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Reducing the Burden of Injury: Advancing Prevention and Treatment
largely unsupported by other federal agencies. Examples are research on injury biomechanics, trauma system design and performance, and residential and recreational injury prevention. For instance, for more than a decade, NCIPC has funded several biomechanics research programs at universities, a commitment totaling about $2 million to $3 million annually. Grant recipients have used NCIPC funds to leverage support from the private sector. Without NCIPC's consistent support, biomechanics as a field of inquiry would have languished, even though it is critical for understanding injury causation (Chapter 4). Biomechanics and other important areas could easily have been forfeited in favor of fields enjoying stronger constituency support. Instead, NCIPC has sustained and nurtured these fields, despite persistent budget limitations.
NCIPC has cultivated a strong extramural program of investigator-initiated grants. These grants consist of individual investigator grants, program project grants, and center grants. NCIPC's extramural grant program has devised a careful process of independent peer review to fund research of high quality. Unfortunately, the program has suffered from chronically low funding. The extramural program's current funding level, about $15 million annually, is woefully insufficient to address NCIPC's vitally important mission. Competition for grants is so great that only 13 percent of applications were awarded funding in FY 1997. By contrast, research programs at NIH typically experience success rates of 20–30 percent. With increased funding over the long term, NCIPC should be able to establish and sustain a critical mass of injury prevention investigators and attract researchers from related fields. Increased funding should be allocated to all types of grants administered by NCIPC. With respect to center grants, the size of each grant should be increased, as discussed below.
Injury Control Research Centers (ICRCs). ICRCs have advanced injury research by bringing together biomedical scientists, epidemiologists and statisticians, social and behavioral scientists, engineers and specialists in biomechanics, policy experts, economists, and lawyers. Cultivation of ICRCs must be considered one of the major advances in the field of injury prevention since the publication of Injury in America (NRC, 1985). Before this program, there were no broad-based research centers dedicated to injury prevention. Although some strong research programs already had been established at individual universities (e.g., Wayne State University's pioneering program in biomechanics research and Johns Hopkins University's program to train injury researchers), no individual center could have achieved the catalytic role and breadth of the current program. In light of the highly important role of ICRCs, the current funding level of each center grant, about $750,000 annually, is not sufficient to cover the full range of activities for which each grant was intended: research, policy formation, and training and technical assistance for state and local injury prevention agencies. A center with a similarly comprehensive mission supported by the NIH for cancer or heart disease frequently receives more than $1 million annually. The