Existing law establishes the State Department of Public Health that is led by the State Public Health Officer, who is appointed by the Governor and subject to confirmation by the Senate. The Governor is authorized to appoint, upon the recommendation of the State Public Health Officer, 2 chief deputies, subject to confirmation by the Senate.

This bill would establish the Office of Tribal Affairs within the department to be led by a Tribal Health Liaison to assist in addressing the public health disparities impacting tribal communities. The bill would require the office to communicate needs and to propose specific solutions from tribal communities to the department and state entities, as specified. The bill would provide that the Tribal Health Liaison be appointed by and serve at the pleasure of the State Public Health Officer and would require the State Public Health Officer to regularly consult with and consider input and information provided by the Tribal Health Liaison. The bill would require the Tribal Health Liaison, among other duties, to regularly consult with California tribal representatives, as specified, and oversee the departments tribal health equity meetings, advisory groups, and workgroups. The bill would make related findings and declarations.

Existing law establishes the State Department of Public Health that is led by the State Public Health Officer, who is appointed by the Governor and subject to confirmation by the Senate. The Governor is authorized to appoint, upon the recommendation of the State Public Health Officer, two 2 chief deputies, subject to confirmation by the Senate.

This bill would establish the Office of Tribal Affairs within the department to be led by a Tribal Health Liaison to assist in addressing the public health disparities impacting Tribal tribal communities. The bill would require the office to communicate needs and to propose specific solutions from tribal communities to the department and state entities, as specified. The bill would provide that the Tribal Health Liaison be appointed by and serve at the pleasure of the State Public Health Officer and would require the State Public Health Officer to regularly consult with and consider input and information provided by the Tribal Health Liaison. The bill would require the Tribal Health Liaison, among other duties, to oversee the departments tribal health equity meetings, advisory groups, and workgroups. The bill would make related findings and declarations.

Existing law establishes the State Department of Public Health that is led by the State Public Health Officer, who is appointed by the Governor and subject to confirmation by the Senate. The Governor is authorized to appoint, upon the recommendation of the State Public Health Officer, two chief deputies, subject to confirmation by the Senate.

This bill would establish the Office of Tribal Affairs within the department to be led by a Tribal Health Liaison to assist in addressing the public health disparities impacting Tribal communities. The bill would provide that the Tribal Health Liaison be appointed by and serve at the pleasure of the State Public Health Officer and would require the State Public Health Officer to regularly consult with and consider input and information provided by the Tribal Health Liaison. The bill would make related findings and declarations.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 1965 (Blanca Rubio) - Public health: Office of Tribal Affairs

Bill Summary:

AB 1965 would establish the Office of Tribal Affairs within the California Department of Public Health (CDPH).

Fiscal Impact:

Unknown ongoing General Fund costs for the CDPH to establish the new office.

Background:

In 2017, the California Health and Human Services Agency (CHHS) released a tribal consultation policy that encourages departments to obtain meaningful input from the tribes on regulations, rules, and policies affecting their communities. The policy recognized that each department has a different statutory mandate and, in some cases, may have tribal requirements in place through existing laws or regulations. The policy requires each department to designate a tribal liaison to serve as the central point of contact for the tribes and advises that the liaison be at the executive level or a designated representative of the department’s executive team.

Current law requires the CDPH to establish the Office of Health Equity to improve the health status of all populations, with a priority on eliminating health and mental health disparities and inequities. According to CDPH, the current tribal liaison is the Deputy Director of the Office of Health Equity. The liaison is responsible for engaging with tribes and other relevant partners to understand tribal needs and serve as the liaison to communicate those needs and issue solutions from tribal communities.

Proposed Law:

Specific provisions of the bill would:

• Establish within the CDPH, an Office of Tribal Affairs to assist in addressing the public health disparities impacting tribal communities, including activities as specified.
• Require that the Office of Tribal Affairs be led by the Tribal Health Liaison, who must be appointed by and serve at the pleasure of the State Public Health Officer.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: AB 1965

SUBJECT: Public health: Office of Tribal Affairs.

SUMMARY:

Establishes the Office of Tribal Affairs, led by a Tribal Health Liaison, within the California Department of Public Health, to assist in addressing public health disparities impacting tribal communities.

Existing law:

1. Establishes the California Department of Public Health (CDPH), directed by a state Public Health Officer, to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to public health and licensing of health facilities, as specified. [HSC §131050]
2. Requires CDPH to establish the Office of Health Equity to achieve the highest level of health and mental health for all people, with special attention focused on those who have experienced socioeconomic disadvantage and historical injustice; work collaboratively with the Health in All Policies Task Force; advise and assist other state departments in their mission to increase access to, and the quality of, culturally and linguistically competent health and mental health care and services; and, improve the health status of all populations and places. [HSC §131019.5]
3. Requires the Office of Health Equity to do the following:
4. Perform strategic planning to develop CDPH plans to close the gaps in health status and access to care among the state’s diverse communities;
5. Conduct departmental policy analysis on specific multicultural health issues;
6. Coordinate projects funded by the state related to improving the effectiveness of services to diverse communities;
7. Identify the unnecessary duplication of services and future service needs;
8. Communicate information within CDPH and to providers of health, social, educational, and support services and to consult regularly with community representatives;
9. Perform internal staff training and assessments and trainings of health care professionals to ensure more culturally competent care;
10. Serve as a resource for ensuring that programs collect data regarding ethnic and racial health statistics, information based on sexual orientation and gender identity, multicultural health issues, issues that impact the health of diverse communities, and health insurance and delivery systems;
11. Encourage innovative responses by public and private entities attempting to address multicultural health issues; and,
12. Provide technical assistance to counties, other public entities, and private entities seeking to obtain funds for initiatives in multicultural health. [HSC §152]

This bill:

