There are 565 federally recognized American Indian/Alaska Native tribal governments in the United States with distinctive histories, cultures, languages and populations. Some Native American groups currently lack federal recognition, although they may have distinctive legal status under state law and for purposes of some federal programs.
The role of tribal public health law is vital for the future of tribal populations given significant health disparities that continue to affect the lives of tribal members. Compared to citizens of other races in the United States, American Indians and Alaska Natives have been documented as having significantly higher rates of chronic disease, such as diabetes, obesity and cardiovascular disease, as well as higher rates of mortality from these diseases and from cancer.
Although tribal governments vary structurally, they all exercise inherent sovereignty over their members and territories. Tribal governments maintain a unique political relationship with the United States, which enables Congress to enact legislation protecting tribal rights and manifesting a “trust relationship” under U.S. federal Indian law. The federal Indian Health Service primarily fulfills this role with respect to health issues affecting American Indians and Alaska Native peoples. The Indian Healthcare Improvement Act, the cornerstone of legal authority governing the health status of tribal populations, was permanently reauthorized in 2010 through the Patient Protection and Affordable Care Act.
Prescription Drug Monitoring Programs (PDMPs) can help clinicians improve decisions regarding opioid prescribing. However, since state laws and regulations governing access to these systems often apply only to providers licensed in the states in which the PDMP is located, and many federal health care workers are not so licensed, many federal providers are not subject to requirements. This fact sheet outlines the policies of the three federal health care institutions with regard to the use of PDMPs when prescribing opioids.
Tribal governments seek to protect the health, safety and welfare of their members as a feature of their inherent sovereign authority. The Indian Self-Determination and Education Assistance Act (Public Law 93-638) enables tribal governments to directly administer their own public health and other programs.
Tribal public health laws interact in important ways with federal, state and local laws, necessitating culturally sensitive and cohesive legal strategies as well as tailored training and resources working with (and within) tribal governments. Tribal governments deal regularly with public health legal issues including:
The Network will provide technical assistance on the relationship between state, local and tribal public health laws and policy issues through collaborative partnerships with tribal governments and organizations. The Network will also secure relevant input from state and local governments and other stakeholders on issues of mutual concern.
For legal assistance and support on tribal public health law:
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The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided does not constitute legal advice or legal representation. For legal advice, please consult specific legal counsel. For more information on the type of legal assistance the Network can provide, please see frequently asked questions.