Roswell Park Comprehensive Cancer Center’s Center for Indigenous Cancer Research (CICR) Recently hosted a webinar featuring National Institutes of Health (NIH) Tribal Health Research Office Director
David R. Wilson, PhD.
The discussion, “A Holistic Approach to Improving American Indian/Alaska Native Health,” touches on the NIH’s engagement with Native and Indigenous individuals and communities, efforts to support and inform scientists and clinicians working with Indigenous communities, and the Office’s work to draw attention to important considerations regarding research in Indigenous communities.
Dr. Wilson was named the first Director of the Tribal Health Research Office in January 2017. Since then, he has worked with leaders of the 574 federally recognized Tribal Nations to address health concerns and collaborate on the NIH’s research portfolio.
“We welcome Dr. Wilson to the international conversation that is unfolding through our webinar series,” says
Rodney Haring, PhD, MSW, Director of the CICR at Roswell Park. “In support of our work to reduce cancer’s impact through culturally informed research, health screenings and interventional efforts, we look forward to hearing in greater detail about the NIH’s work to expand and advance respectful, appropriate outreach to Native and Indigenous communities.” Good afternoon everyone. My name is Dr Rodney Herring. I'm the director for the Center for Indigenous Cancer Research at Roswell Park Comprehensive Cancer Center. Um and I'll be joined with my co host, William maybe who is the community outreach coordinator for the Center for Indigenous Cancer Research. Um If you have any questions um they'd like to to ask throughout Dr Wilson's presentation today, you can enter those in the text box below and will will help moderate the questions near the end. We'll save a few minutes towards the end for questions and answers. Yeah. Um I'd like to introduce our special guest today for our webinar for the Center for Indigenous Cancer Research. Dr Wilson. And that David R. Wilson was appointed the First Director of the Tribal Health Research Office in 2017. The office was created in recognition of the importance of ensuring meaningful input from end collaboration, tribal nations on NIH programs and policies. The office coordinates NIH research related to the health of american indians and Alaska natives across NIH institutes centers and offices. Dr Wilson came to the NIH office of the Director from the Department of Health and Human Services, Office of Minority Health, where he served as a public health advisor and american indian Alaska native Policy lead. He also served as a policy analyst and office of the Director at indian health services and as a senior scientist at the National Institute on aging at NIH. Um He's a great person to have been a great colleague over the years and he does a lot of his work what we would call um the good mind and it's just a great person and an asset to indian country as a whole. So without further ado, I'll turn over to Dr Wilson scan up. Oh, dr herring. I really appreciate the wonderful introduction. And it's a pleasure to be with you here today and everyone else who's joining us virtually. My name is Dave Wilson. I am a member of the Navajo Nation. I'm also the first director for the United Tribal Health Research Office and I'm here to talk a little bit about what our office does and how the NIH has now been approaching our engagement efforts with tribal communities in a more holistic manner or fashion. So I'm going to share my screen ups if I cannot have access to share my screen so that I may present the my power point. That would be wonderful. There we go. All right, alright, so I hope that you can see my screen right now. Are we all good? We're good. Dr Wilson. Okay, great. Thank you so much. Um so it's it's a pleasure to to be able to chat with you today. And I, one of the things I want to start off with is talking a little bit about our logo or emblem era, which coming into the office was one of the first things that we really thought long and hard about what would be something that would be good, a good representation of how our office works And dr herring Put it very nicely about how we coordinate the research that happens across the 27 institutes and centers as it relates to tribal health. So here you can see the dreamcatcher with all the beads are all the different institutes, centers and offices that make up the NIH. And below it here you can see that the things that we focus on our research careers and research programs, communities, policies and and health research. So, um, this is just a, I think a really nice representation of what we do. So now a little bit more about where were we are at, which is at the National Institutes of Health and the mission of the NIH is to seek the fundamental knowledge about nature and the behavior of living systems is something that travel communities have done for centuries. But our goal is to apply what we learn from this, to enhance health, to lengthen life and to reduce illness and disability. And this is really important for many of our tribal communities and underrepresented communities as a whole. So, a little more about the structure of the NIH. You can see here that we lie within the Department of Health and Human Services and we are one of what's called the operating divisions. Um you can see here, the indian Health Service, which I think many of our viewers are familiar with. We also have other operating divisions like the Center for Medicare and Medicaid services, CMS CDC SAMSA. These are all of our partners that we work closely together with because we all have a slightly different mission. Um and we helped to achieve each other's goals. And as I mentioned, the NIH is really focused on research and our goal is to provide research to help better understand everything else that comes along with that, to develop better interventions for tribal communities. So, about the NIH here, um, something that's really important to consider is the NIH has two big parts of, we have an instrumental part and an extra mental part. The instrumental part is where we conduct research on our main campus in Bethesda Maryland. And you can see here that the intramural part of our operating a of our operation is is really, really small. That we, we have. It takes about 11% of our overall budget that we spend intramural e on research. The rest of that, $43 billion, approximately $43 billion dollars that comes to the NIH it goes out in the term or in the form of extra mural grants. And you can see here on this slide the dots show where the funding or where grantees lie and they are all over the country. Um, The NIH receives About 50,000 competitive grants each year. I'm sorry, 70,000, we fund 50,000. So 70,000 applications come in and are reviewed and uh and uh they make up over 22,500 institutions And over 300,000 scientists and researchers are funded through NIH appropriations. So there's a lot of work that happens more extra merrily than it does introverts really. So some of the key things on how the NIH determines who gets funded