1. Establishes within CDPH, an Office of Tribal Affairs (“Office”) to assist in addressing the public health disparities impacting tribal communities and charges the Office with the following responsibilities:
2. Engage with tribes and other relevant partners to understand their needs;
3. Serve as the liaison to communicate needs and to propose specific solutions from tribal communities to CDPH, the California Health and Human Services Agency (CHHS), state COVID-19 task forces, and other state agencies;
4. Ensure that the support and technical assistance provided is culturally competent and timely;
5. Launch and coordinate an advisory board of tribal representatives to ensure ongoing feedback and input on emerging issues for the purpose of ensuring culturally and community-responsive program improvements; and,
6. In collaboration with tribes, develop and establish a tribal consultation policy.
7. Designates the Tribal Health Liaison, appointed by and serving at the pleasure of the State Public Health Officer, as the leader of the Office, and requires the Tribal Health Liaison to oversee CDPH’s tribal health equity meetings, advisory groups, and workgroups, among other duties.
8. Requires the State Public Health Officer to regularly consult with and consider input and information provided by the Tribal Health Liaison.
9. Makes legislative findings that the health impacts of colonialism and state-sponsored trauma persist in tribal communities; existing law requires the state to conduct studies on the health disparities of American Indian and Alaska Native (AIAN) communities across the state; AIAN studies, recommendations, and policy solutions have not been produced by some state agencies, including CDPH, for many years; age-adjusted rates of opioid overdoes death rates in California were the highest among AIANs in 2022; diabetes prevalence and mortality were twice as high among AIANs in California as compared with non-Hispanic Whites; AIAN women had the highest rates of syphilis in 2021; AIAN babies were up to eight times more likely to have newborn syphilis than babies born to White mothers; and AIAN babies had the highest rate of Sudden Infant Death in 2020.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, this bill has costs of less than $150,000 to CDPH to staff the Office (General Fund). CDPH was unable to provide a cost estimate, but notes that it is already executing the provisions of this bill to a great degree with existing staff.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, Tribal and Urban Indian communities have worse health outcomes than any other minority population across nearly every measurable disease prevalence. Many of these health outcomes are related to colonialism, poverty, and historic and intergenerational trauma. No one action will address the many health disparities that exist in tribal communities. However, establishing an Office and appointing a Tribal Liaison with regular access to CDPH’s leadership, will provide a dedicated state resource that is responsible for taking these challenges head-on, and providing policy solutions and recommendations to state leaders.
2. Executive orders requiring consultation with California Native American tribes. In 2011, Governor Brown issued Executive Order B-10-11 recognizing and reaffirming the inherent rights of Native American tribes to exercise sovereign authority over their members and territory and establishing the position of Governor’s Tribal Advisor to serve as a direct link between the tribes and the state. In addition, the order stated that every state agency and department subject to the executive control of the Governor shall encourage communication and consultation with the California tribes and permit representatives of tribal governments to provide meaningful input into the development of legislation, regulations, rules, and policies on matters affecting tribal communities. This order was reaffirmed by Governor Newsom in Executive Order N-15-19, which also issued a formal apology for the actions of the State of California against the tribes and established a Truth and Healing Council to document the historical relationship between the State and California Native Americans in the spirit of truth and healing.
3. CHHS tribal consultation policy. As a result of the 2011 executive order, CHHS released a tribal consultation policy in 2017 to facilitate effective government-to-government consultation between CHHS, its departments, and sovereign California, federally recognized tribes. The policy encourages departments to obtain meaningful input from the tribes on regulations, rules, and policies affecting their communities and to promote opportunities for the departments to learn from tribal program experience to inform program operations and policy development. The policy recognized that each department has a different statutory mandate and, in some cases, may have tribal requirements in place through existing laws or regulation. The policy requires each department to designate a tribal liaison to serve as the central point of contact for the tribes and advises that the liaison be at the executive level or a designated representative of the department’s executive team. It recommends identifying liaisons who are tribal members and to train the liaisons on cultural competency, tribal governments, and tribal sovereignty. The policy also specifies who the primary contact should be for each tribe and to use the contact list maintained by the Governor’s Tribal Advisor, as well as outlines goals on the identification of issues impacting tribes, timing of notification of issues for consultation, frequency of communication, and dissemination of information.
4. Departments with offices of tribal affairs. Some California departments, including the Department of Social Services and the Department of Health Care Services (DHCS) already have an Office of Tribal Affairs. For example, DHCS has an Office housed in its Health Care Benefits and Eligibility Branch. In addition to serving as a liaison with the tribes as required in the CHHS tribal consultation policy, DHCS’s Office also houses the Indian Health Program that: provides financial and technical assistance to 144 Indian Health primary care clinic sites; manages interagency agreements with the CDPH (including the American Indian Maternal Services and Supports grant program and the Tribal Emergency Preparedness and Response Program); ensures ongoing compliance with federal requirements; and, notifies tribes and designees of Indian health programs on proposed changes to the Medi-Cal program. DHCS’ Office also addresses tribal health disparities through an array of programs and initiatives aimed at improving the health of AIAN in California.
5. Office of Health Equity and Tribal Liaison. While CDPH does not currently have an Office of Tribal Affairs, it does have an Office of Health Equity to provide leadership to reduce health and mental health disparities experienced by vulnerable communities in California. The enabling statute does specifically call out people who have experienced socioeconomic disadvantage and historical injustice as a focus; it does not specifically call out the AIAN population. CDPH states that a priority of the Office of Health Equity is building cross-sectoral partnerships and states that it is informed by its advisory committee and stakeholder meetings. The current advisory board does not contain any tribal representatives. According to CDPH, the current Tribal Liaison is the Deputy Director of the Office of Health Equity. The liaison is responsible for engaging with tribes and other relevant partners to understand tribal needs and serve as the liaison to communicate those needs and issue solutions from tribal communities to CDPH, CHHS, state COVID-19 Task Forces, and other state agencies. In addition to another position of Tribal Health Equity Consultant, CDPH has indicated plans to post a Tribal Coordinator position this spring to launch and coordinate an advisory board of tribal representatives to ensure ongoing feedback and input on emerging issues, ensuring culturally and community responsive program improvements.
6. Prior legislation. AB 1467 (Committee on Budget, Chapter 23, Statues of 2012) established the Office of Health Equity within CDPH.
7. Support. The California Tribal Business Alliance write in support stating that the bill makes positive strides to ensure that the unique needs and perspectives of tribal communities are integrated into public health decision-making processes. The California Primary Care Association Advocates, which advocates on behalf of community health centers including Urban Indian Organizations, Native American and Tribal Health Centers, state that the key provisions of this bill such as the designation of a Tribal Health Liaison to lead the Office and the requirement for regular consultation with tribal representatives underscore a commitment to addressing the unique healthcare needs of Native communities.
8. Amendments. Based on input from stakeholders, the author and the committee have agreed to the following amendment to clarify that the Tribal Health Liason is responsible for meeting directly with tribal representatives:

Sec. 2, Health & Safety Code 131022

(a) There is within the State Department of Public Health an Office of Tribal Affairs to assist in addressing the public health disparities impacting tribal communities.

(b) The Office of Tribal Affairs is led by the Tribal Health Liaison, who shall be appointed by and serve at the pleasure of the State Public Health Officer.

(c) The Tribal Health Liaison shall, among other duties, oversee the department’s tribal health equity meetings, advisory groups, and workgroups and shall regularly consult with California tribal representatives on regulations, rules, and policies that may impact tribes.

. . .

SUPPORT AND OPPOSITION:

Support: California Rural Indian Health Board (sponsor)

California Consortium for Urban Indian Health

California Primary Care Association Advocates

California Tribal Business Alliance

California WIC Association

Democratic Club of Claremont

Five individuals

Oppose: None Received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1965

Author:(Blanca Rubio)

As Amended Ver:April 4, 2024

Majority vote

SUMMARY

Establishes the Office of Tribal Affairs (OTA) within the Department of Public Health (DPH), and requires the State Public Health Officer to appoint and regularly consult with a Tribal Health Liaison to lead the OTA. Requires the OTA assist in addressing health disparities and perform duties including: engaging with tribes and other relevant partners to understand their needs; serve as the liaison to communicate needs and to propose specific solutions from tribal communities to the DPH, the California Health and Human Services Agency (CHHSA), state COVID-19 task forces, and other state agencies; ensure that support and technical assistance provided by DPH is culturally competent and timely; launch and coordinate an advisory board of tribal representatives to ensure ongoing feedback and input on emerging issues for the purpose of ensuring culturally and community-responsive program improvements; and, develop and establish a tribal consultation policy in collaboration with the tribes.

Major Provisions

COMMENTS

1. Health Disparities for American Indian and Alaska Native (AIAN) subpopulations.
   1. Life expectancy. According to a 2021 National Vital Statistics report, life expectancy at birth was 71.8 years for the total non-Hispanic AIAN population as of 2019. By comparison, life expectancy at birth was 81.9 years for the Hispanic population, 78.8 years for the non-Hispanic white population, and 74.8 years for the non-Hispanic Black population.
   2. Obesity. According to Kaiser Family Foundation (KFF) survey data, 40% of the non-elderly adult (ages 18-64) AIAN population surveyed are obese, compared to 30% the non-elderly white population.
   3. Asthma. According to KFF survey data, Black and AIAN adults had higher rates of asthma compared to their White counterparts (12% and 13% vs. 10%), while Hispanic, Native Hawaiian and Other Pacific Islander and Asian adults had lower asthma rates than White adults (8%, 6% and 6% vs. 10%).
   4. Diabetes. According to DPH data, diabetes prevalence was two times higher among the AIAN population compared to the non-Hispanic white population in 2019. In 2020, diabetes death was two times higher among the AIAN population compared to the non-Hispanic white population.
   5. Substance Use Disorder (SUD). According to KFF survey data, 15% of the non-elderly adult (ages 18-64) AIAN population surveyed report SUD, compared to 10% the non-elderly white population.
   6. End Stage Renal Disease. According to the Office of Minority Health within the United States Department of Health and Human Services, in 2017, AIAN individuals were twice as likely to be diagnosed with end stage renal disease as non-Hispanic white individuals.
   7. Mental Health. According to DPH's 2023 demographic report, multiracial and AIAN adults in California have higher rates of serious psychological distress during the past year (20.3 and 18.7%, respectively) compared to Black or African American and Asian adults (10.2 and 9.8%, respectively). Additionally, AIAN individuals and white individuals had the highest rates of suicide in 2021, with white individuals maintaining their higher rates into 2022. Suicide rates among AIAN more than doubled from 2020 to 2021.
   8. Syphilis. According to the Centers for Disease Control and Prevention (CDC), babies born to AIAN parents were up to eight times more likely to have newborn syphilis in 2021 than babies born to non-Hispanic white individuals.
   9. Cancer. According to the CDC, AIAN people have much higher rates of getting several cancers, including lung, colorectal, liver, stomach, and kidney cancers, compared to non-Hispanic white people in the United States.
2. Executive Orders. Recent Governors have taken steps to encourage communication and consultation between state agencies and departments with California Indian Tribes. Governor Jerry Brown signed Executive Order B-10-11 which states: "that it is the policy of this Administration that every state agency and department subject to my executive control shall encourage communication and consultation with California Indian Tribes. Agencies and departments shall permit elected officials and other representatives of tribal governments to provide meaningful input into the development of legislation, regulations, rules, and policies on matters that may affect tribal communities." Governor Gavin Newsom reaffirmed his predecessors actions through Executive Order N-15-19, which does the following: "recognizes that the State historically sanctioned over a century of depredations and prejudicial policies against California Native Americans; commends and honors California Native Americans for persisting, carrying on cultural and linguistic traditions, and stewarding and protecting this land that we now share; and apologizes on behalf of the citizens of the State of California to all California Native Americans for the many instances of violence, maltreatment and neglect California inflicted on tribes." Additionally, Executive Order N-15-19 reaffirms and incorporates by reference the principles outlined in Executive Order B-10-11, which requires the Governor's Tribal Advisor and the Administration to engage in government-to-government consultation with California Native American tribes regarding policies that may affect tribal communities.
3. OTA. Some state departments and agencies have already established an OTA, including the Department of Social Services (DSS), the Department of Health Care Services (DHCS), and the Governor's Office of Emergency Services. DPH recently established the Office of Health Equity (OHE). The OHE provides a key leadership role to reduce health and mental health disparities experienced by vulnerable communities in California. The OHE works with community-based organizations and local governmental agencies to ensure that community perspectives and input help to shape a health equity lens in policies and strategic plans, recommendations, and implementation activities. According to DPH, the deputy director of OHE is the current Tribal Liaison and oversees a Tribal Health Equity consultant. Among other duties, the Tribal Liaison ensures engagement with Tribes and other relevant partners to understand needs and serve as the liaison to communicate needs and issue specific solutions from Tribal communities to DPH, CHHSA, state COVID-19 Task Forces, and other State agencies. The Tribal Liaison also ensures that the support and technical assistance provided by DPH is culturally competent and timely, briefs the Director as needed (several times per year) and annually before the Tribal Nations Summit attended by the Governor, Secretaries, Directors, Tribal Liaisons, and Tribal Chairpersons. The Tribal Liaisons also holds a monthly Tribal Information sharing meeting (bi-weekly, now monthly) in partnership with CHHSA Tribal Liaison. In 2022, DPH hired a Tribal Health Equity Lead and established a Tribal Long COVID Work Group. In 2023, DPH established a tribal long COVID Work Group and a Tribal Data Work Group. In the spring of 2024, DPH plans to post a tribal coordinator position to launch and coordinate an advisory board of tribal representatives to ensure ongoing input for culturally appropriate program improvements, and to oversee the DPH Tribal Health Equity meetings, advisory groups, and workgroups, among other duties.

