coordination of health and medically related rehabilitation activities and social services is a long-standing problem that is not easily rectified. Improvements will require energy and direction, a focus on prevention, and a clear strategy for coordination, cooperation, and integration among several federal programs as they are administered at the local level. These federal programs include those concerned with health care (Health Care Financing Administration), disability benefits (Social Security Administration and the Department of Veterans Affairs), vocational rehabilitation (Department of Education), community support (National Institute of Mental Health), and housing (Department of Housing and Urban Development). Thus responsibility for planning, coordination, and evaluation of these activities should be highly placed in the federal government (e.g., in the Office of the Secretary of the Department of Health and Human Services) to facilitate the type of coordinated leadership at the federal level necessary to ensure cooperation at the local level.

RECOMMENDATION 4: Establish a federal interagency council

A standing Interagency Council on Disability Prevention should be established by the Secretary of Health and Human Services. The interagency council should be charged with examining and developing conjoint activities in disability prevention and with identifying existing policies that inhibit disability prevention and rehabilitation. More specifically, the interagency council should be convened semiannually to identify, examine, and foster enhanced disability prevention strategies by (1) recommending the elimination of conflicting public policies and coordinating and integrating programs, (2) developing new policy initiatives, (3) improving service delivery, and (4) setting research priorities. The interagency council should have a permanent staff and issue public reports to the Secretary of Health and Human Services, Congress, and the National Council on Disability.

The members of the interagency council should be high-level administrators drawn from the major agencies involved in the various aspects of disability, which include the following: Centers for Disease Control; Health Care Financing Administration; Alcohol, Drug Abuse, and Mental Health Administration; National Institute on Disability and Rehabilitation Research; Health Resources and Services Administration (HRSA), including the Maternal and Child Health Bureau; Agency for Health Care Policy and Research; Social Security Administration; National Institutes of Health; Consumer Product Safety Commission; Bureau of the Census; and other agencies within the Departments of Health and Human Services, Housing and Urban Development, Education, Transportation, Labor, Defense, Veterans Affairs, and others as appropriate.

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