WHEN I TALK ABOUT MY HEALTH
DEPARTMENT AND DATA BECAUSE WE
DO HAVE ELECTRONIC HEALTH
RECORDS.
THEN I'M TALKING TO DR. MOUSSEAU
AND SHE'S TELLING ME A DIFFERENT
STORY THEN WE HAVE TO HAVE THAT
CONVERSATION BECAUSE I CAN'T
EVEN ASSUME THAT NOT EVERYBODY
HAS THIS AND THERE ARE OTHER
TRIBES GETTING TO THE DIGITAL
AGE.
AND THANKS TO THE EXPANSION OF
BROADBAND AND FIBER OPTICS
REACHING THE RESERVATIONS WE'RE
NOW GETTING THERE.
THE TECHNOLOGY HAS PREVENTED A
LOT OF US FROM GETTING TO A
PLACE THAT HAS IMPACTED OUR
HEALTH.
AND THE ADVANCEMENT OF MEDICINE
IS ALL PUT TOGETHER.
I WANTED TO MAKE THAT POINT.
IT'S NOT AS IF WE DON'T WANT
TRIBES IN OUR GOVERNMENT AND
LEADERSHIP DOESN'T WANT TO BE A
PART OF IS BUT IT'S ALL WRAP YOU
HAD.
IN THE SAME PICTURE.
WE HAVE TO HAVE THE TECHNOLOGY
AND HAVE TO HAVE -- WE ALL HAVE
TO BE PLAYING IN THE SAME FIELD
AND THE EQUITY AS PART OF THAT
EQUITY AND WE AREN'T PLAYING ON
THE SAME FIELD.
>>I APPRECIATE YOU RAISING IT.
OTHER PARTS OF THE COUNTRY ALSO
LACK THE OPTIONS.
IN GENERAL, RURAL AMERICA IS
BEHIND WHAT YOU FIND IN OTHER
AREAS.
PARADOXICALLY IT'S TECHNOLOGY
THAT WILL BE THE EQUALIZER.
ONCE YOU HAVE THE BASIC INTERNET
CAPACITY THEN ALL YOU NEED IS A
LAPTOP AND YOU CAN COMPUTE ON
ALL KINDS OF AMAZING THINGS.
AND YOU CAN DO ALL SORTS OF
REMARKABLE TYPES OF RESEARCH.
THAT'S OUR HOPE WITH THE
INITIATIVE GOING FORWARD TO
EMPOWER TRIBAL NATIONS TO
CONDUCT INCREASINGLY
SOPHISTICATED TYPES OF RESEARCH,
TAKING ADVANTAGE OF THINGS LIKE
ARTIFICIAL INTELLIGENCE OR
MACHINE LEARNING, ELECTRONIC
HEALTH RECORDS AS THEY DO EXIST.
AND SO THAT'S THE IRONY OF IT.
UNTIL YOU HAVE THE BASAL
INFRASTRUCTURE YOU CAN'T TAKE
ADVANTAGE OF THAT BUT ONCE DO
YOU HAVE THE BASAL
INFRASTRUCTURE IT OPENS UP A
RANGE OF POSSIBILITY WE HOPE TO
PARTNER WITH YOU ON SO YOU TAKE
ADVANTAGE OF IT BECAUSE THEN
EVERYBODY BENEFITS.
WE HAVE TO BE MINDFUL THAT NOT
EVERYBODY IS AT THE SAME
READINESS STATE.
HOW TO EVEN THAT BASIC PLAYING
FIE
FIELD.
THERE'S JUST SO MUCH THAT CAN BE
DONE WITHOUT HAVING TO GET A LOT
OF FANCY EQUIPMENT.
WHEN YOU THINK OF A RESEARCH YOU
THINK OF BIG MACHINES AND
POWERFUL NOISES.
JUST NEED A LITTLE LAPTOP AND
NEED TO KNOW HOW TO CODE.
>>HERMINIA: THANK YOU
DR. TABAK.
WE HAVE AN OPPORTUNITY FOR A
GROUP PHOTO.
>>DR. TABAK: ONE, TWO, THREE, DONE.
[SPEAKING NON-ENGLISH]
>>I SAID I'M HONORED AND HAPPY
TO WORK WITH KARINA AND THE TEAM
AT THRO AND ROBIN AS WELL.
SHE WAS MY SUPERVISOR PRIOR TO
KARINA AND I WAS SO HAPPY AND
HONORED TO WORK FOR HER.
I'M HAPPY TO WORK WITH THE TAC
MEMBERS TOO.
I'M HAPPY YOU'RE HERE AND TO SEE
YOU GUYS FACE TO FACE AND THE
PANEL MEMBERS.
THANK YOU.
I WAS MORE THAN THRILLED WHEN A
POSITION OPENED UP IN THE THRO
OFFICE TO GO AHEAD AND MOVE
OVER.
I AM THE SENIOR SCIENCE AND
POLICY ADVISER TO DR. WALTERS
AND REALLY LOOKING FORWARD TO
ALL OF THE THINGS THAT WE BOTH
SEE AS GOOD THINGS TO MOVE
FORWARD WITH.
VERY EXCITED ACTUALLY AND REALLY
HAPPY TO BE AT THIS MEETING.
>>I ALSO WANT TO ACKNOWLEDGE
BONNIE, SHE'S IN ANOTHER MEETING
SHE HAD TO ATTEND ON BEHALF OF
THRO BUT PART OF OUR LEADERSHIP
AND ALSO JULIANA BLOOM OUT ON
MEDICAL LEAVE RIGHT NOW.
SHE'S RECOVERING AND DOING
REALLY WELL BUT CANNOT BE HERE
WITH US TODAY.
I WANTED TO ACKNOWLEDGE HER AS
OUR DEPUTY DIRECTOR AND
ACKNOWLEDGE ROBIN HERE ON BEHALF
OF DPCIPSI AND IS A HUGE
SUPPORT.
THANK YOU.
WE HAVE A SIX-MINUTE BREAK.
ENJOY.
THERE'S FOOD AND DRINKS STILL
OUT THERE IF ANYBODY WANTS
ANYTHING.
>>I'M TURNING IT OVER TO
COUNCILWOMAN FRIAS.
>>HERMINIA: WE HAVE ANOTHER
SPECIAL GUEST PRESENT.
WE HAVE DR. ELISEO PEREZ-STABLE
THE DIRECTOR OF THE NATIONAL
INSTITUTE ON MINORITY HEALTH AND
HEALTH DISPARITIES AT THE
NATIONAL INSTITUTES OF HEALTH.
HIS RESEARCH INTERESTS HAVE
CENTERED ON IMPROVING THE HEALTH
OF INDIVIDUALS FROM RACIAL AND
ETHNIC MINORITY COMMUNITIES
THROUGH EFFECTIVE PREVENTION
INTERVENTIONS UNDERSTANDING
UNDERLYING CAUSES OF HEALTH
DISPARITIES AND ADVANCING
PATIENT-CENTERED CARE FOR UNDER
SERVED COMMUNITIES.
WELCOME AND THANK YOU FOR
SPENDING TIME WITH US.
>>DR. PEREZ-STABLE: WELCOME TO
THE INTRODUCTION AND FOR KARINA
IN HER NEW ROLE.
IT'S AN HONOR TO BE HERE WITH
YOU TODAY.
I LAST SPOKE VIRTUALLY BUT THIS
IS BETTER.
I'LL ADDRESS A FEW NIMHD
SPECIFIC ISSUES BUT WORK DONE
AROUND AMERICAN INDIAN/ALASKAN
NATIVE HEALTH CO-LEDLY NIMHD.
THIS IS A PROJECT THAT TOOK
SEVERAL YEARS TO GET GOING
MODELLING EXISTING DATA IN THE
UNITED STATES TO LOOK AT
OUTCOMES IN THIS CASE LIFE
EXPECTANCY.
THE MODELS ARE SET FOR
MORTALITY.
WE'VE DONE ANALYSES ON MORTALITY
ISSUES.
THEY'RE YET IN FINAL DEVELOPMENT
FOR WHAT PEOPLE WOULD CALL
HEALTHY LIFE EXPECTANCY OR
QUALITY OF LIFE, OTHER OUTCOMES
THAT ARE MORBIDITY RELATED.
AND THE HIGHLIGHT HERE IS ALL
TOO WELL KNOWN TO THIS GROUP IS
HOW AMERICAN INDIAN/ALASKAN
NATIVE LIFE EXPECTANCY HAS BEEN
FLAT.
DURING A PERIOD ILLUSTRATED BY
THIS BOTTOM LINE HERE.
PROGRESS FOR AFRICAN AMERICANS
WHICH IS NOW SORT OF PAUSED IN
THE LAST FEW YEARS AND PROGRESS
FOR THE OTHER POPULATIONS YOU
CAB SEE OVER ALL ALSO PAUSED AS
YOU PROBABLY ARE AWARE.
THIS IS BY COUNTY.
SO ONE OF THE POWERFUL THINGS WE
CAN DO IS LOOK AT MODELLING
THOUGH LATINO/HISPANICS HAVE A
LONGER LIFE EXPECTANCY BUT
SOUTHEASTERN COLORADO AND
NORTHERN NEW MEXICO THEY AREN'T
DOING AS WELL OR THE RIO GRANDE
VALLEY.
YOU CAN SEE THE MAP FOR AIAN IN
THE BOTTOM IS MOSTLY IN THE
RED-ORANGE AREAS.
VERY FEW ARE UP IN THE YELLOWISH
GREEN WHERE YOU'RE OVER 80 LIFE
EXPECTANCY.
EARLIER THIS YEAR WITH THE
CONTRACT THAT WE HAD WITH A
GROUP THAT HAD DONE THIS WORK
ABOUT 10 YEARS AGO CALCULATED
USING DATA FROM THE YEAR 2018.
MOST THE DATA COME FROM THINGS
LIKE THE BEHAVIORAL RISK FACTOR
SURVEY, THE MORTALITY DATA FROM
THE CDC AND THEN THE MEDICAL
EXPENDITURE PANEL SURVEY FUNDED
BY HRQ.
THE COLUMN FOR AMERICAN INDIAN
$27.5 BILLION ISN'T AS BIG AS
OTHER GROUPS FOR AFRICAN
AMERICANS AND HISPANICS BUT THE
PROPORTION IS SMALLER AND THE
EXCESS PREMATURE DEATHS CATEGORY
IS HIGHER THAN IT SHOULD BE OR
NEEDS TO BE FOR THIS POPULATION.
THE MACRO DATA BRING GREATER
AWARENESS ABOUT THE KINDS OF
ISSUES WE'RE DEALING WITH.
THESE ARE DATA ABSTRACTED FROM
THE CDC AND MMWR AND
AGE-ADJUSTED OVERDOSE DEATHS BY
RACE AND ETHNICITY.
WHEN I FIRST GOT TO NIH EIGHT
YEARS AGO THE OVERDOSE EPIDEMIC
WAS NOT AFFECTING AFRICAN
AMERICAN, HISPANICS THE SAME WAY
AND IT'S A CHANGED.
FOR AMERICAN INDIAN/ALASKAN
NATIVE IT HASN'T CHANGED.
IT CONTINUES TO BE A LEADING
CAUSE OF MORTALITY THIS IS A
CORRELATION LOOKING AT INCOME
EQUALITY FOR AMERICAN NATIVE AND
NOT SO MUCH FOR OTHER GROUPS,
BLACKS, WHITES AND LATINOS.
THIS SAY -- IS A STUDY BY THE
PROGRAM WHEN THEY SET UP A
SURVEY WHEN COVID CAME IN 2020.
THE STUDY WAS DONE ONLINE WITH
U-GOV BETWEEN DECEMBER AND 2020
AND FEBRUARY OF 2021.
THIS PAPER PUBLISHED IN THE
AMERICAN JOURNAL OF PUBLIC
HEALTH LOOKED AT THE
DISCRIMINATION BY RACE AND
ETHNIC
ETHNICITY.
THERE WERE SIMILAR SIZED GROUPS
IN ALL THE GROUPS I THINK WITH
ISLANDER I WAS BIGGER AND THE
GROUPS WERE AT HIGHER RATES OF
DISCRIMINATION COMPARED TO WHITE
AMERICANS RESPONDING TO THIS.
JUST TO BE OPTIMISTIC, WHAT
HAPPENED WITH COVID ASSOCIATED
DEATHS BETWEEN 2020 AND 2022,
ONE CAN SAY THAT WELL, HOW MANY
PEOPLE WERE INFECTED AND
SURVIVED AND YOU GET SOME LEVEL
OF IMMUNITY BUT WE REALLY GOT
THE WORD OUT TO OUR COMMUNITIES
ABOUT THE IMPORTANCE OF THE
PANDEMIC AND TO GET VACCINATED.
WHAT WE'RE NOT SHOWING HERE THE
VACCINATION RATES FOR BLACKS AND
LATINOS AND NATIVE
HAWAIIAN/PACIFIC ISLANDERS WERE
SIMILAR TO WHITES BY FALL OF
2022.
YOU SEE THE MORTALITY RATES.
AMERICAN INDIAN/ALASKAN NATIVE
LAGGED A LITTLE BIT BEHIND BUT
THE PROGRESS WAS DRAMATIC.
I LIKE TO SAY THIS WAS CREDIT TO
EVERYBODY ALL OF US GETTING
COMMUNITIES VACCINATED AND HAD
AN IMPACT ON MORTALITY AS WELL
AS OTHER THINGS.
AND A COUPLE WEEKS AGO WITH THE
HEALTH DISPARITIES INSTITUTE AT
THE NIH SHE WAS RECOGNIZED AS
THE AWARDEE FOR THE EARLY STAGE
INVESTIGATOR AND STUDIES
NICOTINE METABOLISM WHICH IS A
REFLECTION OF DEPENDENCE IN
SMOKING EXPOSURE.
SEEING IF NICOTINE REPLACEMENT
IS A BETTER TREATMENT THAN ORAL
DRUGS.
AND THE PREFERENCE WAS MORE FOR
NICOTINE REPLACEMENT THERAPY.
I'LL PUT IN THE PLUG OR THE
HEALTH DISPARITIES RESEARCH
INSTITUTE.
SEVERAL INSTITUTES DO THINGS
LIKE THIS.
THIS WAS IN PART INSPIRED BY THE
NATIONAL INSTITUTE ON AGING BY
THE WILLIAMS PROGRAM WHEN I WAS
ON THEIR COUNCIL 10 YEARS AGO
AND IT'S A WEEK IN BETHESDA OR
FIVE DAYS.
