Tribes are Public Health Authorities: Protecting Tribal Sovereignty in Times of Public Health Crisis

Abstract

The COVID-19 pandemic has highlighted existing gaps in public health systems across the country including federal Indian health systems. Despite treaty obligations to provide health care to American Indians and Alaska Natives, the federal government has consistently underfunded Indian health facilities. Federal Indian health programming remains piecemeal, often falling victim to Congressional politics for continued funding, requiring inter-Tribal competition for grant and cooperative agreement funding, or requiring Tribal cost sharing. Tragically, but, unsurprisingly given failures in federal Indian health policy, many American Indian and Alaska Native communities have experienced health inequities throughout the pandemic. In several states, American Indians have higher rates of COVID-19 infections as well as worse health outcomes, including higher mortality, than their non-Indian counterparts. By exercising their inherent sovereignty as Tribal Nations, many Tribes have been able to mitigate failings in federal Indian health policy in their COVID-19 response. Unfortunately, reports across Indian country have found instances of state and local governments failing to adequately engage Tribal governments in public health activities, even those implicating Tribal members on Tribal lands, citing lack of Tribal public health authority. Not only is this legally inaccurate, but it also limits Tribal public health response efforts, and infringes on Tribal sovereignty.This issue brief discusses the legal authority for Tribes to serve as public health authorities. First, it describes the inherent authority of Tribes to engage in public health activities. Second, it discusses the recognition of Tribal public health authority across federal law and programs. This issue brief ends by discussing strategies to reinforce Tribal authority in times of public health crisis.