TECs Role in Public Health Authority and Tribal Data Sovereignty
On February 13, 2026, the National Indian Health Board hosted a panel discussion titled, “Public Health Authority: Sovereignty in Action”. Panelists included:
- Yvette Roubideaux, MD, MPH, (Rosebud Sioux), Adjunct Professor in the Department of Health Systems, Management and Policy at the Colorado School of Public Health;
- Sheena Lambert, MPH (Eastern Band of Cherokee Indians), Eastern Band of Cherokee Indians Public Health Director, Public Health & Human Service Division; Director of the ECBI Medical IRB;
- Chief Marilyn “Lynn” Malerba (Mohegan Tribe);
- Carrie Field, MPH, Senior Research Analyst, National Indian Health Board, and
- Victoria Warren-Mears, PhD, RDN, FAND, Director of the Northwest Tribal Epidemiology Center (NWTEC).
Public Health Authority and Tribal Sovereignty
The panel discussed how Tribes and TECs use public health authority as an expression of sovereignty. Tribal sovereignty is a Tribe’s inherent right to self-govern, and protect or enhance the health safety, and welfare of its citizens. Public health authority is the authority to protect population health and safety, which includes access to HIPAA-protected health data to surveil disease and evaluate health interventions. Panelists discussed how Tribes and TECs use public health authority to improve the health and well-being of Tribal communities.
Tribal Epidemiology Centers
Dr. Warren Mears discussed the work and role of Tribal Epidemiology Centers (TECs) in public health. The public health authority of TECs differs from the inherent authority that Tribes have as sovereign nations. TECs were granted public health authority through the reauthorization of the Indian Health Care Improvement Act of 2010 (25 U.S.C. §1621m). This allowed for TECs to access data, data sets, monitoring systems, delivery systems, and other protected health information to perform 7 core functions:
- Collect data relating to, and monitor progress made toward meeting, each of the health status objectives of IHS, the Indian Tribes, Tribal organizations, and Urban Indian organizations in the Service Area.
- Evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health.
- Assist Indian Tribes, Tribal organizations, and Urban Indian organizations in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data.
- Make recommendations for the targeting of services needed by the populations served.
- Make recommendations to improve health care delivery systems for Indians and Urban Indians.
- Provide requested technical assistance to Indian Tribes, Tribal organizations, and Urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community.
- Provide disease surveillance and assist Indian Tribes, Tribal organizations, and Urban Indian communities to promote public health.
Access to Public Health Data
Both Tribes and TECs are federally authorized to access health data for public health surveillance; however, only Tribes can enact and enforce laws regarding public health. This includes laws and policies like vaccination requirements, safety regulations in occupational services, food inspections, and quarantine for infectious outbreaks. TECs work at the direction of and in support of the Tribes they serve.
Even with recognized public health authority, Tribes and TECs have difficulty accessing data from federal and state agencies. In a March 2022 Government Accountability Office report, officials found a lack of federal policy for TECs to access Health and Human Services data, resulting in agency officials not recognizing federal legal requirements to provide data and a lack of guidance for TECs to request data under federal law.
Despite the obstacles TECs and Tribes face in accessing data, NWTEC works with state and federal partners to access data on behalf of the Tribes we serve. We work closely with the Indian Health Service to access and utilize patient registration information to reidentify American Indian and Alaska Native (AI/ AN) people in state and federal datasets, providing accurate statistical analysis for the Tribes we serve, helping increase the public health capacity of Tribes.
Building Lasting Relationships with Tribes
“You, as tribal leaders, can expect us to support important tribally driven intiatives at your request,” said Warren-Mears. To build lasting relationships with Tribes, it is important that Tribes lead strategic planning, and TECs recognize and uphold Tribal Sovereignty. Over the last several years, NWTEC has been working towards data modernization. This has improved and changed how TECs provide services to Tribes, including the use of cloud-based tools and decisions about the use of artificial intelligence (AI). One priority for NWTEC in modernization was to ensure we followed our member Tribes’ lead in developing a strategy and policy. At NW Tribes’ direction, we are building infrastructure to benefit Tribes, including: the update of our data governance policies and data sharing agreements to better align with Tribal sovereignty, the services we provide, and to adapt to each Tribe’s needs; on-demand Tribal access to area-level data through a cloud-based tool called the NW Tribal Data Hub; and pausing the use of AI at the direction of our Tribal partners.
AI and the Future of Tribal Sovereignty
AI is the next challenge or opportunity for tribal data sovereignty. While AI could increase capacity for Tribes to provide healthcare, economic stability, and governance, without appropriate oversight, data use policies could impact Tribes’ data sovereignty and environmental resources. Each Tribe will need to make decisions about how or whether to contribute data to AI training models. Lack of contribution could lead to erasure, underrepresentation, and even misrepresentation in AI systems; however, contribution to the data sets could lead to exploitation, surveillance, and ownership issues. Tribes have an opportunity to gain control over their data through the Tribal development of AI systems; however, Tribes will have important decisions to make about how they want to protect sovereignty and benefit from emerging technology. TECs play a role in providing technical assistance to Tribes as they navigate the impacts of AI in their communities.
Dr. Victoria Warren-Mears holds a bachelor’s and master’s degree in home economics from Washington State University and a doctorate in nutrition sciences from the University of Washington. She also completed a certificate of investigation in human subjects at Oregon Health & Science University. For the last 19 1/2 years she has had the honor and privilege of serving the 43 federally recognized tribes of Idaho, Oregon and Washington as the Director of the Northwest Tribal Epidemiology Center. Victoria has worked in Public Health for most of her career. She is passionate about the ethics of tribal data sovereignty, tribal public health systems, and providing support to tribes in public health practice and research, particularly community-based participatory research.
