What Is Legal Preparedness And Why Is It Important To Tribal Nations?

1. What Is Legal Preparedness And Why Is It Important To Tribal Nations? [name of speaker] [title of speaker] [date] Photo Source: IStock.com/creativeye99

2. Disclaimer The contents of this presentation have not been formally disseminated by the Centers for Disease Control and Prevention, ChangeLab Solutions, and the Center for Public Health Practice. The contents should not be construed to represent any agency/organization determination or policy. These presentation materials are for instructional use only and are not intended as a substitute for professional legal or other advice. While every effort has been made to verify the accuracy of these materials, legal authorities and requirements may vary from jurisdiction to jurisdiction and change over time. Always seek the advice of an attorney or other qualified professional with any questions you may have regarding a legal matter.

3. Learning Objectives • Define legal preparedness and its importance to public health emergencies. • Describe why Tribal Nations should be concerned about preparedness and how laws can enhance preparedness for Tribal Nations. • Discuss two examples to highlight the importance of legal preparedness for Tribal Nations.

4. Public Health Preparedness Networks Access to Information Key Components of Public Health Preparedness for Tribal Nations and their Surrounding Communities Government Law Workforce Photo Source: IStock.com/EnisAkso; IStock.com/cnythzl

5. Public Health Law Photo Sources: IStock.com/AlexRaths; CDC/Anita L. Wolfe, Public Health Analyst, NIOSH; depositphotos

6. Public Health Law (cont.) Laws are structures, norms, and rules that a society uses to resolve disputes, govern itself, and order relations between members of the society

7. Tribal Public Health Preparedness Public health preparedness requires public health legal preparedness “attainment by a public health system… of legal benchmarks essential to the preparedness of the public health system” Source: Moulton, AD, et al. What is Public Health Legal Preparedness? J L Med Ethics 2003; 31: 672-683

8. Tribal Legal Preparedness for Public Health Emergencies Aid Resolve Coordinate Respond Law is a foundation for public health response

9. Tribal Public Health Legal Preparedness Source: Moulton AD, Goodman RA, Murphy AM, Rawson AD. What is public health legal preparedness? J Law Med Ethics 2003;31:672-683

10. Key Participants* in Public Health Emergency Response • First responders (e.g., EMS, law enforcement, firefighters); • Elected officials; • Public health agencies; • Legal counsel; • Non-governmental organizations (e.g., Red Cross); • Emergency management agencies; • Health care providers (e.g., physicians, nurses, allied health practitioners, pharmacists); • Healthcare coalitions; • Judges; • Department of Health and Human Services of the United States; • Office of the Assistant Secretary for Preparedness and Response; • Centers for Disease Control and Prevention; • Indian Health Service. • United States Department of the Interior; • Bureau of Indian Affairs. • United States Department of Homeland Security; • Federal Emergency Management Agency. *These key participants come from Tribal Nations, as well as other sources (e.g., county government) Photo Source: IStock.com/f00sion

11. Inherent Tribal Authority Tribal governments have inherent authority to protect the public health and welfare of their citizens Photo Source: IStock.com/JannHuizenga

12. Why Should Tribal Nations Be Concerned About Preparedness? 1918-19 flu and 2009 H1N1 Sexually Transmitted Diseases The national rates for the AI/AN population for STDs such as syphilis, chlamydia, and gonorrhea, are 2-3 times the rates for other races and ethnicities. Deaths among AI/ANs in the United States were roughly four times that of other groups.

13. Why Should Tribal Nations Be Concerned About Preparedness? (cont.) Man-Made Disaster Natural Disaster Technological Disaster Photo Sources: IStock.com/sintez; IStock.com/cylonphoto; Mille Lacs Band of Ojibwe

14. Incidents • Earthquakes • Terrorism • Infectious disease • Cyber-hacking • Environmental • Fire • Floods • Thunderstorms • Tornados • Hurricanes • Winter storms

15. How Can Law Help with Tribal Disaster Needs? • Policies and procedures in place to transit elders to safety or shelter in place during emergencies (e.g., ice storms, flooding) • Memoranda of understanding to administer vaccines or establish points of dispensing during an influenza epidemic • Agreements with first responders to provide services on Tribal land (e.g., fire) • Agreements to replenish food stores (e.g., berries, meat) to Tribal members • Food codes • Public health code Photo Source: Mille Lacs Band of Ojibwe

16. How Can Laws Enhance Preparedness For Tribal Nations? Improve response procedures, plans, and policies Establish legal authority for the detention of individuals with an infectious disease or who are suspected of having an infectious disease Determine clear jurisdictional boundaries Develop laws, policies, and plans to address emergency situations in advance Establish clear protocols Protect government officials, first responders, and others from liability Ensure that Tribal first responders have the necessary authority to take action to address the disaster or emergency Guide law enforcement Clearly define Tribal powers

17. The Importance of Tribal Legal Preparedness: Examples Photo Source: PhotoDisc

18. Battling the Opioid Crisis U.S. Heroin and Non-heroin Opioid death rates per 100,000 people by race/ethnicity, 2015 Source: The Opioid Epidemic: National Trends in Opioid-Related Overdose Deaths from 2000-2015, State Health Access Data Assistance Center (SHADAC), June 2017.

19. Battling the Opioid Crisis: How Can Tribal Legal Preparedness Help? Providing immunity and liability protections for the prescribing and administration of naloxone Expanding Tribal law enforcement jurisdiction to better tackle drug trafficking Expanding by law who can be prescribed overdose reversal drugs and who can administer these drugs Entering into data sharing agreements Drug disposal laws and policies to reduce supply of prescription medications Declaring a state of emergency to trigger greater response Photo Source: IStock.com/-MG-

20. Pipeline Safety Source: Enbridge

21. Pipeline Safety: How Can Tribal Legal Preparedness Help? Dictating a schedule for routine upkeep of existing pipelines Drafting plans that address safety issues and identify gaps Ensuring that operators comply with safety regulations Limiting new pipelines, requiring studies to be done to ensure protection of environment and cultural heritage Providing compensation in the event harm is done Photo Sources: IStock.com/erniedecker; IStock.com/malerapaso; IStock.com/serggn; IStock.com/VladKol; IStock.com/FabioFilzi

22. Summary • Legal preparedness is important to public health emergencies. • There are many reasons why Tribal Nations should be concerned about preparedness, including infectious disease outbreaks and natural disasters. • Laws can enhance preparedness for Tribal Nations. Photo Source: IStock.com/nzphotonz

23. Questions?

24. Resource Library tlpp.pitt.edu

25. Contact Tina Batra Hershey, JD, MPH Assistant Professor, Health Policy & Management Associate Director for Law and Policy, Center for Public Health Practice Graduate School of Public Health Adjunct Professor of Law University of Pittsburgh tbh16@pitt.edu For more information and resources, visit: tlpp.pitt.edu

26. Acknowledgement Funding for this activity was made possible (in part) by the Centers for Disease Control and Prevention and ChangeLab Solutions under Cooperative Agreement Numbers NU38OT000307 and NU38OT000141.  The views expressed in written materials or publications and by the speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.