is that um we are really always thinking about major initiatives to help foster the knowledge base that we've already built up. Um Also, some of the things that we take into consideration are the scientific merit, that's all that's done by external reviewers. So we have external scientists to lead the field in a particular area who come to the NIH and and sit as a collective committee and review the applications that come in and see and determine whether they have a high probability probability of advanced advancing the science in these particular areas. Also identifying gaps. Are there gaps in the research that as it currently exists? Those are also important deciding factors. And does the research that's being proposed, meet help public health needs? And I think this is a really important component or piece that is really relevant for tribal communities, is that we really want to make sure that the work that comes are the research that comes in is serving the needs of the communities and not very subversive, serving the needs of the individual investigator. Something else. That I think it's also important is that how does this add to our current portfolio of funded work? And does it complement, it doesn't synergize it. So these are all really important factors on how the NIH determines who is eligible to receive funding um uh extra merrily. But something else that we do that's critically important to the Tribal health research office is that we do a lot of education, um not only for our intramural scientific community, but also for the extra mural scientific community, something that's really, really integral um that a lot of our scientific members don't really understand or they don't remember, is that tribal nations have a very specific and special relationship with the federal government. The relationship that we have with the government is political and it's legal because we are members of sovereign nations. Um, something else that we continue to communicate to all of our scientists in the field is that Tribal communities are extremely diverse. There are currently 570 for tribal nations. And and with that there is a tremendous amount of diversity even within communities that lie in the same region. Um, and the next slide, I'll show you how we are able to kind of define regions of work, Tribal communities reside, but um, it's really important to recognize that that there's such a tremendous amount of diversity and that has to be taken into consideration when thinking about, how do we include travel communities in biomedical research. It's a really important process that we continue to to undertake at the NIH and across the country as well. So, this is the slide that I was talking about just a little bit earlier. You know, this is something that's really important for us to share and many of our tribal members readily recognize or understand I. H. S. Service areas. And so we use this for our scientific community as well. So when we talk about the phoenix area, the Albuquerque area of the Navajo area, Immediately researchers will understand that the Albuquerque area is comprised of Colorado and New Mexico and they know that there are 26 tribes in that region. So it's a really important educational or identification tool for us and, and our scientists across the country. I think what's most surprising to many of our scientific community members is that there are 231 Alaska federally recognized Alaska villages in the Alaska area. That's the, that's the most as you can see here, that of any particular area in the country. So, it's really important that we extend all of our activities, our engagements in our, our efforts into the Alaska area because there's a tremendous amount of need, tremendous amount of a number of villages that are there to support. Mm hmm. Um, so, something else that I wanted to talk about that's really um, of high interest to us is that the last couple of years there's, we've really seen a tremendous amount of change, not only changed in the administration, which has been fantastic because the current administration has come in and really placed a profound emphasis on increasing the federal government's engagement with tribal communities. And that has been wonderful. That has led to a a bunch of different initiatives that have really been able to support tribal communities. But also there have been um movements on the social justice front, a lot of talk about health equity and inclusion. Um and there's also an effort, a large scale effort that's underway at the NIH. It's called the United Effort, and it's focused on ending or identifying barriers that have been created through structural racism that are inhibiting or prohibiting underrepresented members of our community from participating or taking advantage full advantage of the research that comes out of the NIH or that is sponsored by the NIH. Mhm. As we all know, this is critically important because this is really how uh an important tool for how our communities can address the health disparities that continue to persist in our communities. So, this is something that I'll talk about a little bit later, but this is a really important, so, the changing landscape of everything that has happened over the last couple of years has really been astounding for us at the NIH, but also across the federal spectrum. So, I'm going to talk now shift a little bit about what we've done in terms of our office and um and and some of the responsibilities of the NIH tribal health research office. So as dr Herring mentioned that we the office was created in 2015 and I was appointed the first director in 2017 and Our office serves as the central hub or the central point of communication or contact for all tribal communities. So all 570 for tribal nations, we welcome them to reach out to us and ask us questions about funding opportunities, about student training, opportunities about the research or benefits of of particular interventions. That's what our office was set up to do. But we do this through a lot of different mechanisms as well. Is that not only do we serve as the single point of contact for triumphs, but we also have um mechanisms in place. We we run what's called the NIH tribal health research coordinating committee. And the coordinating committee is comprised of members of each of the different institutes and centers. So what the director of each institute will select an individual to sit on this large committee. And this committee we meet monthly. We actually just recently had our last meeting and we talk about what are some of the agency wide priorities initiatives or efforts that we can all collaborate on together to have a greater impact in tribal communities. Um um from the NIH we also provide assistance to all of our institutes and centers on making sure that our agency adheres to the recently released and implemented NIH tribal consultation policies. The NIH travel consultation policy is critical in part of how we conduct our work and I will um talk about that in in the next couple of slides but know that that has been a huge foundational document for our