摘要：American Indian and Alaska Native (AIAN) governments are sovereign entities with inherent authority to establish and administer public health programs within their communities and will be critical partners in national efforts to prepare for pandemic influenza. Within AIAN communities, some subpopulations will be particularly vulnerable during an influenza pandemic because of their underlying health conditions, whereas others will be at increased risk because of limited access to prevention or treatment interventions.We outline potential issues to consider in identifying and providing appropriate services for selected vulnerable populations within tribal communities. We also highlight pandemic influenza preparedness resources available to tribal leaders and their partners in state and local health departments, academia, community-based organizations, and the private sector. IN THE UNITED STATES, FEDER ally recognized American Indian and Alaska Native (AIAN) governments are sovereign entities with inherent authority to establish and administer public health programs within their respective communities. 1 Comprising approximately 1.5% of the total US population, the AIAN population exceeds 4 million people and includes more than 560 federally recognized Indian tribes and Alaska Native villages. Although many AIAN persons live in rural locations such as reservations, more than 60% now reside in urban settings. 2 3 Criteria for tribal membership vary from tribe to tribe, with tribal enrollment ranging from under 200 to over 300 000 members. The size of a given tribal community (or a tribal government's jurisdictional area) can vary from a few to tens of thousands of acres. Tribes with the largest populations and land bases are primarily located in the western United States, but tribal communities are located in 34 states across the nation. Tribal lands exist both within and across state borders, and many rest on or near international boundaries with Canada and Mexico. 3 4 Tribal lands, reservations, Alaska Native lands, and urban Indian communities are often referred to collectively as ‘Indian country’ and we use the term herein in that sense, in contrast to its more restricted use in federal law. Many AIAN people receive health care from the Indian Health Service (IHS), tribal or Alaska Native health programs, and Urban Indian health centers, but an increasing number also have access to health services through private health insurance plans. 5 Delivery of public health services to AIAN communities and the ability to adequately prepare for and respond to public health events is affected by a number of factors that include the uncertain availability of federal funding, variability in tribal public health infrastructure (e.g., workforce, information systems, public health laws), and a mix of legal and jurisdictional factors that blur the lines of responsibility around public health actions. 1 AIAN governments and communities will be important partners in national preparedness and response efforts to address pandemic influenza. Although prevailing socioeconomic conditions may place entire AIAN communities at increased risk during an influenza pandemic, our focus is on the need to identify specific vulnerable populations within tribal communities and to provide appropriate services for them. Vulnerable populations in tribal communities may include, but are not limited to, persons with chronic diseases or disabilities, elderly community members, urban AIAN people, and residents of remote and isolated areas. The information and resources contained in this paper will be useful for tribal leaders and their partners in state and local health departments, academia, community-based organizations, and the private sector. We produced this paper as a working group that represents a spectrum of backgrounds and expertise from AIAN tribes and tribal organizations, state health departments, and federal agencies. We received valuable input from tribal leaders across the country during a meeting with the Centers for Disease Control and Prevention's (CDC) Tribal Consultation Advisory Committee in July 2008. The information we present was gathered from peer-reviewed and non–peer-reviewed literature on both seasonal and pandemic influenza, web sites, and conference abstracts and proceedings.
