On April 14, 2022 the White House held a Convening on Equity to announce the release of Equity Action Plans from more than 90 federal agencies, including all cabinet-level departments. These action plans are the result of the Executive Order (EO) on “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government” that President Biden signed on his first day in office, which required each agency to create plans to address “any barriers to full and equal participation” in both agency programs and agency procurement and contracting opportunities. The Office of Management and Budget was intimately involved in the crafting of these plans, tasked with partnering with agencies to advance equity, identify new approaches to equity in the federal government, and engage with state, local, Tribal, and territorial governments and other national leaders on equity.
Opening the event in pre-recorded remarks, President Biden emphasized that “Equity is not a one year project – it’s a generational commitment.” Six cabinet secretaries then shared highlights from their respective Equity Action Plans. Several speakers specifically mentioned disparities affecting Tribes and American Indians and Alaskan Natives, as well as the Administration’s commitment to upholding Tribal sovereignty and the Government-to-Government relationship as they work to address these inequities. Several of the described Action Plans will have direct impact on Tribal health policy priorities, including those highlighted below.
- Department of Agriculture (USDA): Of the seven equity actions outlined in USDA’s plan, number six is to “Uphold Federal Trust and Treaty Responsibilities to Indian Tribes,” including a commitment to reducing barriers to participation in programs, expanding Tribal self-determination policies, and incorporating Indigenous values and perspective into program design and delivery. Actions listed under this goal include, among other things, ensuring agency-wide consistency in how “ownership” of Tribal lands is classified and ensuring access to USDA programs for Tribal Lands and Tribal-Owned Entities; reinforcing Tribal jurisdiction/sovereignty through requiring Tribal resolutions of support; and consistently enforcing Tribal treaties and statutes, supported by the creation of a publicly accessible Treaty Database. Other plan priorities are also intended to support Tribal communities. For example, the plan notes that of the 12 agencies still administering the WIC (Women, Infants, and Children) nutrition program using paper coupons rather than an electronic benefit system, 8 are Tribal organizations; USDA will make grants and technical assistance available to modernize these programs.
- Department of Health and Human Services (HHS): The plan from HHS notes that their equity assessment found “tribal communities often have difficulty meeting the service population requirements, match requirements, and/or are under-resourced to apply and successfully compete for grant awards” and list several recommendations received in Tribal consultation for how to resolve those issues. However, the only action the plan states HHS will take in this area is “investigating strategies for addressing these barriers,” including conducting “outreach to both external and internal stakeholders to further inform policy changes.” Each HHS operating division will also conduct an equity assessment. The plan also includes steps to expand interpreter services and in-language content to support access to programs for people with limited English proficiency. The plan further notes the significant disparity in maternal mortality experienced by AI/AN women, and plans to address this through working with states to adopt the state plan option for extending Medicaid coverage for post-partum care, and through soliciting “examples of effective programs and practices to reduce disparities and improve outcomes for postpartum Black or African American and AI/AN people enrolled in Medicaid or CHIP.”
- Department of Commerce: The agency’s first “Equity Action” is “Close the digital divide.” The Federal Communications Commission has been tasked with developing broadband maps which will identify on a location-by-location basis the number of households unserved by highspeed internet infrastructure, and acknowledges that the problem is especially widespread on Tribal lands. The largest investment ($42.45 billion) in broadband infrastructure will be made through the Broadband Equity, Access, and Deployment Program, which distributes large grants to states and territories. The Equity Action Plan explains that states are expected to “address local and community needs, including those of Tribal nations,” but grants from this program will not be awarded directly to Tribal nations. The Tribal Broadband Connectivity Program is also ongoing, and received an additional $2 billion in the Bipartisan Infrastructure Law to award grants for projects that will provide Tribal households with broadband access. The agency states it will hold itself accountable to meeting the stated goals in part through “proactive outreach and engagement” with Tribal communities to provide feedback on needs, barriers, and how the agency can further support their communities.