agency. Our office also is in charge of gathering meaningful input from tribes. Um as we began to think about developing research policies, programs and priorities. So um it's really important events like these to be able to reach out to you and to share with you some of the things that we do and also hear back from the communities about what are some of the research priorities. We would much rather be doing this in person but we know that we are emerging out of a worldwide pandemic and um some places are ready for engagement and some others may not be quite ready just yet. But we are looking forward to the day when we can begin to ramp up our our full travel um into the communities to to hear tribal leaders to hear community members to hear students about their desires to pursue careers in biomedical research. Something else that's also really important that we do is we convene an NIH travel advisory committee and as I mentioned we have and I showed you that map of the I. H. S. Service areas, we have representatives that are made up from each are that come from and represent each of those different I. H. S. Service areas. So that gives us a really good cross section of what are some of the concerns and priorities from different communities across the country. Our NIH tribal Advisory committee. Um We usually met twice in person. That has been restricted because of Covid but we've been meeting uh and we also meet monthly on zoom calls and we talk about what are some of the important ways that the NIH can shift or focus its investment for Tribal health research to be more effective and more impactful. And I'll show you some of the outcomes of what our NIH tech has done in the next couple of slides. But I wanted to go back and talk more about our NIH tribal consultation policy. So the policy that we developed and you can find this on our NIH Tribal Health Research office website is that it was developed with extensive input from our NIH travel advisory committee. They actually gave us the first draft, They worked extremely hard on this and it was a couple of years in the making. But then we also included our NIH Office of Science policy who helped us carry this policy across the finish line. What I really like about this policy is that I feel that it really respects tribal sovereignty and it really um it does strengthen our nation to nation relationship but not only that is that it really complements what we the HHS tribal consultation policies. So there's a larger policy that all of our operating divisions follow but RNA specific policy really really complements that policy and it focuses specifically on behavioral are sorry biomedical research and also behavioral health research. So I had talked a little bit about R. N. I. Travel advisory committee. Well this is some of the recommendations that are NIH tribal advisory committee provided to us. They were instrumental in helping us identify concerns from the community that we really needed to address. Um I think that all of us know that uh something that has is at the forefront of our communities are is the opioid crisis. So in 2018 we had the very first try operating division consultation on the opioid crisis that included CDC Samson and the NIH and it was it was a very effective consultation. We heard a lot of really good recommendations that we used to develop funding announcements that were then the released out as funding announcement, opportunities and applications were then our grants were then funded for the communities to be able to design develop their own interventions to help address this that has not gone away. That has not gone away because And as a result of the COVID-19 pandemic, we've heard an increasing need of communities. Not only were they were we are suffering from the opioid crisis but now there's another added feature to this which is the fentaNYL issue in our communities. So um the we just recently completed last month, the consultation with a program called the helping to end addiction long term and that's even so new that it's not even captured on this slide because it was an immediate response to a lot of the concerns that we heard from our communities helping to end addiction long term program is a congressional e funded funded program that incorporates multiple institutes and centers, the National Institute of Drug abuse, the national Institute of Who neurological disorders and stroke Those are some of the key players involved and also the National Institute of General Medical Sciences. So we had experts from the addiction side, from the pain management side, but also from the training side come together to hear the recommendations from this consultation. Our attack has also been really shedding a lot of light on they say that our tribal community members want to participate in biomedical research but they're really concerned about researchers coming in and identifying something that we're doing and and beginning to mass produce on a large scale. So how can we protect our communities So that if this does happen, we're in an agreement where we get some return on that investment of our intellectual property, so to speak. So we held a consultation on intellectual property and biomedical research and that was absolutely phenomenal in helping our communities understand what does the process for biomedical research look like And when should our communities be involved in that negotiation process for biomedical research. If there are something, if there's a result or something that might come out of us that would be advantageous to our communities. So that was a really informative consultation that we had In 2019. Um you can see here below some of the current ones that we've had. And this is really um we're also pushing the envelope in terms of um novel ways to have communities become more self sufficient in biomedical research. And as a result, we have the Rad X initiative which is the it's a program in response to Covid 19. But they're released, they're they're releasing a funding announcement that's called the Rednecks initiatives data. Tribal data repository. And what we're hoping is that there are a repository will be funded. A single site will be funded. They will be able to utilize tribal governance principles to be able to manage the data that is um that is deposited into this repository from tribal communities as it relates to the rad X. Covid 19 program. It's only it's specific for the COVID-19 data that comes out of these programs. But it's the very first time that we've been able to offer this kind of initiative for tribes to be able to manage their and store and to be able to share their own data. So there's going to be, it's going there's going to be a growth curve, a learning curve associated with this. We all understand that, but we're really hoping that many tribal communities will, will step up to the plate and really say we want to give this a shot and and be the first at trying to make this work and being able to identify what are the critical components that make a successful tribal data repository. So that moving forward, we can continue