WE FOCUS ON EARLY STAGE
INVESTIGATORS AND POSTDOCTORAL
FELLOWS.
THERE'S A FEW LECTURES EACH DAY
BY LEADING SCIENTISTS IN THE
FIELD AND THEN THEY DO A MOCK
GRANT REVIEW SESSION AND HAVE A
WRITING SEMINAR, WAAMC HELPS US
WITH AND PROGRAM STAFF AS WELL
AS NIH PROGRAM STAFF FROM ACROSS
THE AGENCY INTERESTED IN
MINORITY HEALTH, HEALTH
DISPARITIES.
I THINK WE CONTINUE THIS -- WE
DID IT VIRTUALLY FOR THREE
YEARS.
THIS WAS BACK IN PERSON THIS
YEAR.
WE DO IT IN AUGUST.
IT'S A PLEASANT TIME TO BE IN
BETHESDA USUALLY.
AND HAD NOW 458 PARTICIPANTS IN
EIGHT YEARS AND OF COURSE WE
DON'T USE ANY CRITERIA TO SELECT
PEOPLE BUT ABOUT 60% OF OUR
SCHOLARS ARE FROM UNDER
REPRESENTED GROUPS.
WE GET ABOUT 20% PHYSICIANS AND
HAVE NURSES AND PHARMACOLOGY,
DOCTORATES AND FOR SCHOLARS
THINKING ABOUT CAREER IN
RESEARCH, KO1, K08 OR K23 BECAME
AVAILABLE IN 2017 AND WE
INCREASED OUR FUNDING NUMBER WE
HAVE FUNDED OUR APPLICATIONS.
WE DON'T YET FOR FISCAL '23
WHERE IT WILL PLAY OUT.
NIMHD RECEIVED SOME FUNDING AND
IF YOU CAME IN WITH A K AWARD
AND SCORED AT 30 OR BETTER
YOU'LL BE FUNDED UNLESS THERE'S
A DISCONNECT OF THEME WHICH
HAPPENS RARELY AND WE'LL GO UP
HIGHER SCORES AS WELL.
THIS IS SOMETHING TO ENCOURAGE
NEW INVESTORS.
LET ME ADDRESS ISSUES AROUND
RADXUP AND THE TRIBAL ECOLOGICAL
CENTERS.
RADXUP HAS BEEN A REMARKABLE
PROGRAM.
I'LL POINT TO THIS WE'VE
ENROLLED ALMOST 400,000 PEOPLE
SINCE IT WAS LAUNCHED IN
SEPTEMBER/OCTOBER OF 2020.
IT WAS A HUGE INVESTMENT FROM
NIH.
WHEN THE PANDEMIC CAME AND
APPROPRIATIONS CAME WAS FOR
TESTING AND THE ONE THAT WAS
IMPORTANT WAS TAC TO DEVELOP THE
TESTS AND THE AT-HOME TESTS THAT
WERE AVAILABLE WERE A PRODUCT OF
THAT PIPELINE OF INNOVATION
CREATED BY NIH AND NIBIB THE
BIOMEDICAL ENGINEERING
INSTITUTE.
WE WERE ASKED TO DEVELOP A
PROGRAM TO ADDRESS THE
DISPARITIES IN UNDER SERVED
COMMUNITIES AND STAY IN THE LANE
OF TESTING.
EVERYTHING WE DID HAD TO BE WITH
TESTING.
WE STILL HAVE A FEW SMALL AWARTS
-- AWARDS IT MAKE IN THE FINAL
PHASE OF RADXUP BUT PROUD OF THE
SUCCESS IT'S HAD OVER THE YEARS
AND SEE THE NUMBERS OF PEOPLE
TOUCHED BY THIS AND THE
INFRASTRUCTURE CREATED.
ONE OF THE LESSONS --
EXPERIENCES WE HAD WITH RADXUP
IS HOW DO WE GET PEOPLE TO
MEASURE THINGS THE SAME WAY?
NIMHD HAS BEEN ON A CAMPAIGN, IF
YOU WISH, TO GET INVESTIGATORS
TO USE SIMILAR MEASURES, SAME
MEASURES FOR MEASURING SOCIAL
DETERMINATES OF HEALTH.
THAT'S ON THE PHOENIX WEBSITE.
THERE'S A PAGE WHERE WE HAVE THE
MEASURES THAT HAVE BEEN VETTED
BY GROUPS OF EXPERTS.
WE ALSO PUT ALL THE AND HAVE
INDIVIDUAL KINDS OF CONSTRUCTS.
WE PLAN TO REVIEW THOSE NOW BUT
FOR NOW THEY'RE THE ONES THAT
HAVE BEEN PRESENT OR USUALLY
ADAPTED FROM OTHER NATIONAL
SURVEYS.
YOU CAN SEE THE LIST OF THE
KINDS OF THINGS WE DEVELOPED OR
VETTED MEASURES ON.
WE HAVEN'T DEVELOPED THE
MEASURES, THEY ALREADY EXISTED.
AND WE CALL THEM PROTOCOLS IN
THE PHOENIX LANGUAGE THEY HAVE.
AND THE IDEA WITH RADXUP IS WE
WANT EVERYONE TO COLLECT COMMON
DATA.
HERE WE HAD 138 PROJECTS,
400,000 PEOPLE EVENTUALLY
ENROLLED.
HOW CAN WE GET PEOPLE TO DO
THINGS THE SAME.
NIH CAN SCREAM ABOUT IT AND GET
25 PEOPLE TO DO IT BUT CAN WE
GET THIS TO HAPPEN?
IT WAS PROBABLY HARDER THAN I
THOUGHT.
IT WOULD BE.
THE SCIENTIFIC ARGUMENT WAS NOT
THE ISSUE MORE THE OPERATIONAL
AND PRACTICAL ONE AND ALSO UNDER
A NATIONAL EMERGENCY.
THERE WAS NO TIME TO REALLY
REACT, CONTRIBUTE, PAUSE AND
THINK ABOUT THE MEASURES.
BUT THEY HAPPENED.
MAYBE WE GOT ABOUT 80% OF THE
PROJECTS DOING MOST OF THE
COMMON DAY ELEMENTS AND OTHERS
WHO MODIFIED SOME OF THEM.
IN THIS MAP YOU SEE THE
ILLUSTRATION OF THE AMERICAN
INDIAN/ALASKAN NATIVE AWARDED
PROJECTS.
IT DOESN'T INCLUDE A COUPLE
THOUSAND PARTICIPANTS WHO WERE
ENROLLED IN OTHER PROJECTS
BESIDES THESE 10 AND THEY'RE
SPREAD AROUND THE COUNTRY AND
THE NUMBER OF PARTICIPANTS IS
IMPORTANT IN THE GROUP.
NOW, ONE RESULT THAT CAME OUT OF
THIS AND THERE'S A NUMBER OF
PAPERS PUBLISHED, THIS ONE EARLY
ON A CROSS SECTIONAL SURVEY IN
THE GREAT PLAINS ASKING ABOUT
WHAT THE FACTORS THAT WOULD
CONTRIBUTE TO THE TESTING AND
TURNED OUT HAVING A FULL-TIME
JOB REPORTING YOU WERE ABLE TO
ISOLATE YOURSELF IF DIAGNOSED IN
ENDORSING THE COVID-19 TESTING
IS ONLY NEEDED IF ONE HAS
SYMPTOMS.
CORRELATED WITH HAVING BEEN
PREVIOUSLY TESTED FOR COVID-19.
OPPOSED TO THE OPPOSITE.
THE RADXUP DATA USE AND SHARING
WENT THROUGH TRIBAL
CONSULTATION.
IT WAS CLEAR FROM THE BEGINNING
WE WOULD NOT BE ASKING THE
PROJECTS TO SHARE DATA THE SAME
WAY WE ASKED EVERYBODY ELSE.
FIVE PROJECTS EXHIBITED DATA USE
AGREEMENT WITH OUR COORDINATING
CENTER AND TRANSFERRED DATA AND
THEY'RE REQUIRED FROM THE TRIBAL
IRBs.
SOME PROJECTS ENROLLED AMERICAN
INDIAN/ALASKAN NATIVE AS WELL AS
PEOPLE FROM OTHER GROUPS AND THE
COORDINATING CENTER WITHHELD THE
DATA FROM ALL ANALYSIS, ALL
REPORTS, ALL DASHBOARDS, ALL
DATA SETS AND UPLOADS TO THE
RADXUP DATA HUB AND IT'S A
CENTRAL HUB FOR THE RADX DATA
AND THE OTHER COMPONENTS.
WE'RE ALSO EXCLUDING ZIP CODES
GIVEN THE POTENTIAL LOSS OF
PRIVACY OF INDIVIDUALS IN ZIP
CODES WHERE FEW PEOPLE LIVE.
THIS LED TO THE PROPOSAL OF A
TRIBAL DATA REPOSITORY.
WE HAVE A CONCLUSION ON THIS
THOUGH IT'S STILL IN THE FINAL
PROCESS IN MAY OF 2020 WAS THE
FINAL CONSULTATION OF COVID-19
RESEARCH AND I WAS PRESENT
THOUGH THE PRESENTATION WAS FROM
TA
TARA SCHWETZ AND RICK WOYCHIK
AND THERE WAS A TRIBAL
CONSULTATION WITH MYSELF AND
DAVE WILSON AND SUSAN GREGORIC
AND THERE WAS A WEBINAR AND
THERE WERE QUESTIONS FROM BOTH
THE FORMAL TRIBAL CONSULTATION
AND INTERESTED PARTIES WE
CLEARED THE CONCEPT AND REVIEWED
APPLICATIONS AND AT THE END OF
MAY WE WERE ABLE TO AWARD $7
MILLION THAT WILL GO TO THE
NATIVE, BIO NATIVE CONSORTIUM
FOR THE TRIBAL DATA REPOSITORY.
BECAUSE OF LOGISTICAL CHALLENGES
IT ENDED UP THE MONEY WAS
TRANSFERRED TO THE MAJOR DATA
HUB THAT IS BASED AT STANFORD
AND THEY'LL RECEIVE A SUB AWARD
FROM THAT GROUP.
AND THERE'S BEEN AN ONGOING
RELATIONSHIP WITH THE
COORDINATION CENTER WE WERE
SLUMENT THEM TO HELP BUILD ON
THE COMMUNITY ENGAGEMENT AND
COORDINATION TO SUPPORT THE
TRIBAL DATA REPOSITORY BUT NOT
TO BE LEADING ON THAT POINT.
IS THE ORIGIN OF THE TRIBAL DATA
REPOSITORY WAS TO DEVELOP THE
INDEPENDENT RESEARCH DATA
REPOSITORY GOVERNED UNDER
PRINCIPLES AND PRACTICES OF
TRIBAL SOVEREIGNTY.
IT'S THE FIRST TIME NIMHD HAS
DONE THIS AND PROVIDE
RESPONSIBLE DATA SHARING AND
ACCESS TO RESEARCHERS AND THOSE
WORKING WITH RAD X AND AMERICAN
INDIAN/ALASKAN NATIVE RESEARCH
DATA.
THE IDEA AND THE COORDINATING
CENTER KNEW WHAT TO DO AND THIS
WAS A WAY TO SUPPORT THAT ASPECT
WHILE THE GOVERNANCE OF THE
TRIBAL DATA REPOSITORY WOULD
REST ELSEWHERE.
ONE OF OUR GOALS WAS TO SUPPORT
AND PROI MOTE NATIVE SCIENTISTS
WORKING WITH THE COMMUNITIES AND
WHATEVER THE LIMITATIONS THERE
MAY BE.
THE PARTNERSHIP WITH THE OFFICE
OF DATA SCIENCE STRATEGIES HAS
BEEN 100% WITH SUSAN GREGORIC
AND HER STAFF IN HER OFFICE.
THEY HAVE REALLY BEEN THERE WITH
US EVERY STEP OF THE WAY.
THE TRIBAL ECOLOGICALLY CENTERS
THERE'S BEEN AN RELATIONSHIP
BETWEEN NIMHD AND THE TRIBAL
EPIDEMIOLOGY CENTERS DATING BACK
TO THE EARLY 2000s AND THERE WAS
SUPPORT FOR THE TRIBAL
EPIDEMIOLOGY CENTERS AND IT WENT
FROM NIMHD TO THE INDIAN HEALTH
SERVICE CREATED THE TRIBAL
EPICENTERS UNDER THE
AUTHORIZATION OF THE INDIAN
HEALTH CARE IMPROVEMENT ACT.
THE CDC HAS ALSO BEEN SUPPORTIVE
AND PROVIDING A BULK OF THE
FUNDING FOR THE TRIBAL
EPIDEMIOLOGY CENTERS.
AND IN ALL THE WORK THEY DO THIS
GROUP IS FAMILIAR IN HOW TO
ADDRESS THE CONCERNS AND HEALTH
ISSUES AND CHALLENGES OF THE 3
MILLION AMERICAN INDIAN/ALASKAN
NATIVE INDIVIDUALS IN THE U.S.
THE EPICENTERS ARE DISTRIBUTED
UP ACCORDANCE TO THE INDIAN
HEALTH SERVICE AREAS AND IT'S
LARGE AND IN THE WEST AND ALASKA
IT'S ITS OWN AND THERE'S A TOTAL
OF 12 IN THE ADMINISTRATIVE
AREAS THIS IS A RESOURCE IN OUR
PERSPECTIVE WE WERE NOT
LEVERAGING THIS THE NIMHD IN
DISCUSSION WITH THE INDIAN
HEALTH SERVICE PRIOR TO THE
PANDEMIC HAD A PLAN TO DIRECTLY
FUND AN ENTITY THAT WOULD HAVE
TO COMPETE TO SUPPORT THE TEC
FROM NIH OPPOSED TO THE TRANSFER
TO THE INDIAN HEALTH SERVICES.
AND WE WERE DELAYED AND SET BACK
IN THE BLAN TO DO THIS.
BUT ULTIMATELY IT HAPPENED AND
THE AWARD WAS GIVEN TO THE
UNIVERSITY OF CLINICAL TRIAL
WHERE THE RESOURCE CENTER IS
LOCATED.
OUR COMMITMENT HAVE BEEN TO THE
$70,000 PER SITE RANGE.
THE TOTAL COMMITMENT WAS NOT
QUITE $800,000, $900,000 WITH
OVERHEAD.
WE INCREASED THAT TO $100,000
PER TECH AS AN AUTOMATIC
FOUNDATION.
THERE'S NO DETAIL EXPECTATION
FOR THE $100,000 THIS IS MONEY
IT SUPPORTS THE TEC'S FUNCTIONS
IN WHATEVER THEY ARE.
