Costs of occupational injuries in agriculture

OBJECTIVE: This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992. METHODS: The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance. RESULTS: Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion. CONCLUSIONS: The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs.     

PCV16 Smoking Related Costs in the United States

Smoking is a high-risk behavior that affects the health and economic welfare of society. Thus, it is important to quantify the economic burden smoking places on social institutions in the United States.
OBJECTIVE: The purpose of this review paper is to analyze smoking cost studies and to provide estimates that represent the economic costs of smoking from different perspectives of society, and as a whole.
METHODS: Current Contents (1996–), Health Star (1970–), and Medline (1966–) databases were searched through the use of pertinent subject headings and key words: tobacco use, smoking, cost, and economics. The internet was utilized to identify potential sources of epidemiological and cost information on smoking. Recent cost-of-illness studies using different methodologies: human capital, incidence, and prevalence were chosen for review based on their relevance.
RESULTS: Preliminary results indicate that the published cost studies available underestimate the "true" costs of smoking. The most current articles approximate annual direct medical costs to health care payers of $50 billion (1993); inflating to 1997 equals $59 billion or $1,200 per smoker. Although the latest cost studies do not attempt to estimate indirect costs, past studies have found indirect costs to be 1.5–2 times the direct costs. Therefore, using direct and indirect costs we estimate total smoking costs to be $150 billion (1993); inflating to 1997 equals $176 billion or $3,500 per smoker.
CONCLUSION: Quantifying the cost of smoking is a difficult task due to tobacco use infiltrating many aspects of life and the dependency of cost on perspective. Cost-of-illness studies provide cost estimation data which can be useful in aiding decision-makers who are allocating health care resources.     

Costs of occupational injuries and illnesses in California

OBJECTIVES: The purpose of this study was to estimate the annual incidence, the mortality, and the direct and indirect costs associated with occupational injuries and illnesses in California in 1992. To achieve this, we performed aggregation and analysis of national and California data sets collected by the U.S. Bureau of Labor Statistics, California Workers' Compensation Insurance Rating Bureau, California Division of Industrial Relations, the National Center for Health Statistics, and the U.S. Health Care Financing Administration. METHODS: To assess incidence of and mortality from occupational injuries and illnesses, we reviewed data from state and national surveys and applied an attributable risk proportion method. To assess costs, we used the cost-of-illness, human capital, method that decomposes costs into direct categories such as medical expenses and insurance administration expenses as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Some cost estimates were drawn from California data, whereas others were drawn from a national study but were adjusted to reflect California's differences. Cost estimates for injuries were calculated by multiplying average costs by the number of injuries. For the majority of diseases, cost estimates relied on the attributable risk proportion method. RESULTS: Approximately 660 job-related deaths from injury, 1.645 million nonfatal injuries, 7,079 deaths from diseases, and 0.133 million illnesses are estimated to occur annually in the civilian California workforce. The direct ($7.04 billion, 34%) plus indirect ($13.62 billion, 66%) costs were estimated to be $20.7 billion. Injuries cost $17.8 billion (86%) and illnesses $2.9 billion (14%). These estimates are likely to be low because: (1) they ignore costs associated with pain and suffering, (2) they ignore home care provided by family members, and (3) the numbers of occupational injuries and illnesses are likely to be undercounted. CONCLUSION: Occupational injuries and illnesses are a major contributor to the total cost of health care and lost productivity in California. These costs are on a par with those of all cancers combined and only slightly less than the cost of heart disease and stroke in California. Workers' compensation covers less than one-half of the costs of occupational injury and illness.     

Health care costs of physical inactivity in Canadian adults

The purpose of this study was to provide a contemporary estimate of the health care cost of physical inactivity in Canadian adults. The health care cost was estimated using a prevalence-based approach. The estimated direct, indirect, and total health care costs of physical inactivity in Canada in 2009 were $2.4 billion, $4.3 billion, and $6.8 billion, respectively. These values represented 3.8%, 3.6%, and 3.7% of the overall health care costs.     

Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991

This study presents three estimates--ranging from low to high--of the direct and indirect costs of the AIDS epidemic in the United States in 1985, 1986, and 1991, based on prevalence estimates provided by the Centers for Disease Control (CDC). According to what the authors consider their best estimates, personal medical care costs of AIDS in current dollars will rise from $630 million in 1985 to $1.1 billion in 1986 to $8.5 billion in 1991. Nonpersonal costs (for research, screening, education, and general support services) are estimated to rise from $319 million in 1985 to $542 million in 1986 to $2.3 billion in 1991. Indirect costs attributable to loss of productivity resulting from morbidity and premature mortality are estimated to rise from $3.9 billion in 1985 to $7.0 billion in 1986 to $55.6 billion in 1991. While estimated personal medical care costs of AIDS represent only 0.2 percent in 1985 and 0.3 percent in 1986 of estimated total personal health care expenditures for the U.S. population, they represent 1.4 percent of estimated personal health care expenditures in 1991. Similarly, while estimated indirect costs of AIDS represent 1.2 percent in 1985 and 2.1 percent in 1986 of the estimated indirect costs of all illness, they are estimated to rise to almost 12 percent in 1991. Estimates of personal medical care costs were based on data from various sources around the United States concerning average number of hospitalizations per year, average length of hospital stay, average charge per hospital day, and average outpatient charges of persons with AIDS. For estimating the indirect costs the human capital method was used, and it was assumed that average wages and labor force participation rates of persons with AIDS were the same as those for the general population by age and sex.     

Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988

The high prevalence of alcohol and drug abuse and mental illness imposes a substantial financial burden on those affected and on society. The authors present estimates of the economic costs from these causes for 1985 and 1988, based on current and reliable data available from national surveys and the use of new costing methodology. The total losses to the economy related to alcohol and drug abuse and mental illness for 1988 are estimated at $273.3 billion. The estimate includes $85.8 billion for alcohol abuse, $58.3 billion for drug abuse, and $129.3 billion for mental illness. The total estimated costs for 1985, $218.1 billion, include $51.4 billion for direct treatment and support costs; $80.8 billion for morbidity costs, the value of reduced or lost productivity; $35.8 billion for mortality costs, the value of foregone future productivity for the 140,593 premature deaths associated with these disorders, based on a 6 percent discount rate and including an imputed value for housekeeping services; and $47.5 billion in other related costs, including the costs of crime, motor vehicle crashes, fire destruction, and the value of productivity losses for victims of crime, incarceration, crime careers, and caregiver services. The cost of acquired immunodeficiency syndrome associated with drug abuse is estimated at $1 billion, and the cost of fetal alcohol syndrome is estimated at $1.6 billion. The estimates may be considered lower limits of the true costs to society of alcohol and drug abuse and mental illness in the United States.     

The socioeconomic costs of mental illness in Spain

Mental illness affects a large number of people in the world, seriously impairing their quality of life and resulting in high socioeconomic costs for health care systems and society. Our aim is to estimate the socioeconomic impact of mental illness in Spain for the year 2002, including health care resources, informal care and loss of labour productivity. A prevalence-based approach was used to estimate direct medical costs, direct non-medical costs, and loss of labour productivity. The total costs of mental illness have been estimated at 7,019 million euros. Direct medical costs represented 39.6% of the total costs and 7.3% of total public healthcare expenditure in Spain. Informal care costs represented 17.7% of the total costs. Loss of labour productivity accounted for 42.7% of total costs. In conclusion, the costs of mental illness in Spain make a considerable economic impact from a societal perspective.      

Costs of diabetes and its complications in Poland

Objective

Diabetes mellitus (DM) is a major health problem with severe complications and a significant impact on quality of life. It constitutes an enormous burden of disease due to high prevalence, severe co-morbidities and high costs for society. This study is the first comprehensive study on the direct and indirect costs of DM (type 1 and type 2) and associated complications in Poland.

