摘要：Despite the potential for public health strategies to decrease the substantial burden of injuries, injury prevention infrastructure in state health departments is underdeveloped. We sought to describe the legal support for injury prevention activities at state health departments. We searched the Lexis database for state laws providing authority for those activities, and categorized the scope of those laws. Only 10 states have authority that covers the full scope of injury prevention practice; in the others, legal authority is piecemeal, nonspecific, or nonexistent. More comprehensive legal authority could help health departments access data for surveillance, work with partners, address sensitive issues, and garner funding. Efforts should be undertaken to enhance legal support for injury prevention activities across the country. APPROXIMATELY 50 MILLION nonfatal injuries 1 and 180 000 deaths from injury occur each year in the United States. Lifetime costs associated with medical expenses and lost productivity from all injury types are estimated to exceed $400 billion. 2 The public health approach to injury prevention, based on the core public health functions of assessment, policy development, and assurance, 3 includes surveillance to define the scope of the problem, identification of risk and protective factors, development and testing of prevention and control strategies, and assurance of widespread adoption of those strategies that prove to be effective. 4 This approach could have a large positive impact on the public’s health. Although injuries impose a substantial public health burden, and effective public health strategies could decrease that burden, public health practice has been relatively slow to take on injury prevention. In recognition that public health needed to increase its focus on injury prevention, the Centers for Disease Control and Prevention created its National Center for Injury Prevention and Control in 1992 (although injury and violence work at the agency dates back to the late 1970s and early 1980s). State and local health department infrastructure to address injuries has been growing since that time as well, but the injury prevention infrastructure in most health departments, if it exists at all, remains small and underfunded relative to the magnitude of the injury problem. Government public health agencies function within an authorizing environment defined by statute and sometimes clarified by rule or regulation. 5 Although broad statutory authority allows agency leaders some freedom to define their activities, if the agency moves into a new arena without unambiguous legal authority, its activities may be open to challenge, particularly if they involve regulation or are fraught with political implications, as are so many issues in public health, including injury prevention. Clear authority to engage in injury prevention activities is essential if public health agencies are to engage robustly in this area. We investigated laws in all 50 states that pertain to authorizing health departments to undertake a robust slate of injury prevention activities. We found that the scope of legal authority for injury prevention activities varies widely across the country regarding which kinds of injuries are addressed and which legal tools an injury prevention program is explicitly authorized to use. If state health departments are to fully realize their potential to prevent injuries, efforts to make the legal basis for the full range of injury prevention activities more comprehensive across the country should be undertaken.