to refine this process and this practice to better protect tribes, but also to better serve tribal communities in terms of the biomedical research. Okay, so some of the other things that have been absolutely foundational for our office to to really think about how we're um serving tribal communities is building in research capacity but also understanding where are we starting from? So in 2015 and in 2018 we released what are what we call the american indian Alaska Native health research portfolio analysis. So this and these documents are located on our website but they really give us a good snapshot of how the agency was investing the funding towards tribal or for tribal communities. And it really, it breaks out where which parts of the country were funded and what particular types of research was funded. So you can, you can go and see that currently we are getting ready to release a collection of years which would be from 2019 to 2021. And we're thinking that maybe more years involved because many of the grants that are funded by the NIH are multi year grants and they don't change that much from year to year. So having, you know, an accumulation of more years would be more meaningful for the communities. But this is really important for us to identify where we started and also to be able to see where shifts might happen or where they need to happen to better serve tribal communities. We've heard from tribal leaders that said, we've looked at your research portfolio analysis and we don't see enough behavioral health in our region. How can we make those change dr Wilson and I and that those, those are the kinds of things that we really want to hear from tribal communities to help extend those opportunities where they're needed. So, something else that has been absolutely critical is creating the first NIH strategic plan to for tribal health research. And this is an NIH strategic plan. So this is an NIH wide strategic plan, it's not just for the NIH tribal Health Research office, this is for all 27 institutes, centers and offices and you can see here that we we did consultation across the country across each of the different HHS regions and had Tremendous amount of really good feedback and out of all the feedback that we received. These are the big top four areas that tribal communities really wanted us to focus on. And you can see here that the really important enhancing communication and collaboration, building research, capacity, expanding research as it exists in communities, but also I think most importantly is enhancing cultural competency and also increasing our community engagement levels when we're thinking about biomedical research. So currently we are getting ready to go into consultation For the next version. You can see the next year in 2023 this council are this strategic plan, Will will be closed down and we're hoping in 2024 to release the new console, our strategic plan for the NIH um in terms of tribal health Right now, what we're doing also is building a report, a comprehensive report that shows everything that has happened from 2019 to 2023. So tribal communities would be able to look at that and say, Okay, we see here that there's a tremendous amount of work going on in a specific area, but not so much in another area during consultation, we hope to be able to show this, share this and then receive that feedback where we would like the NIH to think about shifting its investment to better meet some of these priorities for our community. So know that that report is on its way, We're hoping to have our report um done by mid May before we go to consultation. So this is uh NIH wide strategic plan, but some of the other ways that we've been trying to engage our tribal communities is through different types of mechanisms or types of creating awareness. One of the ways that we've been doing this is having interviews with institutes, centers institute directors. So here you can see we've actually had three of them, we don't have the latest one up here, but you can definitely find it on our website. But having conversations with this is the National Institute of Mental Health Dr Joshua Gordon? Who really laid out very nicely and talked about what they're seeing On a grand scale as a result of COVID-19 in terms of mental health and what tribal communities might be facing as well and how research would be able to support and address and create interventions to help those individuals struggle struggling with mental health issues in light of a worldwide pandemic. Um Following that conversation, we had a wonderful conversation with Dr Nora Volkow, who's the director of the National Institute on Drug abuse and she talked about again related to tribal health issues. What are they seeing? What are some of the things that we should be considerate of? Our are really thinking about one of the things that she did really mention and vocalizes. It's really important for our tribal communities to think about um substance misuse and substance abuse and addiction as a disease as a chronic disease. It is not a personality flaw and and that's a wonderful message that we need to continue to amplify in our communities, you know, to make sure that our community members receive that help that they are suffering from a chronic disease and it's not something wrong with their character. Um and I think that we will be more successful in reaching those in addressing their conditions and and saving lives and making our communities safer places. So um the most recent one we had was with dr chris well who is the director of the National Institute of Arthritis and musculoskeletal diseases. Um that is a fantastic institute because many of our tribal communities are. Community members suffer from arthritis and other musculoskeletal conditions, skin, so periodic arthritis psoriasis, all of the different things that I think many of you can can can relate to. So it was another wonderful conversation. Um please check those out. We're hoping to expand those to bring more awareness about the research about how it impacts our communities and and thinking about opportunities for research. You know, maybe you want to participate in a clinical trial that will help understand a condition more that you can share with your community. So I talked a little bit about all these different pieces but I want to Give an example now about this convert or this this topic of a more holistic approach to how we're engaging in biomedical research and I think one of the best examples that I have really been able to relate to is our most recent engagement with addressing the COVID-19 pandemic and also um Creating awareness for tribal communities, but also getting travel communities to conduct their own Phase three clinical trials as it relates to the different vaccines that were being developed by different companies. So as we know early on operation warp speed as it was normal formerly known as um and then it evolved into the operation and then it was eventually dissolved, but it was a it was a collaboration between all of these really important agencies at in the government at the