Dr. Nathaniel Cobb, MD
Division of Epidemiology
Indian Health Service
5300 Homestead Rd NE
Albuquerque NM 87110
Phone: (505)248-4132
E-mail: nathaniel.cobb@ihs.gov
Dr. Nathaniel Cobb,
Thank you for the quick response.
As I am sure you must have been thinking as you wrote this response to me, I would not find it satisfactory.
I have contacted all the heads of Indian Health at each of the tribes that operate casinos over the last three years on this issue--- NOT ONE SINGLE ONE has responded by e-mail or been willing to talk to me on the phone.
Quite frankly, I seriously doubt there are circumstances where the impact of second-hand smoke can be dealt with in one fell swoop.
Yet, we both know this is more about casino PROFITS and the way casino PROFITS influence POLITICS.
What are you suggesting, is that it will take some kind of revolution in this country before an agency like yours which has a mandate to educate on this serious issue will act?
I find this coming from a medical doctor such as you very strange; that on this one single issue involving human health where so many lives can be saved and health maintained you suggest that it is up to a union to take the action rather than you.
What you are suggesting is that tribal leaderships motivated solely by profits are to be given into on a health care issue so adversely affecting human health as the issue of workers being forced to work in an environment composed of second-hand smoke because you do not want to rock the boat--- using as your excuse: "sovereignty."
There seems to be a clear admission here on your part that these tribal governments involved in gaming have been so corrupted by money they don't even care about the health of their own people let alone anyone else.
As you are fully aware, most of these casinos are run by outside management firms only using sovereignty to escape protecting the rights of casino workers to be free from second-hand smoke in their employment.
You come up with this flimsy excuse that the issue of smoke-free casinos cannot be addressed because the details of the conference--- the Indian Health Summit--- are already set and established.
However, what is preventing those who will be doing the presentations on the serious consequences of tobacco from raising the issue concerning the need for these casinos to go smoke-free because it is a matter of fundamental human rights for workers not to be forced to work in these conditions that we all know are seriously detrimental to human health?
You, as a medical doctor, are requesting that I should send you further information regarding the consequences of working in these smoke-filled casinos?
It is almost unbelievable that you, being a medical doctor, have even written these words.
That you acknowledge you have known about this problem and not insisted the politicians correct this, is a disgrace. You are the expert witness here.
I find it very difficult to understand how the scientific and medical community has managed to turn out the most respected from these professions to testify:
- Against the tobacco companies in law suits;
- At Congressional and State Legislative hearings for "freedom to breath" legislation;
- In support of smoke-free workplaces for everyone else except casino workers.
But, for some reason there is complete, total, overwhelming and absolute silence when it comes to the issue coercing these casinos in the Indian Gaming Industry to go smoke-free to protect the health of two-million casino workers.
At this point, since you agree this is a very serious problem; I would request that you convey my concerns--- AND WHAT YOU CLAIM ARE YOUR SHARED CONCERNS--- to each and everyone of those people who will be participating in the tobacco workshops, forums or making any presentations on tobacco and request that they specifically address the problem of second-hand smoke in casinos and make suggestions and recommendations how this issue will be resolved by coercing these casino managements to go smoke-free.
The Manitoba, Canada government has taken the stand that they will not approve any further casino Compacts or upgrades or new licenses for any casino unless it will be smoke-free.
Something is very wrong with the scenario you bring forward here. I find it kind of strange that a public official such as yourself, who has a legislated mandate to provide the leadership in protecting human health, would tell a citizen writing to you to go and do your job for you.
I expect you to communicate your concerns regarding second-hand smoke (environmental tobacco smoke) to each member of the United States Congress, every single state legislator in each and every state; and, I expect that you will convey your concerns as a medical doctor and in your capacity as a public official with the specific mandate to raise this concern with the Bureau of Indian Affairs and the Secretary of the Department of Interior; and further, that you instruct all of those employed at the local and state levels working for Indian Health Services to immediately undertake discussions about this with their tribal governments.
Sovereignty has nothing to do with this issue.
