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OCR for page 99
7
Current Federal Expenclitures for
Injury-Related Research
The committee was charged to determine, to the extent
possible, the adequacy of total federal funding of the
major kinds of trauma research and to explore the impor-
tance of pr ivate research and funding contributions from
pr ivate , nongovernment sources . Th is chapter describes
the extent of support from the various federal agencies
and categorizes them according to the types of research
that the committee has identified as necessary if the
nation is to move toward reducing injuries and injury-
related deaths.
The motor-vehicle and insurance industries support
some research, mainly on motor-vehicle injuries, but the
support is modest relative to the need. We know of no
major source of private funds for research on injury. In
contrast, large amounts of money are raised by private
groups interested in cancer, heart disease, and respira-
tory diseases. Although no private organization, even
one as large as the American Cancer Society, can alone
support a large portion of the research in the subject of
its interest, private organizations do play a critical
role. They can provide seed money for the initiation of
research centers. They can support innovative research
that has not received attention from the federal agencies.
As important, but not as tangible, private organizations
focus interest on various subjects and keep the public,
the federal agencies, and the Congre';s aware of the
importance of those 'subjects. Whether a major fund-
raising effort for injury research comparable with that
devoted to the noted diseases is feasible in a society
where mailboxes are clogged with computerized appeals to
support all sorts of causes is problematic.
To assess current federal support for injury-related
r esearch , the committee reviewed research expenditures in
99
OCR for page 100
100
relevant federal agencies dur ing the 1983 f iscal year .
The agencies were asked to respond with lists of projects
and budgets; these were supplemented by a search of
records in a few instances where it appeared that the
work of some agencies was not listed. This survey was
not exhaustive, but it is unlikely that major expendz-
tures were overlooked. The survey was based on reports
of projects from the agencies and computerized indexes of
research expenditures. This summary deals only with
expenditures by civilian agencies. Much of the informa-
tion from the military services was too sketchy for
refined categorization. Some of the military research
might be relevant to the prevention and treatment of
civilian injuries, but most of the military research is
oriented to military operational activities, such as the
Air Force's development and testing of pilot e Section
seats.
Each listed project was coded according to the inter-
ests outlined by the committee, which are substantively
reviewed in the individual chapters of this report:
epidemiology, prevention, biomechanics, treatment, and
rehabilitation. Many projects deal with more than one
category; in such cases, the committee determined the
major emphasis of the research and assigned a code
accordingly. These data are mostly from fiscal 1983
budgets, but that is ambiguous in some cases.
Expenditures for research in the various aspects of
injury epidemiology are presented in Table 7-1. Most of
the funds allocated to epidemiology were expended on
surveillance programs both for research purposes and for
identifying problems to be addressed by regulatory
agencies. The major expenditures were related to motor-
vehicle injuries and those associated with some other
consumer products. The Fatal Accident Reporting System
(FANS) and the National Accident Sampling System (NASS)
developed by the National Bighway Traffic Safety Adminis-
tration (AETNA) are designed to monitor trends in mator-
vehicle fatalities (FARS) and nonfatal crashes (MASS).
Both are used extensively by extramural researchers. The
National Electronic Injury Surveillance System (NEISS) is
the major research activity of the Consumer Product
Safety Commission. Through NEISS, a sampling of hospital
emergency rooms provides information on consumer products
(with exceptions, such as motor vehicles and firearms)
that are involved in injuries treated in hospitals.
Relatively small amounts were expended in fiscal 1983 to
document psychologic consequences and calculable dollar
OCR for page 101
101
TABLE 7-1 Federal Support for Research on Injury
Epidemiology in Fiscal 1983
Subject and Source of Support
Thousands
of Dollars
A. Incidence and severity
Federal Aviation Administration
National Highway Traffic Safety
Administration
National Institutes of Health
Centers for Disease Control
Consumer Product Safety Commission
B. Costs
National Institutes of Bealth
C . Psycholog ic consequences
National Institute of Mental Health
D. Methodology
National Highway Traffic Safety
Administration
National Institutes of Health
E. Behavioral factors
National Instituter of Health
Alcohol, Drug Abuse, and Mental
Health Administration
National Institute of Occupational
Safety and Bealth
F. Product-related factors (e.g., guns,
cars, industrial machines)
National Bighway Traffic Safety
Administration
National Institutes of Health
National Institute for Occupatione1
Safety and Bealth
G. Social environmental factors
National Institutes of Health
B. Physical environmental factors
other than products
TOTAL
193
7,526
988
160
2,999
104
245
9,104
810
27
975
115
1,241
79
99
432
o
25,097
OCR for page 102
102
costs of injuries. The relatively large amount listed
under Methodology includes capital funds for computers
and computer time that are no doubt used for a variety of
tasks in addition to processing and maintaining in jury
surve illance data .