Methods

In order to estimate the direct medical costs of DM and its complications, including the costs of medical consultation, hospitalisation, rehabilitation, drugs and medical equipment, data from the National Health Fund were used. Indirect costs on loss of productivity due to diabetes and its complications were based on data obtained from the ZUS (Social Insurance Institution) and from GUS (Poland’s Central Statistical Office). Attributable risk methodology was used to assess the burden of DM complications.

Results

A continuous increase of the direct costs of diabetes has been observed since the year 2005. In the analysed time period (2005–2009) the direct costs of medical services for both types of DM doubled. DM is a cause of significant sickness absence and incapacity for work and therefore is associated with a growing productivity decline in Poland. The highest direct costs and indirect costs are associated with treatment of diabetes-related complications. Direct costs of hospital complication treatment were EUR 332 million, which exceeded by more than five times the direct costs of hospital treatment of diabetes per se, which in the same year amounted to EUR 58.5 million. The indirect costs of diabetes-related complications were higher by 41 % compared with indirect costs related to DM itself. Total costs of health care services for DM and its complications amounted to EUR 654 million, which constitutes a 2.8 % of total health care costs in Poland. Total DM cost in Poland in 2009 amounted EURO 1.5 billion.

Conclusions

DM is causing a growing economic burden on the health care system and on Polish society in terms of health care and productivity losses. Most of the total cost of diabetes are indirect costs caused by productivity losses. Both direct and indirect costs are driven by the cost of diabetes complications.     

Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991

This study presents three estimates ranging from low to high of the direct and indirect costs of the acquired immunodeficiency syndrome (AIDS) epidemic in the United States in 1985, 1986, and 1991, based on prevalence estimates provided by the Centers for Disease Control (CDC). According to the author's best estimates, personal medical care costs of AIDS in current dollars will rise from $630 million in 1985 and $1.1 billion in 1986 and $8.5 billion in 1991. Nonpersonal costs (for research, screening, education, and general support services) are estimated to rise from $319 million in 1985 to $542 million in 1986 to $2.3 billion in 1991. Indirect costs attributable to loss of productivity resulting from morbidity and premature mortality are estimated to rise from $3.9 billion in 1985 to $7.0 billion in 1986 to $55.6 billion in 1991. While estimated personal medical care costs of AIDS in 1985 and 1986 represent only 0.2% and 0.3%, respectively, of such estimated expenditures for the U.S. population in these 2 years, they represent 1.4% of these estimated costs in 1991. Similarly, while estimated indirect costs of AIDS represent 1.2% in 1985 and 2.1% in 1986 of the estimated indirect costs of all illness, they are projected to rise to almost 12% in 1991. For estimating the indirect costs, the human capital method was used, and it was assumed that average wages and labor force participation rates of persons with AIDS were the same as those for the general population by age and sex.     

The economic costs of Alzheimer's disease.

This paper estimates the economic costs of Alzheimer's Disease to individuals and to society, based on review of published Alzheimer's Disease-related research. The analysis is derived from epidemiological projections and cost information for the United States population in 1983. Estimated costs include both direct medical care and social support costs, as well as indirect costs, such as support services provided by family or volunteers, and the value of lost economic productivity in Alzheimer's Disease patients. Mid-range estimates of net annual expected costs for an Alzheimer's Disease patient, excluding the value of lost productivity, are $18,517 in the first year and $17,643 in subsequent years, with direct medical and social services comprising about half of these costs. Under base case assumptions, the total cost of disease per patient in 1983, was $48,544 to $493,277, depending upon patient's age at disease onset. The estimated present value of total net costs to society for all persons first diagnosed with Alzheimer's Disease in 1983 was $27.9-31.2 billion. Development of a public or private insurance market for the economic burdens of Alzheimer's Disease would fill some of the gaps in the current US system of financing long-term chronic disease care.     

