It did not take very long for the committee to realize that ''injury prevention and control" is a large field, even if "the field" is understood to encompass only people and organizations who embrace this identity. As discussed in Chapter 1, the injury field is defined by its allegiance to the public health perspective and particularly by its use of the tools and methods of public health to prevent or ameliorate injuries. So defined, the injury field is part of a broader array of people and agencies devoted to promoting safety, whose methods and perspectives differ from those of public health, including the tort system, criminal justice, alcohol control, and fire protection. One of the greatest challenges facing the leaders of the injury field is to develop creative and effective ways of coordinating their own efforts and promoting collaboration with agencies and constituencies outside the field.

Public-Private Partnerships

Many reports in human services and public health in recent years have touted the value, indeed the necessity, of creating "strategic partnerships" between public and private organizations to harness private energy and leverage public resources. Many examples of successful public-private partnerships are mentioned in this report, involving state and local governments, foundations, and advocacy organizations, as well as regulatory agencies and regulated industries. These efforts must be replicated throughout the field. An area that is ripe for public-private cooperation, through public education and advocacy, is raising the salience and visibility of injury prevention and demonstrating program cost-effectiveness to health care payers, including self-insured employers.

Roles of Federal Agencies

It is also important to clarify the roles of federal agencies and to facilitate coordination among them. Injury prevention and treatment cover a vast terrain. Numerous federal agencies play important roles in supporting injury science or carrying out the national agenda in injury prevention and treatment. This potpourri of federal responsibilities emerged piecemeal over several decades rather than as components of a coordinated national plan. This is not to say that the federal response has been weak or wasteful. To the contrary, the key federal agencies have accomplished a great deal over the past three decades in building a new scientific field and reducing the burden of injury. The problem is one of missed opportunities due to lack of focus, cohesion, and coordination. The committee believes that the federal response could be strengthened significantly by several key refinements of the present organizational architecture of injury prevention and treatment.

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