STRENGTHENING THE PUBLIC HEALTH INFRASTRUCTURE

The strengthening of a well-developed injury prevention program in the state health department is the foundation for state and local injury prevention efforts. In many states, however, this key element is only a fledgling effort. There is wide disparity between states in the extent to which injury prevention is a priority program at the health department level. A 1988 survey of state and territorial health departments found that 10 states had a separate injury program or unit devoted solely to injury prevention (Harrington et al., 1988). Forty percent of the states or territories allocated one full-time equivalent (FTE) or less to injury prevention, and the major sources of funding for state injury prevention efforts were MCH block grants, and PHHS block grants (Harrington et al., 1988).

This picture seems to have changed little in the intervening 10 years. The committee and staff interviewed state personnel from 30 state departments of health and found that there is still wide disparity in the size and funding of injury prevention programs independent of state size and population: 3 of the 30 states have extensive injury programs with 14–23 FTEs and more than $1.5 million in funding, whereas 8 of the 30 states have 1.5 FTEs or less devoted to injury prevention. The primary sources of funding continue to be MCH and PHHS block grants, and the majority of states have only limited direct state funding. Little funding for state capacity building is available from the National Center for Injury Prevention and Control (NCIPC) and the funding that is made available is often earmarked for specific programs of NCIPC interest. Consequently, locally prioritized prevention programs often lack needed resources. Injury prevention programs are administratively placed in a variety of different divisions of the state health department (e.g., epidemiology, health promotion, maternal and child health, chronic disease prevention, EMS, environmental health). Program placement is important in that it may influence not only the division's priorities for the injury prevention program but also the specific injuries that the program may target (e.g., maternal and child health may target only childhood injuries).

The State and Territorial Injury Prevention Directors' Association (STIPDA)1 Safe States initiative outlines five core elements necessary for a well-developed injury prevention program: (1) statewide and local data collection and analysis; (2) program design, implementation, and evaluation; (3) coordination and collaboration; (4) technical support and training; and (5) policy development (STIPDA, 1997). In some cases, components (e.g., surveillance) may be administratively located in separate divisions of the health department, and close collaboration between divisions is crucial.

1

STIPDA is a national organization made up of designated members from every state health department. STIPDA's mission is to sustain, enhance, and promote the ability of state, territorial, and local health departments to reduce death and disability from injury.



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