Siamit: A Novel Academic-Tribal Health Partnership in Northwest Alaska.

PROBLEM: American Indians and Alaska Natives hold a state-conferred right to health, yet significant health and health care disparities persist. Academic medical centers are resource-rich institutions committed to public service, yet few are engaged in responsive, equitable, and lasting tribal health partnerships to address these challenges. APPROACH: Maniilaq Association, a rural and remote tribal health organization in Northwest Alaska, partnered with Massachusetts General Hospital and Harvard Medical School to address health care needs through physician staffing, training, and quality improvement initiatives. This partnership, called Siamit, falls under tribal governance, focuses on supporting community health leaders, addresses challenges shaped by extreme geographic remoteness, and advances the mission of academic medicine in the context of tribal health priorities. OUTCOMES: Throughout the 2019-2020 academic year, Siamit augmented local physician staffing, mentored health professions trainees, provided continuing medical education courses, implemented quality improvement initiatives, and provided clinical care and operational support during the COVID-19 pandemic. Siamit began with a small budget and limited human resources, demonstrating that relatively small investments in academic-tribal health partnerships can support meaningful and positive outcomes. NEXT STEPS: During the 2020-2021 academic year, the authors plan to expand Siamit's efforts with a broader social medicine curriculum, additional attending staff, more frequent trainee rotations, an increasingly robust mentorship network for Indigenous health professions trainees, and further study of the impact of these efforts. Such partnerships may be replicable in other settings and represent a significant opportunity to advance community health priorities, strengthen tribal health systems, support the next generation of Indigenous health leaders, and carry out the academic medicine mission of teaching, research, and service.

Avian and pandemic influenza: a biosocial approach. Introduction.

The Harvard University Asian Flus and Avian Influenza Workshop, held in December 2006, introduced a biosocial approach to the preparation for and control of pandemics. A biosocial approach brings together the biological and social sciences to develop an integrative, collaborative response to the threat of pandemic influenza. The articles in this supplement provide a representative sampling of some of the ways in which the workshop worked toward this biosocial vision. These articles address the historical "siting" of epidemics, political and structural pandemic preparedness in China, lessons to be taken from the 1976 "swine flu affair," possibilities for genetic engineering as an alternative to poultry vaccination, issues to be considered in the control of infectious disease in swine and avian species, the ecology of influenza in migratory birds, and issues of stigma and trust during the control of epidemics. The need to build public trust and public health infrastructure is one of the primary messages of this collection.

Asian flus in ethnographic and political context: A biosocial approach.

This collection highlights some of the social, cultural, political and economic factors that must be considered in developing a biosocial approach to pandemic influenza control and prevention. To date, most discussions of the current spread of avian influenza and a predicted human influenza pandemic have lacked rigorous analysis of the local contexts in which flus arise and in which the effects of a pandemic would most strongly be felt. Such local engagement is necessary to the development of an effective and ethical programme of epidemic control. The papers in this special issue take a step towards filling this gap by exploring the local moral worlds associated with avian influenza in China, Indonesia and Thailand.