Guided by the Washington State Department of Health’s Transformational Plan and in partnership with tribal sovereign nations across Washington State, we are working to uphold our government to government relationship with Tribes, address long standing inequities, and promote public health across communities through milestone initiatives focused on health equity. We are accomplishing our work under the umbrella of the Department’s Office of Tribal Public Health and Relations. The milestones initiatives include: (1) Foundational Public Health Services, where Tribes are one of the four governmental public health partners shaping this initiative and receiving core state dollars to improve health; (2) the Healthy Environment for All (HEAL) Act, an historic step toward eliminating environmental and health disparities; (3) a Tribal Health Equity Zone initiative to support communities in effecting change at a local level by shifting decision-making to those who live and work in those communities; and (4) Implementing a 988 hotline for and operated by tribes, the Native and Strong Hotline.

We are accomplishing this work with tribes through formal consultation and collaboration. This means listening to Tribes and responding by adapting program and services to meet the needs of American Indian and Alaska Natives through Washington state.

Our goal is to share innovative ways to utilize tribal expertise and involvement to improve health in a culturally appropriate way. We will also share consultation and collaboration procedures and how states can uphold government to government relationships when designing initiatives.

Background

Cherokee Nation Behavioral Health and Emory University conducted a substance misuse prevention trial funded by the National Institute on Drug Abuse, as part of the HEAL Initiative. The trial targeted rural adolescents living on or near the 6950 square mile Cherokee Nation Reservation within northeast Oklahoma. The trial aimed to promote mental health and curb substance misuse through an integrated school and family intervention.

Methods

Nine Connect Kits for Family Action (CKFAs) were sent to caregivers of a high school student cohort spanning three years (10^th-12^th grade). Themes and objectives for each year were developed from data gleaned from prior interventions. We received caregiver and youth feedback via a survey. The effectiveness of the intervention is being evaluated with a cluster randomized trial involving 20 high schools and a cohort followed over three years.

Results

Nine CKFAs were mailed to 500 families across 10 schools, each containing information, action tips, and resources to support parenting during adolescence. Corresponding media was disseminated throughout each community. Caregiver feedback was positive toward receiving the kits and expressed appreciation for resources that promoted family experiences and meaningful discussions. Caregivers also noted the valuable insights gained and gratitude for the practicality of items for the entire household.

Conclusions

Throughout our collaborative project, we’ve learned the importance of developing and sustaining strong partnerships with our community partners, engaging community to ensure cultural and developmental appropriateness, and having tribal oversight. These are key to establishing trust in research and showing how research can benefit Indigenous families.

Issues: More than 500 abandoned uranium mine and mill waste sites pose significant exposure risks to frontline communities on the Navajo Nation, and people who live around them have elevated risks for chronic diseases.

Description: Here we summarize findings of the Diné Network for Environmental Health (DINEH) Project and the ongoing Navajo Birth Cohort Study (NCBS), which in 2018 joined NIH’s ECHO (Environmental influences on Child Health Outcomes) Program. Our environmental health investigations employed common methods to assess exposures, encompassing surveys, GIS mapping of waste sites, environmental data (soils, water, air), and biomonitoring of metal concentrations in study participants. Fieldwork, including recruitment, enrollment, and assessment of more than 1,300 individuals enrolled in the DiNEH Project was led by trained Navajo team members.

Lessons Learned: In the DiNEH Project, proximity to abandoned uranium mines was found to increase the risk of chronic metabolic ailments among nearby residents. These findings led EPA to adopt a strategy of prioritizing remediation at mines near where people are living. Yet the methods and findings of population-based studies are rarely considered in remediation strategies for these sites. NCBS has revealed elevated metal concentrations in the blood and urine of more than 1,000 participants, highlighting pervasive environmental toxicant exposures across the Navajo Nation, including in newborns and children up to the age of 4 years.

Recommendations: These studies were initiated with broad community engagement in examining uranium exposures. The culmination of two decades of environmental health research on uranium exposures within the Navajo Nation furnishes substantive evidence to guide the remediation efforts for abandoned uranium mines.

Issues: Abandoned uranium mines and mill tailing contamination on Indigenous land is harmful and should be remediated, particularly within Naabeehó Bináhásdzo (the Navajo Nation). This work highlights the ongoing health impacts, such as cancer-related illnesses, stemming from past uranium mining activities and the importance of addressing these issues using traditional ecological knowledge.

Description: Our multidisciplinary approach to addressing uranium contamination draws heavily on personal experiences and familial connections to uranium mining. It emphasizes integrating Navajo cultural principles and traditional ecological knowledge into research and policy development. Collaborating with the Dine’ Hataalii Association, our team navigates the complexities of honoring traditional teachings while addressing contemporary challenges. Through fieldwork in the Navajo Nation, Dr. Rock aims to amplify community voices and promote sustainable solutions rooted in Navajo culture by working with Native American grassroots organizations.

Lessons Learned: Integrating Indigenous perspectives and traditional knowledge into efforts to address environmental contamination is pivotal to the success of this work. Lessons learned include the significance of community engagement, cultural competence, and collaboration with Indigenous organizations in both research and policy development.

Recommendations: Based on their experiences, we recommend prioritizing Indigenous-led initiatives and policies that align with Navajo fundamental laws and values. And advocate for continued collaboration with Indigenous communities and organizations, emphasizing the need for inclusive, culturally relevant approaches to addressing environmental challenges. We suggest further research into the intersection of traditional ecological knowledge and modern environmental science to inform more effective solutions to uranium contamination and other environmental issues facing Indigenous communities.