THAT COMMITMENT WILL CONTINUE
THE IDEA WAS TO PROVIDE MORE
TECHNICAL ASSISTANCE ON ISSUES
THAT MAY COME UP PARTICULARLY
AROUND DATA SCIENCE AROUND THE
OFFICE OF DATA SCIENCE
STRATEGIES WAS INTERESTED IN
WAYS TO SUPPLEMENT THIS TO BUILD
MORE CAPACITY IN DATA SCIENCE.
RESEARCH SKILLS, MENTORING AND
THEN ALSO WORK WITH NIH ON
DISSEMINATION OF RESOURCES AND
COULD BE A COMPENDIUM OF
AVAILABLE RESOURCES BY THE TECs.
I SEE THIS AS THE BEGINNING OF
THE VISION FOR THE TRIBAL
EPICENTERS AND FOR NIMHD TO BE
ABLE TO THEN WORK WITH A NETWORK
OF TRIBAL-BASED ORGANIZATIONS TO
CONDUCT RESEARCH PRIMARILY BY
NATIVE INVESTIGATORS.
THAT WAS MY VISION WITH THE
WHOLE PROBLEM TO MAKE IT A
DIRECT RELATIONSHIP BETWEEN THE
INSTITUTE AND THE INVESTIGATORS
ON THE GROUND.
I SEE THE FOUNDATIONAL FUNDING
AND THE RESOURCE CENTER IS JUST
A FIRST STEP.
IT'S TO FACILITATE OPPORTUNITIES
FOR GRANT FUNDING FROM NIH AND
OTHER INSTITUTES.
I THINK IF WE HAVE A FUNCTIONING
NETWORK THAT'S GATHERED WITH
SOME SORT OF COORDINATION AND WE
CREATE OPPORTUNITIES FOR PEOPLE
TO APPLY FOR GRANTS THAT CAN BE
IMPLEMENTED IN THE AREAS WHETHER
LED BY THE TECs OR NOT, OTHER
NIH INSTITUTE COULD BE
POTENTIALLY INTERESTED IN
SUPPORTING THAT.
OUR EXPERIENCE WITH THE RESEARCH
CENTERS FOR MINORITY
INSTITUTIONS WHICH WE INHERITED
AND IS FUNDED FOR THE LAST 40
YEARS WITH CONGRESSIONAL LINE
ITEM HAS IMPLIED IT CAN WORK.
IT TAKES TIME AND IT COULD BE A
FOCUS OF AND THIS IS SOMETHING
NIH LAUNCHED AND HOW WE SEE THE
ISSUES OF MINORITY HEALTH AND
HEALTH DISPARITIES FOR
POPULATIONS.
AND LISTS THE SITES FOR RADXUP
AND OTHERS.
THANK YOU SO MUCH.
>>THANK YOU
.
>>HERMINIA: DO WE HAVE ANY
QUESTIONS OR COMMENTS?
>>IT WAS INTERESTED WHEN YOU
WERE LOOKING AT THE AND WHERE
THEY WERE STAYING STABLE AND
WENT UP TO 2019 OR SOMETHING
LIKE THAT.
DURING COVID IT INCREASED
SIGNIFICANTLY.
MORE SO THAN THE REST OF THEM.
I DON'T KNOW THAT IT HAD A
CORRELATION TO LACK OF
VACCINATIONS.
IT WOULD BE INTERESTING TO LOOK
AT THAT BECAUSE I THINK THERE
WERE OTHER THINGS GOING ON.
>>DR. PEREZ-STABLE: THERE WERE
DEATHS FROM MARCH TO SEPTEMBER
THAT WAS SUSTAINED IN 2021 AND
DROPPED SUBSTANTIALLY IN 2022
THIS IS THE WHOLE COUNTRY.
DISPROPORTIONATELY, AMERICAN
INDIAN/ALASKAN NATIVE AND
AFRICAN AMERICANS AND LATINOS
AND HISPANICS SUFFERED A
DISPROPORTIONATE IN EXCESS
DEATHS AND IN MALES MORE THAN
FEMALES.
ALL RELATED PROBABLY TO SOCIAL
FACTORS RELATED TO CONTINUING
WORK IN WHAT CONTEXT, LACK OF
ABILITY TO ISOLATE AND LACK OF
ACCESS TO CARE SO PEOPLE WILL
GET SICK AND NOT GET THIS THE
CARE EARLY ON IN THE EPIDEMIC
ESPECIALLY.
LATINOS LOST AROUND TWO YEARS OF
LIFE EXPECTANCY FROM COVID.
WILL THAT BE RECOVERED?
WE DON'T KNOW.
WE HAVE TO WAIT AND SEE.
SO THE LOSS OF LIFE EXPECTANCY
IS REAL.
I WHAT STANDS OUT TO ME WHEN I
LOOK AT THIS AND WHEN I LEARNED
ABOUT THIS BECAUSE IN MY PRIOR
LIFE IN ACADEMICS I DIDN'T KNOW
THESE KINDS OF INFORMATION WITH
THIS LEVEL OF DEAL.
AMERICAN INDIAN/ALASKAN NATIVE
HEALTH STARTED TO DECLINE IN THE
1950s.
TRACK BACK THE LIFE EXPECTANCY
GOING BACK 70 YEARS AND HAD
SMALL INCREASES BUT THE GENERAL
TREND HAS BEEN IN THE WRONG
DIRECTION.
THESE 20 YEARS THE DATA IS MORE
ROBUST AND EASIER TO COMPARE.
THE GAINS MADE FOR BLACKS AND
SIMILAR SITUATIONS STABILIZED
WERE NOT PRESENT FOR AMERICAN
INDIANS FOR THE OVER ALL
U.S. POPULATION AND WHITES IN
PARTICULAR THERE'S BEEN A
DECREASE IN LIFE EXPECTANCY OVER
THE LAST SIX YEARS OR SO.
THOUGHT PRIMARILY TO THE
OVERDOSE AND THE OTHER FACTORS
AS WELL.
I'M OPTIMISTIC.
I THINK WE WILL RECOVER SOME OF
THE LOSS FROM COVID BUT I DON'T
THINK IT WILL BE BACK TO WHERE
WE WERE.
>>ONE MORE OBSERVATION.
I GUESS THE $100,000 FROM MY
POINT OF VIEW ISN'T A LOT OF
MONEY.
$100,000 IS BETTER THAN ZERO BUT
JUST A COMMENT.
THANKS.
>>POINT WELL TAKEN.
I'M NOT ARGUING WITH THAT.
IT'S A $1.2 MILLION COMMITMENT.
THAT'S WHERE I SEE THIS.
THE IDEA IS WE HAD THIS
COMMITMENT IN THE PAST AND NOW
WE WANT TO EMBRACE THAT
COMMITMENT DIRECTLY AND BUILD ON
THAT.
THIS WAS NOT DONE AS A ONE-OFF
OR THIS IS WHAT WE'LL DO AND
THAT'S IT.
MY GOAL IS TO BUILD OUT FROM
THAT FOUNDATION.
IT WILL TAKE TIME AND IT WILL
TAKE MORE RELATIONSHIP BUILDING
AS WE TRANSITION TO THIS.
BUT I AGAIN THINK THAT WE CAN DO
A LOT MORE WITH THE TRIBAL
EPIDEMIOLOGY CENTERS AS A
FOUNDATION TO DO MORE OF THIS
KIND OF RESEARCH WITH THE
POPULATION AND WITH NATIVE
INVESTIGATORS.
>>HERMINIA: ANY OTHER QUESTIONS
OR COMMENTS?
>>I NEVER HEARD OF IT BEFORE.
I WAS LOST IN THE PRESENTATION
BECAUSE I DIDN'T HAVE A FOUNDING
ON IT'S MY OWN PERSONAL
SITUATION.
>>DR. PEREZ-STABLE: WHAT PART
WAS LOST?
>>THE RADX.
I DIDN'T KNOW ANYTHING ABOUT IT
BEF
BEFORE.
>>DR. PEREZ-STABLE: RAPID
ACCELERATION AND IT WAS WITH THE
PANDEMIC START THAENGD ORIGINAL
CONVENING OF WHAT NIH WOULD DO
ABOUT IT THERE WAS EMPHASIS OVER
VACCINE DEVELOPMENT AND WHAT CAN
WE DO TO SIROLOGICALLY AND THE
SOCIAL AND BEHAVIORAL SCIENTISTS
CAME TO THE TABLE AND STARTED
RAISING THE ISSUES AND IT BECAME
EVIDENT WITHIN A MONTH THE
COMMUNITIES OF COLORS WERE BEING
DISPROPORTIONATELY IMPACT AND
BROUGHT NIMHD AND OTHER
SCIENTISTS HERE INTO THE
LIMELIGHT OF WHAT CAN WE DO
ABOUT IT?
AND WE AND YOU HAVE TO DO
SOMETHING WITH TESTING.
WE HAVE 10 PROJECTS FUNDED
FOCUSSED ON AMERICAN
INDIAN/ALASKAN NATIVES.
THAT WAS NOT BY ACCIDENT.
WE WERE INTENTIONAL IN HOW WE
TRIED TO DIRECT THE FUNDS AND IT
WAS AFRICAN AMERICAN, LATINO
HISPANICS AND HAWAIIAN AND OTHER
UNDER SERVED POPULATIONS WERE
INCLUDED AND WE CAN CERTAINLY
REFER YOU TO MORE DETAIL.
I DON'T WANT TO BORE ALL OF US
WITH THOSE.
IT'S ENGAGED WITH LARGE
POPULATIONS ON A LARGE SCALE AND
WHAT BARRIERS DO WE NEED TO
OVERCOME TO GET ACADEMIC
RESEARCHERS AND COMMUNITY
ORGANIZATIONS AND LEADERS AND
PEOPLE AT THE TABLE.
THERE'S MANY BUMPS AND LEARNED
LESSONS BUT OVER ALL WE'VE CRIT
TO BE SUCCESSFUL FROM ANY WAY WE
LOOK AT IT.
>>THAT EXPLANATION WRAPS MY
MIND AROUND WHAT WE'RE TALKING
ABOUT IT'S GREAT BUT ONE OF THE
WITH IT BEING FUNNELED THROUGH A
UNIVERSITY IT MEANS LESS MONEY
IS ABLE TO GO TO THE TRIBAL
EPICENTERS.
CLARIFY THOUGHTS AROUND PUTTING
IT THROUGH THE UNIVERSITY AND
THEN TO THE CENTERS OPPOSED TO
DIRECTLY FUNDING THE TRIBAL
EPICENTERS.
>>DR. PEREZ-STABLE: IN THE
PRIOR FORMAT WE TRANSFERRED TO
THE TRIBAL HEALTH SERVICE AND
WASN'T GOING DIRECTLY FROM NIH
TO THEM AND IN MY THINKING, DO
WE DO 12 DIFFERENT CONTRACT OR A
GRANT COMPETITION WHERE THEY SAY
APPLY AND ONLY HAVE 12 TO GIVE
OR TRY TO CHARGE ONE ENTITY TO
RECEIVE THE FUNDS AND DISTRIBUTE
THEM?
YES, THERE'S GOING TO BE
OVERHEAD NO MATTER WHAT WE DO
THERE'LL BE OVERHEAD.
IT WAS AN OPERATIONAL DECISION
TO MAKE IT MORE SIMPLER IN THAT
REGARDS.
AT THE SAME TIME THE GROUP WAS
ASKED TO DO RESEARCH METHODS OR
DATA SCIENCE OR GRANT WRITING
SKILLS.
WHATEVER IT WAS EACH OF THE
SITES NEEDED.
THAT WAS THE VISION.
>>PREVIOUSLY THE FUNDING WOULD
GO FROM NIH TO HIS.
>>DR. PEREZ-STABLE: THEY WERE
FUNDING THE TRIBAL EPICENTERS
AND OUR SVRS WAS CON ED.
WE COULD HAVE DONE THINGS
DIFFERENTLY AND BETTER.
I WON'T SAY ANYTHING'S PERFECT.
THE VISION AND PRINCIPLE IS WHAT
A WANT TO EMPHASIZE.
THEY'RE NOT LIFE TIME BUT CYCLES
AND CAN BE REVISITED GOING
FORWARD.
AND THIS IS NOT NECESSARILY NIH
THOUGH WE REPRESENT THE NIH IN
THIS CASE TO BUILD OUT THE
NETWORK TO FORTIFY AND BUILD TO
MORE RESEARCH ORIENTED.
THAT'S WHAT NIH DOES.
AS THEY DO THE OTHER 25 OTHER
THINGS THEY'RE CHARGED WITH
DOING IN TERMS OF SURVEILLANCE
OF THE POPULATION.
WE HAVE BUILT THAT WITH THE
DIRECTORS OF THE TEC AND THEY'RE
STAFF AND POPULATION.
I VISIT THE NEW MEXICO TEC
BEFORE THE PANDEMIC BUT MY HOPE
IS WE CAN GET MORE FAMILIAR AND
WE HAD AN OPPORTUNITY SEVERAL
YEARS AGO WE SAID THESE ARE
GRANTS FOR TRIBAL EPICENTERS AND
IT WAS OPEN AND A TEC COULD
APPLY AND WE FUNDED SEVERAL ALL
FROM TECs.
OREGON AND NATURAL AND NAVAJO
FOR SURE AND THERE WAS EXCELLENT
WORK OUR COUNCIL REPRESENTED.
>>THANK YOU FOR THE WORK.
>>I ALSO WANTED TO COMMENT ON
THE STATS SHARED WITH THE LIFE
EXPECTANCY AN WITH OUR
POPULATION AND IT VARIES.
IN SOME OF OUR COMMUNITIES WE'VE
SEEN HE DECLINE AND ONE THING WE
SEE IN OUR COMMUNITIES THAT
OTHER EXPERIENCES DON'T
EXPERIENCE AND I ALWAYS SHARED
THIS WITH OTHER PEOPLE AS A
TRIBAL LEADER THERE'S NO DEGREE
OF SEPARATION IN OUR COMMUNITIES
WE EXPERIENCE LOSS IN OUR
COMMUNITIES DIRECTLY.
WHEN THE WHOLE COVID-19 AND OUR
LOSSES, IT WAS DIRECT.
OUR CEREMONIES ARE ALL
INTEGRATED.
WHEN SOMETHING HAPPENS IN OUR
COMMUNITY AS A TRIBAL LEADER
IT'S NOT OPERATED THERE'S
SOMEONE AT YOUR DOOR THAT IS
THERE AND YOU ATTEND THE
SERVICES.
