treatment and rehabilitation; (2) establish injury surveillance systems and support prevention activities; (3) promote professional education and training; (4) establish interdisciplinary injury research centers; and (5) serve as clearinghouse, coordinator, and lead agency on injury prevention and control among federal agencies and private organizations.

Soon after Injury in America was released, Congress appropriated funds for a pilot program for injury control at CDC, and two years later, a new IOM-NRC committee reviewed its progress. In Injury Control (NRC, 1988), the committee concluded that the program had been sufficiently successful to warrant permanent support. It commended the CDC program for establishing five interdisciplinary research centers; sponsoring a new program of extramural research; and building staff expertise for intramural research, database development, coordination, and technical assistance. However, the committee expressed disappointment that the program had been given inadequate resources to carry out its broad mission and noted that the program had underemphasized acute care and biomechanics during its start-up phase. During the intervening years, there have been several efforts to determine priorities for injury prevention and treatment (e.g., National Committee [1989]; NCIPC [1993]; NIH [1994]; IOM [1997]).

In 1997, the current Committee on Injury Prevention and Control was established by the IOM with funding from the Robert Wood Johnson, W.K. Kellogg, and John D. and Catherine T. MacArthur foundations, to review the present status and direction of the field in light of earlier IOM-NRC reports and to make appropriate recommendations for advancing the field and for reducing the burden of injury in America. The committee's charge, however, is broader than those of the earlier IOM-NRC committees, encompassing "opportunities and barriers" for practice as well as research (Injury in America focused exclusively on research) and "the response by public and private agencies," not only the activities of the CDC program. Recognizing the breadth of its charge, the committee decided not to replicate the work of its predecessors, choosing instead to focus on areas that had not received attention in prior reports and on current issues or challenges confronting the injury field as a whole.

This report characterizes the injury problem in the United States, assesses the current response by the public and private sectors, and presents recommendations for reducing the burden of injury in America. To introduce the issues addressed by the committee, this chapter outlines the history of the injury field, discusses the public health approach to injury prevention and treatment, and assesses progress in the development of the injury field.

ORIGINS OF THE INJURY FIELD

For centuries, human injuries have been regarded either as random and unavoidable occurrences ("accidents" or "acts of God") or as untoward consequences of human malevolence or carelessness. From this perspective, the main



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