NIH. What we did is the National Institute of Allergy and infectious Disease. They have a longstanding group of of researchers who have worked and you can see here these are some of the of the consortiums that came together, the HIV Prevention Trials Network and the HIV vaccine trials Network. All of these folks have had decades of experience working in communities addressing diseases that have sometimes have been seen as stigmatizing. You know, that I have um not always been welcomed in terms of not only the people who have been suffering from the disease, but also from the research community. So, um it was really important to have these folks involved because they provided the expertise about what are some of the critical things that we need to be thinking about as we begin to go. And and as these vaccines are being developed and how do we want to message this so that we are creating clear consistent messages for our community members to want to actually take the vaccines and have confidence in the vaccines when they're available. Another thing that happened is that we convened american indian and Alaska native panels. So when the pharmaceutical companies would send us the vaccine protocol, we would share these with R. A. I. N. Panels and they would review them and say some of these things in here are not going to be seen well by the community. So the community, so the vaccine sponsors made adjustments to these research protocols, but not only that is the communication materials that were being developed by the NIH, by the FDA, by the CDC. Were also presented to these panels and these panels which were made up of community members of community health advisors, community researchers. They review these as well and said, you know, this, this needs to be reframed or shaped or presented in a different way that really helped us effectively reach the tribal communities in terms of what the messaging needed to be. But not only that is that when we engage tribal nations from our office, one of the things that we did is we went and actually went into tribal councils, um dr Fauci and I went into closed sessions with tribal nations on the great plains and in the pacific northwest on the Navajo nation, we held town halls, we had conversations with whoever really wanted to ask questions about what was happening. We tried to be as much as upfront and as it clear about all the information that we had on hand as possible so that everybody would have confidence as this, this unprecedented feet of creating vaccines was underway. Um, some of the things that we also really encourage tribal communities is to identify trusted partners, but we didn't force that. They said if you wanted to do this on your own, then absolutely. You know, if you have the capacity to do this, you can do this research on your own. But if you want to bring in a partner that is absolutely your decision. Our ultimate goal here is you can see the bubble between tribal nations and clinical trials process. It's our goal was not to increase the number of Ai and community members that would receive the vaccine. It was to increase the number of tribal nations that had the opportunity to exercise their sovereignty and make that decision. Yes, we have confidence in this vaccine. No, we need more information or yes, we want to conduct clinical trials on our own or no. We want to conduct clinical trials with with a trusted partner. This was all a part of how we really wanted to do this. And I think this shows a pretty holistic way of how we've done this, including community members, including tribal leaders, including tribal health departments with including town halls and community members and also including the vaccine sponsors. So this was an important um effort that we've never seen before in terms of the vaccine sponsors being so open to wanting to include tribal communities and really working hard with us to make that happen. Um And I think that that really showed um as many of our tribal communities demonstrated that they were willing to protect their families to protect their communities and did receive the vaccines and and that was um I think we heard a lot about that in the news. So now I'm going to take a little bit of a shift here and talk um now that because we are we're having this conversation with the Center for Indigenous Cancer Research. I really want to be mindful and kind of focus on that topic. So the slides that I'm going to talk about next have been provided by a wonderful collaborator, Dr Shobha Srinivasan who is um a program officer at the National Cancer Institute. We've worked closely together for many years and she was gracious enough to give us some slides that would help show and demonstrate what the National Cancer Institute has been doing um in terms of their tribal health research. So um I hope many of you on this call. No this program because it's a wonderful program. The arena program, its intervention research to improve native american health. And Um as you can see that the program started in in 2011 and now the responsibility has shifted a little bit. It was at n. c. I. But now it's being managed by NATO but there's still some tremendously impactful research that's being supported through this program. Um You can see here that the N. C. I. Is currently funding three projects the R. O. Ones and I'll talk a little bit more about the early stage colorectal cancer screening initiative that's underway. Um but there's also they're also funding an R. 21 on smoking sensation sensation. So really important topics for our communities. Something else that that dr srinivasan really wanted to for me to communicate is this is a really important resource or tool for our communities to to be able to to utilize. And it's a native american cancer control literature database. And um you can see here this would help us understand what kind of research is being done in our communities but also what are some of the interventions that we might be able to proposed in our communities to help address rising rates of cancer incidents in our communities. I think that's one of the really um one of the things that we've been seeing across the board as a result of the worldwide pandemic is that many of our community members have skipped or have not been able to receive their annual checkups or their screenings because of the pandemic. And as a result you know cancer incidences are going up and we really want to make sure that everybody is making sure that they go to their annual checkups to stay on top of their health and it's critically important. Um But this is an important database that I wanted to mention also. Many of you have, I hope you're aware of the cancer Moonshot Initiative which was launched during the Obama Administration. And what they're really trying to do is to accelerate the progress in cancer research. And and some of the things that are critically important for tribal communities is involved in the prevention and screening part of this um but also enhancing the data sharing component of this. And this is something that has also been an area of contention for many