Your department and agency is involved in this conference. As a result, you have a mandate to bring this issue forward.
I assume you do not request permission from tribal governments to raise any other issues related to human health; so why would you have conceded your mandate on this vital issue to tribal governments with no demonstrated concern on this issue?
To suggest that this issue can wait until another conference, where both you and I know that I will never receive permission to speak on this issue, is about as insensitive and uncaring a response that anyone could ever expect to receive from a public official who has the scientific and medical background to know and understand that thousands of casino workers will lose their health while others will die from second-hand smoke they are forced to breath as terms and conditions of employment.
I am requesting that you carry out the mandate you have from Congress and act to make sure this issue is addressed at your upcoming conference with the aim of resolving this issue once and for all.
I expect to receive written confirmation that you have taken such action.
I assume that President Barack Obama would not appreciate you dragging your feet on this issue since he is so concerned about health care costs; I don't think I have to lecture you, a medical doctor, about the costs involved in trying to cure cancers, heart and lung problems associated with second-hand smoke in the workplace.
With all the attention now focused on accusations of frivolous government spending, I would think you would be more sensitive to the need to bring this issue forward at your upcoming conference.
Respectfully,
Alan L. Maki
Director of Organizing,
Midwest Casino Workers Organizing Council
Cc: Maggie Bird
President,
Midwest Casino Workers Organizing Council
-----Original Message-----
From: Nathaniel Cobb [mailto:nathaniel.cobb@ihs.gov]
Sent: Thursday, April 23, 2009 2:18 PM
To: amaki000@centurytel.net
Cc: Jones, Candace (IHS/NPA); Karol, Susan (IHS/HQE); Wohr, Megan S (IHS/PHX)
Subject: Casino workers and smoking
Dear Mr. Maki:
Your email (below) was forwarded to me for response, as the Agency lead for tobacco control. Thank you for your suggestions - I completely agree that environmental tobacco smoke (ETS) in Casinos is a serious health issue for both the employees and the patrons. Labor law is outside my expertise and purview, but I will try to address a few of the many questions you raise:
1. Can we have a session on casino workers and ETS exposure at the Indian Health Summit?
- reasonable suggestion, but the practical answer is that we did invite the public to submit abstracts, that deadline has passed, and we have already finalized the agenda and cannot add another session. We do have a tobacco session scheduled, but nothing was submitted that focused specifically on casinos.
2. Have we discussed this issue with ACS, AHA, or ALA?
- yes. In discussions with ACS, we have agreed that local advocacy may be the most effective way to approach this issue.
3. Can IHS work with BIA to ban smoking in Casinos?
- IHS is an agency of Health and Human Services, not Interior. We have no regulatory role with regard to Gaming compacts, so no direct influence. In our advisory role with regard to health issues, we may make recommendations to another agency. Your suggestion has merit, and I will discuss it with senior leadership within IHS. I note that you have cc'd your email to your congressional delegation. The Congress has much more power to dictate terms of Indian Compacts than we do, so you should continue to work closely with them. A formal letter to a Member of Congress or to an Agency Head, with a clearly worded request, will always get a response.
4. What else can we do?
- It is true that ETS exposure is a health issue, but the solutions are political. We have great respect for Tribal Sovereignty, and unless and until Tribal Leaders support a smoking ban in casinos, it is not likely to happen. So my suggestion is that you contact the National Indian Health Board and ask for a time slot to present the issue at their next Consumer Conference. That meeting is a great opportunity to influence the thinking of Indian Country leadership.
Thank you for your concern, and I look forward to attending your session at the NIHB conference! If you have any educational materials or scientific studies of ETS and casino workers, I would appreciate your sending me copies.
