Chapter 2) and what is already known about prevention. Available funding for state and local public health departments has frequently been too restrictive, has placed an emphasis on the development of separate and categorical programs, and generally has received limited state appropriations. A federal commitment is needed to provide the funding to sustain state injury prevention programs, similar to the Section 402 formula grant funding from NHTSA that is used to support state highway safety offices and the Governors' Highway Safety Program. Further, it is critical that program funding include monies for a strong evaluation component. Evaluation is integral to improving program effectiveness, but too often receives limited or no specific funding.
Federal funding for injury prevention programs in state and local health departments comes from multiple funding streams including MCH and PHHS block grants.2 Little funding, however, is made available for state and local capacity building (i.e., instituting and maintaining an ongoing injury prevention program).
From FY1989 to 1993, the NCIPC funded 15 state and community-based injury prevention capacity-building grants (totaling $3.9 million per year) with the goal of developing, expanding, or improving injury programs. An evaluation of these grants (Hersey et al., 1995) found that they had been used successfully to support and strengthen injury prevention infrastructures in the 15 locations and recommended expansion of the program to support core injury programs in all 50 states. However, because of funding constraints, by the mid-1990s, NCIPC began to transform these grants into more focused cooperative agreements that targeted specific proven interventions, such as smoke detectors and bicycle helmets, or specific surveillance efforts, such as head and spinal cord injuries, burns, or firearm injuries. States without established injury programs, however, found it difficult to compete for these cooperative agreements, thus, in FY 1997, NCIPC introduced new cooperative agreements for Basic Injury Program Development similar to, but smaller in scale than, the former capacity-building grants. The awards, made to only four states at $75,000 per year for three years, are for the development of a state plan to establish or strengthen injury prevention activities. It is difficult to build a state infrastructure for injury prevention with such limited and short-term funding. Increased federal funding is needed to provide capacity-building funds while allowing practitioners to set local priorities for implementing injury prevention interventions (see Chapter 8).