feature
have some health concerns. White Mesa
was one of the places our [study] group
went. They were concerned about heavy
metals, particularly uranium.”
That kind of outreach and public health
laboratory support is not unique. And it is
becoming ever more common as health
departments and their collaborators
intensify efforts to empower underserved
communities and reduce health
disparities.
Proactive vs. Reactive
Public Health
P
ublic health laboratories,
said Atkinson-Dunn, have
“been addressing health
disparities as long as public
health laboratories have
existed.” She said, “When
you look at our infectious disease group,
the bread and butter of what they do is
STD and TB testing. And the majority
of communities we serve [with those
programs] are those who are seeking care
at free clinics.”
Indeed, the average state public health
laboratory performs HIV diagnostic testing
In Utah, a liaison with the health agency’s Office of American Indian/Alaska
Native Health Affairs helped the laboratory navigate the complex relationship
between the state government and the Ute Mountain Ute Tribal government.
on about 21,000 specimens per year,
according to APHL data. Three quarters
of state public health laboratories
provide first-line TB drug susceptibility
testing. And 82% of state public health
laboratories test children’s blood for
lead. All of these activities mainly target
low-income individuals, though they
indirectly benefit the larger society
as well.
Yet in the public health laboratory, as in
public health writ large, there is a growing
effort to “more consciously” address
health disparities, said Jennifer Rakeman,
PhD, director of the New York City Public
Health Laboratory.
Thus, instead of waiting for residents
to ask for services, more public health
laboratories are proactively sending staff
out into the community to learn how the
laboratory can help.
In Utah, a liaison with the health agency’s
Office of American Indian/Alaska Native
Health Affairs, Melissa Zito, MS, RN,
helped the laboratory navigate the
complex relationship between the state
government and the Ute Mountain Ute
Tribal government. Zito said “tribes don’t
always want to work with us, because of
historical mistrust” and explained that
there is a formal consultation process
agreed to by all American Indian tribes
in Utah to assure “we’re working on a
government-to-government basis that
recognizes their Tribal sovereignty.”
Gaining buy-in from all vested parties was
key to project success.
Ultimately, the health department
collected urine specimens and well water
samples from 19 communities throughout
the state, including Utah’s White Mesa
Reservation. Altogether, 7.4% of the urine
specimens exceeded 0.029 µg uranium/g—
the 95 th percentile value from the National
Health and Nutrition Examination Survey
(NHANES), a CDC study that examines a
nationally representative sample of about
5,000 people/year. (The NHANES value is
used because there is no official reference
standard for safe human uranium
exposure.) And 2.5% of all the well water
samples exceeded the US Environmental
Protection Agency maximum contaminant
level of 30 µg uranium/g.
Since the Utah Department of Health is
still analyzing test data, Atkinson-Dunn
said findings will first be shared with the
state’s environmental epidemiologist and
Ute Mountain Ute Tribal public health
authorities upon completion. In addition,
every participant will receive their own
test results, along with information to put
results “into perspective” and to facilitate
follow-up.
“This is a research study with
[institutional review board oversight],”
said Atkinson-Dunn. “So we have to be
very clear that the results are in no way
diagnostic. And that’s why we direct
[participants] to other resources if they
have questions about what this data
means for their personal health.”
In the meantime, the Ute Mountain Ute
Tri