--
Nathaniel Cobb MD
Chief, Chronic Disease Branch
Division of Epidemiology
Indian Health Service
5300 Homestead Rd NE
Albuquerque NM 87110
(505)248-4132
From: Alan Maki [mailto:amaki000@centurytel.net]
Sent: Wednesday, April 22, 2009 9:47 PM
To: Kimi De Leon; Joan Kim
Cc: 'Jim Hart'; 'John Kolstad'; 'Kip Sullivan'; 'Carl Levin'; 'Sen.Jim Carlson'; rep.bill.hilty@house.mn; rep.tom.anzelc@house.mn; rep.tom.Rukavina@house.mn; rep.tony.sertich@house.mn; ddepass@startribune.com; mmiron@bemidjipioneer.com; bswenson@bemidjipioneer.com; 'Chris Spotted Eagle'; jgoldstein@americanrightsatwork.org; teresa_detrempe@klobuchar.senate.gov;
peter.erlinder@wmitchell.edu; peter.makowski@mail.house.gov; esquincle@verizon.net; 'Walter Tillow'; nursenpo@gmail.com; 'Steve Early'; 'Joshua Frank'; 'Ta, Minh'; 'Rhoda Gilman'; 'David Shove'; 'ken nash'; 'Ken Pentel'; WCS-A@yahoogroups.com; MARKOWIT@history.rutgers.edu; tdennis@gfherald.com; 'Myers, John'; loneagle@paulbunyan.net; 'Thomas Kurhajetz'; mhoney@u.washington.edu; moderator@portside.org; debssoc@sbcglobal.net; 'Tom Meersman'; peterb3121@hotmail.com; laurel1@dailyjournal-ifalls.com; jscannel@aflcio.org; rgettel@uaw.net; gdubovich@usw.org; info@jamesmayer.org; mzweig@notes.cc.sunysb.edu; rachleff@macalester.edu; advocate@stpaulunions.org; elizabeth_reed@levin.senate.gov; 'Alan Uhl'; 'Charles Underwood'
Subject: Re: Question on Indian Health Summit
To whom it may concern;
Could you tell me if there will be a discussion at the Indian Health
Summit--- July 7-9, 2009 in Denver, Colorado--- concerning the issue of casino workers in the Indian Gaming Industry and the impact to their health of second hand smoke in their workplaces?
Could you advise me if there have been any discussions about this with the American Cancer Society and/or the Heart and Lung Foundation?
I am very concerned since I find nothing on this important topic among any of the materials you are distributing for the Indian Health Summit.
With health care costs become an important topic for discussion it would seem that this issue would at least merit some kind of mention at an Indian Health Summit considering the large number of Native Americans employed in the Indian Gaming Industry.
Perhaps you would be interested in having me address one of the plenary sessions since this topic has not been considered previously.
I would point out that I have contacted my of the local offices and administrators of the Indian Health Services concerning this issue and no one will speak to me.
With the Indian Health Services being part of the Department of Interior and associated with the Bureau of Indian Affairs, it would only seem logical that no further casino "Compacts" would be approved unless they contain provisions banning and prohibiting smoking.
I would also suggest that the Indian Health Services insist that all existing "Compacts" be re-opened so a ban and prohibition on smoking can be inserted into them.
Compacts" are nothing more than contracts and the Obama Administration has seen fit to insist that previously negotiated contracts with labor unions be re-negotiated so there is definitely a precedent that has been established for doing this and I am sure you will agree with me that there could not be a better argument made for renegotiating these "Compacts" than to protect the health of hundreds of thousands of workers employed in these casinos who, in addition to working in these smoke-filled working environments are not protected under any state or federal labor laws, which makes this problem of being employed in a work environment detrimental to human health even a more serious concern.
Perhaps the Indian Health Services could make a recommendation to the Bureau of Indian Affairs and the Secretary of the Department of Interior that the Secretary of Labor, Hilda Solis, becomes involved so that the protection of casino workers' rights under all state and federal labor laws protecting all other workers in the United States be included at the time the Compacts are re-opened to protect the health of casino workers.
If you have any doubts second-hand smoke contributes to an unhealthy work environment and that second-hand smoke is recognized as a leading contributor to a variety of cancers and heart and lung diseases please do not hesitate to request additional information. I will be more than happy to attend your Indian Health Care Summit with the necessary resource materials.
With some two-million workers now employed in the Indian Gaming Industry we want to make sure everything possible is being done to protect the health and well-being of these workers.