The costs of unintentional home injuries

BACKGROUND: Unintentional home injuries impose significant, but little reported, costs to society. The most tangible are medical and indirect costs. A less-tangible cost is the value of lost quality of life due to impairment or death. METHODS: A societal perspective was adopted in estimating unintentional home injury costs. All costs associated with the injuries are included in the analysis-costs to victims, families, government, insurers, and taxpayers. The costs are incidence based, meaning all costs that will result from an injury over time are counted in the year that the injury occurs. RESULTS: Unintentional home injuries cost U.S. society at least $217 billion in 1998. The cost of fatal unintentional injuries alone was $34 billion, with nonfatal injuries accounting for the remaining $183 billion. The largest cost was the value of lost quality of life at $162 billion. Medical costs and indirect costs were $22 billion and $33 billion, respectively. CONCLUSIONS: These estimates indicate that unintentional home injuries, especially falls, are a major problem in the United States. Falls are a particular problem in need of more attention.     

Economic burden of occupational injury and illness in the United States

Context: The allocation of scarce health care resources requires a knowledge of disease costs. Whereas many studies of a variety of diseases are available, few focus on job‐related injuries and illnesses. This article provides estimates of the national costs of occupational injury and illness among civilians in the United States for 2007. Methods: This study provides estimates of both the incidence of fatal and nonfatal injuries and nonfatal illnesses and the prevalence of fatal diseases as well as both medical and indirect (productivity) costs. To generate the estimates, I combined primary and secondary data sources with parameters from the literature and model assumptions. My primary sources were injury, disease, employment, and inflation data from the U.S. Bureau of Labor Statistics (BLS) and the Centers for Disease Control and Prevention (CDC) as well as costs data from the National Council on Compensation Insurance and the Healthcare Cost and Utilization Project. My secondary sources were the National Academy of Social Insurance, literature estimates of Attributable Fractions (AF) of diseases with occupational components, and national estimates for all health care costs. Critical model assumptions were applied to the underreporting of injuries, wage‐replacement rates, and AFs. Total costs were calculated by multiplying the number of cases by the average cost per case. A sensitivity analysis tested for the effects of the most consequential assumptions. Numerous improvements over earlier studies included reliance on BLS data for government workers and ten specific cancer sites rather than only one broad cancer category. Findings: The number of fatal and nonfatal injuries in 2007 was estimated to be more than 5,600 and almost 8,559,000, respectively, at a cost of $6 billion and $186 billion. The number of fatal and nonfatal illnesses was estimated at more than 53,000 and nearly 427,000, respectively, with cost estimates of $46 billion and $12 billion. For injuries and diseases combined, medical cost estimates were $67 billion (27% of the total), and indirect costs were almost $183 billion (73%). Injuries comprised 77 percent of the total, and diseases accounted for 23 percent. The total estimated costs were approximately $250 billion, compared with the inflation‐adjusted cost of $217 billion for 1992. Conclusions: The medical and indirect costs of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Workers’ compensation covers less than 25 percent of these costs, so all members of society share the burden. The contributions of job‐related injuries and illnesses to the overall cost of medical care and ill health are greater than generally assumed.     

The social and economic costs of alcohol abuse in Minnesota, 1983.

Alcohol abuse in the State of Minnesota has an impact on health, health care resources, and the economy. Alcohol abuse was related to 3.3 per cent (1,150) of deaths in Minnesota in 1983; of these, almost one-third were the result of fatal injuries. Alcohol abuse contributed to 12 per cent (33,909) of all years of potential life lost, two-thirds of which were secondary to injury. The estimated cost of alcohol abuse ranged from $1.4 billion to $2.1 billion, representing from 2.8 per cent to 4.3 per cent of all personal income of Minnesotans, from 32 per cent to 50 per cent of State expenditures, and from 26 to 39 times the alcohol excise tax revenues generated in 1983. Alcohol-related direct medical care costs were estimated to be at least $216 million, 3.8 per cent of Minnesota medical costs for 1983. Costs of reduced on-the-job productivity and short-term absenteeism related to alcohol abuse were estimated to be between $630 million and $1.2 billion. The documentation of the costs of alcohol abuse is an important step in the campaign to reduce alcohol-related deaths, morbidity, and health care costs.     

