Communicable diseases – Reporting; Indians; North American; Indians of North America; Public health surveillance


Community Health and Preventive Medicine | Epidemiology | Health Policy | Immune System Diseases | Public Health | Virus Diseases


We assessed participation in public health surveillance networks among Indian Health Service, tribal, and urban (I/T/U) Indian health facilities for a group of infectious diseases, and barriers to participation. We conducted surveys of I/T/U facilities and key informant interviews with representatives of tribal, urban, and national American Indian/Alaska Native (AI/AN) agencies. For the surveys, frequencies and percentages of responses in each response category were calculated. Qualitative methods were used to analyze interview content. The proportion of facilities participating in case reporting is suboptimal across facility types and diseases. Even when reporting is occurring, there is little feedback to tribal agencies. Lack of trust between tribal authorities and state/local governments, lack of feedback on surveillance efforts, and gaps in coordination of activities were identified as barriers to participation in surveillance. Our findings indicate weaknesses in surveillance systems for monitoring infectious diseases among AI/AN people, and have implications for addressing health disparities.