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Reducing the Burden of Injury: Advancing Prevention and Treatment
postdoctoral training (see Chapter 8), there is no comparable training program anywhere in the federal government for injury prevention in a non-occupational setting. Such training has to emphasize the same interdisciplinary orientation that underlies the research described earlier in this chapter. Training should include epidemiology, biostatistics, program evaluation, engineering, ergonomics, economics, biomechanics, law, and behavioral sciences, all of which form the backbone of injury prevention. Recommendations for training in non-occupational prevention research have been made repeatedly by the National Research Council and the Institute of Medicine (NRC, 1985, 1988), but funding has not been forthcoming.
The lack of research training is a major barrier to the development of the field of injury prevention. Training attracts young people to a field and equips them for a lifelong commitment to research and education. A cadre of talented young researchers ensures the growth, innovation, and continuity of a field. Training programs are supported in every major field of public health, with the exception of injury prevention. (Treatment of trauma is supported by training programs of the National Institutes of Health; see Chapter 8.)
In addition to funds for training, the maintenance of a vital extramural research community will require adequate funding for investigator-initiated, peer-reviewed research grants. It is necessary to ensure viable careers for the country's best young researchers and to sustain experienced investigators. Investigator-initiated research should be encouraged to ensure the emergence of innovative approaches to injury research. To ensure the scientific rigor of this research, proposed projects should be peer-reviewed by scientists outside the sponsoring federal agencies. These points and the need for sustained federal research support are addressed further in Chapter 8.
Public health agencies need not be the only sources of research funding. There also are opportunities to recruit employers and health care payers as partners in funding prevention research. These organizations have strong economic incentives to support research that can lead to injury reductions. Injury reductions can yield cost savings, in terms of lower health care costs, workers' compensation costs, and indemnity costs. Moreover, the cost savings to payers can be realized almost immediately after the successful introduction of an intervention program. In contrast, cost savings from disease-oriented prevention programs take longer to realize because of the time lag between intervention and health outcome (e.g., reductions in stroke or heart attack). The immediacy of cost savings should be especially tantalizing for employers, because the total number of fatal and nonfatal job-related injuries is far higher (more than 13 million annually) than that for job-related illnesses (Leigh et al., 1997).
The committee recommends the expansion of research training opportunities by the relevant federal agencies (e.g., NCIPC, NIOSH, and the National Highway Traffic Safety Administration [NHTSA]). This includes an increase in the number of individual