Deputy Secretary Eric Hargan Keynote Address at National Native American Heritage Month 2019

Deputy Secretary Eric Hargan Keynote Address at National Native American Heritage Month 2019


GOOD MORNING, EVERYONE. THANK YOU ALL SO MUCH FOR
JOINING US HERE TODAY. IT’S AN HONOR FOR ME TO BE HERE
AT THE THIRD NATIONAL NATIVE AMERICAN HERITAGE MONTH THAT
I’VE ATTENDED HERE AT HHS, AT LEAST DURING THIS TOUR OF DUTY
HERE AT THE DEPARTMENT. AT THE TIME UNDER PRESIDENT
TRUMP, IT’S BEEN AN HONOR FOR ME TO TAKE A PARTICULARLY ACTIVE
ROLE IN WORKING ON OUR RELATIONSHIPS WITH TRIBAL
COMMUNITIES. REGARDING THE WORK OF THE INDIAN
HEALTH SERVICE, THE ADMINISTRATION FOR NATIVE
AMERICANS, AND ALL THE OTHER WAYS THAT OUR OTHER COMPONENTS
OF HHS WORK WITH TRIBAL COMMUNITIES. NOW TODAY I’M GOING TO TALK TO
YOU SPECIFICALLY ABOUT SOME I’VE SEEN AND HEARD FROM MY WORK WITH
TRIBAL LEADERS AND TRIBAL COMMUNITIES, INCLUDING THROUGH
THE WORK AS WAS REFERENCED IN THE SECRETARY’S TRIBAL ADVISORY
COMMITTEE OR THE STAC UNDER THE TRUMP ADMINISTRATION FOR THE
FIRST TIME THAT WE KNOW OF, WE’VE COMMITTED TO HOLDING A
MEETING OF THE STAC EACH YEAR OUT IN INDIAN COUNTRY SO WE CAN
GAIN PERSPECTIVE DIRECTLY FROM COMMUNITIES. I WANT TO EMPHASIZE THAT CLOSE
RELATIONSHIPS WITH TRIBAL COMMUNITIES AND IMPROVING THE
HEALTH AND WELL-BEING OF AMERICAN INDIANS AND ALASKA
NATIVES IS A PRIORITY FOR THIS ADMINISTRATION. AS PRESIDENT TRUMP PUT IT IN HIS
PROCLAMATION FOR THIS EVENT, WE QUOTE, “RECOGNIZE THAT OUR
CULTURE IS MORE VIBRANT BECAUSE OF THE SPECIAL
GOVERNMENT-TO-GOVERNMENT RELATIONSHIP BETWEEN THE UNITED
STATES AND INDIAN TRIBES.” AND I’D BE REMISS AS WE
CELEBRATE THIS EVENT JUST A FEW DAYS AFTER VETERANS’ DAY NOT TO
ACKNOWLEDGE AND PRAISE THE INCREDIBLY PROUD HERITAGE OF
AMERICAN INDIANS AND ALASKA NATIVES WHO HAVE SERVED IN THE
ARMED FORCES OF THE UNITED STATES AT HIGHER RATES, WE’RE
TOLD, BY DOD THAN ANY OTHER ETHNIC GROUP IN THE UNITED
STATES. SO DURING NATIONAL NATIVE
AMERICAN HERITAGE MONTH, THE PRESIDENT’S PROCLAMATION SAID WE
ALSO REAFFIRM OUR COMMITMENT TO WORK WITH TRIBAL COMMUNITIES TO
ADDRESS SERIOUS ISSUES AFFECTING THEM AND TO HELP PROTECT THEIR
RICH AND DIVERSE HERITAGE. NOW THIS WORK TO PROTECT NATIVE
HERITAGE STRENGTHENED OUR GOVERNMENT-TO-GOVERNMENT
RELATIONSHIPS WITH TRIBES AND ADDRESSED THE ISSUES AROUND
HEALTH AND WELL-BEING THAT TRIBES FACE, GOES ON ALL ACROSS