This bill establishes a standalone OTA, separate from the OHE.

According to the Author

Tribal and urban Indian communities have worse health outcomes than any other minority population across nearly every measurable disease prevalence. Many of these health outcomes are related to colonialism, poverty, and historic and intergenerational trauma. The author continues that no one action will address the many health disparities that exist in Tribal communities. The author concludes that establishing an OTA and appointing a Tribal Liaison with regular access to DPH's leadership will provide a dedicated state resource that is responsible for taking these challenges head-on, and providing policy solutions and recommendations to state leaders.

Arguments in Support

The California Consortium for Urban Indian Health (CCUIH) states that Office of Tribal Affairs established by this bill would play a crucial role in addressing the persistent health disparities faced by Tribal communities across California. The key provisions of this bill, such as the designation of a Tribal Health Liaison to lead the Office of Tribal Affairs and the requirement for regular consultation with Tribal representatives, underscore a commitment to addressing the unique healthcare needs of Native communities. CCUIH believes that these provisions have the potential to significantly impact Urban Indian Health Organizations by fostering increased collaboration, support, and resource allocation towards improving health outcomes for urban Native American populations. CCUIH recommends amendments to include language ensuring the active engagement of Indian Health Programs statewide utilized by DHCS and DSS to enhance the effectiveness in addressing the needs of AIAN individuals.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, costs of less than $150,000 to DPH to staff the OTA (General Fund). DPH was unable to provide a cost estimate, but notes that it is already executing the provisions of this bill to a great degree with existing staff.

VOTES

ASM HEALTH: 15-0-1

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ABS, ABST OR NV: McCarty

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta, Villapudua

UPDATED

VERSION: January 29, 2024

CONSULTANT: Eliza Brooks / HEALTH / (916) 319-2097 FN: 0002793

Date of Hearing: April 2, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 1965 (

Author:(Blanca Rubio) – As Introduced Ver:January 29, 2024

SUBJECT: Public health: Office of Tribal Affairs.

SUMMARY: Establishes the Office of Tribal Affairs (OTA) within the Department of Public Health (DPH). Specifically, this bill:

1. Requires the OTA to be led by a Tribal Health Liaison to assist in addressing the public health disparities impacting Tribal communities.
2. Provides that the Tribal Health Liaison will be appointed by and serve at the pleasure of the State Public Health Officer (PHO).
3. Requires the PHO to regularly consult with and consider input and information provided by the Tribal Health Liaison.
4. Makes related findings and declarations to that effect that tribal communities face significant health disparities.

