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Cross Cutting II

Public Health Law Subcommittee
Chair: Dr. John Middaugh
Director, Division of Community Health Southern Nevada Health District

Law imageCSTE National Office contact: Lauren Rosenberg (

Identifiable health data are the lifeblood of public health surveillance and
other activities. Their use is essential to effective public health activities and public health research. Public health authorities at all levels of government seek increasingly greater types and volume of personally-identifiable health information, including through data exchanges between public health entities. Too often, however, acquisition and use of identifiable health information through existing public health databases are restricted or limited due to privacy norms or other policies.  Public health authorities may be reticent to share identifiable health data with others, even for legitimate public health purposes, because of concerns over individual privacy or legal interpretations of privacy laws.  As a result, public health entities in varying jurisdictions may lack access to available health data to conduct essential services and research.

Recent activities include assessments on the impact of the Family Educational Rights and Privacy Act on surveillance, on the HIPAA privacy rule concerning CDC’s Biosense program and has conducted work on defining Public Health Practice vs. Research.


These subcommittees and interest areas differ in the commitment required and frequency of activities. Please click on the tabs above to learn more!

Border International


Tribal Epidemiology Subcommittee
Chair: Dr. Michael Landen
Deputy State Epidemiologist, New Mexico Department of Health

American Native Dance CSTE National Office contact: Annie Tran (

The CSTE Tribal Epidemiology Subcommittee consists of epidemiologists and others working with American Indians / Alaska Natives (AI/AN) in states, local, territorial and tribal health agencies and epidemiology centers. For the past 10 years, CSTE has been successful in bringing together key players for Public Health Surveillance, Health Data Sharing, and Public Health Authority in Indian Country.

Issues surrounding the responsibility for public health services for AI/AN populations are more complex than for other populations because of the unique legal and historical status of AI/AN peoples. As sovereign nations, AI/AN tribes are governed by a varying combination of tribal, federal, and state laws. Often, reservations and other tribal lands exist as jurisdictional islands within state boundaries, and AI/AN people may reside and seek health services on or off reservations. Uncertainty about public health authority and the respective responsibilities of federal, state, local, and tribal governments to conduct the public health core functions, including surveillance, complicates the delivery of essential public health services.

With funding from the Centers for Disease Control (CDC) along with other sources, CSTE has conducted assessments of tribally-operated and urban Indian health care facilities to assess their case reporting practices and identify barriers to tribe and provider participation in public health surveillance. A brief report of the results can be found here. With these results, CSTE will document current case reporting practices to guide recommendations for improvement.

In 2012, CSTE released a report entitled,"Legal Issues Concerning Identifiable Health Data Sharing Between State/Local Public Health Authorities and Tribal Epidemiology Centers in Selected US Jurisdictions" which assessed state laws regarding data sharing in a sample of states with federally recognized tribes. Through legal research and analysis, the report identified state-specific laws (statutes, regulations, cases, etc) that authorize or limit the sharing of identifiable public health activities. The laws and statutes references in this report illustrate the precedence of data-sharing agreements. The report provides a foundation for examining potential privacy issues and solutions for current and potential TEC's partners regarding privacy implications of state and laws in selected juridictions, as well as to facilitate public health data sharing.

A workgroup of this subcommittee conducted a study during the 2009 H1N1 Influenza pandemic to develop a better understanding of mortality risk factors in the AI/AN population that could lead to improved prevention and control of influenza. The intended benefit of the study was to gather information that could lead to public health practice measures that prevent and control death and severe disease in AI/AN. Both national influenza vaccination and antiviral use recommendations have been changed to reflect the increased risk to these populations, partly as a result of the CSTE tribal epidemiology subcommittee’s MMWR in December 2009. The workgroup is continuing their efforts to understand this dispartiy in mortality risk mong AI/AN through analysis of the data collected through a case-control study.

CSTE has also collaborated with Tribal Epidemiology Centers (TEC) to host several meetings. In May 2009, CSTE partnered with the Northern Plains and Great Lakes Tribal Epidemiology Centers in hosting the first ever “Tribal Epidemiology Liaison Training”. In April 2010, CSTE hosted a meeting with the United Southern & Eastern Tribes aimed at developing recommendations on how tribes, states, and TECs might better partner to improve AI/AN disease surveillance, enhance communication and collaboration, and introduce the production of tribal specific reports for public health decision making. A third regional meeting is being planned in February 2012 for the western region with a focus on improving data linkages and reducing racial misclassification among AI/AN populations. The tentative agenda is available here. For more information about this meeting, please contact Annie Tran.

A small workgroup of CSTE members has also compiled a toolkit for epidemiologists interested in data linkage. This collection of resources provides a brief overview of tribal data linkage as well as tools this workgroup has found useful in initiating data linkage.

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