Medical costs and productivity losses due to interpersonal and self-directed violence in the United States

BACKGROUND: Violence-related injuries, including suicide, adversely affect the health and welfare of all Americans through premature death, disability, medical costs, and lost productivity. Estimating the magnitude of the economic burden of violence is critical for understanding the potential amount of resources that can be saved if cost-effective violence prevention efforts can be broadly applied. From 2003 to 2005, the lifetime medical costs and productivity losses associated with medically treated injuries due to interpersonal and self-directed violence occurring in the United States in 2000 were assessed. METHODS: Several nationally representative data sets were combined to estimate the incidence of fatal and nonfatal injuries due to violence. Unit medical and productivity costs were computed and then multiplied by corresponding incidence estimates to yield total lifetime costs of violence-related injuries occurring in 2000. RESULTS: The total costs associated with nonfatal injuries and deaths due to violence in 2000 were more than $64.8 [corrected] billion. Most of this cost ($64.4 billion or 92%) was due to lost productivity. However, an estimated $5.6 billion was spent on medical care for the more than 2.5 million injuries due to interpersonal and self-directed violence. CONCLUSIONS: The burden estimates reported here provide evidence of the large health and economic burden of violence-related injuries in the U.S. But the true burden is likely far greater and the need for more research on violence surveillance and prevention are discussed.     

Economic burden of seasonal influenza in the United States

BackgroundSeasonal influenza is responsible for a large disease and economic burden. Despite the expanding recommendation of influenza vaccination, influenza has continued to be a major public health concern in the United States (U.S.). To evaluate influenza prevention strategies it is important that policy makers have current estimates of the economic burden of influenza.ObjectiveTo provide an updated estimate of the average annual economic burden of seasonal influenza in the U.S. population in the presence of vaccination efforts.MethodsWe evaluated estimates of age-specific influenza-attributable outcomes (ill-non medically attended, office-based outpatient visit, emergency department visits, hospitalizations and death) and associated productivity loss. Health outcome rates were applied to the 2015 U.S. population and multiplied by the relevant estimated unit costs for each outcome. We evaluated both direct healthcare costs and indirect costs (absenteeism from paid employment) reporting results from both a healthcare system and societal perspective. Results were presented in five age groups (<5 years, 5–17 years, 18–49 years, 50–64 years and ≥65 years of age).ResultsThe estimated average annual total economic burden of influenza to the healthcare system and society was $11.2 billion ($6.3–$25.3 billion). Direct medical costs were estimated to be $3.2 billion ($1.5–$11.7 billion) and indirect costs $8.0 billion ($4.8–$13.6 billion). These total costs were based on the estimated average numbers of (1) ill-non medically attended patients (21.6 million), (2) office-based outpatient visits (3.7 million), (3) emergency department visit (0.65 million) (4) hospitalizations (247.0 thousand), (5) deaths (36.3 thousand) and (6) days of productivity lost (20.1 million).ConclusionsThis study provides an updated estimate of the total economic burden of influenza in the U.S. Although we found a lower total cost than previously estimated, our results confirm that influenza is responsible for a substantial economic burden in the U.S.     

The Socioeconomic Burden of Coronary Heart Disease in Korea

Objectives

We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data.

Methods

A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective.

Results

Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556).

Conclusions

The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.     

