Friday, April 4, 2025
4/4/2025
Moving Upstream to Investigate and Address Health Inequity through Public Health Services at the Tule River Indian Health Center - The Tule River Indian Health Center (TRIHCI) applies to the Native Public Health Resilience funding announcement to offer new and expanded activities related to essential public health service (EPHS) #2: Investigate, diagnose, and address health problems and hazards affecting the population. TRIHCI is a Tribally affiliated 501c3 organization founded in 1973 and located on the Tule River Reservation, which is approximately 84 square miles and has approximately 1600 residents. TRICHI serves approximately 7,000 American Indians and Alaskan Natives throughout Tulare County and has approximately 2700 active patients. Our patient community faces many social determinants of health challenges, especially related to economic and educational factors, and also has faced several environmental health threats in the last five years. Within this context, TRIHCI offers an array of services, such as: primary care, dental, emergency medical, mental health, community health representatives, and specialist care, such as ophthalmology and podiatry. Since November 2023, TRIHCI has been delegated limited public health authority from the Tule River Tribe and wishes to expand our services with this authority. However, we have been unable to address the inequitable rates of communicable and chronic conditions due to our SDoH setting and environmental threats with our healthcare services alone. An unmet need in our community is that we lack the resources to work upstream and prevent or mitigate emerging health threats before they impact the community. To address our high rates of disease, we plan to offer new preventative and proactive initiatives to mitigate health challenges before they emerge. We envision a Public Health Department working upstream to proactively identify and mitigate emerging health challenges including communicable disease, chronic disease, and environmental health through epidemiological identification and analysis. The core elements of EPHS #2 that will be our required activities are: (1) anticipate, prevent, and mitigate emerging health threats through epidemiologic identification, and (2) monitoring real-time health status and identifying patterns to develop strategies to address chronic diseases and injuries. For the first required activity, we will focus on decreasing our high rates of communicable diseases. We will pursue several evidence-based strategies within this activity, per PHAB’s accreditation standards and measures. For the second required activity, we will focus decreasing rates of chronic diseases, injuries and other health conditions, especially diabetes and asthma. We will again follow evidence-based strategies from PHAB’s accreditation standards and measures. In addition to these required activities, our plan also includes one related, allowable activity: creating a new IT data infrastructure to allow us to investigate, diagnose, and address health problems and hazards affecting the population that is necessary for us to create new internal capacity to allow for performance monitoring, case investigation, and epidemiological analysis. To implement these services, we seek funding for .6 FTE of our Public Health Officer, 1 FTE for our Administrative Specialist and 300 hours for our onboarded IT Contractor. Key supplies within our budget are subscriptions for a communicable disease control system and an integration engine to align data automatically within our system. This project builds on many strengths within the Tule River Tribal community and leverages our experiences with several major activities and accomplishments performed within the last five years that relate to this project such as our COVID-19 response, electronic case reporting grant project, navigating several environmental health emergencies, ongoing partnership with the local county around disease intervention services for sexually transmitted infections, and publication of our first community health assessment in March 2024.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).