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The sovereign status of tribes exempts American Indian lands from local and state governmental regulations and laws. Although reservations are situated within state borders, as independent nations they are often excluded from the advantages of interjurisdictional coordination and collaboration that exist among local and state public health agencies. Infectious diseases, which are a major cause of morbidity, mortality and disability, affect American Indian populations disproportionately.
This document focuses on the importance of policies that include tribes in a comprehensive multijurisdictional public health system that can address infectious disease outbreaks.