YOU KNOW WHAT'S HAPPENING IN
YOUR COMMUNITY AND EVERYBODY IS
RELATED.
IT'S ALL COMMUNAL.
WE KNOW WHAT HAPPENS IN OUR
COMMUNITIES AND THAT'S NOT THE
SAME FOR OTHER ELECTED
OFFICIALS.
YOU CAN SEPARATE YOURSELF BUT
NOT IN OUR COMMUNITIES.
THERE'S NO SEPARATION.
THAT MAKES IT VERY DIFFERENT AND
IT'S VERY IMPORTANT FOR US TO
ALWAYS TAKE CARE OF OUR
COMMUNITIES AND ONE OF THE
THINGS THAT WE EXPERIENCE AND I
KNOW WE'VE EXPERIENCED IN OUR
COMMUNITIES IS THE DIFFERENCE OF
OUR PEOPLE AS THEY'RE DYING
YOUNGER.
YOU KNOW THE FLAT RATE AND
APPRECIATE THERE'S RESEARCH AND
WE'RE PUMPING SO MUCH MONEY INTO
OUR HEALTH CARE SYSTEM, WE'RE
DOING THIS FOR PREVENTION AND
HEALTH CARE AND WELLNESS AND
DOING THIS AND YET WE'RE STILL
LOSING PEOPLE TO DIABETES.
WE'RE STILL LOSING PEOPLE
BECAUSE THEY'RE GIVING UP.
THEY'RE FATALISTIC, WHY SHOULD I
BOTHER?
I DON'T WANT TO ANYMORE AND STOP
GOING TO DIALYSIS.
FOR REASONS WE DON'T KNOW AND WE
NEED TO FIND OUT WHY DO WE LOSE
PEOPLE IN THEIR 30s TO RENAL
FAILURE?
THAT'S TOO YOUNG AND THE IMPACT
THAT'S HAVING.
THOSE ARE THINGS IN OUR
COMMUNITY AND THEY'RE LOSING.
AND THINGS LIKE GOING BLIND AND
THINGS THAT SHOULDN'T BE
HAPPENING.
THERE ARE THINGS THAT TECHNOLOGY
HAS ALREADY TAKEN CARE OF AND
IT'S LIKE THERE'S A DISCONNECT
AND A QUESTION DOB ASKED ABOUT
THOSE GOING BACK TO THE SOCIAL
DETERMINATES TOO.
AND THE DISPARITY OF WHAT'S
HAPPENING AND WHAT'S GOING ON IN
THE COMMUNITY AND IN PEOPLE'S
LIVES AND WHAT'S GOING ON
SPIRITUALLY AND EMOTIONALLY AND
IN SOMEBODY'S LIFE PREVENTING
THEM FROM WANTING TO LIVE A LIFE
THEY DESERVE.
IT'S IMPACTING THE WHOLE
COMMUNITY.
YEAH, I BRING THAT UP BECAUSE I
SEE THAT WHEN WE LOSE SOMEBODY
IT'S LIKE, WHAT HAPPENED?
I THINK ABOUT THOSE THINGS.
>>DR. PEREZ STABLE: THANK YOU
FOR THE COMMENTS.
IT'S THE REFLECTION OF LIVED
EXPERIENCE AND NOT JUST
INDIVIDUALLY BUT YOUR COLLECTIVE
IS WHAT YOU'RE SHARING AND I
THINK SOMETIMES IT'S HARD FOR
PEOPLE TO LISTEN TO THAT
ESPECIALLY THE OUTSIDE COMMUNITY
AND IT'S IMPORTANT EVERYONE
LISTEN TO IT AND I DO THINK
SCIENTISTS AND CLINICIANS AND
PEOPLE WHO RUN SERVICES NEED TO
BE A PART OF THE COMMUNITY AND
UNDERSTAND WHAT PEOPLE WOULD
LIKE AND HOW THEY LIVE.
I APPRECIATE THAT.
I THINK THAT'S A VERY IMPORTANT
POINT.
IN THE TRIBAL AND INDIAN
COUNTRY, PEOPLE REFER TO
GENERALLY THERE'S ALSO THE
COMPONENT OF VIRALITY AND
DISTANCE AND LACK OF TECHNOLOGY
THAT EXACERBATES MANY OF THESE
ISSUES AND THE AMERICAN INDIANS
WHO LIVE IN AN URBAN SETTING GET
NOT LOST BUT CERTAINLY ARE THEY
THERE?
WHO ARE THEY?
WHERE ARE THEY LOCATED?
THERE'S EXPERTS ON THE TOPIC.
AND GETTING A HANDLE ON THAT AND
ADDRESSING IT IS IMPORTANT.
THERE'S A LOT TO LEARN ABOUT
WHAT THE EXPERIENCE IN THE
AMERICAS ARE.
NATIVE PEOPLE IN LATIN AMERICA
PARTICULARLY MEXICO, OUR
NEIGHBOR ARE MORE NUMEROUS BUT
THERE'S A TREMENDOUS GAP THAT
EXISTS THEN MORE SOUTH THE MORE
NATIVE PEOPLE ARE AND THE
DIFFERENCE IN POWER IS OBVIOUS
FOR ANYONE WHO'S BEEN TO MEXICO
BUT THERE'S MORE MIXTURE.
IT'S NOT HAPPENED AS MUCH IN
RESEARCH AND WHAT ARE THE GOOD
VALUES OR THINGS TO LEARN ON IN
OUR COMMUNITIES HERE NOT JUST
AMERICAN INDIANS BUT THE OTHER
MINORITIZED COMMUNITIES.
THERE'S AN ASSUMPTION THAT IF
YOU'RE POOR YOU'RE GOING TO HAVE
BAD HEALTH AND THE DATA ON A
POPULATION BASED INDICATE THE
POORER YOU ARE THE WORSE YOUR
HEALTH IS BUT IT DOESN'T HAVE TO
BE THAT WAY AND HAS NOT ALWAYS
BEEN THAT WAY.
THE ORIGINAL PEOPLE WHO BECAME
OBESE AND DEVELOPED DIABETES
WERE PEOPLE WITH MONEY THAT
COULD BUY FOOD AND HYPERCALORIC
DENSE FOOD AND NOW THINGS ARE
TURNED AROUND.
I DO AND EXPECT OUR SCIENTISTS
WILL BEGIN TO LOOK AT THESE
ASPECTS AND HAVE TO THINK MORE
IN TERMS OF ASSOCIATIONS AND
THINK OF INTERVENTIONS TO MAKE A
DIFFERENCE TO FIND THE PATHWAYS
TO MAKE A DIFFERENCE.
ALSO TO FIND THE STRENGTHS THAT
EXIST IN OUR COMMUNITY SO IT'S
NOT ALWAYS ABOUT ADVERSITY.
YOU MENTIONED THE SPIRITUALITY
AND THE SENSE OF ELDERS.
ALL THE FACTORS IN MAINSTREAM
U.S. COMMUNITY ARE NOT -- DON'T
GET THAT KIND OF ATTENTION OR
VALUE PERHAPS FROM OTHER
MINORITIZED COMMUNITIES.
>>HERMINIA: THANK YOU FOR YOUR
PRESENTATION.
>>KARINA: IT WAS A
COMPREHENSIVE OVERVIEW AND THANK
YOU FOR BEING HERE.
WE'RE A LITTLE BIT BEHIND TIME
SO IF WE COULD JUST IF YOU NEED
A QUICK BIO BREAK OR QUICK
STRETCH AND THEN IT'S TIME FOR
DR. WARNE TO JOIN US AND GET
READY FOR HIS PRESENTATION.
TWO MINUTES.
THAT REALLY MEANS FIVE MINUTES
INDIAN TIME.
>>KARINA: THANK YOU DR. WARNE
FOR BEING HERE AND RECOGNIZING
WE'RE A LITTLE BIT BEHIND TIME
BUT I APPRECIATE YOU BEING ABLE
TO JOIN US TODAY.
HE SERVE AS THE CO-DIRECTOR OF
THE CENTER FOR INDIGENOUS HEALTH
AND AS A TENURED FULL PROFESSOR
AT THE BLOOMBERG SCHOOL OF
PUBLIC HEALTH AT JOHNS HOPKINS
IN MARYLAND SERVING AS THE
PROVOST FELLOW FOR INDIGENOUS
HEALTH STRATEGY.
>>GOOD DAY EVERYONE AND JUST
REFLECTING MY EXPERIENCE AT NIH
IN THIS ARENA, I'VE KNOWN MANY
OF YOU OUT THERE MORE THAN 20
YEARS SO LONG STANDING
CONNECTIONS TO PEOPLE AT NIH
THROUGH ASSOCIATION OF NATIVE
AMERICAN PHYSICIANS AND DEEPLY
BLESSED AND HONORED TO WORK WITH
MANY OF YOU FOR A LONG TIME AND
WE WERE ALL 7 YEARS OLD WHEN WE
STARTED.
PERFECT.
I'LL TALK ABOUT FUTURE
DIRECTIONS AND WHAT WE'RE
LOOKING ADD IN TERMS OF THE
HOLISTIC ROUTES AND LOOKED AT
THE CHALLENGES WE'RE FACING AS
AMERICAN INDIAN/ALASKAN NATIVES.
WHEN THINK OF THE FUTURE IT'S
NOT JUST THE DISPARITIES AND
WHAT ARE OUR STRENGTHS WITHIN
OUR CULTURES AND TRADITIONAL
WAYS TO PROMOTE HEALTH IN A MORE
MEANINGFUL MANNER BUT ALSO MEANS
WE HAVE TO STUDY THINGS IN A
DIFFERENT WAY AND PERHAPS A
DIFFERENT METHODOLOGY.
I'M EXCITED ABOUT THE FUTURE OF
INDIGENOUS HEALTH RESEARCH AND
THINKING ABOUT EVEN THE
CHALLENGES AN APPROACHES TO HOW
WE STUDY -- AND APPROACHES TO
HOW WE STUDY TRADITIONAL
MEDICINE AND I GREW UP WITH
MEDICINE MEN AND FAMILY HEALERS
I BEGAN INTEGRATING OUR CULTURAL
WAYS AND IF WE'RE STUDYING
TRADITIONAL MEDICINE AND SHOWING
THE EVIDENCE IT'S WORKING FOR
US, WE HAVE TO LOOK AT THE WAY
WE'RE STUDYING THINGS.
A RANDOMIZED CONTROL TRIAL
ALWAYS THE BEST METHODOLOGY?
IF WE'RE STUDYING A PILL AND
PLACEBO THAT'S FINE BUT WHAT IF
WE'RE STUDYING A CEREMONY EVEN
SOMETHING AS SIMPLE AS PRAYER.
WHAT'S A PLACEBO FOR PRAYER?
IF YOU COME UP WITH ONE LET ME
KNOW.
WE CAN'T JUST INVENT THINGS LIKE
A PLACEBO PILL WHEN WE TALK
ABOUT TRADITIONAL INTERVENTION.
WE NEED A DIFFERENT WAY OF
THINKING ABOUT OUR
METHODOLOGIES.
THERE'S A WHOLE GROWING ARENA OF
INDIGENOUS METHODOLOGIES WE'LL
TALK ABOUT BRIEFLY.
AND IDEALLY WILL INCREASE IT IN
EFFORTS AND EXCITED ABOUT THOSE
MOVING FORWARD BECAUSE WE NEED
MORE CLINICAL RESEARCH NOT JUST
DISTRICTIVE EPIDEMIOLOGY OF
DISPARITIES AND LEAD THE
CLINICAL TRIALS AND NEED MORE
CAPACITY IN INDIGENOUS LED
TRIALS AND RESEARCH.
AND I WANTED TIME TO TOUCH ON
EVERYTHING BECAUSE THERE'S SO
MANY THINGS TO TALK ABOUT AND
EACH COULD BE A DAY LONG
DISCUSSION AND I'LL BRIEFLY
TOUCH ON A FEW OF THESE.
IN ADDITION TO THE WHOLE IDEA OF
MORE Ph.D.s AND OTHERS FROM
INDIGENOUS POPULATIONS DOING THE
WORK AND CLOSE ON THE INDIGENOUS
SCHOOL OF HEALING ARTS AND
SCIENCES AND THAT MAY BE A WAY
TO OPEN FURTHER DOORS IN THIS
ARENA.
I THINK IT'S IMPORTANT TO THINK
ABOUT THE TERMINOLOGY AS WELL.
AS A RACIAL GROUP WE'RE AMERICAN
INDIAN/ALASKAN NATIVE AND WORK
WITH THE NATIONAL INSTITUTE OF A
MINORITY HEALTH AND HEALTH
DISPARITY AS A MINORITY
POPULATION AND HAVE A UNIQUE
FEDERAL STATUS AND HAVE A TRIBAL
ADVISORY COMMITTEE.
PART OF THE DISCUSSION IS BASED
ON OUR STATUS AS A MINORITY
POPULATION BUT THE WHOLE MEETING
IS REALLY BASED ON THE UNIQUE
POLITICAL STATUS.
IT'S IMPORTANT FROM A RESEARCH
PERSPECTIVE BECAUSE WHEN WE
THINK ABOUT OUR POPULATION,
OFTEN WE USE IHS DATA AS A PROXY
FOR IND AMERICAN INDIAN/ALASKAN
NATIVE BUT THERE'S OVER 9
MILLION PEOPLE WHO SELF-IDENTIFY
AS AMERICAN INDIAN/ALASKAN
NATIVE AND THE IHS USER
POPULATION IS 2 MILLION.
KEEP THAT IN MIND WHEN WE LOOK
AT THE DATA.
IHS IS A MINORITY OF AMERICAN
INDIANS AND ALASKAN NATIVES.
WE USE TERMINOLOGY
INTERCHANGEABLY.
NATIVE AMERICAN IS LEGALLY
DEFINED INCLUDING HAWAI'I AND
NATIVE SAM -- SAMOANS ARE NATIVE
AND NATIVE AMERICAN IS AN
APPROPRIATE TERM BUT IF WE'RE
THINKING ABOUT THE AMERICAN
INDIAN/ALASKAN NATIVE
POPULATIONS OR TRIBAL
POPULATIONS, I TRY TO BE
CONSISTENT WITH THE TERMINOLOGY
WE'RE USING.
MANY OF US NOW USE THE TERM
INDIGENOUS.
THAT'S REFLECTIVE OF THE
ORIGINAL INHABITANTS OF VARIOUS
PARTS OF THE GLOBE.