of our tribal communities is how and when. Um and who shares data for tribal research. Um and those are some of the things that we're also working on um that we can talk about during the Q. And A session. So this is one that I really wanted to talk about. This is a terrific effort that's being led by en ci and and you can see here that there are three different regions of the country that are being funded in the Southwest in well actually there's two of them in the southwest in Arizona new Mexico and in Oklahoma. But the colorectal cancer screening efforts in trouble communities is critically important because so many of our community members are coming down with with colorectal cancer and it is it is if we detected early enough, there's a really good outcome if we're able to treat it early enough. But here you can see that right here, some of the long term goals of this program are to enhance health equity, you know, through the reduction of of colorectal cancer disparities uh that we've been seeing amongst our community members. So if you're in these regions, it's really important for you to think about. Maybe there's an opportunity to participate in some of these studies are um you know, some of these research studies. So also a part of this is the parallel effort. This is the the acronym is access. And um the goal is again to increase screening in tribal communities. Uh here, you can see more a little more detail about this to use evidence based strategies here to test the efficacy. Um we're hoping that some of these interventions will really increase awareness in our communities and increase uh tribal community members receptiveness to being screened early and often because I think that's going to be the real goal about how we can reduce the cancer incidents, you know, right now. Currently, American Indians from ages 50 to 75 r really suffering the most from from this from this disease. So we're hoping this strategy will help us get this under control. Okay, the three sites that I had mentioned there are members of this access consortium. And you can see here this is where sharing data becomes critically important because all these different sites are conducting research with um other communities. And so the findings from one community, we're hoping that will be shared across other communities to help identify interventions that might be employed or deployed immediately to help reduce the number or the in the incidence of cancer um in in many tribal communities. Yeah. So the project timeline for this study, you can see here that it's it's actually been a couple of years back In Fy 18 and 19 is when they began thinking about this study and they've begun creating the protocols for it. And that has happened, you know, even through covid 19, they've been able to really try to turn on a dime and adapt the how they are engaging communities. I think one of the things that can be said is that the zoom platform has really become more acceptable across many different communities in the past. Um face to face engagement was preferred. But now, I think with the zoom or with the virtual platforms, we've actually been able to engage more communities. And and uh and as a result, we've had more communities be able to participate in um in different activities at the NIH and through each of these different studies. So, And here, you can see right now, um in Fy 21 and 22, the focus of these programs are to increase their their screening efforts as everybody gets back into the workplace, there are also developing materials hopefully from some of the things that they're beginning to see as a as a as a result of their participation in the studies for the prior couple of years. So we'll wait and see. But I think this is a critically important effort that N. C. I. Is leading um for our communities. So this is another tool that's really important for our communities here is this year registry data. And I think many of you are also aware of this is that it's a it's an extremely powerful tool for us to be able to conduct cancer surveillance what's happening where throughout the communities. So this is the the I wish we had more platforms like this for other disease conditions. Because and I know we do but not specifically for american indian Alaska native community members. Some of the things that we've heard, especially during the time of Covid 19, there's a lot of our public health departments, tribal public health departments really didn't know what was happening in the communities because we didn't have that that single point of access in terms of the data in the in the infectious rates that were happening in our in our local communities. So now these are all been a part of how do we plan for the next public health emergency. And I think that a lot of the things that with the questions are being asked related to covid can be applied to a lot of the things that we've already been working on in terms of cancer research and um cardiovascular research and others. So I know that this program is out there and it's a critically important tool for us to continue to conduct surveillance in our communities. So something else that I wanted to mention is that not only do we have to have or to extend research opportunities to our community members, but we also have to think about how we're developing the next generation of american indian and Alaska native cancer research scientists. Um and some of the ways that we're doing that are through specific programs here. You can see that this is the program that's been created by hee to address that specific or particular needs. Um They're promoting indigenous research leadership. I'm not sure what the acronym would would be, but P. I. R. L. And what you can see here is that their goal is actually To increase the success rates of American Indian Alaska native research scientists as they submit applications to the NIH. And you can see here that they've had a 20% success rate. And that's actually a pretty good success rate. So we're hoping that this program will continue. We'll get more american indians and Alaska natives who want to continue to conduct research and participate in research for their communities and be able to actually participate in some of these uh leadership programs. So I talked about the research and I talked about the NIH, but one of the things that I really want, everyone who's watching this too to really think about is and and this is what we're doing at the NIH. Is that through cultural awareness and increased community engagement. Thinking about how we can incorporate culture into the biomedical research process is really how we're going to increase um the numbers of american indians and Alaska natives that really want to participate and actually use Western science as a tool to help improve health. And we've begun those conversations, we sponsored a Um a traditional medicine summit in 2019. It was a terrific first engagement where we heard a lot about the importance of cultural ways of healing and how that should be centered on how that should be synergize did with Western medicine to help