EXISTING LAW

1. Establishes the Office of Health Equity (OHE) within DPH to do all of the following:
   1. Perform strategic planning to develop departmentwide plans for implementation of goals and objectives to close the gaps in health status and access to care among the state’s diverse racial and ethnic communities, women, persons with disabilities, and the lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) communities;
   2. Conduct departmental policy analysis on specific issues related to multicultural health;
   3. Coordinate projects funded by the state that are related to improving the effectiveness of services to ethnic and racial communities, women, and the LGBTQQ communities;
   4. Identify the unnecessary duplication of services and future service needs;
   5. Communicate and disseminate information and perform a liaison function within DPH and to providers of health, social, educational, and support services to racial and ethnic communities, women, persons with disabilities, and the LGBTQQ communities.
   6. Consult regularly with representatives from diverse racial and ethnic communities, women, persons with disabilities, and the LGBTQQ communities, including health providers, advocates, and consumers;
   7. Perform internal staff training, an internal assessment of cultural competency, and training of health care professionals to ensure more linguistically and culturally competent care;
   8. Serve as a resource for ensuring that programs collect and keep data and information regarding ethnic and racial health statistics, including those statistics described in reports released by Healthy People 2020, and information based on sexual orientation, gender identity, and gender expression, strategies and programs that address multicultural health issues, including, but not limited to, infant and maternal mortality, cancer, cardiovascular disease, diabetes, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), child and adult immunization, osteoporosis, menopause, and full reproductive health, asthma, unintentional and intentional injury, and obesity, as well as issues that impact the health of racial and ethnic communities, women, and the LGBTQQ communities, including substance abuse, mental health, housing, teenage pregnancy, environmental disparities, immigrant and migrant health, and health insurance and delivery systems;
   9. Encourage innovative responses by public and private entities that are attempting to address multicultural health issues;
   10. Provide technical assistance to counties, other public entities, and private entities seeking to obtain funds for initiatives in multicultural health, including identification of funding sources and assistance with writing grants; and,
   11. Requires DPH to biennially prepare and submit a report to the Legislature on the status of the activities required by this chapter. [HSC § 152]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, Tribal and urban Indian communities have worse health outcomes than any other minority population across nearly every measurable disease prevalence. Many of these health outcomes are related to colonialism, poverty, and historic and intergenerational trauma. The author continues that no one action will address the many health disparities that exist in Tribal communities. The author concludes that establishing an OTA and appointing a Tribal Liaison with regular access to DPH’s leadership will provide a dedicated state resource that is responsible for taking these challenges head-on, and providing policy solutions and recommendations to state leaders.
2. BACKGROUND.
   1. Health Disparities for American Indian and Alaska Native (AIAN) subpopulations.
      
      1. Life expectancy. According to a 2021 National Vital Statistics report, life expectancy at birth was 71.8 years for the total non-Hispanic AIAN population as of 2019. By comparison, life expectancy at birth was 81.9 years for the Hispanic population, 78.8 years for the non-Hispanic white population, and 74.8 years for the non-Hispanic Black population.
         
      2. Obesity. According to Kaiser Family Foundation (KFF) survey data, 40% of the non-elderly adult (ages 18-64) AIAN population surveyed are obese, compared to 30% the non-elderly white population.
         
      3. Asthma. According to KFF survey data, Black and AIAN adults had higher rates of asthma compared to their White counterparts (12% and 13% vs. 10%), while Hispanic, Native Hawaiian and Other Pacific Islander and Asian adults had lower asthma rates than White adults (8%, 6% and 6% vs. 10%).
         
      4. Diabetes. According to DPH data, diabetes prevalence was two times higher among the AIAN population compared to the non-Hispanic white population in 2019. In 2020, diabetes death was two times higher among the AIAN population compared to the non-Hispanic white population.
         
      5. Substance Use Disorder. According to KFF survey data, 15% of the non-elderly adult (ages 18-64) AIAN population surveyed report substance use disorder, compared to 10% the non-elderly white population.
         
      6. End Stage Renal Disease. According to the Office of Minority Health within the United States Department of Health and Human Services, in 2017, AIAN individuals were twice as likely to be diagnosed with end stage renal disease as non-Hispanic white individuals.
         
      7. Mental Health. According to DPH’s 2023 demographic report, multiracial and AIAN adults in California have higher rates of serious psychological distress during the past year (20.3 and 18.7 percent, respectively) compared to Black or African American and Asian adults (10.2 and 9.8%, respectively). Additionally, AIAN individuals and white individuals had the highest rates of suicide in 2021, with white individuals maintaining their higher rates into 2022. Suicide rates among AIAN more than doubled from 2020 to 2021.
         
      8. Syphilis. According to the Centers for Disease Control and Prevention (CDC), babies born to AIAN parents were up to eight times more likely to have newborn syphilis in 2021 than babies born to non-Hispanic white individuals.
         
      9. Cancer. According to the CDC, American Indian and Alaska Native (Native American) people have much higher rates of getting several cancers, including lung, colorectal, liver, stomach, and kidney cancers, compared to non-Hispanic white people in the United States.
         
   2. Executive Orders. Recent Governors have taken steps to encourage communication and consultation between state agencies and departments with California Indian Tribes. Governor Jerry Brown signed Executive Order B-10-11 which states: “that it is the policy of this Administration that every state agency and department subject to my executive control shall encourage communication and consultation with California Indian Tribes. Agencies and departments shall permit elected officials and other representatives of tribal governments to provide meaningful input into the development of legislation, regulations, rules, and policies on matters that may affect tribal communities.” Governor Gavin Newsom reaffirmed his predecessors actions through Executive Order N-15-19, which does the following: “recognizes that the State historically sanctioned over a century of depredations and prejudicial policies against California Native Americans; commends and honors California Native Americans for persisting, carrying on cultural and linguistic traditions, and stewarding and protecting this land that we now share; and apologizes on behalf of the citizens of the State of California to all California Native Americans for the many instances of violence, maltreatment and neglect California inflicted on tribes.” Additionally, Executive Order N-15-19 reaffirms and incorporates by reference the principles outlined in Executive Order B-10-11, which requires the Governor's Tribal Advisor and the Administration to engage in government-to-government consultation with California Native American tribes regarding policies that may affect tribal communities.
      
