Exploring Legal Issues in Tribal Public Health Data and Surveillance

Abstract

Tribes are sovereign nations with a government-to-government relationship with the United States. Within the United States, there are 573 federally recognized Tribal nations with distinct governments, cultures, and histories. Each Tribe exercises both political sovereignty and cultural sovereignty through Tribal governance and their unique cultural teachings. As part of the exercise of this sovereignty, Tribes have the inherent authority to engage in public health activities that support the safety and welfare of their citizens. An essential component to public health practice includes the collection and surveillance of health data. Surveillance data allows for the identification of health issues as well as instances in which certain populations are being disproportionately burdened by these health issues. This data is essential to effective policy making. Law is the foundation of public health practice, including the underpinnings of public health data collection and surveillance and ensuring the privacy of such data. Much has been written on public health data and surveillance at the state and local level. Yet, Tribal law and the federal laws that define the relationships between Tribes, states, and the federal government add an additional complexity to the collection and surveillance of law for American Indian and Alaska Natives. This article explores legal issues in Tribal data and surveillance. First, this article provides a summary of Tribal public health and health care systems. Next, it outlines surveillance laws and practical challenges in Tribal surveillance. Finally, it describes some of the legal strategies used to promote effective data collection and surveillance.