improve um the community's health in tribal communities. So we're hoping that this will lead into a next um traditional medicine summit. They will continue the conversation about how we can include more of traditional ways into the research process and how we get more students and more community members to understand, but also to trust science and trust american indian Alaska native research as we continue to build our critical mass across the country, why these are so important and why all of this is really coming together is going to be on my final slide here and this is just a snapshot of where we're headed, where we started and where we're headed. You can see here in 2000 and 18 the NIH investment was 180 million and this actually this trend extends back many years. So it's pretty much been about 100 and 80 million. But as our office um was stood up in 2000 and 17, you can see here that there's been a tremendous increase in the investment of tribal health research from the NIH. And this is just because this has been because it's been a coordinated effort across the entire agency that all of our institutes and centers have really come together as a terrific partners to increase our engagement in tribal communities and as a result we have seen this really significant increase in our investment. And our goal now is to make sure that we have more tribal communities that want to participate or that want to have that opportunity to, to participate in research but are also have their, their Children or their students become biomedical research to help improve american indian Alaska native community health and to address some of the social determinants of health that we all know um continue to um, to inhibit our communities and looking for ways to change that. So with that I wanted to say thank you so much for your attention. I know that there was a tremendous amount of information. Um please feel free to go to our website here. You can see the link, NIH forward slash tribal health, a wealth of information lies that we're actually going to be doing a website refresh. So it'll be easier to find really important information. Um we also have a linkedin account where you can see um research opportunities, training opportunities for students and if you have any questions that you want to send to me directly, there's my email address there Dave dot wilson to at NIH dot gov. I I welcome you to reach out to me and look forward to any kind of correspondent you may have. So with that I want to say thank you and I will turn it back over to dr herring. Excellent. Uh we appreciate your time today um and sharing all this powerful and wonderful and and information with our communities and our our colleagues across the country. Um there were two questions in the chat box that for you, Doctor Wilson, the first one was in regards to the number of um american in the Alaskan. They had a P. I. S. And R. O. Ones. I know there was a report in 2000 and 15 and it's being updated but can you shed any preliminary insights onto what those numbers were and what they may look like. Yeah. Yeah. So that's a terrific question and we really haven't done a comprehensive analysis of what are the numbers out there. We're really trying to build from within and trying to create training opportunities, not only for the younger generations, but also opportunities for those who are already at that um at the early career, early scientific career phase. So to be honest, I don't know exactly what those numbers look like. Um it would be great to be able to identify all of those folks because there are areas of need, we want to increase the numbers of american indian Alaska natives that serve on the Center for Scientific Review study section. So it's so it's critically important for our community members to who have that that that lived experience to be able to sit in on study sections and review applications that come in that are specific for tribal communities. Um but currently we don't have that, but we are, this is all a part of the process. Um so yeah, great question. But we don't have those numbers yet. Okay, great. Yeah, I agree. You know, I think it's important to see that upward trend to not only in our own one applications and awards, but also in K applications and what that may look like across across our native nations and our up and coming indigenous scientists. The other question that was posed was um for um for both communities and for academics and researchers and tribal leaders. What is the best way to share research priorities and maybe um is it through your office and or through attack and other similar type committees and maybe you can share a little bit about the different committees that you're aware of and the new one that's emerging. I see through HHS I think it's HHS Yeah, well I think that when it's at the office of Minority Health at HHS, um, the best way to do this is actually to send those priorities or those concerns directly to me. But there's also that opportunity to engage the, the I. H. S. Service area representative for the NIH Travel advisory committee. So on our website we have a list of all the current delegates and their their contacts so that you would be able to reach out to them too. You know, say, hey, you know, chief, I won't name anybody, but you know, please be aware of being, um, I wanted to voice our community's concerns. I'm from, you know, x, y and Z and we want to share our concerns related to uranium exposure or the numbers of wild fish that are no longer swimming in our estuaries and so those kinds of things would be brought to our attention. And then we would engage institutes and and offices to be able to reach out to the communities to get a better idea. So one of the ways that we're actually doing this as well is that if there's a community that would like for us to visit or to go out and have a conversation with him. You know, that's also welcome. We recently, um, I recently went out with the National Institute of digestive disorders and kidneys. Director dr Griffin Rodgers to the southwest and we met with tribes in Tucson, we met with tribes in phoenix to talk about the release of the new strategic plan for that institute but also to talk about some of their community priorities. And we heard so many wonderful ideas and concerns that we're now using to create new um um strategic initiatives for communities for tribal communities um that are interested in diabetes research. Mhm. Excellent. And I think maybe one last question uh um from myself here I had two more questions. Um One uh you know you did talk a little bit about the training opportunities for health professionals but are there other opportunities that you're aware of that are um perhaps in in the pathway of being released or um that people can apply for? Yeah. Absolutely. Um let me I will put it in the chat. So whoever is interested you know, please reach out to, we have a new senior advisor for our office and he is a former he's a former Ceo at one of the I. H. S. Health clinics and he has a tremendous passion. He's our our senior advisor for um training and development