IN THE U.S. PART OF NORTH
AMERICA AND THERE'S INDIGENOUS
PEOPLES ALL OVER THE WORLD AND
WE SHARE A LOT OF COMMON HEALTH
OUTCOMES BASED ON COLONIZATION,
HISTORICAL TRAUMA AND
MARGINALIZATION.
WE SEE SIMILAR PATTERNS IN
DISPARITIES AND THINK WE HAVE
MUCH TO LEARN FROM EACH OTHER IN
LOOKING AT INDIGENOUS APPROACHES
TO HEALTH AND HEALING.
WE KNOW THE HISTORY.
OF COURSE THIS IS SHOWING THE
LOWER 48 STATES.
WE DIDN'T DRAW THE LINES BETWEEN
THE U.S. AND COMMAND OR THE
U.S. AND MEXICO.
THOSE LINES WERE DRAWN FOR US IN
THE COLONIZATION PROCESS.
WHEN WE THINK OF LOSS OF LAND
AND WE LOST TRADITIONAL FOODS
AND BECAME DEPENDENT ON FOOD
PROGRAMS THAT WERE NOT HEALTHY
FOR US AND WE LOOKED AT
LAND-BASED HEALING AND THE
SPIRITUAL CONNECTION TO PLACE.
CLEARLY IT'S GOING TO BE AN
INTERGENERATIONAL IMPACT IN
TERMS OF THE LOSS OF LAND AND
RESOURCES AS INDIGENOUS PEOPLES.
THERE'S COMPELLING EVIDENCE NOW
THROUGH EPIGENETICS LOOKING AT
CHANGES FROM DNA FROM EXTERNAL
STRESSORS.
TOXIC STRESS CAN CHANGE THE DNA.
I'M SURE MANY ARE FAMILIAR BUT
ONE OF THE PROCESSES THAT CAN
OCCUR IS METHYLATION.
A CARBON ATTACHES TO A
NUCLEOTIDE AND CAN HAVE AN
IMPACT ON GENE EXPRESSION.
I THINK EPIGENETICS IS PROVIDING
A SCIENTIFIC PLATFORM TO BETTER
UNDERSTAND INTERGENERATIONAL
TRAUMA AND HEALTH DISPARITIES
FROM THESE EXTERNAL STRESSORS
LIKE HISTORICAL TRAUMA.
IN ADDITION, LOSS OF OUR FOOD
SYSTEMS.
I KNOW A LOT OF US GREW UP WITH
THESE FOODS, THE CANNED BEEF AND
PORK AND SPAM-LIKE PRODUCTS NOT
SURE WHAT'S IN THERE.
WE ALL LIKE THE COMMODITY
CHEESE, BRICKS OF CHEESE BUT
MOST PEOPLE DIDN'T GROW UP WITH
THIS OUTSIDE OF OUR POPULATION
AND I'LL HIGHLIGHT THAT'S A HUGE
CONTAINER OF FOOD CORN SYRUP
THAT'S NOT AND IF YOU LOOK AT
THE LABEL THAT SAYS USE IN BABY
FORMULA, ISN'T THAT REMARKABLE?
WHEN WE THINK OF HISTORIC FOOD
POLICY ADDED TO OUR DISPARITIES
AND WHEN WE THINK OF THE
ENGINEERED FOODS AND HOW THEY'RE
NOT NATURE LIKE VEGETABLE
SHORTENING AND CORN SYRUP AND
ENRICHED FLOUR WHAT IS HAPPENING
IN TERMS OF TRADITIONAL
EPIGENETICS AND HOW IS THAT
CHANGING OUR DARN AND HOW IT'S
PASSED FROM ONE GENERATION TO
THE NEXT AND WHEN WE THINK OF
TRADITIONAL FOOD WE THINK OF
FRIED BREAD.
WE NEVER FRIED DOUGH.
THAT'S NOT A TRADITIONAL
AMERICAN INDIAN FOOD AND IT'S
BEEN ACCULTURATED AND PEOPLE
DOING THE BEST THEY COULD WITH
THEIR FOOD AND FLOUR AND
SHORTENING.
NOW WHEN I GO HOME THERE'S AN
EXPECTATION THERE'S FRIED BREAD
AND AN ALWAYS ASK WHY AND PEOPLE
SAY IT'S TRADITIONAL AND I SAID
IT'S NOT TRADITIONAL TRIBAL FOOD
BUT TRADITIONAL USDA FOOD BUT
NOT OURS AND WHAT'S THE IMPACT
ON GENERATIONS WITH THE
UNHEALTHY FOODS AND THERE'S
NUTRITIONAL FOODS AND THERE'S A
CHOKEBERRY SIMILAR TO A
BLUEBERRY AND STUDIED IT AND
LOOKED FOR CHANGES IN
INFLAMMATION AND EPIGENETICS AND
SIMPLY ADDED EX TRACT OF
CHOKEBERRY JUICE AND IT REDUCED
INFLAMMATION IN A STATISTICALLY
SIGNIFICANT MANNER AND
CHOKEBERRY ACTUALLY DEMETHYLATED
THE DNA AT THE INTERLEUKIN 6
GENE.
THIS ISN'T CELL CULTURE, THIS IS
KIND OF REMARKABLE STUFF AT THE
SUB CELLULAR LEVEL OUR
TRADITIONAL MEDICINE, FOOD IS
HAVING A MEASURABLE AND
SIGNIFICANT IMPACT THE NEXT STEP
IS TO STUDY IT IN HUMAN BEINGS.
WE HAD A GRANT COBRE THE FOR THE
INDIGENOUS TRAUMA AND RESILIENCE
RESEARCH CENTER AND TESTED IN
HUMAN BEINGS AND COLLECTED DATA
COLLECTION IN VIVO WE SAW
STATISTICALLY SIGNIFICANT
REDUCTIONS IN INFLAMMATION AND
DEMETHYLATION WITH CHOKEBERRY
JUICE.
ISN'T THAT REMARKABLE AND ONE
EXAMPLE OF MANY OF OUR FOODS
THAT CAN BE SIGNIFICANT.
AND I APPRECIATE NIH AND OUR
FORMER PROGRAM OFFICIAL DEEPLY
INVOLVED IN THE PROJECT AND
WE'RE EXCITED ABOUT SOME OF
THOSE OUTCOMES AS WE'RE MOVING
FORWARD.
ANOTHER AREA TO LOOK AT BEYOND
TRADITIONAL EPIGENETICS AND
TRAUMA IS ADVERSE CHILDHOOD
EXPERIENCES.
WE KNOW WE HAVE POORER OUTCOMES
RELATED TO ADVERSITY DURING
CHILDHOOD AND STRONG
CORRELATIONS TO MORE ADVERSE
CHILDHOOD EXPERIENCES.
ONE THING WE'RE PLEASED WITH THE
NATIONAL CENTER FOR INJURY
PREVENTION THEY REDID THE ACE
PYRAMID SO ADVERSE CHILDHOOD
EXPERIENCES ARE NOT AT THE BASE
AND NOW GENERATIONAL EMBODIMENT
AND HISTORICAL TRAUMA ARE THERE
RECOGNIZING IT CAN PUT PEOPLE AT
GREATER RISK FOR ADVERSE
EXPERIENCES AND WE SEE
DISRUPTIONS IN NEUROLOGICAL AND
SOCIAL DEVELOPMENT AND NEGATIVE
IMPACT ON HEALTH BEHAVIOR AND
ULTIMATELY EARLY DISEASE AND
EARLY MORTALITY WHICH WE'RE
SEEING REFLECTED IN THE DATA.
WHEN WE THINK OF TRADITIONAL
CHALLENGES IT REMINDS ME OF A
STORY FROM THE NORTHWESTERN
PLAINS OF THREE SISTERS WALKING
ALONG A RIVER AND SEE BABIES AND
YOUNG CHILDREN IN THE WATER
STRUGGLING IT STAY AFLOAT.
THE FIRST SISTER DECLARES IT'S
AN EMERGENCY WE NEED TO GET THE
BABIES OUT OF THE WATER.
THE SECOND SISTER THINKS ABOUT
THAT AND SAID NO, WE NEED TO
TEACH THE BABIES HOW TO SWIM SO
THEY CAN SURVIVE IN THE WATER
AND THE THIRD SISTER KEEPING
WALKING UP STREAM AND THE OTHER
SISTERS GET ANGRY AND SAID WHY
AREN'T YOU SAYING WITH US AND
THE SAID I'M SEEING WHO IS
PUTTING THE BABIES IN THE WATER
AND STOP THEM.
THAT'S ESSENTIALLY WHAT WE'RE
TALKING ABOUT IN THE STORY.
DO WE NEED EACH OF THOSE
SISTERS?
ABSOLUTELY.
WE NEED CRISIS INTERVENTION AND
NEED EMERGENCY AND ACUTE CARE.
WE ALSO NEED THE SECOND CENTER
FOCUSSING ON MANAGING DISEASES
LIKE DIABETES AND HYPERTENSION,
ETCETERA.
WE ALSO NEED THE OTHER SISTER
FOCUSSING ON PRIMARY
INTERVENTION.
WHEN WE GO UPSTREAM WE HAVE TO
INCLUDE HISTORICAL TRAUMA AND
ADVERSITY DURING CHILDHOOD AND
THOSE EVENTS UP STREAM HAVING AN
IMPACT ON OUR PEOPLE AND HEALTH.
WE HAD RESPECT FOR INDIGENOUS
KNOWLEDGE AND YOU MAY HAVE SEEN
THESE FROM GUATEMALA THE IMAGES.
THEY HAVE UNCOVERED ANCIENT
GIGANTIC CITIES IN GUATEMALA
THAT WERE CITIES AND USING NEW
TECHNOLOGIES TO USE THE RADAR TO
LOOK THROUGH THE FOLIAGE AND SEE
THE SIZE OF THOSE CITIES.
IN INDIGENOUS AMERICA THE CITIES
IN AT THAT TIME WAS THE FURTHEST
ADVANCED IN THE WORLD AT THAT
TIME IN HISTORY.
THIS IS A PICTURE OF A WILLOW
TREE.
WHAT ASPIRIN COMES FROM WILLOW
BARK?
ASPIRIN.
YES.
SO WE'VE BEEN USING WILLOW BARK
TEA AS A MEDICINE FOR YEARS
UNTIL BAYER DISCOVERED IT AND
NOW IT'S A MODERN MEDICINE.
THINK OF HOW MANY THINGS WE USE
ASPIRIN FOR AND THAT'S
TRADITIONAL AMERICAN INDIAN
MEDICINE.
I AM ASKED IF THERE'S HOSPITALS
THAT INTEGRATE THIS INTO THEIR
HEALTH CARE AND EVERY ONE.
IF YOU SUSPECT A HEART THE FIRST
THING THEY DO IS GIVE YOU WILLOW
BARK BUT IT'S NAMED SOMETHING
ELSE AND WE HAVE OUR OWN SCIENCE
THAT IS DEEPLY VALUABLE.
THE FIRST DOCUMENTED BULB
SYRINGE WAS AMERICAN INDIAN
USING A BIRD BLADDER AND BIRD
BONE BASICALLY THE SAME TYPES OF
TECHNOLOGY FOR TODAY OF CLEANING
WOUNDS AND THAT TYPE OF THING.
THE INCA POPULATION HAD EVIDENCE
OF THE FIRST BRAIN SURGERYIES W
KNOW PEOPLE SURVIVED THE SURGERY
BECAUSE THE BONE WAS HEALED.
THIS IS PROBABLY A BURR HOLE
WHICH WE USE IN AND WE HAVE TE
SAME PROCESS TO CREATE A WAY TO
RELIEF THE PRESSURE SO THE
INDIVIDUAL SURVIVES.
AMERICAN INDIANS WERE DOING THIS
THOUS ANDS OF YEARS AGO USDA IS
RECOGNIZING AGRICULTURE AND NOW
WE JUST THINK OF YELLOW SWEET
WORN AS MASS PRODUCED BUT WE
NEED TO LOOK AT THE HEALTH IMOF
INDIGENOUS CORN?
THAT'S PART OF OUR TRADITIONAL
FOOD SYSTEMS.
EVEN THE WHITE HOUSE IS NOW
COMMITTED TO ELEVATING
INDIGENOUS KNOWLEDGE IN FEDERAL
POLICY DECISIONS.
THE TIME IS PERFECT TO BE DOING
THIS WORK AND EXPAND ON IT.
WE LOOKED AT SOCIAL DETERMINES
OF HEALTH.
I WAS ON A WRITING TEAM FOR THE
FORUM ON INDIGENOUS ISSUES AND
HAVE INDIGENOUS DETERMINATES OF
HEALTH AND RECOGNIZING WHEN WE
THINK OF SOCIAL DETERMINATES OF
HEALTH WE THINK OF THE NEGATIVE
OUTCOMES AND POVERTY AND
HOMELESSNESS OR LACK OF ADEQUATE
EDUCATION AND THOSE TYPES OF
THINGS AND WE HAVE STRENGTHS IN
OUR CULTURES AN SOCIAL LIVES.
THERE'S GOOD PRELIMINARY DATA
OUT OF CANADA THAT SHOWS THINGS
LIKE LANGUAGE PRESERVATION IS
PROTECTIVE OF HEALTH AND
PARTICIPATION IN CEREMONY IS
PROTECTIVE IN HEALTH.
THESE ARE THE TYPES OF THINGS WE
SHOULD BE STUDYING AND INVESTING
UP AND WE CAN SHOW AS THEY
IMPROVE HEALTH OUTCOMES THIS IS
THE WORK WE NEED TO DO.
IT'S NOT ALL GOING TO BE DONE IN
A LABORATORY SETTING WE HAVE TO
WORK EFFECTIVELY.
THERE'S ALL KINDS OF HEALING
SYSTEM FOR AMERICAN
INDIAN/ALASKAN NATIVE AND HANDS
ON METHOLOGIES, BOTANICAL AND
MIND-BODY AND PURIFICATION
INTERVENTIONS AND THERE'S WORK
DONE FOR GENERATIONS.
MANY OF OUR COMMUNITIES HAVE
HELD ON TO THESE TRADITIONAL
CULTURAL PRACTICES AND THERE'S
REAL STRENGTH AND HISTORICALLY
30 YEARS AGO WHEN I WAS STARTING
TO DO THIS WORK THERE WHETHER OR
NOT MANY OF US AND NOW THERE'S
SO MANY WELL EDUCATED INDIGENOUS
PEOPLE WE WOULD BE LEADING THESE
TYPES OF STUDIES AND I REALLY
BELIEVE THE HEALTH OF FUTURE
GENERATIONS DEPENDS ON OUR
ABILITY TO INTEGRATE CULTURALLY
BASED INTERVENTIONS NOT JUST THE
TYPICAL INTERVENTIONS IN OTHER
POPULATIONS.
