Arguing in this journal that injury and violence are important public health problems is surely preaching to the choir. What is perhaps less obvious is the issue of how well prepared public health systems are to lead prevention efforts. This paper addresses that issue and recommends policy directions to strengthen infrastructure.

INFRASTRUCTURE GAPS

In the USA, state health agencies are often forced to follow federal funding streams. With the exception of rape prevention funds provided on a formula basis to each state, there are no requirements to address injury control. Few states have designated lead agencies for injury control, and, according to a 2005 survey of existing state injury control programs, only 11 of 49 states (plus Washington, DC) reported operating under a government mandate.1

Further complicating the problem, in most health agencies, injury control units are not prominently placed in the hierarchy (L Beltsch personal communication, 2002). The further down the organizational chart these units are, the less likely they are to have the “ear” of leaders and ability to influence priority setting. These lower status units often have too few resources to hire the most experienced practitioners, thus doubly handicapping efforts to compete for both scarce resources and attention. Overcoming these handicaps is exacerbated by the lack of training opportunities for staff.

This pattern is repeated all over …