CHANDLER, Ariz. (AP) — Health Secretary Robert F. Kennedy Jr. spent time in tribal communities in Arizona and New Mexico this week highlighting ways they are trying to prevent chronic disease among Native Americans and Alaska Natives, something he has said is one of his top priorities.

But Kennedy didn’t appear to publicly address a Native health program using traditional medicine and foods to tackle disproportionate rates of conditions like diabetes and liver disease. The program, called Healthy Tribes, was gutted in this month’s federal health layoffs.

Some Native leaders say they are having trouble grasping the dissonance between Kennedy’s words and his actions. With little information, they wonder if Healthy Tribes is part of the Trump administration’s push to end diversity, equity and inclusion efforts. There also is confusion about what and who is left at the 11-year-old program, which was part of the U.S. Centers for Disease Control and Prevention, under Kennedy’s agency, and doled out $32.5 million a year.

Tribal leaders and health officials told The Associated Press that cuts to the Healthy Tribes program are another violation of the federal government’s legal obligation, or trust responsibility, to tribal nations under treaties, law and other acts. That includes funding for health care through the Indian Health Service, as well as education and public safety for citizens of the 574 federally recognized tribes.

But federal funding has long fallen short of meeting those needs, leaving tribal governments to rely on additional grants and programs like Healthy Tribes.

“So many layers of communications of collaboration and partnerships have just been turned off,” said Onawa Miller, a Quechan Indian Nation citizen and director of tribal public health for United South and Eastern Tribes, which serves 33 tribes in those regions of the U.S. She said her organization already has received its annual $2 million in Healthy Tribes funding.

Several tribal facilities received an email from a CDC employee April 1 notifying them that the positions of many people who staffed the Healthy Tribes program had been eliminated “as part of the reduction in force efforts at CDC.”

The American Federation of Government Employees union, which represents thousands of workers at the CDC in Atlanta, said more than 30 civil servant jobs were or are being eliminated. That includes 11 positions in the Healthy Tribes program and others in the larger Division of Population Health.

An email sent to the account of Healthy Tribes director Dr. Julianna Reece, an enrolled member of the Navajo Nation, was met with an automated reply: “Due to the recent HHS reduction in force, I have been placed on administrative leave and will be separated from the agency on June 2nd.” Reece did not respond to requests for comment sent to her federal and personal email accounts.

Native leaders call change ‘a violation of trust’

Part of the government upheaval in the past several weeks includes top officials at the National Institutes of Health being offered transfers to Indian Health Service offices far from Washington, D.C. The National Indian Health Board also has said the government eliminated key staff and programs at the Office of the Assistant Secretary for Health’s Center for Indigenous Innovation and Health.

The government is required to consult with tribes on decisions impacting them, like mass layoffs in February at the Indian Health Service that were rescinded hours later, and tribal leaders have warned the Trump administration that such consultations are not happening. In some cases tribes can take legal action against the U.S. for failing to meet its trust responsibilities.

“It is a violation of trust, without a doubt,” said W. Ron Allen, chairman of the Jamestown S’Klallam Tribe in Washington state.

The U.S. Department of Health and Human Services did not answer questions related to the Healthy Tribes cuts but told the AP in an email that the Indian Health Service was not impacted by this month’s workforce reductions and there are no plans to consolidate any of its offices.

Kennedy’s swing through the Southwest included a visit to a community health center in metro Phoenix that provides physical and mental health care to Native people and a hike with the Navajo Nation president. He also moderated a panel at the Tribal Self-Governance Conference, held on the Gila River Indian Reservation in Arizona, but didn’t take questions from the audience, tribal leaders on stage or journalists.

Allen said he had a constructive conversation with Kennedy, reminding him IHS is already underfunded and understaffed and that tribes rely on additional federal grants and programs.

“Your issue is to reduce the central office, and so we’re OK with that, but move the functions that serve the tribes out to the tribes,” Allen said he told Kennedy. “Because if we don’t have those resources, how are we gonna make our communities healthy? He agrees.”

Grants fund traditional medicine practices

Research shows Native Americans have shorter life expectancies than other ethnic groups, and the Indian Health Service says they face higher mortality rates from chronic conditions like diabetes and liver disease.

In Seattle, Healthy Tribes money pays for a program called GATHER, which focuses on integrating traditional tribal medicine practices into health care. Providers at the Seattle Indian Health Board can use medicine made from plants grown in a community garden. A traditional Native medicine apprentice or healer is a part of a patient’s care team.

Seattle Indian Health Board President Esther Lucero, a descendant of the Navajo Nation, said her staff meets with people from the CDC and other Healthy Tribes grantees bimonthly to discuss project updates and ensure compliance with grants. But after last week’s layoffs, they are having trouble contacting anyone.

“If you can’t actually administer the dollars, how are you going to actually get them out to the programs?” she said. “With this current administration, it’s almost like every day we receive an unexpected notice, and then we will get a follow-up notice that says … you need to move forward as usual.”

Lycia Ortega, interim CEO of Los Angeles-based United American Indian Involvement, echoed concerns about the ambiguous and somewhat confusing messages. Her organization uses Healthy Tribes money to foster connections between younger people and elders in Native American and Alaska Native communities.

Native communities have had to push back against the Trump administration’s efforts to cut programs that might be considered DEI initiatives, she said, with the help of lawyers, policy experts and watchdogs who point out areas where the government might not be honoring the trust responsibility.

Native people “have a distinct political power,” said Ortega, a citizen of the Fort Yuma Quechan Indian Tribe, but “there are policymakers who see tribes as a threat rather than a partner.”

Stephen Roe Lewis, governor of the Gila River Indian Community, said he told Kennedy privately that consulting with and engaging in respectful partnerships with tribes is key to fulfilling the federal government’s trust responsibilities.

Since the Trump administration began making massive cuts to the federal workforce, many tribal leaders have had to clarify with newly appointed federal officials that services to tribes are not based on race but rather on the political status of tribal nations.

“I made it very clear, we are not DEI — as tribal nations, as a political entity,” he said.

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Bose reported from Jackson, Mississippi, and Bohrer from Juneau, Alaska. Associated Press writers Terry Tang in Phoenix and Mike Stobbe in New York contributed.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.