HHS AS YOU ALL WELL KNOW. THROUGH THE ADMINISTRATION FOR
NATIVE AMERICANS AT ACF, FOR INSTANCE, WE SUPPORT PROGRAMS
THAT HELP PASS ON TRIBAL LANGUAGES TO YOUNGER
GENERATIONS. HHS HAS BEEN ACTIVELY INVOLVED
IN PROMOTING THE BI INDIAN ACT AS WELL AS PREFERENCES IN
CONTRACTING AND TAKING PART IN TOWN HALLS THAT EDUCATE TRIBES
AND CONTRACTORS ABOUT OPPORTUNITIES TO ENCOURAGE
BUSINESS WITH TRIBAL COMMUNITIES. THIS PAST YEAR, THE CDC PROVIDED
SUPPORT FOR THE NAVAJO EPIDEMIOLOGY CENTER TO HELP
PROTECT MEMBERS OF THE NAVAJO NATION FROM PESTS THAT CAN CARRY
VIRUSES INTO THEIR HOMES. THROUGH THE MATERNAL INFANT AND
EARLY CHILDHOOD HOME VISITING PROGRAM
OR THE MIECHV, THAT HELPS SUPPORT VULNERABLE MEMBERS
OF TRIBAL COMMUNITIES. THESE ARE JUST A FEW EXAMPLES,
AND I EMPHASIZE JUST A FEW, OF THE KIND OF BREADTH OF WORK THAT
WE DO HERE AT THE DEPARTMENT ON TRIBAL ISSUES. AS I’VE MENTIONED, I’VE TAKEN
THE LEAD ON THE STAC, PROVIDING A CLOSE LINK FOR TRIBAL LEADERS
TO COMMUNICATE CONCERNS TO HHS LEADERSHIP. NOW THAT’S COVERED A WHOLE RANGE
OF ISSUES, BUT IT OFTEN FOCUSES IN PARTICULAR ON IHS, AND ON
PUBLIC HEALTH CHALLENGES. THOSE ARE THE KINDS OF ISSUES I
WAS ABLE TO LEARN A GREAT DEAL ABOUT DURING MY TRAVELS TO
INDIAN COUNTRY OVER THE LAST YEAR OR SO, AND THAT’S WHAT I
WANT TO SHARE WITH YOU RIGHT NOW AND WE’LL START OFF WITH
SOMETHING I THINK A LITTLE HUMOROUS, IF THIS WORKS. OKAY, WELL NOT THIS ONE, BUT
CELEBRATING NATIVE AMERICAN HERITAGE, THIS IS GOING TO BE
THE FUNNY ONE, SO THERE YOU GO. I JUST GOT THAT CARTOON SENT TO
ME BY ANOTHER CONFERENCE I ATTENDED, COMPLETELY OUT OF THE
BLUE, NOT MY WORK, BUT A HEALTHCARE LAWYER, THAT’S MY
BACKGROUND. DURING MY TIME AS DEPUTY
SECRETARY, I’VE HAD THE PLEASURE OF VISITING A NUMBER OF TRIBES
AND TRIBAL LANDS. NOW EACH NEW TRIBAL COMMUNITY,
I’VE HAD THE CHANCE TO VISIT OFFERS THE OPPORTUNITY TO DEEPEN
MY UNDERSTANDING OF THE TRIUMPHS AS WELL AS CHALLENGES OF INDIAN
COUNTRY. IHS WAS ONE OF MY FIRST I WORKED
FOR AS DEPUTY COUNSEL UNDER THEN ALEX AZAR. WHEN I CAME BACK AFTER THE
ELECTION, WHEN I CAME TO IHS TO VISIT, ONE OF THE STAFF THERE
SAID, WELCOME HOME, BECAUSE WE WORKED SO CLOSELY TOGETHER
DURING MY TIME PREVIOUSLY AT HHS UNDER PRESIDENT BUSH, WHICH
PROVIDED A WARM RE-ADMISSION INTO THE IHS FAMILY WHEN I CAME
BACK TO HHS, WHICH WAS MUCH APPRECIATED. NOW OVER THE LAST THREE YEARS,
HHS HAS BEEN HONORED TO JOIN TRIBAL LEADERS EACH YEAR FOR OUR
