摘要：American Indian/Alaska Native tribal governments are sovereign entities with inherent authority to create laws and enact health regulations. Laws are an essential tool for ensuring effective public health responses to emerging threats. To analyze how tribal laws support public health practice in tribal communities, we reviewed tribal legal documentation available through online databases and talked with subject-matter experts in tribal public health law. Of the 70 tribal codes we found, 14 (20%) had no clearly identifiable public health provisions. The public health–related statutes within the remaining codes were rarely well integrated or comprehensive. Our findings provide an evidence base to help tribal leaders strengthen public health legal foundations in tribal communities. IN AN ERA WHEN PUBLIC health threats are growing in number, severity, and complexity, it is critical to ensure that all levels of government have the capacity to mount effective public health responses. Failure to do so threatens a government's ability to deliver essential public health services to its population. The 10 essential public health services are: Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure a competent public health and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Conduct research for new insights and innovative solutions to health problems. 1 Laws are an essential tool for improving public health capacity and thus public health outcomes. 2 Effective responses to emerging threats and the attainment of public health goals require that governments and their partner organizations be legally prepared. Public health legal preparedness is defined as a public health system's attainment of specified legal benchmarks or standards that include ensuring the presence of effective legal authority to carry out essential public health services, establishing and sustaining the competencies of public health professionals to apply that authority through laws, providing for coordination of law-based efforts across jurisdictions and sectors, and developing and disseminating information about best practices in public health law. 3 American Indian/Alaska Native (AIAN) tribal governments are sovereign entities with the authority to enact their own health regulations to protect the health, safety, and welfare of their communities. Jurisdictional authorities in Indian country are complex, however, because the delivery of public health services is often distributed across tribal, county, state, and federal public health systems. The Indian Health Service (IHS) continues to be the primary provider of public health services in some regions, but in other areas, tribal governments are increasingly assuming these responsibilities. Tribal communities are generally not subject to state public health laws, and the extent to which tribal governments have codified public health authority within tribal law is not clear. Recent instances of successful intergovernmental cooperation in times of crisis were made possible by prior agreements concerning specific public health authorities. 4 Successful collaborations such as these demonstrate the valuable role that intergovernmental agreements and other legal tools play in facilitating effective public health responses. Tribal leaders are aware of the legal gaps in public health authority, and they have begun to explore ways to strengthen the legal foundations of public health within their systems of government. Although their heightened interest in public health law has been catalyzed in part by federal and state emergency preparedness initiatives, it also goes hand in hand with the tenets of tribal self-determination. The Centers for Disease Control and Prevention (CDC) Tribal Public Health Law Work Group was established in response to tribal requests for greater CDC involvement in this important arena. Recognizing the urgent need for a more thorough understanding of extant tribal public health law, the Tribal Public Health Law Work Group sought to analyze how tribal laws currently support public health practice in tribal communities. To our knowledge, this report is the first published account of such an analysis, the results of which can serve as an evidence base for tribal leaders as they develop strategies to establish stronger legal foundations for public health in their communities.