and his name is most Hern. And so if you're interested please reach out to him because right now he is coordinating all of the research opportunities. So if you're interested in nursing research which is which is a critical area for our communities or if you're interested in in dental and cranial facial research, which is also a tremendous need in our communities, reach out to him and he's making a list and connecting all of our institutes centers with all of those training opportunities. So he'll be able to send you that information depending upon what discipline you're you're most interested in. Thank you. My last question is I know there were um uh conversations about, you know, looking at behavioral interventions and and there's been discussions around that, but also um you know, I think there's been a lot of movement in the field of environment and what that means to our communities. Can you expand a little bit about uh your office's involvement and um conversations about environment and perhaps environment and cancer. Yes, absolutely important topic. So we work closely with the National Institute of the Environment Health Sciences, N. I E. H. S. And they're located in north Carolina. They're one of the few institute's that's outside of the main campus in Bethesda. And our NIH tribal advisory committee has really been um acutely interested in engaging with this institute. So we're hoping that things trend down in terms of infection rates so that we can hold our fall in person meeting at Triangle park in north Carolina to specifically talk about the environmental issues that are ongoing. Our NIH tribal advisory committee also provided recommendations to the N. I E. H. S. Strategic plan on climate change. And so that is something that will be coming out soon. So the tech has really had a big interest in this. We're seeing that and and we all know this that our environment is a critical part of our well being in our in our health and our conditions. So we can't go without thinking about environment as a as a um as a key influencer and and how we improve health. And I keep saying it's the last question, but we keep getting chat. So we have a few minutes left. So if you don't mind. Okay. Um uh the question is um the throw policy established with tribes has an impact at a macro level. Would it be beneficial to establish a similar policy between designated centers and tribes at a state and local level? Yeah, that's a that's a really good question. Um and and it's important for us to to consider that um our relationship as a federal agency is a government to government relationship with the tribal with the sovereign nations across the country. Um, so any of these en ci designated centers, we encourage them to reach out and and um we also have terms and conditions of awards that they must follow. So, um and also best practices. So it would be great for the National Cancer Institute and these designated centers to have these lesson listening sessions with local communities to get a better understanding of what's happening in their local area or region. This is something that's actually going to start happening more and more. So the policy was just released in ar implemented in March. And so there's a lot of learning that's happening right now at the agency, but the National Institute of Allergy and infectious disease, we have a remote site that's in Montana that works specifically on highly infectious diseases. But they also do a wonderful job of training the Blackfeet and the Crow community members there that are interested in biomedical research. But what they want to do is now to have more of a of a formal engagement with those communities now that we have a policy now that they understand what is the appropriate way to engage our nations, that they're going to be doing this and I'm sure that this will extend the best practices that we've seen. You've seen there was a list of engagements that we had in terms of consultations each time we've had one, we've learned something different and we're hoping to share that information with more. So the more partners so that hopefully this will become standard practice in the future. Excellent. And this will be the last last question um in the past and this isn't like uh promote our center, but it comes from a participant in the chat box in the past. We uh we used to have conferences sponsored by dr cholera at the Mayo clinic, spirited eagles program and the Native Research Network. Uh these conferences had american indian Alaska native Research project project presentations, which gave us the opportunity to kind of share information network and possibly replicate methods in our respective communities. Does your office anticipate sponsoring any type of conference in the future, perhaps at Roswell Park where the Center for Indigenous Cancer Research? So that that's a terrific question. And right now we are building that critical master those connections that we've never had before across the NIH. I'm hoping that ultimately that will lead to and we have this at at a lower level where we have students that come to the NIH Um at the most before the pandemic broke out, we had 30 Native American students actually, I think it was 25 from different communities that that came to the NIH during our eight week summer internship program. When they came we had specific curriculum for them. So we met with them, we talked about all the different research disciplines that happened across the NIH. We had a picnic to talk about what their future might look like in terms of biomedical research. So, and these were more uh undergraduate level students. So I think what we're talking about here might be um including those undergraduates, but also thinking about the graduates and their early career professionals as well, that would be a terrific opportunity. We're also increasing our engagement with longstanding organizations that have supported um aI and students in bio in research as a whole. And that includes the american indian Society for Engineering and Sciences, Aces but also sadness, A society for advancement of Hispanics, chicanos, and native americans in science. And we're also exploring opportunities to engage with scientific societies, you know that that support minority committees that have minority communities that may have one or two Ai and community members that are researchers that are involved in these scientific societies. So bringing these all together and that goes to one of your earlier questions is that it's really a process to go through all these different avenues to identify who's out there and their willingness to participate in some of these larger scale efforts. But it's a part about building that critical mass. It's critically important. Well thank you. We appreciate your time today, um the information and we look forward to uh staying in contact and wishing everybody on the call a wonderful day and and a blessed day and I really appreciate everybody's time on the on these very important topics Sony away. And uh we'll we'll keep in touch everyone. Thank you. Thank you. Doctor Wilson