SEMIANNUAL MEETINGS OF THE STAC, AND NEW TO THIS ADMINISTRATION,
WE’RE HOPING 1STAC MEETING EACH YEAR IN INDIAN COUNTRY. SO FAR IN OKLAHOMA, THEN ALASKA,
AND THEN EARLIER THIS YEAR IN ARIZONA. THIS MEETING SIGNIFIES ONE OF
THE WAYS THAT WE ARE FULFILLING THE COMMITMENT THIS
ADMINISTRATION HAS MADE TO STRENGTHENING THE
GOVERNMENT-TO-GOVERNMENT RELATIONSHIP WITH THE 573
FEDERALLY RECOGNIZED TRIBES IN THE UNITED STATES. IN OCTOBER 2018, I HAD THE
PLEASURE OF JOINING MY HHS COLLEAGUES ON A TRIP TO ALASKA,
WHERE APPROXIMATELY 40% OF FEDERALLY RECOGNIZED TRIBES ARE
LOCATED. WE VISITED WITH COMMUNITY
LEADERS AND FAMILIES THROUGHOUT THE STATE TO SEE THE TRIUMPHS OF
ALASKA NATIVE COMMUNITIES AS WELL AS THE CHALLENGES THAT FACE
REMOTE TRIBAL COMMUNITIES. NOW I GREW UP ON A FARM IN
ILLINOIS AND AROUND THE RURAL CLINIC THAT MY LATE MOTHER
WORKED AT, AND I THOUGHT I UNDERSTAND RURAL AND REMOTE
HEALTHCARE. BUT ALASKA WAS A SERIOUS EYE
OPENER FOR ME. WHAT I THOUGHT I KNEW. HERE’S A PHOTO OF THE HHS
DELEGATION UP IN ALASKA. DON’T LET THE SMILES FOOL YOU,
IT WAS, IN FACT, A VERY COLD DAY, FOR THOSE OF YOU WHO WERE
THERE. LATER ON, WE ACTUALLY RODE A
BOAT ACROSS THE RIVER NEARBY TO A TOWN WITH, I THINK, 12 HOMES
OUT IN INTERIOR OF ALASKA. AND WHILE IT WAS CERTAINLY A
UNIQUE EXPERIENCE FOR US, FOR MANY OF THE PEOPLE IN THAT
COMMUNITY, IT WAS ACTUALLY COMMON FORM OF TRANSPORTATION
THAT THEY USED EACH DAY. AND OF COURSE WE WERE THERE TO
SEE AGAIN DEPARTMENTAL WORK THAT WAS GOING ON IN A TOWN WITH
12 — I THINK 12 HOMES TOTAL. AND YET THERE WAS STILL HHS WORK
GOING ON IN THAT COMMUNITY, AS WELL AS THE COMMUNITY — THE
SOMEWHAT LARGER COMMUNITY THAT WE HAD JUST LEFT TO GO ACROSS
THE RIVER. SO WHEN YOU THINK ABOUT THE
BREADTH AND DEPTH OF WHAT WE DO AND HOW WE AFFECT PEOPLE, WHEN
YOU REALIZE THAT A TOWN OF PROBABLY 20 TO 25 PEOPLE IN
REMOTE INTERIOR OF ALASKA, YOU STILL SEE THE WORK OF THE
DEPARTMENT GOING ON EVEN THERE. AND A PLACE — NO ROADS, BUT BY
BOAT ACROSS A VERY SMALL TOWN. DURING OUR COMMUNITY VISITS, IT
BECAME ABUNDANTLY CLEAR THAT THE QUALITY OF CARE OFFERED IN
ALASKA NATIVE HEALTH FACILITIES SHOULD BE A POINT OF PRIDE FOR
EVERYONE INVOLVED IN TRIBAL HEALTH. IN FACT, THE SOUTH CENTRAL
FOUNDATION IN ALASKA IS A TWO-TIME RECIPIENT OF THE
PRESTIGIOUS MALCOLM BALDRIDGE AWARD. IT’S ALSO CLEAR THEY BUILD ON
THE STRENGTHS OF TRIBAL CULTURE, CUSTOMS AND COMMUNITY TO DELIVER