WE CAN INCORPORATE CULTURAL
PERSPECTIVES INTO OUR RESEARCH
DESIGN.
THERE'S SEVERAL BOOKS.
IF YOU'RE INTERESTED IN AN Ph.D.
IN INDIGENOUS HEALTH WE HAVE IT
AT UNIVERSITY OF SOUTH DAKOTA
AND THESE THE RESOURCES WE USE.
INDIGENOUS METHODOLOGIES AND
CEREMONY AND DECOLONIZING AND
THERE'S WONDERFUL SCHOLARSHIP
OUT THERE NOW.
IT'S THE BLEND OF WESTERN
RESEARCH KNOWLEDGE METHODS WITH
INDIGENOUS METHODS AND IT'S A
VEN DIAGRAM AND AT THE CROSSOVER
THERE'S OPPORTUNITIES TO CONDUCT
MEANINGFUL RESEARCH AND IT HAS
AN IMPACT THAT IS MEANINGFUL.
WE TRIED TO CREATE CONDITIONS IN
WHICH THERE IS NO IMPACT BETWEEN
THE RESEARCHER AND SUBJECT.
WE KNOW THAT'S NOT TRUE.
THERE'S AN IMPACT.
BUT IT CAN BE ACCOUNTED OR AND
PART OF THE MEASUREMENT PROCESS.
WE HAVE AN IMPACT ON THE
PATIENTS OR THE SUBJECTS WHEN
WE'RE CONDUCTING RESEARCH IN THE
COMMUNITY.
WE'RE NEVER GOING TO REPLICATE A
STERILE LAB IN A COMMUNITY.
WE NEED DIFFERENT
COMMUNITY-BASED METHODOLOGY TO
UNDERSTAND THESE THINGS.
WE HAVE A MORE HOLISTIC PROSPECT
ON HEALTH.
ANOTHER WORD FOR DOCTOR IS
PHYSICIAN.
WE'RE SAYING UP FRONT WE DEAL IN
THE PHYSICAL ARENA THEY HAVE THE
SAME LATIN ROOT MEANING
SCIENCES.
WE ALSO KNOW THERE'S A MENTAL TO
HEALTH AND WHEN WE THINK OF
INTERRATIONAL PUBLIC HEALTH AND
THERE'S AN IMPACT ON OVER ALL
WELL BEING.
WE CAN'T FORCE UNDERSTANDING OF
ARENAS TO FIT INTO A PHYSICAL
MOLE AND HAVE TO BE MORE
HOLISTIC.
IT'S A BIG CHALLENGE.
WHAT I SEE IS WE'RE TRYING TO
FORCE HOLISTIC PRINCIPLES INTO A
PHYSICAL MODEL AND CAN'T ALWAYS
WORK EFFECTIVELY.
WE HAVE TO BE MORE INDIGENOUS
AND HOLISTIC ABOUT
METHODOLOGIES.
WE'RE TRYING TO RECRUIT MORE
PEOPLE INTO CLINICAL TRIALS AND
DID A CIRCLE OF TRUST MODEL.
WE'RE LOOKING AT THE COMMUNITY
AS HAVING A ROLE IN THIS AND THE
RESEARCH AND CLINICAL TRIALS ARE
BEING LED BY INDIGENOUS
ACADEMICS AND RESEARCHERS.
WE HAVE THE WORLD'S FIRST
DOCTORATE IN INDIGENOUS WITH
SPECIALIZATION AND IN PROCESS OF
GETTING THAT DEVELOPED.
AND WE HAVE MORE IN THE ACADEMIC
YEAR AND FALL OF 2025 WE'LL HAVE
THE OFFICIAL ROLL OUT AND WE
HAVE A Ph.D. IN INDIGENOUS
HEALTH AND LOOKING AT WE HAVE AT
INDIGENOUS PUBLIC HEALTH THROUGH
A PUBLIC HEALTH LENS AND THERE'S
OVERLAP IN THE PRINCIPLES.
AND WE'LL ROLL OUT AN MPH AT
JOHNS HOPKINS.
I WANT TO APPRECIATE NIDA.
THERE'S THE CLINICAL TRIALS
NETWORK.
I'M THE P.I. FOR WHAT'S CALLED
THE GREAT PLAINS INITIATIVE
WITHIN THE OHIO NODE OF THE
CLINICAL TRIALS NETWORK.
IT'S A RELATIVELY SIMPLE
PROJECT.
WE'RE DEVELOP COMMUNITY-DRIVEN
RESEARCH AGENDA THROUGH
QUALITATIVE METHODS AND DOING
INTERVIEWS AND FOCUS GROUPS.
AND WE NEED TO ASK THE COMMUNITY
WHAT ARE THEIR RESEARCH QUESTION
OR PRIORITIES OR HYPOTHESES.
THIS HAS LED TO MEANINGFUL
DISCUSSIONS.
ONE OF OUR PARTNERS THAT'S AN
OPIOID TREATMENT RECOVERY
PROGRAM FOR ALL ADDICTION AND
INCORPORATED CEREMONY IN THEIR
PROGRAM THERE'S SIX CEREMONIES
IN 12 WEEKS.
THEY COINED A NEW TERM,
MEDICATED ASSISTED TREATMENT AND
HAVE C.A.T., CEREMONY ASSISTED
TREATMENT AND THE DATA IS
COMPELLING AND THEY WANT TO
STUDY THIS.
THAT'S THE ARENA IN WHICH WE CAN
MAKE MEANINGFUL IMPACT.
WE ESTABLISHED INDIGENOUS HEALTH
AND LOOKING AT INDIGENOUS
MEDICINE AS CLINICAL SCIENCE AND
ULTIMATELY AND I'LL CLOSE WITH
IN THE DISCUSSION IS THE NEED
FOR AN INDIGENOUS SCHOOL OF
HEALING ARTS AND SCIENTISTS.
AN INDIGENOUS MEDICAL SCHOOL.
THERE'S A MODEL FOR THIS.
THERE'S 105 HISTORICALLY BLACK
COLLEGES AND UNIVERSITIES IN THE
COUNTRY.
THEY HAVE FIVE MEDICAL SCHOOLS
IN THEIR NETWORK, FIVE IN THE
HBCU SYSTEM.
THIS IS A MAP OF THE TRIBAL
COLLEGES AND UNIVERSITIES AND
THIS IS A MAP OF THE TRIBAL
MEDICAL SCHOOLS.
IT'S A BLANK, THERE IS NONE.
WE CAN FIX THIS IF WE CHOOSE TO.
IF WE WANT TO THINK BIG AND HAVE
OUR OWN MEDICAL SCHOOL AND
SCHOOL OF HEALING ARTS AND
SCIENCES WE COULD BE THE LEADERS
IN DOING THIS TYPE OF RESEARCH
BECAUSE WE CAN DEVELOP IT
OURSELVES AND THE RIGHT WAY.
IN MY OWN EXPERIENCE IN AND WE
NEED TO FIX AND BUILD OUR OWN
SYSTEM.
WE PROPOSE AN INDIGENOUS SCHOOL
AND MULTIPLE DISFLIPSS -- DISDI
DISCIPLINES AND NURSES AND WE A
MEDICAL SCHOOL WITH MEDICINE MEN
AND WOMEN ON FACULTY TEACHING
OUR STUDENTS.
WE CAN DECOLONIZE THE CURRICULUM
AND I ASKED IN MEDICAL SCHOOL,
WHAT IS MAGICAL ABOUT FOUR
YEARS?
OUR POTENTIAL STUDENTS GREW UP
IN UNDER RESOURCED POPULATIONS.
THEY MAY NOT HAVE HAD ACCESS TO
LABORATORY SETTINGS IN HIGH
SCHOOLS.
THINGS OTHER POPULATIONS MAY
TAKE FOR GRANTED.
WE HAVE LAND-BASED HEALING
PRINCIPLES.
AS INDIGENOUS PEOPLES OUR
POPULATIONS HAVE BEEN HERE FOR
1,000 GENERATIONS WHEN THE LAND
IS THE DUST OF OUR ANCESTORS.
THE BUILDING BLOCKS OF FUTURE
GENERATIONS AND IT MEANS
SOMETHING TO US.
WE SHOULD BE PROMOTING WELLNESS
NOT JUST TREATING DISEASE.
HERE'S A RADICAL THOUGHT, WHAT
IF MEDICAL SCHOOL WAS ACTUALLY A
HEALING EXPERIENCE INSTEAD OF
TRAUMATIC EXPERIENCE?
ISN'T THAT RADICAL?
WE ACTUALLY WANT HEALING IN OUR
FUTURE HEALERS INSTEAD OF
TRAUMATIZING THEM?
AND WHAT WE DO DOESN'T MAKE ANY
SENSE.
THERE'S REASONS FOR THIS.
HOW MANY MEDICAL SCHOOL
CURRENTLY HAVE AN AMERICAN
INDIAN DEAN?
ZERO.
THE DECISION MAKING TABLES
AROUND CURRICULUM DEVELOPMENT
AND PRIORITIES ARE ZERO.
WE CAN WAIT FOR THE CURRENT
SYSTEM TO FIX IT OR DO IT
OURSELVES.
I'VE BEEN DOING WORK ON THIS IN
PRELIMINARY DISCUSSIONS AND
THINKING ABOUT LOCATIONS, IT HAS
TO BE A BIG ENOUGH CITY TO
SUPPORT MEDICAL INFORMATION.
THERE'S ALWAYS PUSHBACK WHEN
THERE'S A NEW MEDICAL SCHOOL
BECAUSE OF COMPETITION FOR
CLINICAL TRAINING SITES AND
SIGNIFICANT NUMBER OF AMERICAN
INDIAN/ALASKAN NATIVE AND THINK
OF SOME SITES, FLAG STAFF,
ARIZONA, SANTE FE, NATURAL AND
ANCHORAGE, ALASKA AND OTHERS.
COULD BE MORE THAN ONE SITE.
WHEN I THINK OF THE FUTURE OF
INDIGENOUS HEALTH WE CAN'T
UNCOUPLE THAT FROM THE FUTURE OF
INDIGENOUS MEDICINE AND THE
FUTURE OF INDIGENOUS HEALING
SYSTEMS AND THE FUTURE OF
INDIGENOUS HEALTH EDUCATION AND
IF WE WANT TO DO THIS IN A
HOLISTIC WAY AND IN AN
INDIGENOUS WAY WE HAVE TO LOOK
AT THE WHOLE PICTURE.
THAT'S A PICTURE OF THE NEW NOW
TRIBALLY MANAGED.
THAT LOOKS LIKE A BEAUTIFUL
MEDICAL SCHOOL TO ME AND LOOKS
LIKE A GREAT OPPORTUNITY.
WE'RE DOING SOME INITIAL
STRATEGY PLANNING AND HAVING
THOSE DISCUSSIONS NOW BUT IN THE
INTEREST OF TIME I'LL END IT
WITH ONE LAST QUOTE FROM A
TRADITIONAL HEALER FROM THE LATE
1800s.
WE DIDN'T HAVE A WRITTEN
LANGUAGE HISTORICALLY AND MET
WITH A WRITER AND THEY PUBLISHED
A BOOK CALLED BL BLACK ELK SPEA.
THIS IS HIS QUOTE.
OF COURSE IT IS NOT I WHO CURE.
IT WAS THE POWER FROM THE OUTER
WORLD AND THE VISIONS AND
CEREMONIES HAD ONLY MADE WE LIKE
A HOLE THROUGH WHICH THE POWER
COULD COME TO THE TWO-LEGGEDS.
IF I THOUGHT THAT I WAS DOING IT
MYSELF THE HOLE WOULD CLOSE UP
AND NO POWER COULD COME THROUGH.
I WAS UNFORTUNATE I WENT TO
STANFORD FOR MEDICAL SCHOOL BUT
HUMILITY WAS NOT THE CORE, I
KNOW IT'S A SHOCK BUT THAT'S THE
WAY IT IS.
WHEN PEOPLE LOSE THEIR HUMILITY
IN MEDICINE THEY LOSE THEIR
ABILITY TO BE HEALERS AND WHEN
THEY LOSE THEIR HUMILITY IN
TEACHING THEY LOSE THEIR ABILITY
TO REACH.
I'D SAY IT'S ALSO TRUE IN
RESEARCH.
WE HAVE TO BE HUMBLE ENOUGH TO
LEARN NEW THINGS AND TO
RECOGNIZE THERE MAY BE OTHER
WAYS OF DOING THIS WORK THAT
WOULD BE MORE EFFECTIVE FOR OUR
POPULATIONS.
I TRY TO REMEMBER THAT IN MY
DAILY PRACTICE AND HOPE YOU WILL
DO AND I'LL END IT THERE.
THANK YOU ALL, VERY MUCH.
NOT SURE IF YOU WANT ME TO TAKE
QUESTION OR COMMENTS BECAUSE I
KNOW WE'RE OVER A LITTLE BIT.
>>I DON'T HAVE A QUESTION BUT I
HAVE TO SAY, BRAVO.
I APPRECIATE ALL THE WORK YOU'RE
DOING AND EXCITED TO SEE WHERE
YOU GO AND HOW THIS DEVELOPS.
I'M ALREADY THINKING I WHO I CAN
REFER.
>>SOUNDS WONDERFUL, THANK YOU.
S.
>>DR. WARNE: WE HAVE A GREAT
COLLABORATING INSTITUTION ON THE
WORK IN JOHNS HOPKINS.
I KNOW WE'RE OVER TIME SO --
>>I DO APPRECIATE YOUR
PRESENTATION AND I THINK IT
WAS -- I THINK IT'S A BREATH OF
FRESH AIR TO HEAR EVERYTHING YOU
HAVE TO SAY.
I LOOK FORWARD TO CONTINUING TO
HEAR MORE GOOD THINGS THAT
YOU'RE WORKING ON AND THAT YOU
CONTINUE TO MENTOR SO MANY OF
OUR TRIBAL CITIZENS AND OUR
FUTURE PEOPLE THAT ARE WORKING
ON RESEARCH AND PEOPLE THAT ARE
DOING GREAT THINGS.
SO YOU HAVE DONE SO MANY
WONDERFUL THINGS AND TO KNOW
THAT PEOPLE ARE FOLLOWING IN
YOUR FOOTSTEPS IS GREAT.
THANK YOU.
I APPRECIATE EVERYTHING YOU'RE
DOING.