   3. OTA. Some state departments and agencies have already established an Office of Tribal Affairs (OTA), including the Department of Social Services (DSS), the Department of Health Care Services (DHCS), and the Governor’s Office of Emergency Services. DPH recently established the OHE. The OHE provides a key leadership role to reduce health and mental health disparities experienced by vulnerable communities in California. The OHE works with community-based organizations and local governmental agencies to ensure that community perspectives and input help to shape a health equity lens in policies and strategic plans, recommendations, and implementation activities. According to DPH, the current Tribal Liaison is the Deputy Director of the OHE, who oversees a Tribal Health Equity consultant. Duties for this position include, among other things: engagement with Tribes and other relevant partners to understand needs and serve as the liaison to communicate needs and issue specific (COVID, data sharing) solutions from Tribal communities to DPH, the California Health & Human Services Agency (CHHSA), state COVID-19 Task Forces, and other State agencies, as specified. The Tribal Liaison also ensures that the support and technical assistance provided by DPH is culturally competent, and timely. The Tribal Liaison briefs the Director as needed (several times per year) and annually before the Tribal Nations Summit attended by the Governor, Secretaries, Directors, Tribal Liaisons, and Tribal Chairpersons. In 2020, in response to the COVID-19 State of Emergency, a DPH Tribal Information sharing meeting (bi-weekly, now monthly) was established in partnership with CHHSA Tribal Liaison. In 2022 a Tribal Health Equity Lead was hired. In 2022 a Tribal Long COVID Work Group was established and in 2023 a Tribal Data Work Group was established. To help coordinate work on non-COVID AIAN disparities, a Tribal Coordinator position is expected to be posted later this spring 2024. This position will launch and coordinate an advisory board of Tribal representatives to ensure ongoing feedback and input on emerging issues, ensuring culturally and community responsive program improvements. The position will oversee the DPH Tribal Health Equity meetings, advisory groups, workgroups, among other duties.

This bill establishes a standalone OTA, separate from the OHE.

1. SUPPORT. The California Consortium for Urban Indian Health (CCUIH) states that Office of Tribal Affairs established by this bill would play a crucial role in addressing the persistent health disparities faced by Tribal communities across California. The key provisions of this bill, such as the designation of a Tribal Health Liaison to lead the Office of Tribal Affairs and the requirement for regular consultation with Tribal representatives, underscore a commitment to addressing the unique healthcare needs of Native communities. CCUIH believes that these provisions have the potential to significantly impact Urban Indian Health Organizations by fostering increased collaboration, support, and resource allocation towards improving health outcomes for urban Native American populations. CCUIH recommends amendments to include language ensuring the active engagement of Indian Health Programs statewide utilized by DHCS and DSS to enhance the effectiveness in addressing the needs of AIAN individuals.
2. PREVIOUS LEGISLATION.
   1. AB 2655 (Blanca Rubio) of 2022 would have required DPH to enter into a data sharing agreement with the California Tribal Epidemiology Center for access to and use of the California Reportable Disease Information Exchange and the California Immunization Registry systems no later than January 1, 2023, and prohibits the California Tribal Epidemiology Center from disclosing any information received to any person or entity, except in response to a court order, search warrant, or subpoena, or as otherwise required or permitted by specified federal medical privacy regulation. AB 2655 died on the Senate inactive file.
   2. AB 1467 (Committee on Budget), Chapter 23, Statues of 2012 established the OHE within DPH.
3. AMENDMENTS. The author may wish to amend this bill to specify the duties of the OTA.

REGISTERED SUPPORT / OPPOSITION:

Support

The California Consortium for Urban Indian Health (CCUIH)

Opposition

None on file.

Analysis Prepared by: Eliza Brooks / HEALTH / (916) 319-2097

Date of Hearing: April 24, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 1965

Author:(Blanca Rubio) – As Amended Ver:April 4, 2024

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill establishes the Office of Tribal Affairs (OTA) within the California Department of Public Health (CDPH), and requires the State Public Health Officer (PHO) to appoint and regularly consult with a Tribal Health Liaison to lead the OTA and assist in addressing the public health disparities impacting Tribal communities.

FISCAL EFFECT:

Costs of less than $150,000 to CDPH to staff the OTA (General Fund). CDPH was unable to provide a cost estimate, but notes that it is already executing the provisions of this bill to a great degree with existing staff.

COMMENTS:

1. Purpose. According to the author:

Tribal and Urban Indian communities have worse health outcomes than any other minority population across nearly every measurable disease prevalence. Many of these health outcomes are related to colonialism, poverty, and historic and intergenerational trauma. No one action will address the many health disparities that exist in Tribal communities. However, establishing an OTA and appointing a Tribal Liaison with regular access to CDPH’s leadership, will provide a dedicated state resource that is responsible for taking these challenges head-on, and providing policy solutions and recommendations to state leaders.

1. Background.
   
   Health Disparities. American Indian and Alaska Native (AIAN) populations experience poorer health outcomes, from a life expectancy ten years shorter than that of the Hispanic population and seven years shorter than that of the non-Hispanic white population, and higher rates of obesity, asthma, substance use disorder, and cancer than non-Hispanic whites. Rates of diabetes, end stage kidney disease, and severe psychological distress were twice as high among the AIAN population as among the non-Hispanic white population. The Centers for Disease Control and Prevention (CDC) reports that in 2022, AIAN babies were nine times as likely to have congenital syphilis as non-Hispanic white babies.
   
   Executive Orders. In 2011 Governor Jerry Brown signed Executive Order B-10-11, which required every state agency and department to encourage communication and consultation with California Indian Tribes. Governor Gavin Newsom signed Executive Order N-15-19, which acknowledged and apologized for California’s history of violence against, and other maltreatment of, tribes. Additionally, Governor Newsom, with Executive Order N-15-19, required the Governor's Tribal Advisor and the administration to engage in government-to-government consultation with California Native American tribes regarding policies that may affect tribal communities.
   