Costs of Alcohol and Drug-Involved Crime

A large proportion of violent and property crimes involve alcohol or other drugs (AOD). AOD use only causes some of these crimes. This paper estimates the costs of AOD-involved and AOD-attributable crimes. Crime counts are from government statistics adjusted for underreporting. The AOD-involved portion of crime costs is estimated from inmate surveys on alcohol and illicit drug use at the time of the crime. The costs and AOD-attributable portion of AOD-involved crimes come from published studies. They include tangible medical, mental health, property loss, future earnings, public services, adjudication, and sanctioning costs, as well as the value of pain and suffering. An estimated 5.4 million violent crimes and 8 million property crimes involved AOD use in 1999. Those AOD-involved crimes cost society over $6.5 billion in medical and mental health care and almost $65 billion in other tangible expenses (in 1999 dollars). If the value of pain, suffering, and lost quality of life is added, AOD-involved crime costs totaled $205 billion. Violent crimes accounted for more than 85% of the costs. Roughly estimated, crimes attributable to alcohol cost $84 billion, more than 2 times the $38 billion attributable to drugs. Although American media—news and entertainment—dwell on the links between drugs and crime, alcohol-attributable crime costs are double drug-attributable ones. Effective efforts to reduce the abuse of alcohol and illicit drugs should reduce costs associated with crime.     

Lifetime Cost of Abusive Head Trauma at Ages 0–4, USA

This paper aims to estimate lifetime costs resulting from abusive head trauma (AHT) in the USA and the break-even effectiveness for prevention. A mathematical model incorporated data from Vital Statistics, the Healthcare Cost and Utilization Project Kids’ Inpatient Database, and previous studies. Unit costs were derived from published sources. From society’s perspective, discounted lifetime cost of an AHT averages $5.7 million (95% CI $3.2–9.2 million) for a death. It averages $2.6 million (95% CI $1.0–2.9 million) for a surviving AHT victim including $224,500 for medical care and related direct costs (2010 USD). The estimated 4824 incident AHT cases in 2010 had an estimated lifetime cost of $13.5 billion (95% CI $5.5–16.2 billion) including $257 million for medical care, $552 million for special education, $322 million for child protective services/criminal justice, $2.0 billion for lost work, and $10.3 billion for lost quality of life. Government sources paid an estimated $1.3 billion. Out-of-pocket benefits of existing prevention programming would exceed its costs if it prevents 2% of cases. When a child survives AHT, providers and caregivers can anticipate a lifetime of potentially costly and life-threatening care needs. Better effectiveness estimates are needed for both broad prevention messaging and intensive prevention targeting high-risk caregivers.     

The economic impact of alcohol abuse and alcoholism

The economic effects of alcohol abuse are as damaging to the nation as the health effects, affecting the family, the community, and persons of all ages. Underaged drinking is interfering with children's development, affecting the nation's ability to respond to economic challenge in the future. The college aged may be the most difficult to educate about alcohol abuse because of drinking patterns established at an early age and susceptibility to advertising inducements. Health care costs for families with an alcoholic member are twice those for families without one, and up to half of all emergency room admissions are alcohol related. Fetal alcohol syndrome is one of the top three known causes of birth defects, and is totally preventable. Alcohol abuse and alcoholism are estimated to have cost the nation $117 billion in 1983, while nonalcoholic drug abuse that year cost $60 billion. Costs of alcohol abuse are expected to be $136 billion a year by 1990, mostly from lost productivity and employment. Between 6 and 7 million workers are alcoholic, with an undetermined loss of productivity, profits, and competitiveness of American business. Alcohol abuse contributes to the high health care costs of the elderly beneficiaries of Federal health financing programs. Heavily affected minorities include blacks, Hispanics, and Native Americans. Society tends to treat the medical and social consequences of alcohol abuse, rather than its causes. Although our experience with the consequences of alcohol abuse is greater than that for any other drug, public concern for its prevention and treatment is less than for other major illnesses or abuse of other drugs.(ABSTRACT TRUNCATED AT 250 WORDS)