AN IMPRESSIVE WHOA PERSON CARE, DRIVING THE DELIVERY OF QUALITY
HEALTHCARE IN AN EXTREMELY CHALLENGING ENVIRONMENT. NOW, OF COURSE PROVIDING CARE IN
RURAL AND REMOTE AREAS IS A CHALLENGE. ONE OF THE MOST SIGNIFICANT
PROBLEMS AMERICAN HEALTHCARE FACES. THE CHALLENGES AS I NOTED ARE
ESPECIALLY SUBSTANTIAL IN ALASKA, AMERICA’S MOST SPARSELY
POPULATED STATE BY FAR, AND IN OTHER PARTS OF INDIAN COUNTRY. IN ALASKA, WE GOT TO SEE HOME
GROWN SOLUTIONS TO THESE CHALLENGES, THE ALASKA COMMUNITY
HEALTH PROGRAM, PROVIDING ACCESS 24/7, 365 DAYS A YEAR IN THE
MOST RURAL AND REMOTE PARTS OF ALASKA. WE’RE PROUD TO NOTE THAT IHS AND
THE TRIBES ARE NOW PARTNERING TO DEVELOP THESE LESSONS INTO
SOLUTIONS FOR AMERICAN INDIANS AND ALASKA NATIVES LIVING IN THE
LOWER 48 STATES. IHS, THE TRIBES, THE OFFICE FOR
MINORITY HEALTH AND HRSA AND A NUMBER OF OUR OTHER AGENCIES ARE
WORKING TOGETHER ON HOW TO DEVELOP THIS PROGRAM FURTHER TO
HELP ISSUES OF TRIBAL HEALTH IN THE LOWER 48 STATES. WE’VE HAD OVER 50 YEARS OF
WORKING ON IT IN ALASKA, SO I THINK THE CONCEPT IS PROVEN BUT
IMPLEMENTATION IS ALWAYS DIFFICULT. WE ALSO SAW THIS WORK IN ACTION
IN HUGHES, A COMMUNITY SO REMOTE THAT AS WITH SOME OF THE OTHER
VILLAGES WE VISITED, WHEN YOU SEARCH FOR DIRECTIONS ONLINE,
THE RESULT IS WE CAN’T FIND DIRECTIONS FOR THIS JOURNEY. LITERALLY YOU CAN’T.
THERE WAS NO WAY FOR THE — NOT EVEN THE INTERNET COULD FIGURE
OUT WHERE WE WERE GOING. SO A LITTLE BIT OF A SURPRISE
THERE. THEY USED AN ONLINE DIAGNOSTIC
TOOL TO EXAMINE A PATIENT WITH A RASH AND THEN CONSULT WITH A
PHYSICIAN ASSISTANT AND PHARMACIST IN FAIRBANKS, ABOUT
250 MILES AWAY, ON TREATMENT APPROACHES THROUGH A TWO-WAY
INTERNET CONNECTION. AND THAT’S WHAT YOU’RE SEEING
TAKING PLACE RIGHT THERE. AGAIN HUGHES HAS PROBABLY ABOUT
50 PEOPLE, I THINK, 50 TO 70 PEOPLE MORE OR LESS. SO THEN MEDICINE TO TREAT THE
RASH WAS THEN PRESCRIBED IN FAIRBANKS, BY THE PHYSICIAN
ASSISTANT AND THE PHARMACIST WORKING TOGETHER, AND IT WAS
DISPENSED THROUGH A VENDING MACHINE IN THE HUGHES CLINIC. SO THAT’S THE VENDING MACHINE
THAT LOOKS JUST LIKE ONE YOU GET SNACKS OUT OF BUT IT’S ACTUALLY
GOT PHARMACEUTICALS IN IT, AND WHEN THEY SCAN THE BARRED CODE
THAT’S SENT TO THEM ELECTRONICALLY FROM THE
FAIRBANKS CLINIC, THEY SCAN IT INTO THE VENDING MACHINE AND
OUTCOMES THE PHARMACEUTICAL TO ADDRESS THE RASH. THAT’S AN INTERESTING
APPLICATION OF TELEHEALTH THAT WE’RE ALL DRIVING TOWARDS, BUT
