new initiative aims to help states and localities build their capacity for disability prevention, develop surveillance systems for high-priority disabling conditions, and use the results of epidemiological analyses to identify targets for intervention and guide development of prevention strategies. In 1988 the CDC program initiated cooperative projects in nine states. In five of these states, the aim is to develop plans for disability prevention efforts; in four others, projects will focus on the implementation and evaluation of disability prevention plans.

Four university-based projects, begun in 1989, constitute the beginning of an effort to develop data bases on secondary complications. Concentrating on such problems as urinary tract infections and decubitus ulcers in people with spinal cord injuries and late-developing complications in people with poliomyelitis, the epidemiologic studies are expected to yield more detailed understanding of the scope of such problems and to aid identification of cost-effective interventions.

The CDC programs are notable for their public health approach to disability prevention. However, complementary programs, which also embody an integration of efforts, are carried out under the aegis of other agencies. For example, the National Institute of Child Health and Human Development (NICHHD) supports a variety of longitudinal, multidisciplinary studies on the biological and behavioral factors involved in normal and abnormal growth and development, from gametogenesis through maturity. Early detection and intervention, as well as restoration of function in children with disabling conditions, are overriding goals of the institute-supported research. Similarly, a major focus of research sponsored by the National Institute on Aging (NIA) is preventing degeneration of physical and mental functions in the elderly. In addition, the need and potential for rehabilitation among the elderly are addressed in NIA's epidemiologic, behavioral, clinical, and basic research programs.

In November, 1990, a National Center for Medical Rehabilitation Research was established within the NICHHD. The mandate of the center includes the conduct and support of research and research training, the dissemination of health information, and other programs for rehabilitation of individuals with physical disabilities stemming from diseases or disorders.

Public- and Private-Sector Partnerships

This committee believes that disability poses one of the greatest challenges currently facing the public health system. Recognizing it as such makes disability prevention a federal, state, and local responsibility. Government involvement at all three levels is a necessary condition for progress, but by themselves, public-sector efforts are not sufficient. Also necessary



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