   Office of Health Equity (OHE) and Tribal Liaison. CDPH established the OHE to play a leadership role in reducing health disparities experienced by vulnerable communities in California. OHE works with community-based organizations and local governmental agencies to ensure that community perspectives and input help shape a health equity lens in policies and strategic plans, recommendations, and implementation activities. According to CDPH, the deputy director of OHE is the current tribal liaison and oversees a tribal health equity consultant. Among other duties, the tribal liaison ensures the support and technical assistance provided by CDPH is culturally competent and timely, briefs the CDPH director, and holds a monthly tribal information sharing meeting in partnership with the California Health and Human Services Agency tribal liaison. CDPH has also hired a tribal health equity lead, and established a tribal long COVID Work Group and a Tribal Data Work Group. CDPH plans to soon post a tribal coordinator position to launch and coordinate an advisory board of tribal representatives to ensure ongoing input for culturally appropriate program improvements, and to oversee the CDPH Tribal Health Equity meetings, advisory groups, and workgroups, among other duties.
2. Prior Legislation. AB 1467 (Committee on Budget), Chapter 23, Statues of 2012 established the OHE within CDPH.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 2, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 1965 (

Author:(Blanca Rubio) – As Introduced Ver:January 29, 2024

SUBJECT: Public health: Office of Tribal Affairs.

SUMMARY: Establishes the Office of Tribal Affairs (OTA) within the Department of Public Health (DPH). Specifically, this bill:

1. Requires the OTA to be led by a Tribal Health Liaison to assist in addressing the public health disparities impacting Tribal communities.
2. Provides that the Tribal Health Liaison will be appointed by and serve at the pleasure of the State Public Health Officer (PHO).
3. Requires the PHO to regularly consult with and consider input and information provided by the Tribal Health Liaison.
4. Makes related findings and declarations to that effect that tribal communities face significant health disparities.

EXISTING LAW

1. Establishes the Office of Health Equity (OHE) within DPH to do all of the following:
   1. Perform strategic planning to develop departmentwide plans for implementation of goals and objectives to close the gaps in health status and access to care among the state’s diverse racial and ethnic communities, women, persons with disabilities, and the lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) communities;
   2. Conduct departmental policy analysis on specific issues related to multicultural health;
   3. Coordinate projects funded by the state that are related to improving the effectiveness of services to ethnic and racial communities, women, and the LGBTQQ communities;
   4. Identify the unnecessary duplication of services and future service needs;
   5. Communicate and disseminate information and perform a liaison function within DPH and to providers of health, social, educational, and support services to racial and ethnic communities, women, persons with disabilities, and the LGBTQQ communities.
   6. Consult regularly with representatives from diverse racial and ethnic communities, women, persons with disabilities, and the LGBTQQ communities, including health providers, advocates, and consumers;
   7. Perform internal staff training, an internal assessment of cultural competency, and training of health care professionals to ensure more linguistically and culturally competent care;
   8. Serve as a resource for ensuring that programs collect and keep data and information regarding ethnic and racial health statistics, including those statistics described in reports released by Healthy People 2020, and information based on sexual orientation, gender identity, and gender expression, strategies and programs that address multicultural health issues, including, but not limited to, infant and maternal mortality, cancer, cardiovascular disease, diabetes, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), child and adult immunization, osteoporosis, menopause, and full reproductive health, asthma, unintentional and intentional injury, and obesity, as well as issues that impact the health of racial and ethnic communities, women, and the LGBTQQ communities, including substance abuse, mental health, housing, teenage pregnancy, environmental disparities, immigrant and migrant health, and health insurance and delivery systems;
   9. Encourage innovative responses by public and private entities that are attempting to address multicultural health issues;
   10. Provide technical assistance to counties, other public entities, and private entities seeking to obtain funds for initiatives in multicultural health, including identification of funding sources and assistance with writing grants; and,
   11. Requires DPH to biennially prepare and submit a report to the Legislature on the status of the activities required by this chapter. [HSC § 152]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, Tribal and urban Indian communities have worse health outcomes than any other minority population across nearly every measurable disease prevalence. Many of these health outcomes are related to colonialism, poverty, and historic and intergenerational trauma. The author continues that no one action will address the many health disparities that exist in Tribal communities. The author concludes that establishing an OTA and appointing a Tribal Liaison with regular access to DPH’s leadership will provide a dedicated state resource that is responsible for taking these challenges head-on, and providing policy solutions and recommendations to state leaders.
2. BACKGROUND.
   1. Health Disparities for American Indian and Alaska Native (AIAN) subpopulations.
      
      1. Life expectancy. According to a 2021 National Vital Statistics report, life expectancy at birth was 71.8 years for the total non-Hispanic AIAN population as of 2019. By comparison, life expectancy at birth was 81.9 years for the Hispanic population, 78.8 years for the non-Hispanic white population, and 74.8 years for the non-Hispanic Black population.
         
      2. Obesity. According to Kaiser Family Foundation (KFF) survey data, 40% of the non-elderly adult (ages 18-64) AIAN population surveyed are obese, compared to 30% the non-elderly white population.
         
      3. Asthma. According to KFF survey data, 15% of the non-elderly adult (ages 18-64) AIAN population surveyed are obese, compared to 10% the non-elderly white population.
         
      4. Diabetes. According to DPH data, diabetes prevalence was two times higher among the AIAN population compared to the non-Hispanic white population in 2019. In 2020, diabetes death was two times higher among the AIAN population compared to the non-Hispanic white population.
         
      5. Substance Use Disorder. According to KFF survey data, 15% of the non-elderly adult (ages 18-64) AIAN population surveyed report substance use disorder, compared to 10% the non-elderly white population.
         
      6. End Stage Renal Disease. According to the Office of Minority Health within the United States Department of Health and Human Services, in 2017, AIAN individuals were twice as likely to be diagnosed with end stage renal disease as non-Hispanic white individuals.
         
