Resource Library

Public health emergencies, including infectious disease outbreaks and natural disasters, are issues that every community faces. To address these threats, it is critical for all jurisdictions to understand how law can be used to enhance public health preparedness, as well as improve collaboration and coordination across jurisdictions. This Resource Library is designed to provide relevant resources to Tribal Nations seeking to enhance their legal preparedness capacity. While most resources have a Tribal focus, some resources are included that are generally applicable to legal preparedness for public health emergencies and natural disasters.


Administrative Preparedness Strategies: Expediting Procurement and Contracting Cycle Times During an Emergency

This article describes an assessment of whether administrative preparedness processes that were intended to expedite the acquisition of goods and services during a public health emergency affect estimated procurement and contracting cycle times using data from 2014-2015 applications to the Hospital Preparedness Program and Public Health Emergency Preparedness (HPP-PHEP) cooperative agreements. Public Health Reports (2017)

Assessing Cross-sectoral and Cross-jurisdictional Coordination for Public Health Emergency Legal Preparedness

This article highlights the need for coordinated planning and action among jurisdictions when responding to disasters and emergencies. Journal of Law, Medicine and Ethics (March 3, 2008)

Assessment of Public Health Workforce Bioterrorism and Emergency Preparedness Readiness Among Tribes in Washington State: a Collaborative Approach Among the Northwest Center for Public Health Practice, the Northwest Portland Area Indian Health Board, and the Washington State Department of Health

This article examines the collaboration, methodology, results, and lessons learned stemming from the experience of a unique university, state, and Tribal collaborative model for public health emergency preparedness assessment activities. Journal of Public Health Management and Practice (November 2005)

At-a-glance- Lessons learned from launching the Manitoba Take-Home Naloxone Program

This article evaluates the Government of Manitoba’s Take-Home Naloxone Program, which was started in January 2017. By September 2017, there were 60 operating sites in the area, which distributed 765 Naloxone kits to people at risk for opioid overdose. Heath Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice (June 2018)

Collaborating with Sovereign Tribal Nations to Legally Prepare for Public Health Emergencies

This article first explains legal preparedness and Tribal sovereignty and then describes the relationship between Tribal Nations, the US government, and states. Specific Tribal concerns with respect to emergency preparedness and the importance of coordination and collaboration across jurisdictions for emergency preparedness are discussed. Examples of collaborative efforts between Tribal and other governments to enhance legal preparedness are described. The Journal of Law, Medicine & Ethics (July 12, 2019)

Community Perspectives on Drug/Alcohol Use, Concerns, Needs and Resources in Four Washington State Tribal Communities

This article discusses substance use, abuse, and dependence in four Washington State Tribal Communities. Data show that prescription medications and alcohol were perceived as most prevalent and concerning within those communities. Journal of Ethnicity in Substance Abuse (January 3, 2015)

Deaths Related to 2009 Pandemic Influenza A (H1N1) Among American Indian/Alaska Natives – 12 States, 2009

This article discusses the burden of H1N1 influenza deaths in the AI/AN population by compiling surveillance data from certain states and comparing death rates. Centers for Disease Control and Prevention (December 11, 2009)

Disaster Preparedness Resource Allocation and Technical Support for Native American Tribes in California

This article aims to assess emergency preparedness among Native American Tribes in California to inform future development of priorities and strategies for improvement. Journal of Homeland Security and Emergency Management (2016)

Disaster Preparedness Training for Tribal Leaders

This article summarizes a training for Tribal public health preparedness, including the importance of cultural competency, respect for Tribal sovereignty, inclusion of historical examples of indigenous preparedness, and incorporation of Tribal community networks. Journal of Occupational Medicine and Toxicology (January 15, 2008)

Drug, Opioid-Involved and Heroin-Involved Overdose Deaths Among American Indians and Alaska Natives- Washington, 1999-2015

This article describes the opioid crisis in Indian Country, specifically in Washington State. Nationally, American Indians and Alaska Natives (AI/AN) have experienced the largest increases in drug and opioid-involved overdose mortality rates compared with other racial/ethnic groups. Misclassification of AI/AN race is known to underestimate AI/AN mortality rates. Centers for Disease Control and Prevention (December 21, 2018)

Emergency Declarations and Tribes: Mechanisms Under Tribal and Federal Law

This article summarizes several types of emergency declarations, including Tribal declarations, Stafford Act declarations, and federal public health emergency declarations, and their implications for Tribes. Michigan State International Law Review (2015)

Emergency Preparedness Training for Tribal Community Health Representatives

This article describes the development and evaluation of online Public Health Emergency Preparedness (PHEP) training adapted to the learning styles and needs of Tribal Community Health Representatives (CHRs). Journal of Immigrant and Minority Health (April 2012)