THIS IS A TREMENDOUS EXAMPLE OF HOW THIS HAPPENS. THEY FLY THE PHARMACEUTICAL
SUPPLIES IN EVERY SO OFTEN BY PLANE TO THE COMMUNITY AND
RESTOCK THESE VENDING MACHINES WITH THE EXPECTED
PHARMACEUTICALS THAT WOULD BE NEEDED FOR THE COMMUNITY. THANKS TO THE ADVANCED SYSTEMS
THE EMPLOY, THEY’RE INSTANTLY SHARED THROUGH ELECTRONIC
MEDICAL RECORD, TELEHEALTH WITH NO TRAVEL NEEDED. THAT’S A FASCINATING EXAMPLE OF
HOW IHS AND THE TRIBES WORK TOGETHER TO PROVIDE REALLY,
REALLY CREATIVE SOLUTIONS FOR THE COMMUNITY THAT NEEDS THEM
VERY MUCH. I WISH I HAD MORE TIME TO TALK
ABOUT THE AMAZING PEOPLE AND PLACES I VISITED WHILE IN
ALASKA. THE TRIP WAS A SIGNIFICANT
OPPORTUNITY TO HEAR DIRECTLY ABOUT THE CHALLENGES THAT RURAL
AND TRIBAL COMMUNITIES FACE IN OBTAINING ACCESS TO HEALTHCARE,
ESPECIALLY WHEN IT COMES TO MENTAL HEALTH AND SUBSTANCE USE. I WAS ALSO AN EXCELLENT CHANCE
TO SEE SOLUTIONS TO THESE CHALLENGES AND TO HIGHLIGHT THE
GOOD WORK GOING ON IN THESE COMMUNITIES. AND HERE WE ARE IN THE CURRENT
YEAR, ARIZONA. THIS YEAR FOR OUR STAC, I HAD
THE PLEASURE OF VISITING THE STATE OF ARIZONA. AS YOU CAN SEE, WE VISITED A
NUMBER OF DIFFERENT LOCATIONS WITH DIFFERENT TRIBAL PROGRAMS,
INCLUDING THOSE WITH A MORE URBAN FOCUS, ALTHOUGH THIS TIME
WE WERE TRAVELING ON THE GROUND, NOT THROUGH THE AIR, OR THE
RIVER, LIKE WE HAD TO IN ALASKA. BUT STILL, WE TRAVELED QUITE A
BIT OF DISTANCE, NOTHING LIKE ALASKA BUT STILL A LOT. I SPENT MY FIRST DAY IN INDIAN
COUNTRY WITH THE NAVAJO NATION, WHICH IS ONE OF THE LARGEST
TRIBAL GOVERNMENTS WITH A LAND BASE THAT’S ACTUALLY LARGER THAN
THE STATE OF WEST VIRGINIA, SO THE NAVAJO HAVE THEIR OWN
SIZEABLE STATE, ALMOST. BOUNDARIES TOUCH FOUR SEPARATE
STATES AND HAVE A POPULATION OF OVER 250,000 TRIBAL CITIZENS. THERE I AM INEVITABLY IN A SUIT
IN THE MIDDLE OF THE DESERT. MY FIRST STOP WITH THE NAVAJO
NATION ELDERS PROGRAM WHICH RECEIVES A GRANT FROM HHS’S
GRANT FOR COMMUNITY LIVING TO DELIVER ON SITE HOME DELIVERED
MEALS, TRANSPORTATION AND SUPPORTIVE SERVICES TO NAVAJO
ELDERS. WE THEN VISITED THE NAVAJO
NATION’S LOOP HEAD START CENTER, WHICH PROVIDES CARE FOR
CHILDREN. RIGHT NOW THEY OPERATE MORE THAN
75 HEAD START CENTERS AND MULTIPLE HOME-BASED PROGRAMS. NEXT, WE VISITED THE DILCON
WELLNESS CENTER TO MEET WITH THE SPECIAL DIABETES PROGRAM, WHICH
HAS BEEN A KEY FACTOR IN THE IMPROVEMENT SEEN IN
DIABETES-RELATED HEALTH PROBLEMS IN AMERICAN INDIAN AND ALASKA
