The AI/AN population faces multiple historical, social, economic, and health challenges. The public health infrastructure required to address these inequities is complex, under-resourced, and under-developed. It requires a systems-based approach to address gaps in data and build public health capacity to promote health and prevent disease in AI/AN communities. AI/AN people are a minority population that differs from other U.S. racial and ethnic minorities. They have special rights due to a unique historic and legal government-to-government relationship that federally recognized Tribes have with the U.S. government. This relationship was established through numerous Supreme Court decisions, treaties, legislation, and Executive Orders.

Some of this legislation relates to the healthcare challenges of the AI/AN population. The Indian Health Care Improvement Act (IHCIA) was passed in 1976 and amended in 1992. The amendment declared, “it is the policy of this Nation, in fulfillment of its special responsibilities and legal obligation to the American Indian people, to assure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.” IHCIA established the legal and programmatic structure for providing health care and public health services to AI/AN people.5

The 1992 amended IHCIA included authorization for establishing the TEC program. The first three TECs were established in 1996. They included the Alaska area, the Great Lakes area, and the Phoenix area. There are now 12 unique TECs vital to the public health system supporting AI/AN communities throughout the United States. They are funded in part by the Indian Health Service (IHS). There is a TEC in each of the IHS administrative areas and another serving Urban Indian Organizations across the country.

Permanently reauthorized in March 2010 in the “Patient Protection and Affordable Care Act,” IHCIA included provisions designating TECs as public health authorities. A public health authority, or covered entity, is granted authority and responsibility for public health matters as part of its official mandate and may use or disclose protected health information (PHI) without written approval by the individual. It also provided TECs “access to data, data sets, monitoring systems, delivery systems, and other protected health information in the possession of the Secretary” of the Department of Health and Human Services (DHHS). The Act was a significant step toward achieving health equity for AI/AN people