Fighting Opioid Abuse in Indian Country

This article describes the Muckleshoot Reservation’s needle exchange program and naloxone distribution program for Tribal members. The Muckleshoot Behavioral Health Center sees around 170 patients who have an opioid use disorder. The article describes the use and positive results of medically-assisted treatment, particularly buprenorphine, to help treat opioid use disorder. The Pew Charitable Trusts (December 6, 2016)

Five Legal Preparedness Challenges for Responding to Future Public Health Emergencies

This article provides a brief summary of five U.S. legal preparedness topics that warrant additional consideration: (1) EUA implementation at the local level; (2) expansion of health care practitioner scopes of practice; (3) evidence base for non-pharmaceutical interventions; (4) crisis care liability protections for health care practitioners; and (5) liability associated with failing to adequately plan for disasters. Journal of Law, Medicine and Ethics (2011)

Governing Disaster: The politics of Tribal sovereignty in the context of (un)natural disaster

This article examines recent changes in U.S. Tribal disaster policy to explore implications both for discrete disaster events that occur on reservations and for the ongoing disaster of colonization. Ethnic and Racial Studies (2016)

Improving Competencies for Public Health Emergency Legal Preparedness

This article reviews options for public health professionals, their legal counsels, and relevant partners to better understand and improve their competency in public health emergency legal preparedness to enable more effective management of emergency events. Journal of Law, Medicine & Ethics (2008)

Improving Information and Best Practices for Public Health Emergency Legal Preparedness

This article outlines many potential options for action to improve the information element of legal preparedness for all-hazards public health emergencies. Journal of Law, Medicine & Ethics (2008)

Improving Laws and Legal Authorities for Public Health Emergency Legal Preparedness

This article discusses considerations for policymakers and practitioners responsible for all-hazards emergency preparedness when hazards and threats prompt use of and challenges to traditional and untested public health law. Journal of Law, Medicine & Ethics (2008)

Indian Health Service Pharmacists Engaged in Opioid Safety Initiatives and Expanding Access to Naloxone

This article discusses Indian Health Service pharmacist involvement in and impact on the opioid epidemic, as well as innovative and promising practices implemented to meet the needs of Tribal communities. Journal of the American Pharmacists Association (March - April 2017)

Pandemic Influenza Preparedness and Vulnerable Populations in Tribal Communities

This article outlines potential issues to consider in identifying and providing appropriate services for selected vulnerable populations within Tribal communities and also highlights pandemic influenza preparedness resources available to Tribal leaders and their partners in state and local health departments, academia, community-based organizations, and the private sector. American Journal of Public Health (2009)

Public Health Legal Preparedness In Indian Country

This article provides an evidence base to help Tribal leaders strengthen public health legal foundations in Tribal communities. American Journal of Public Health (2009)

Responding to Public Health Emergencies on Tribal Lands: Jurisdictional Challenges and Practical Solutions

This article identifies some of the most pressing jurisdictional issues that may confront governments responding to a public health emergency on Tribal land, with the aim of highlighting the nature of the problem and the need for action. The article goes on to examine the most promising means of addressing jurisdictional uncertainty. The Yale Journal of Health Policy, Law, and Ethics (2015)

Reviving Local Tribal Control in Indian Country

This article discusses how working with non-Indian governments to build cooperation will allow Indian Tribes to expand their ability to self-govern, while meeting the needs of non-Indian governments that are frustrated by the limited application of state law in Indian country. The Federal Lawyer (2006)

Sadie Afraid of His Horses-Janis

This article is a Pandemic Influenza Storybook created by the CDC, which provides readers with a look at the impact pandemic flu events have had on both survivors and the families and friends of non-survivors. These stories are not folklore, but personal recollections. This is the story of Sadie Afraid of His Horses-Janis. Centers for Disease Control and Prevention (April 9, 2013)

The Opioid Epidemic in Indian Country

This article discusses how opioid use has increased within Indian Country at similar rates to the increase seen among non-Hispanic whites. However, in some areas like the Great Lakes and Pacific Northwest, the rates of opioid use disorder are higher. Additionally, this article summarizes innovative medical and legal efforts taken by Tribal communities to combat the crisis, including culturally cognizant counseling and the tradition of banishment. The Journal of Law, Medicine, and Ethics (July 17, 2018)

What is Public Health Legal Preparedness?

This article aims to update the concept of public health legal preparedness and articulate it as a goal, to review current efforts to strengthen public health’s legal preparedness, and to lay out a preliminary, general approach toward achieving and sustaining full public health legal preparedness. Journal of Law, Medicine & Ethics (2003)


The contents of this website have not been formally disseminated by the Centers for Disease Control and Prevention, ChangeLab Solutions, and the Center for Public Health Practice. The contents should not be construed to represent any agency/organization determination or policy. These website materials are for instructional use only and are not intended as a substitute for professional legal or other advice. While every effort has been made to verify the accuracy of these materials, legal authorities and requirements may vary from jurisdiction to jurisdiction and change over time. Always seek the advice of an attorney or other qualified professional with any questions you may have regarding a legal matter.