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transmit to the Congress a report analyzing the incidence and causes of childhood injuries in the United States and containing recommendations for such legislation with respect to injury control as the Secretary considers appropriate.
“AUTHORIZATIONS OF APPROPRIATIONS
"SEC. 394. (a) To carry our [section 391,] sections 391 and 392, there are authorized to be appropriated [$5,000,000 $10,000,000 for each of the fiscal years [1987,] 1988, [and 1989,] 1989, and 1990. Of the amounts appropriated under this [subsection] section for any fiscal year, not more than 20 percent may be used for Federal administrative expenses to carry out such section for such fiscal [year.] year.
["(b) To carry our section 392, there are authorized to be appropriated $5,000,000 for each of the fiscal years 1987, 1988, and 1989, of the amounts appropriated to under this subsection for any fiscal year, not more than 20 percent may be used for Federal administrative expenses to carry out such section for such fiscal year.".] Amend the title so as to read: "A bill to improve the public health through the prevention of injuries.".
V. COMMITTEE VIEWS
The Committee is aware that injuries kill more Americans aged 1-34 than all diseases combined and accidents are the leading cause of deaths for individuals up to age 44. Injury is the fourth leading cause of mortality for individuals of all ages and a leading cause of disability. There are more than 80,000 people who develop new and permanent disabilities annually because of injuries to the brain or spinal cord.
The Committee accepts the conclusion of the National Research Council and the Institute of Medicine in their 1985 report, Injury in America, that injury is not an insoluble problem. Progress in solving this problem is impeded by the popular view that injuries are accidents which are largely the result of faulty behavior or random occurrences; therefore, are not amenable to successful efforts at control. The Committee believes that with the proper effort, considerable progress can be made in this area. Efforts to understand the causes of injuries, prevent their occurrence, and diminish their impact will only succeed if these goals are made priorities.
The Committee recognizes that, in the past, injury was not a major research or public health priority. No federal agency was designated as a lead agency for this important health problem. The dollars spent on injury research and control were meager. The Committee seeks to make injury a public health priority by amending the Public Health Service Act and authorizing a Center for Injury Control as a standing feature of the Public Health Service within the Center for Disease Control.
The Committee recognizes that solving the problem of injuries will require the activity of individuals with expertise in varied fields including: epidemiology, engineering, biomechanics, prevention, medical treatment, and rehabilitation. It will require significant research in this area. It will also require coordinated public
health efforts at the federal, state, and local level to focus attention on the problem and translate the benefits of research into meaningful public health programs to reduce the toll of injury.
The authorization of a Center for Injury Control within the Center for Disease Control is expected to provide a focus on injuries at the federal level and to stimulate a research effort that will elicit a response from researchers in the relevant disciplines. The Center is expected to support and coordinate that research effort. The Center is also expected to stimulate efforts at the federal and state level to control and prevent injuries. Since the CDC is the principal agency with responsibility for federal-state cooperation in addressing public health problems, it is anticipated that over several years injury control will become a priority area for such cooperation.
The initial authorization level for the Center contained in this legislation is modest. An appropriation for the same amount is already being distributed for the 1986 fiscal year and is under consideration for 1987. Therefore, the authorization contained in this legislation would not go into effect until 1988.
It is recognized that the New Center directors may find it difficult to address the full agenda described in this bill in a single year or two. The Committee wishes to confer on the new Center's director(s) discretion to implement this program as they feel is appropriate in the ensuing years.
With this bill, the Committee also makes special note of the problem of injuries to children and adolescents. Two-thirds of all deaths of children over the age of 15 are due to injuries. Half of all deaths of children age 1 to 15 are due to injuries.
Expanded efforts are already underway to focus increased attention on this important area of children's health. Earlier this year, the nation celebrated Children's Accidents Prevention Week for the first time. Several new public service announcements addressing injuries to children were released by the Department of Health and Human Services during that week for television broadcast.
The Committee wishes to increase the attention given to the problem of injuries to children. This legislation mandates a report on this topic. The report should describe the scope of the problem and include recommendations toward a solution. Such recommendations should focus on the research agenda as well as suggestions for federal and state agendas to address this problem. Recommendations regarding a research program and control efforts should acknowledge with activity at the new Center and lay the foundation for further development of the Center's activities. Recommendations for legislation at the federal and state level are also expected to be contained in the report.
VI. VOTES IN COMMITTEE
S. 2648 was unanimously passed by the Labor and Human Resources Committee and reported favorably.
Hon. ORRIN G. HATCH,
VII. COST ESTIMATE
CONGRESSIONAL BUDGET OFFICE,
Chairman, Committee on Labor and Human Resources, U.S. Senate, Washington, DC.
DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the attached cost estimate for S. 2648, the Injury Prevention Act of 1986, as ordered reported by the Senate Committee on Labor and Human Resources on August 6, 1986.
If you wish further details on this estimate, we will be pleased to provide them.