>>THANK YOU VERY MUCH.
I APPRECIATE IT.
>>KARINA: THANK YOU, DR. WARNE.
>>HERMINIA: OKAY.
SO WE'RE GOING TO GO ON AND LET
ME CHECK MY AGENDA TO SEE WHERE
I AM.
SO NEXT ON THE AGENDA WE HAVE A
CHARTER REVIEW AND VOTE AND WE
TALKED ABOUT THIS WITH THE TEC
SO WE'RE GOING TO TABLE THIS FOR
THE NEXT TEC MEETING.
CAN I GET CENSUS FROM THE TEC
AND MOVE ON TO THE ELECTION OF
THE TAC CHAIR AND CO-CHAIR.
WE TALKED ABOUT THIS YESTERDAY
IN THE TAC CAUCUS.
SO WITH THE TAC -- DO WE HAVE A
QUORUM?
ALL RIGHT.
DO WE WANT TO MOVE FORWARD ON
ELECTIONS FOR THE CHAIR AND
SELECTION OF A CO-CHAIR?
DO WE HAVE ANY NOMINATIONS?
>>STEVEN: I'LL NOMINATE YOU FOR
CHAIR.
>>I SECOND THE NOMINATION.
>>HERMINIA: OKAY.
I WILL ACCEPT THE NOMINATION FOR
CHAIR.
ALL RIGHT, WELL I'LL CALL FOR A
VOTE.
ANY DISCUSSION BEFORE WE VOTE?
ALL RIGHT, ROLL CALL FOR A VOTE.
KENDRA, DO YOU MIND DOING THE
ROLL CALL FOR THE VOTE?
>>YES.
>>HERMINIA: I'LL AB TAIN.
-- ABSTAIN.
>>YES.
>>.
YES.
>>HERMINIA: SO MOTION CARRIES
AND THANK YOU EVERYONE FOR THE
NOMINATION AND FOR YOUR
CONFIDENCE IN MY LEADERSHIP.
I APPRECIATE IT.
THANK YOU.
AND WE'LL MOVE ON FOR CO-CHAIR.
DO WE HAVE ANY NOMINATIONS FOR
CO-CHAIR?
ANY INTEREST FOR CO-CHAIR?
OKAY.
I'LL BE HAPPY TO NOMINATE DEBBIE
DANFORTH FOR CO-CHAIR.
>>YOU HAVE TO BE AN ELECTED
OFFICIAL TO BE A CO-CHAIR.
>>HERMINIA: OH.
OKAY.
WE DID GO OVER THAT THE LAST
TIME.
ARE YOU INTERESTED IN SERVING AS
CO-CHAIR?
>>DEBBIE: IF IT HAS TO BE AN
ELECTED OFFICIAL.
>>HERMINIA: I NOMINATE.
WE'LL DO ROLL CALL SECONDED BY
STEVEN.
>>ABSTAIN.
>>YES.
>>ABSTAIN.
>>YES.
>>SORRY, MOTION CARRIES.
THANK YOU EVERYONE FOR THE VOTE
AND CONGRATULATIONS AND THANK
YOU FOR STEPPING UP IN THE ROLE.
I APPRECIATE THAT.
THANK YOU FOR HELPING BECAUSE
IT'S BEEN HARD NOT HAVING A
CO-CHAIR FOR THE LAST FEW
MONTHS.
I REALLY DO APPRECIATE THAT.
AND OKAY, WE'LL MOVE ON TO THE
NEXT ITEM ON THE AGENDA THE NEXT
STEPS AND DISCUSSION.
WE'LL TURN IT OVER TO
DR. WALTERS.
>>GREAT.
THANK YOU.
CONGRATULATIONS MADAME CHAIR AND
CO-CHAIR.
WE WANTED TO LEAVE A LITTLE BIT
OF TIME TO TALK A LITTLE BIT
ABOUT NEXT STEPS FOR TAC
PRIORITIES AND DEVELOPING A
STRATEGY PLAN AND A RECOGNIZE A
HALF HOUR WON'T DO IT JUSTICE
BUT WANTED TO TURN TO YOU TO SEE
HOW WE CAN START THAT
CONVERSATION AND MY SUGGESTION
WOULD BE ALSO WE SET UP A
DIFFERENT TIME A WORKING TIME
FOR A GOOD HOUR AND A HALF MAYBE
TO REALLY DIVE IN AND DIVE DEEP
BASED ON DISCIPLINARY
DISCUSSION.
BEFORE WE MOVE FORWARD WITH
THAT, ONE PRIORITY IS TO GET
MORE MEMBERS ON BOARD OF THE TAC
AS WELL AND WE'RE WORKING ON
THAT RIGHT NOW.
WE'RE SOLICITING SOLE
NOMINATIONS FROM A COUPLE AREAS,
NAVAJO AND OKLAHOMA IS COMING
THROUGH WITH POTENTIAL PERSON
AND WHAT OTHER AREAS DO WE HAVE
REMAINING?
ALASKA?
>>CALIFORNIA.
>>ALBUQUERQUE.
>>MM-HMM.
>>PHOENIX.
>>BILLINGS.
>>BILLINGS AND NARCH MEMBERS.
>>THAT'S CORRECT.
>>KARINA: I'M ASKING, BEGGING,
I DON'T KNOW, IF YOU HAVE PEOPLE
YOU KNOW, COLLEAGUES, WE'VE BEEN
DOING OUTREACH OURSELVES AND
TALKING TO PEOPLE BUT WE WOULD
REALLY ENCOURAGE --
>>HERMINIA: ONE OF THE THINGS I
WANTED TO ASK ABOUT WAS FOR THE
MEMBER AT LARGE IF THERE WERE
DIFFERENT ELIGIBILITY.
>>BRITTANY: I THINK IT WOULD BE
GOOD FOR URBAN REPRESENTATION
BUT OF COURSE IT'S COMPLICATED
BECAUSE OF THE NEED TO BE A
TRIBAL REPRESENTATIVE OR
APPOINTED BY DELEGATE FROM A
TRIBAL COMMUNITY.
IS THAT SOMETHING WE CAN --
>>IF
>>KARINA: IF THEY'RE AN
EMPLOYEE THERE ARE TRIBES IN
URBAN AREAS SO THAT'S SOMETHING
TO KEEP IN MIND AND CONSIDER.
WE HAVE A CALIFORNIA DELEGATE
AND THAT'S AN EXAMPLE OF
ENCOURAGING A TRIBAL GROUP TO
PUT FORTH A DELEGATE THAT'S IN
AN URBAN AREA POTENTIALLY BUT
YOU STILL HAVE TO BE AN EMPLOYEE
OR TRIBAL LEADER.
>>STEPHEN: IT SAYS YOU CAN AN
APPOINTED TRIBAL LEADER.
SO A TRIBAL LEADER CHAIR OF AN
INDIAN TRIBE CAN APPOINT AN
URBAN DELEGATE IF THEY WANTED
TO.
>>KARINA: THAT'S A GREAT
QUESTION.
WE CAN PUT THAT FORWARD TO OUR
OFFICE OF GENERAL COUNSEL.
MY UNDERSTANDING IS I THINK
THEY'RE HONORING THE TRIBAL
SOVEREIGNTY OF HOW PEOPLE SELECT
LEADERS OPPOSED TO A SITUATION
WHERE THE CHIEF DELEGATES AN
EMPLOYEE BUT I APPRECIATE
REPRESENTATIVE JOCK YOUR POINT
ON URBAN REPRESENTATION AS WELL.
>>STEPHEN: WHAT I WILL SAY IS
IN WASHINGTON STATE WE HAVE A
GROUP AND I'M THE CHAIR OF 29
TRIBES AND TWO IN URBAN
PROGRAMS.
ALSO, TWO CENTERS AND THEY
AREN'T OFFICIALLY IN URBAN
PROGRAMS BUT THEY DO THEIR
CENTERS WORK WITH THEM AND THEY
WORK WITH US ON HEALTH ISSUES
AND SO IT'S REALLY IMPORTANT FOR
ALL OF US TO STAY ENGAGED WITH
THE INDIAN PEOPLE UNDER
REPRESENTED.
WE HEARD THREE OUT OF 9 MILLION
MAYBE.
>>KARINA: I HAVE FULL
APPRECIATION, BORN AND RAISED IN
AN URBAN AREA I RECOGNIZE THAT
FOR SURE BUT WE'D BE HAPPY TO
CHECK ON THE NOTIFICATION OF
THAT.
IN TERM OF THE STRATEGY PLAN
IT'S BETWEEN NOW AND DECEMBER
WE'RE HOPING TO GET A DRAFT
INITIAL PLAN AND OUTLINE GOING.
IT WILL PROVIDE CONSULTATION
FROM THE TAC AND THAT'S WHAT WAS
DONE PREVIOUSLY.
>>STEPHEN: WE HAD A DISCUSSION
IN OUR CAUCUS AND IT WOULD BE
HELPFUL TO KNOW HOW THE STRATEGY
PLAN WAS IMPLEMENTED WITH NIH,
WHAT AFFECT DID IT HAVE.
WHAT WAS BROUGHT INTO PRACTICE
SO WE CAN UNDERSTAND.
AND I DON'T KNOW ANY WERE
MEASURABLE BUT WOULD BE HELPFUL
TO UNDERSTAND HOW DID THE
STRATEGY PLAN AFFECT NIH BEFORE
WE START ON ANOTHER.
>>KARINA: ABSOLUTELY.
ONE THING WE'RE HOPING TO DO IS
TO GET A VERY GOOD PORTFOLIO
ANALYSIS GOING SOME ARE
CONTRIBUTED TO THRO AND SOME
WERE FOR NATIVE DEVELOPMENT.
WE'LL BE SURE TO DOCUMENT ALL OF
THAT AND BUILDING INITIATIVES
AND WORKFORCE DEVELOPMENT.
-- I HAVE THE SAME QUESTIONS.
I'VE BEEN HERE THREE MONTHS AND
I NEED TO KNOW WHERE ARE WE AND
WHERE THE BASELINE IS AND WHERE
WE'VE BEEN SUCCESSFUL AND
ANOTHER THING THAT WON'T BE DONE
IN SIX MONTHS BUT FOR THE
10-YEAR ANNIVERSARY OF THRO IS
TO HAVE A 10-YEAR REVIEW OF
WHAT'S HAPPENED FOR OVER 10
YEARS.
AGAIN, WITH THE IDEA WHERE DO WE
GO FROM HERE AND HOW TO LAUNCH
STRONGER IN THE FUTURE.
>>SO IT'S PROBABLY AN UNFAIR
REQUEST REALLY ALMOST TO ASK YOU
SINCE YOU HAVEN'T BEEN HERE THAT
LONG BUT I THINK YOU TO THE
INSTITUTES AND ASK THEM HOW DID
THEY IMPLEMENT PARTS OF THE
STRATEGIC PLAN OR NOT.
THAT'S ALWAYS BEEN OURS OUR
GOAL.
>>KARINA: I'LL BE DOING TOURS.
>>STEPHEN: THEY DIDN'T READ IT.
>>KARINA: SOME HAVE DONE WELL
AND SOME HAVE MISSED SOME
OPPORTUNITIES SO WE HOPE TO
FOCUS ON THAT.
>>HERMINIA: I THINK ONE OF THE
THINGS WE HAD TALKED ABOUT IN
OUR CAUCUS IS WHAT WOULD BE
HELPFUL FOR US AS A TAC WORKING
WITH YOU IS HAVING A WORKING
SESSION AND WHAT WOULD BE REALLY
BENEFICIAL IS HAVING AN ONSITE
WORKING SESSION.
THE ZOOM IS VERY DIFFICULT TO
REALLY JUST GET TO WORK.
IT TOOK US A LONG TIME TO GET
OUR PRIORITIES ORGANIZED AND PUT
TOGETHER AND LOOKING AT THE
STRATEGIC PLAN TO HAVE THAT
SESSION WHERE WE CAN HAVE
DIALOGUE AND WE JUST STARTED
THREE MONTHS AGO AND IT TOOK A
LONG TIME TO EVEN SET UP THIS
MEETING AND WE WANT TO CONTINUE
THIS MOMENTUM AND WANT TO BE
ABLE TO SIT DOWN WITH YOU AND
YOUR TEAM AND BE ABLE TO SAY,
HEY, LET'S HAVE THIS DIALOGUE
AND LET'S REALLY CALENDAR OUT
HOW WE WANT TO DO THE NEXT YEAR.
ONE THING WE DIDN'T GET TO DO AT
THE MEETING WE HAD TALKED ABOUT
IS THE CALENDAR FOR THE NEXT
YEAR, HOW WE WANT TO SEE OUR
PEOPLE DIFFERENT CENTERS AND
INSTITUTE COME AND PRESENT WHEN
WE DO OUR ZOOM SESSIONS AND WE
HAD CHANGED OUR AGENDA FROM LAST
YEAR WHEN WE PRESENT EVERY
SINGLE MONTH TO EVERY OTHER
MONTH AND CHANGE IT TO EVERY
OTHER MONTH.
THERE HAVE BEEN CHANGES BUT WE
HAVEN'T REALLY BEEN ABLE TO SEE
THE DIFFERENCE BECAUSE THERE'S
CHANGES HERE TOO.
SO WE NEED THAT SESSION WHERE WE
CAN SIT DOWN WITH YOU AND LOOK
AT WHAT YOU PRESENTED YESTERDAY
AND WHAT WE HAVE WITH OUR
STRATEGIC PLAN AND THEN ROLL OUT
THIS CALENDAR SO THAT NIH KNOWS
WHO WE WANT TO PUT ON OUR
CALENDAR FOR THE NEXT YEAR ON
OUR ZOOM SESSIONS.
WE THE WE'RE GOING TO BE MEETING
IN ADVANCE.
THAT'S BEEN AN ISSUE FOR US.
IT'S BEEN AN ISSUE OF THE
CALENDAR IN BECAUSE YOU NEEDED
THE BEST NOTICE WHO WE WANT TO
SEE.
WE NEEDED ADVANCE NOTICE SO WE
HAVE ALL THE INFORMATION SO WE
CAN READ UP ABOUT THE STUDIES
AND WHAT'S HAPPENING.
WE KNOW WE ARE PREPARED WITH OUR
QUESTIONS AND WE'RE READY FOR
THOSE MEETINGS AND THAT'S BEEN
LIKE ONE OF THE THINGS THAT'S
BEEN A CHALLENGE MONTH TO MONTH
LIKE WHO ARE WE GOING TO MEET
WITH AND THE STAFF WAS TRYING TO
GET THOSE PEOPLE.