      7. Mental Health. According to DPH’s 2023 demographic report, multiracial and AIAN adults in California have higher rates of serious psychological distress during the past year (20.3 and 18.7 percent, respectively) compared to Black or African American and Asian adults (10.2 and 9.8%, respectively). Additionally, AIAN individuals and white individuals had the highest rates of suicide in 2021, with white individuals maintaining their higher rates into 2022. Suicide rates among AIAN more than doubled from 2020 to 2021.
         
      8. Syphilis. According to the Centers for Disease Control and Prevention (CDC), babies born to AIAN parents were up to eight times more likely to have newborn syphilis in 2021 than babies born to non-Hispanic white individuals.
         
      9. Cancer. According to the CDC, American Indian and Alaska Native (Native American) people have much higher rates of getting several cancers, including lung, colorectal, liver, stomach, and kidney cancers, compared to non-Hispanic white people in the United States.
         
   2. Executive Orders. Recent Governors have taken steps to encourage communication and consultation between state agencies and departments with California Indian Tribes. Governor Jerry Brown signed Executive Order B-10-11 which states: “that it is the policy of this Administration that every state agency and department subject to my executive control shall encourage communication and consultation with California Indian Tribes. Agencies and departments shall permit elected officials and other representatives of tribal governments to provide meaningful input into the development of legislation, regulations, rules, and policies on matters that may affect tribal communities.” Governor Gavin Newsom reaffirmed his predecessors actions through Executive Order N-15-19, which does the following: “recognizes that the State historically sanctioned over a century of depredations and prejudicial policies against California Native Americans; commends and honors California Native Americans for persisting, carrying on cultural and linguistic traditions, and stewarding and protecting this land that we now share; and apologizes on behalf of the citizens of the State of California to all California Native Americans for the many instances of violence, maltreatment and neglect California inflicted on tribes.” Additionally, Executive Order N-15-19 reaffirms and incorporates by reference the principles outlined in Executive Order B-10-11, which requires the Governor's Tribal Advisor and the Administration to engage in government-to-government consultation with California Native American tribes regarding policies that may affect tribal communities.
      
   3. OTA. Some state departments and agencies have already established an Office of Tribal Affairs (OTA), including the Department of Social Services (DSS), the Department of Health Care Services (DHCS), and the Governor’s Office of Emergency Services. DPH recently established the OHE. The OHE provides a key leadership role to reduce health and mental health disparities experienced by vulnerable communities in California. The OHE works with community-based organizations and local governmental agencies to ensure that community perspectives and input help to shape a health equity lens in policies and strategic plans, recommendations, and implementation activities. According to DPH, the current Tribal Liaison is the Deputy Director of the OHE, who oversees a Tribal Health Equity consultant. Duties for this position include, among other things: engagement with Tribes and other relevant partners to understand needs and serve as the liaison to communicate needs and issue specific (COVID, data sharing) solutions from Tribal communities to DPH, the California Health & Human Services Agency (CHHSA), state COVID-19 Task Forces, and other State agencies, as specified. The Tribal Liaison also ensures that the support and technical assistance provided by DPH is culturally competent, and timely. The Tribal Liaison briefs the Director as needed (several times per year) and annually before the Tribal Nations Summit attended by the Governor, Secretaries, Directors, Tribal Liaisons, and Tribal Chairpersons. In 2020, in response to the COVID-19 State of Emergency, a DPH Tribal Information sharing meeting (bi-weekly, now monthly) was established in partnership with CHHSA Tribal Liaison. In 2022 a Tribal Health Equity Lead was hired. In 2022 a Tribal Long COVID Work Group was established and in 2023 a Tribal Data Work Group was established. To help coordinate work on non-COVID AIAN disparities, a Tribal Coordinator position is expected to be posted later this spring 2024. This position will launch and coordinate an advisory board of Tribal representatives to ensure ongoing feedback and input on emerging issues, ensuring culturally and community responsive program improvements. The position will oversee the DPH Tribal Health Equity meetings, advisory groups, workgroups, among other duties.

This bill establishes a standalone OTA, separate from the OHE.

1. SUPPORT. The California Consortium for Urban Indian Health (CCUIH) states that Office of Tribal Affairs established by this bill would play a crucial role in addressing the persistent health disparities faced by Tribal communities across California. The key provisions of this bill, such as the designation of a Tribal Health Liaison to lead the Office of Tribal Affairs and the requirement for regular consultation with Tribal representatives, underscore a commitment to addressing the unique healthcare needs of Native communities. CCUIH believes that these provisions have the potential to significantly impact Urban Indian Health Organizations by fostering increased collaboration, support, and resource allocation towards improving health outcomes for urban Native American populations. CCUIH recommends amendments to include language ensuring the active engagement of Indian Health Programs statewide utilized by DHCS and DSS to enhance the effectiveness in addressing the needs of AIAN individuals.
2. PREVIOUS LEGISLATION.
   1. AB 2655 (Blanca Rubio) of 2022 would have required DPH to enter into a data sharing agreement with the California Tribal Epidemiology Center for access to and use of the California Reportable Disease Information Exchange and the California Immunization Registry systems no later than January 1, 2023, and prohibits the California Tribal Epidemiology Center from disclosing any information received to any person or entity, except in response to a court order, search warrant, or subpoena, or as otherwise required or permitted by specified federal medical privacy regulation. AB 2655 died on the Senate inactive file.
   2. AB 1467 (Committee on Budget), Chapter 23, Statues of 2012 established the OHE within DPH.
3. AMENDMENTS. The author may wish to amend this bill to specify the duties of the OTA.

REGISTERED SUPPORT / OPPOSITION:

Support

The California Consortium for Urban Indian Health (CCUIH)

Opposition

None on file.

Analysis Prepared by: Eliza Brooks / HEALTH / (916) 319-2097