With best wishes,
RUDOLPH G. PENNER, Director.
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
1. Bill number: S. 2648.
2. Bill title: Injury Prevention Act of 1986.
3. Bill status: As ordered reported by the Senate Committee on Labor and Human Resources on August 6, 1986.
4. Bill purpose: To improve the public health through the prevention of injuries.
5. Estimated cost to the Federal Government:
The costs of this bill fall within budget function 550.
Basis of Estimate: An authorization level for all portions of the bill except the study is stated in the bill. We assume authorized amounts are fully appropriated at the beginning of each fiscal year. Outlays are estimated using spendout rates computed by CBO on the basis of similar health services program data.
No stated authorization appears in the bill for a study on the incidence and causes of childhood injuries, to be completed by January 1, 1989. The study would most likely be conducted by the Division of Injury Epidemiology and Control within the Centers for Disease Control (CDC). According to CDC, the research and control activities provided for in the bill would give them enough information to complete the required study at no additional cost to the federal government.
6. Estimated cost to State and local government: The budgets of state and local governments would not be directly affected as a result of enactment of this legislation.
7. Estimate comparison: None.
9. Estimate prepared by: Carmela Dyer.
10. Estimate approved by James L. Blum, Assistant Director for Budget Analysis.
VIII. REGULATORY IMPACT STATEMENT
The Committee has determined that there will be a minimal amount of regulatory burden and paperwork. Activities of the Center for Injury Control are currently conducted within the Centers for Disease Control, and those activities will continue without a need for increased regulation.
IX. FAMILY FAIRNESS STATEMENT
The Committee believes this legislation will have a beneficial impact on families as a result of improvements in the nation's health and the health of individuals. The current human toll of death and disability from injury which falls disproportionately on the young represents countless family tragedies. The working years of life lost, and the financial strain caused by the injury problem is also a heavy burden to families throughout the country.
The focus on injury which will be expanded through the Center authorized here should contribute to an acceleration of efforts around the country to make injury an important health priority. Over the long term, the reduction in injury rates, the diminution of the physical impact of injuries, and the improvements in treatment and rehabilitation which are expected to result from the establishment of injury as a health priority will be of significant and lasting benefit to families.
X. SECTION-BY-SECTION ANALYSIS
S. 2648-INJURY PREVENTION ACT OF 1986—A BILL TO IMPROVE THE PUBLIC HEALTH THROUGH THE PREVENTION OF INJURIES
Section 1 of the bill cites the Act as the "Injury Prevention Act of 1986."
Section 2 (parts (a) and (b)) sets forth the findings of Congress and the purposes of the act. Injury was found to be a major public health problem in the United States, particularly among children and the elderly. The purposes of this act are to promote research into injury control, to promote cooperation between research specialists, and to promote coordination between private and public entities in the area of injury control.
Section 3 sets forth to amend Title III of the Public Health Service Act by adding a new part entitled "Part J-Injury Control." Section 391 of part J directs the Secretary through the Director of the Centers for Disease Control to conduct, assist and provide grants for research in the area of injury control, and to disseminate the practical findings of the research.
Section 392 of part J directs the Secretary through the director of centers for Disease Control to promote and assist in injury control activities carried out at local, state and regional levels.
Section 393 of part J directs the Secretary through the Director of Centers for Disease Control to report, by January 1989, the inci
dence and causes of childhood injuries in the United States and recommended injury control legislation.
Section 394 of part J authorizes the appropriation of $10,000,000 for each of the fiscal years 1988, 1989 and 1990 for research and coordination activities relating to injury control.
XI. CHANGES IN EXISTING LAW
In compliance with rule XXVI paragraph 12 of the Standing Rules of the Senate, the following provides a print of the statute or the part or section thereof to be amended, or replaced (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
TITLE III-GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
PART J-INJURY CONTROL
SEC. 391. (a) The Secretary, through the Director of the Centers for Disease Control, shall—
(1) conduct, and give assistance to public and nonprofit private entities, scientific institutions, and individuals engaged in the conduct of, research relating to the causes, mechanisms, prevention, diagnosis, treatment of injuries, and rehabilitation from injuries; and
(2) make grants to public and nonprofit private entities (including academic institutions, hospitals, and laboratories) and individuals for the conduct of such research.
(b) The Secretary, through the Director of the Centers for Disease Control, shall collect and disseminate, through publications and other appropriate means, information concerning the practical applications of research conducted or assisted under subsection (a).
SEC. 392. (a) The Secretary, through the Director of the Centers for Disease Control, shall—
(1) assist States and political subdivisions of States in activities for the prevention of injuries; and
(2) encourage regional activities between States designed to reduce injury rates.
(b) The Secretary, through the Director of the Centers for Disease Control, may
(1) enter into agreements between the Service and public and private community health agencies which provide for cooperative planning of activities to deal with problems relating to injuries and injury control; and