If I have addressed this letter to the wrong persons, would you please provide me with the name of the proper person/s and department/s this letter should be sent to.
If you think this issue concerning the impact of second-hand smoke on the health of casino workers is not significant enough to be discussed at the Indian Health Summit would you be so kind as to advise me of your decision and how it was reached?
Thanking you in advance for your timely consideration;
Alan L. Maki
Director of Organizing,
Midwest Casino Workers Organizing Council
58891 County Road 13
Warroad, Minnesota 56763
Phone: 218-386-2432
Cell phone: 651-587-5541
E-mail: amaki000@centurytel.net
Check out my blog:
Thoughts From Podunk
http://thepodunkblog.blogspot.com/
Cc: Maggie Bird
President,
Midwest Casino Workers Organizing Council
Dr. Cobb delivered this report way back in 2002:
Nathaniel Cobb, M.D.
Determinants of Cancer Mortality and Cancer Survival among American Indians and Alaska Natives
Friday, March 15
American Indian and Alaska Natives (AI/AN) represent one of the most vulnerable populations in the United States, with heavier burdens of many disease categories (diabetes, injury, alcohol related deaths, tuberculosis, suicide, etc.) and more unfavorable measures of health and economic status (infant mortality rate, life expectancy, poverty rate) than all other ethnic groups in the US. Once considered very rare among AI/AN, cancer is now their second leading cause of death. There is a remarkable variation of cancer rates among tribes, which may be caused by genetic, environmental, or behavioral differences. Although overall rates of cancer among AI/AN are still lower than the US all-races rates, 5-year survival from cancer is much worse than other groups. In this presentation I will describe geographic patterns of cancer mortality among AI/AN and advance hypotheses to explain the variability. I will also present results of research that attempts to explain the disparity in cancer survival rates through analysis of various characteristics of the patient (age, distance from hospital, frequency of visits, other conditions) and the health care system (missed opportunities, referral patterns, screening).
Dr. Cobb received his undergraduate degree from Fort Lewis College in Durango, Colorado and his M.D. from Harvard Medical School. He trained in Family Practice at the University of New Mexico, and after practicing with Indian Health Service for several years, he completed the two year Epidemic Intelligence Service fellowship at the Centers for Disease Control and Prevention in Atlanta. Dr. Cobb also completed the academic portion of the Cancer Prevention and Control fellowship at the National Cancer Institute.
Dr. Cobb is currently Director of the Chronic Disease Epidemiology Section of the Indian Health Service National Epidemiology Program, Chief Medical Officer for IHS National Programs, and Director of the IHS Cancer Prevention and Control Program. In addition to his IHS duties, he teaches at the University of New Mexico MPH program and maintains a part-time clinical practice in Emergency Medicine. He also races bicycles and tries to stay ahead of two teenage sons.
References:
Patterns of Cancer Mortality among Native Americans. Cancer 1998;83:2377-83. MEDLINE
I notice Dr. Nathaniel Cobb made a nice little contribution to Barack Obama's campaign. It seems that among the bureaucrats in the Indian Health Services there is quite the little pool of campaign contributions... I find it interesting that there have been no surveys done by the Indian Health Services asking patients if they are employed in environments of second-hand smoke; but, patients are asked if they smoke:
Person
Candidate
Address
Rick Kruis
Donation of $4,664 to Presidential elections 2008
Democrat
Rick Kruis
Physician
Indian Health Service
Updated
Q2/2008
Barack Obama
$4,664
910 SUSAN AVE
Gallup NM
Nathaniel Cobb
Donation of $1,274 to Presidential elections 2008
Democrat
Nathaniel Cobb
Physician
Indian Health Service
Updated
Q3/2008
Barack Obama
$1,274
PO BOX 2939
Corrales NM
Ronald Belinski
Donation of $1,163 to Presidential elections 2008
Republican
Ronald Belinski
Physician
Indian Health Service
Updated
Q1/2008
Ron Paul
$1,163
13910 E 89TH ST N
Owasso OK
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