In addition to surveillance, epidemiology includes
studies of factors involved in initiation and severity of
in jury. Categor ies E through H in Table 7-1 refer mainly
to f ield research. Behavioral re';ez~rch was directed
primarily at the effects of alcohol and drugs on injury
incidence. Relatively small amounts were expended to
study the effects of vehicle and environmental factors as
causes.
The major expenditures for prevention research (Table
7-2) were provided by the Federal Highway Administration
(FHA) and NHTSA. They were directed at the behavior of
motor-vehicle operators and pedestrians and at modifica-
tions of motor vehicles and road environments that would
prevent collisions or ameliorate their severity. Almost
two-thirds of the National Institutes of Health (NIB)
expenditures for research on preventing injurious behavior
was for evaluations of measures to counter dr iving by
alcohol-impaired persons--the type of research that would
normally be supported by NHTSP.. Despite the remarkable
success of vehicle and environments modifications in
reducing fatalities and severe in juries, 'such as the
reduction in deaths of children caused by falls from tall
buildings in New York, very little investigation of
that type of prevention of other than motor-vehicle
injuries was supported in fiscal 1983. The major efforts
were N~TSA's crash-testing programs listed under ~Product-
related factors. and programs in FBA on roadside hazards,
listed under Environmental factors.. The FRA effort on
implementation of safety research and development, listed
under Organization and delivery,- is also a noteworthy
exception to the general lack of Of for t in that sub ject .
The funds devoted to injury mechanisms and bionic
mechanics are shown in Table 7-3. A substantial
proportion of the NIB allocations in directed at basic
science in pursuit of spinal cord regeneration and
understanding of the consequences of injury at the
cellular level. The categor ies and dollar amounts in
some instances suggest more activity in the research
discussed than was seen to be the case when the project
descriptions were examined in detail. For example,
virtually none of the NIB funding under ~Mechanisms. was
directed at research in biomechanic';. Support of research
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103
TABLE 7-2 Federal Support for Research on Injury
Prevention in Fiscal 1983
Sub ject and Source of Suppor
Thousands
of Dollars
A. Behavioral factors
Coast Guard
Federal Highway Administration
National Highway Traffic Safety
Administration
National Institutes of Health
National Institute for Occupational
Safety and Health
B. Product-related factors
Federal Aviation Administration
Federal Highway Administration
National Highway Traffic Safety
Administration
Consumer Product Safety Commission
C. Environmental factors
Coast Guard
Federal Aviation Administration
Federal Highway Administration
National Institutes of Health
National Institute for Occupational
Safety and Bealth
D. Organization and delivery
Federal Highway Administration
National Institute for Occupational
Safety and Bealt}1
E. Host physical susceptibility (e.g.,
osteoporosis )
National Institutes of Health
TOTAL
150
3,220
2,3g4
910
63
637
450
7,293
320
318
181
7, 305
48
141
1,507
33
480
25,450
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104
TABLE 7-3 Federal Support for Research on Injury
Mechanisms and Biomechanics in Fiscal 1983
Subject and Source of Support
Thousands
of Dollars
A. Mechanisms
National Highway Traffic Safety
Administration
National Institutes of Health
National Institute for Occupational
Safety and Health
B. Biolog ic response and adaptation
National Institutes of Health
National Institute for Occupational
Safety and Health
Veterans ' Administration
C. Secondary consequences (infections, etc.)
National Institutes of Health
TOTAL
1,676
5,891
570
13,142
21
3,039
6,002
30,341
in biomechanics is included in the S1.7 million listed
for NRTSA, and the military services contributed an
unknown amount. Many projects listed by the NIH computer
as injury-related were excluded from our accounting, on
the grounds that the connection was not evident in the
project abstracts. These included projects investigating
psychic ~trauma. not related to physical injury, labora-
tory ~accidents. involving biologics, birth injury, and
the like. Had the HIM computer totals for Trauma and
injury. been used without project-by-project examination,
grants for cancer center core support, aplastic anemia
centers, etc., would have been included. Some of the
included projects are of questionable relevance, but they
do deal with infection, which often complicates the
outcome of injury.