WE REALLY WANT TO MAKE SURE TO
CALENDAR OUT AND PRIORITIZE NOW
THAT WE HAVE THAT FOR PEOPLE WE
WANT TO HAVE AT THE ZOOM
SESSIONS.
WHAT INSTITUTES, WHAT WOULD BE
THE BEST FOR US WE DIDN'T GET TO
DO THAT AT THE SESSION.
ONE DAY WORKING SESSION WOULD BE
HELPFUL.
EVEN A HYBRID OF SOME SORT LIKE
THIS WOULD BE HELP FFUL HELPFUL.
WOULD ANYBODY ELSE LIKE TO
COMMENT?
>>VERY HELPFUL.
IT MAKE SENSE TO THINK OF TO AN
EVERY OTHER MONTH AND WHO IS
DESIGNING FOR WHICH MONTH WE CAN
ORGANIZE THAT.
IT'S NOT LIKE YOU'RE WANTING A
ONE-DAY WORKING SESSION PERHAPS
IN PERSON SOMETIMES SOON TO
START.
IS THAT IT?
ALL RIGHT.
THANK YOU.
IN THE MEANTIME SOME HOME WORK
I'LL BE DOING IS STARTING A
LISTEN TOUR WITH OUR I.C.
DIRECTORS UNTIL WE CAN GET IT
CALENDARED FOR THE 12 TO 16
MONTHS OUT KNOW I'M STARTING THE
PROCESS.
AND I WAS IN ALASKA AND MET WITH
FOLKS.
WE'RE STARTING TO DO SOME OF
THIS AND WE'LL BE ACCELERATING
THAT AS WELL.
GATHERING NOTES AND I'LL LOOK AT
THE STRATEGIC PRIORITIES I'VE
LAID OUT.
WHAT I'M HOPING TO DO IS
PROBABLY IN PREPARATION FOR OUR
WORKING MEETING IS TO BEGIN TO
THINK ABOUT BASED ON THE
LISTENING TOURS AND BASED ON
SOME OF THE LITERATURE AND
LOOKING AT THE ISSUES AND THE
STRATEGIC PLANNING FOR
LEADERSHIP AND ENGAGEMENT AND
TRIBAL CONSULTATION ENGAGEMENT.
WHERE SOME OF THESE MAY GO AND
DON'T GO AND SUBSTANTIVE AREAS
IDENTIFIED YOU WANT US TO THINK
ABOUT AND I'M GOING TO THE
TRIBAL OPIOID SUMMIT AND
LISTENING TO THE ISSUES FOR
SUBSTANCE ISSUES AND WHAT
RESEARCH NEEDS TO BE HAPPENING
AND THINKING ABOUT THAT.
AND ALSO ADDRESSING ISSUES
AROUND TRYING TO CREATE MORE
TRANS-NIH APPROACHES TO SOME
POLICIES AND GUIDELINES WITH
RESPECT TO DATA MANAGEMENT AND
SHARING AND GENOMIC AND BIO
SPECIMEN DATA AND INSTEAD OF
TROUBLE SHOOTING AT EACH I.C.
IT'S BETTER TO HAVE LARGER
POLICIES.
WE STARTED SOME OF THE WORK IN
THE AREA OF DATA SHARING BUT
THERE'S MORE WORK TO BE DONE AND
SO .
>>SINCE OUR SCOPE IS TO ALSO
LOOK AT POLICIES, PROCEDURES AND
IDENTIFY OPPORTUNITIES FOR
INCREASING EQUITY AND ACCESS FOR
INDIGENOUS HEALTH RESEARCH WOULD
BE TO FOCUS ON POLICIES.
HAVING A BALANCE BETWEEN LOOKING
AT INDIVIDUAL STUDIES AND SAYING
SOME OF THESE EXAMPLES OF
AMAZING RESEARCH THEN ALSO
LOOKING AT SOME OF THE EXISTING
POLICIES.
LIKE I WOULD BE INTERESTED -- I
KNOW THERE IS -- THERE ARE
POLICIES ALREADY ON THE BOOKS
BUT HAVING A PRESENTATION ON
THOSE EXISTING POLICIES AND MORE
OF A DISCUSSION IDENTIFYING
OPPORTUNITIES WOULD BE
INTERESTING TO THINK OF EXAMPLES
BECAUSE THERE'S ALWAYS SUCH
DIVERSITY THAT NEEDS TO BE
FIGURED OUT LIKE THIS POLICY
NEEDS TO BE THIS WAY BECAUSE
THIS STUDY IS DOING THINGS THIS
WAY AND THIS STUDY HAS TO DO IT
THIS WAY AND WE NEED TO
ACCOMMODATE.
IT WOULD BE NICE TO HAVE A
LITTLE BIT OF THE CASE STUDIES
OF INDIVIDUALS AND THERE'S AN
EXAMPLE OF THE RAW NIH POLICY
AND WAYS TO SUPPORT YOUR WORK
>>WE'LL BE HAPPY TO BRING THAT
BACK.
>>I MENTIONED IN CAUCUS AND I
TALKED TO DR. WARNE EARLIER
TODAY, I FIRST MET HIM AT A
MEETING.
THAT'S THE WAY WE CONNECT UP
RESEARCH AND I WAS THINKING IT
MIGHT BE HELPFUL TO SEND A
REPRESENTATIVE TO THAT TO HAVE
DISCUSSIONS WITH THEM ON WHAT'S
GOING ON AND DIFFICULT AND WHAT
THE PERSPECTIVE IS THE ABILITY
TO ENGAGE NIH IN RESEARCH
OPPORTUNITIES.
>>I DON'T KNOW IF THEY'RE STILL
HAVING MEETINGS.
>>KARINA: WE'LL LOOK TO GO TO
RESEARCH MEETINGS.
THAT'S A GREAT SUGGESTION.
ANOTHER OPTION FOR US TO
CONSIDER IS SUPPORT A CONFERENCE
HERE AND SHARE ALL THE RESEARCH
CURRENTLY BEING DONE.
WE'RE GOING TO DO THAT A NUMBER
OF YEARS AGO WITH A PROGRAM WITH
OVER 50 SUCCESSFUL GRANTS AND WE
SAW A NUMBER TO WHAT FEELS LIKE
THREE DAYS AGO, THERE'S AN
OPPORTUNITY TO THINK ABOUT DOING
SOMETHING LIKE THAT AS WELL.
WRING BRING -- BRINGING PEOPLE
IN AND SHARING RECOMMENDATIONS.
WE TALKED ABOUT INCREASING
OPPORTUNITIES FOR DISSEMINATION
AND THERE'S OPPORTUNITIES THAT
WE COULD TAKE ADVANTAGE OF
PROVIDING LINKS TO THE WEBSITE.
AND ONE THING I GOT FROM THE
RESEARCHERS WASN'T SO MUCH
HAVING THEM TALK ABOUT THE
RESULTS BUT HAVING TO TALK ABOUT
THE PROCESSES AND THE WAYS TO
ENGAGE WITH THE COMMUNITIES THAT
WERE SO INSPIRING.
SO SHOWCASING THOSE TYPE OF
STORIES, I THINK WOULD REALLY
ENCOURAGE OTHER COMMUNITIES TO
DO SOME MORE THINGS.
A RESEARCH REPORT WENT OUT THAT
WAS NOTHING LIKE WE HEARD FROM
THEM BUT THE REPORT TO NIH ON
THE TOPIC WAS NOT EXACTLY THAT.
TO ME THAT WAS INSPIRING TO ME
AND A LOT OF PEOPLE.
THEY HAVE A PRESENTATION IN THE
RESULTS OF OUR RESEARCH AND ALL
THIS KINDS OF STUFF.
IT WILL ENCOURAGE OTHER
COMMUNITIES TO DO THINGS LIKE
THIS.
>>THERE'S WAYS TO SHARE
INFORMATION THIS IS AN EXAMPLE
ALSO OF DIFFERENT RESULTS.
WE WERE SHARING THE METHODS AND
THE METHODOLOGICAL APPROACHES
ROOTED IN CULTURE AND COMMUNITY.
AND HOW POWERFUL THAT IS.
THERE'S AN OPPORTUNITY TO BRING
THE JUNIOR INVESTIGATORS AND
OTHER INTERESTED IN PURSUING A
CAREER AND SEEING THESE KINDS OF
PROJECTS IN ACTION WOULD BE
GREAT.
>>WE HEARD FROM A RESEARCH
STUDY YESTERDAY THEY RESPONDED
TO THE TRIBE'S STATE OF
EMERGENCY AND GOT RESOLUTIONS.
WE RECENTLY DID A RESOLUTION TO
SUPPORT A WEBSITE OR DATABASE TO
DISSEMINATE THE RESEARCH DONE
AND WE HAVE A RESEARCH REVIEW
BOARD.
I THINK THAT'S THE OTHER PART OF
IT IS OUR TRIBE'S COMMITMENT TO
LEADING IN THE MIDDLE.
I CAN SEND THAT AS WELL BUT
WONDERING IF THERE'S ANY OTHER
TRIBAL SUPPORT IN THE FORM OF
RESOLUTI
RESOLUTIONS OR HELPFUL TO THE
TAC IN SUPPORT OF OTHER THINGS.
AND IF YOU THINK OF ANYTHING
LIKE THAT --
>>KARINA: THAT'S AN EXCELLENT
SUGGESTION.
I STARTED THINKING AROUND
EMERGENCY RESPONSE ISSUES AND
TRIBAL IRB ISSUES.
IT WOULD BE NICE TO BE PROACTIVE
AND CONNECT SOMETHING IN PLACE
TO FACILITATE QUICK MOVEMENT
THAT ENSURES THE WORK AND AND WE
CAN LEARN FROM THAT AND LOOK AT
RESPONSE.
>>ALSO, I'M ON THE DIRECT
SERVICE TRIBES FOR INDIAN HEALTH
SERVICE.
WE'RE HAVING OUR MEETING NEXT
MONTH AND IT INCLUDES TRIBE THAT
RECEIVE DIRECT IHS SERVICES.
IF I COULD, I'M THE VICE CHAIR
AND HAD TO STEP OUT TODAY FOR A
MEETING
MEETING AND LET THEM KNOW WE'D
HAVE IT PRESENTED NEXT MONTH
EITHER VIRTUALLY OR IN PERSON.
I KNOW HHS TAC IS MEETING AT THE
SAME TIME BUT IF WE CAN FORMALLY
REQUEST THEM TO PRESENT IT WOULD
BE A WAY TO ROOF THE AREAS AND
REPRESENTS IN THE AREAS AND LET
THEM KNOW WHAT'S GOING ON.
I'M VERY INTERESTED IN HOW THAT
WILL WORK WITH OUR INDIAN HEALTH
SERVICE.
>>WE'RE ABLE TO GO OUT TO
COMMUNITIES.
>>I THINK YOU'LL BE TOURING SO
YOU'LL BE GOING ALL OVER.
IS THERE ANYTHING ELSE FROM THE
MEETING IN THE LAST 48 HOURS
THAT YOU WANT TO MAKE SURE I
WALK AWAY WITH AND THINK ABOUT
AND PLAN FOR?
THOUGHTS ON NEXT STEPS?
>>I JUST WANT TO MENTION ONE
MORE THING THAT IS CONTINUOUSLY
BROUGHT UP IN OUR CAUCUS AND THE
PAST TWO DAYS AND I GUESS
THROUGHOUT THE WHOLE MEETING HAS
BEEN COMMUNICATION.
AND WE INCLUDE RESEARCH AND
COMMUNITY WITH HOW DO YOU BEST
COMMUNICATE WITH RESEARCH IN OUR
TRIBAL COMMUNITIES AND QUARTERLY
REPORTS WE CAN SHARE WITHIN
COMMUNITIES.
THERE'S A LOT OF DIFFERENT
THINGS AND THAT'S ANOTHER THING
WHEN WE MEET AGAIN --
>>WE HAVE
>>
>>KARINA: WE HAVE A NEWS LETTER
AND WE CAN FOLLOW-UP.
>>HERMINIA: THE OTHER THING
ABOUT SOME OF THE THINGS IS THE
FOLLOW UP AND MAKE SURE STUFF
DOESN'T GET LOST BECAUSE WE WANT
TO MAKE SURE THERE'S CONTINUITY.
>>IF THERE'S ANYTHING ELSE THAT
ARISES LET US KNOW.
I'LL BE ABLE TO GET BACK TO YOU
AFTER TALKING TO FOLKS ABOUT
ONE-DAY MEETING AND ARRANGE
THAT.
ANYTHING ELSE?
IF NOT I THINK WE'RE READY TO
MOVE FORWARD.
WE'RE CLOSE TO BEING ON TIME.
WELL, ALL RIGHT.
THANK YOU TO EACH AND EVERY ONE
OF YOU.
I APPRECIATE GETTING THE
OPPORTUNITY TO SPEND TIME WITH
YOU IN PERSON.
I APPRECIATE THE INSIGHTS AND
THE QUESTION AND THE IDEAS THAT
HAVE BEEN FORTIFIED BY ALL OF
YOU AND LOOK FORWARD TO
CONTINUING TO MOVE FORWARD ON
OUR STRATEGIC PLAN AND OTHER
THINGS WE OUTLINED THAT ARE
IMPORTANT.
AGAIN, IF THERE'S ANYTHING ELSE
YOU NEED AFTER THE MEET THAT
COMES UP FOR YOU, PLEASE JUST
GIVE US A CALL.
AND THANK YOU FOR TRAVELLING THE
DISTANCE AND ESPECIALLY TO OUR
ALASKAN NATIVE MEMBER I
RECOGNIZE THE BURDEN OF
TRAVELLING A GREAT DISTANCE.
THANK YOU.
I KNOW ALL OF YOU ARE SUPER BUSY
IN YOUR COMMUNITIES AND I KN
KNOW -- ALSO WANT TO THANK
EVERYBODY WHO ATTENDED IN
PERSON.
AND ALSO VIA WEBCAST.
WE'RE GOING TO END AND WE'LL
CLOSE WITH A BLESSING AND
DONNA --
>>I DECIDED I'D SING A PRAYER
SONG.
[NON-ENGLISH]
I'M TOLD THE NAME OF THE SONG IS
WELCOME ALL THE POWERS OF
NATURE.
WE KNOW THAT IN THESE DAYS AS WE
WORK TOGETHER THE DAYS OF
CLIMATE CHANGE AND THINGS GOING
ON YOU MAY RECALL ON THE OTHER
SIDE OF OUR ANCESTORS CAN HELP
US.
THANK YOU.