NATIVE PEOPLE, AND TO MY MIND, IT REALLY SERVES AS KIND OF AN
EXAMPLE OF HOW TO IMPLEMENT DIABETES PROGRAMS GENERALLY. THEY’VE HAD SO MUCH SUCCESS IN
IMPLEMENTING HOW TO DEAL WITH WELLNESS AND DIABETES CHALLENGES
IN A PARTICULAR POPULATION THAT FOR MY MIND, IT’S A VERY GOOD
MODEL OUTSIDE OF, FRANKLY, IHS. THEY INCORPORATE HEALTHY
TRADITIONAL FOODS INTO THEIR PROGRAMMING SUCH AS UNSWEETENED
FLAT BLUE CORNBREAD COOKIES. THAT’S BLUE CORNMEAL BUT CAN’T
QUITE SEE THE COOKIES, UNFORTUNATELY WE DIDN’T HAVE
THOSE IN THERE. THE NEXT DAY WE VISITED THE SALT
RIVER PIMA MARICOPA INDIAN COMMUNITY IN THE METROPOLITAN
PHOENIX AREA, WE HAD A CHANCE TO TOUR THE PHOENIX INDIAN CENTER,
TO SHOW HOW URBAN TRIBAL POPULATIONS ACCESS TO CARE
DIFFERS FROM RURAL TRIBES. PIMC IS THE INDIAN HEALTH
SERVICE’S LARGEST HEALTHCARE FACILITY, PROVIDING DIRECT
HEALTHCARE SERVICES TO OVER 140,000 PEOPLE. IT ALSO PROVIDES SPECIALTY CARE
TO RURAL AND REMOTE TRIBAL HEALTHCARE FACILITIES IN
ARIZONA, IN NEVADA AND IN UTAH. SO ITS REACH IS VERY LARGE. TO GIVE YOU AN IDEA OF THE
IMPACT THIS HAS FOR TRIBAL COMMUNITIES, PATIENTS OF PIMC
REPRESENT 67% OF THE 573 TRIBES. SO HUNDREDS AND HUNDREDS OF
TRIBES AND TRIBAL MEMBERS ARE GETTING SERVICES HERE AT PIMC. SO AS A LAWYER WHO USED TO GET
PAID TO TALK, I COULD STAND HERE ALL DAY AND NO DOUBT ENTHRALL
YOU WITH STORIES FROM MY TRAVELS TO INDIAN COUNTRY, BUT I DON’T
WANT TO STEAL THE THUNDER FROM THE UPCOMING PANEL, ESPECIALLY
NOT FROM CHAIRMAN ALLEN, SO I’D LIKE TO LEAVE YOU WITH THIS
INSTEAD. ALL THESE EXPERIENCES AND MY
REGULAR ONGOING INVOLVEMENT IN TRIBAL ISSUED AND BUDGET
DELIBERATIONS HAVE BEEN A HIGHLIGHT OF MY TIME SO FAR AS
DEPUTY SECRETARY. I WANT ALL OF YOU TO KNOW THAT
YOU CAN SEE ME AND SECRETARY AZAR AS ADVOCATES FOR BETTER
HEALTH AND BETTER SERVICES IN INDIAN COUNTRY. PROTECTING THE HEALTH AND
WELL-BEING OF THE AMERICAN PEOPLE IS NOT A LOFTY GOAL BUT
WE JUST REPEAT TO EACH OTHER, IT’S THE MISSION OF THIS
DEPARTMENT THAT YOU ALL DELIVER ON EACH DAY. SO AS WE OBSERVE NATIVE AMERICAN
HERITAGE MONTH, IT’S IMPORTANT TO ALWAYS REMEMBER THAT BY
CARRYING OUT OUR MISSION EFFECTIVELY, WE ENSURE THE RICH
AND DIVERSE HERITAGE OF AMERICAN INDIANS AND ALASKA NATIVES LIVES
ON AND OUR GOVERNMENT-TO-GOVERNMENT
RELATIONSHIPS ARE STRENGTHENED DAILY FOR MANY GENERATIONS TO
COME. THANK YOU ALL VERY MUCH. [APPLAUSE]

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