Research expenditures relevant to treatment of the
injured are indicated in Table 7-4. All ';uch funds in
fiscal 1983 were allocated for technology, such as
surgical techniques and devices. No funds were allocated
OCR for page 105
105
directly for training or for organization and delivery of
services, although some of the funds for multidisciplinary
centers include such research. All the funds allocated
for treatment research were directed at treatment in hos-
pitals. No research on emergency response and treatment
at the site of the injury event was included in the data
submitted to or found by the committee.
The funding for long-term care and rehabilitation,
summarized in Table 7-5, was more balanced among medicine
and technology, training, and organization and delivery
of services than was funding for research on acute care,
but the total was low, in the light of the enormous costs
of tak ing care of persons who survive in jur ies with ma jor
loss of function.
In addition to the supper t shown in the tables, the
National Transportation Safety Board (NTSB) expended S14
million for investigations, technology and safety programs
in f iscal 1983 that could not be categor ized because of
the interdisciplinary nature of the work. Although the
interdisciplinary approach of the NTSB-supported work is
commendable, the lack of a sampling plan results in
questionable generalizability of the f indings. The
investigation of fatal motor-vehicle crashes by NTSB
duplicates much of the effort of N=SA's FARS program,
albeit in greater detail, but without a sampling scheme.
Table 7-4 Federal Support for Research on Acute Care of
the In jured in Fiscal 1983
Sub ject and Source of Suppor t
Thousands
of Dollars
A. Technology
National Institutes of Health
Health Resources and Services
Administration
B. Training
C. Organization and delivery
TOTAL
4,125
451
o
o
4,576
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106
TABLE 7~o Federal Support for Research on Long-Term Care
and Rehabilitation of the Injured in Fiscal 1983
Sub Sect and Source of Support
Thousands
of Dollars
A. Medicine and Technology
National Institutes of Health
Veterans' Administration
National Institute of Handicapped Research
B. Training
Veterans' Administration
National Institute of Handicapped Research
C. Organization and delivery
Veterans' Administration
National Institute of Handicapped Research
Health Resources and Services
Admin is tr ation
TOTAL
1, 382
6,020
2,117
800
733
800
612
128
12,592
The specification of research allocations in a given
year might not reflect the extent of involvement of
agencies in relevant fields in other years or unsuccessful
attempts by the agencies to find investigators to study
problems that are recognized as needing attention. Never-
theless, in some cases where one would expect some expen-
ditures under current agency missions, there were none.
Expenditures in a given year are perhaps more relevant
when compared with allocations to other health-related
research in the same year. The total expenditure for
injury research by NIE, about S34.4 million, is less than
2 percent of the total NIB research budget.86
In 1980, motor-vehicle injuries alone cost the federal
government S1. s billion in public assistance programs,
S86 million in federal employees ' worker compensation
and sick leave, and 35~6 billion in revenue losses. 3 0
Although the costs of all injuries have not been re-
searched adequately, they were undoubtedly two to three
times those amounts. Even a modest reduction in current
death and injury rater would save hundreds of millions,
OCR for page 107
107
if not billions, of dollars in government expenditures
and in loss of revenues, not to mention the costs to
individuals and organizations not associated with
government.
The total federal expenditures for nonmilitary research
on injuries were approximately S112 million in fiscal
1983. Although injury results in the loss of more eco-
nomically productive years of life than cardiovascular
disease and cancer combined, the support for research on
injury control is relatively small (Figure 7-1, on page
108), about 11 percent of that for research on cancer and
18 percent of that on cardiovascular disease. This is
not intended to imply that the retirement years are
inherently any less valuable than the preretirement
years. But the welfare of the retired depends sub-
stantially on the productivity of the working population.
The committee believes that substantial inroads in
current injury rates would result from research requiring
substantially less support than is now expended on cancer
and cardiovascular disease. An increment in current
funding with close monitoring of the application of the
research results could illustrate the investment value of
such expenditures for the entire population.
OCR for page 108
108
4 1 Million
Years of
Lite Lost
S1 12 Million
Research
Expenditures
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:$624 Million :
Research Expenditures
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2.1 Million
Years at
Life Lost
Injury Caneer Heart Dnea - /Stroke
FIGURE 7-1 Preretirement years of life lost annually and
federal research expenditures for ma jar causes of death
in the United States. Years of life lost derived from
National Center for Health Statistics. ~ 2 6 The total
federal expenditure for injury research is the sum of the
amounts discussed in this chapter plus a 5 percent
increment for administration, the latter in line with NIH
administration costs. Expenditures for research on
neoplasm and cardiovascular diseases are the 1983 f iscal
year budgets of the National Cancer Institute and the
National Heart, Lung, and Blood Institute . ~ 6
Representative terms from entire chapter:
traffic safety
