UNIT 3 - AOS 1B Flashcards
1
Q
National Health Priority Areas
A
A collaborative initiative endorsed by the commonwealth and all state territory governments.
The NHPA initiative seeks to focus the health sectors attention on diseases or conditions that have a major impact on the health of australians
The NHPA”S represent the disease groups with the largest burden of disease and potential costs to the Australian Government
2
Q
dot points for nhpa definition
A
- collaborative imitative endorsed by commonwealth states territory
- seeks to focus on health sectors on diseases or conditions that have major impact on health of australians
- represent the disease groups with largest BOD and potential costs to australian government
3
Q
what are the nine NHPAS
A
- Mental health
- Asthma
- Diabetes mellitus
- Dementia
- Cancer control
- Obesity
- arthritis and Musculoskeletal conditions
- Injury prevention and control
- Cardiovascular health
4
Q
define costs
A
one of the main reasons why each NHPA was selected is due to the cost of illness to an individual and/or community
5
Q
what are the three types of costs
A
- direct
- indirect
- intangible
6
Q
direct costs
A
- easy to measure
- a direct result of illness
- eg. medication or treatment
7
Q
indirect costs
A
- more difficult to measure in monetary value
- costs to individual/communities as a result of illness but not related directly to illness itself
8
Q
intangible
A
- costs which can not be allocated a monetary value
- reduced to human emotion
- eg. pain, anxiety and stress
9
Q
NHPA - mental health
A
relates to a state of well being in which the individual realises their own abilities and can cope with the normal stresses of life, work productively and fruitfully and is able to make a contribution to their community.
The initial focus of the NHPA is to combat depression
10
Q
mental health - reason for selection
A
- most common non fatal burden of disease
- estimated up to 45% of australians will experience mental illness at some stage of life
11
Q
list mental health biological factors
A
- body weight
- chemical imbalance
12
Q
mental health biological factors - body weight
A
no definitive relationship but obesity could influence eating habits and consequentially mental health
13
Q
mental health biological factors - chemical imbalance
A
chemical in brain assists in controlling mood.
Suggesting a deficiency in chemical ceratonin may contribute to depression and other illnesses
14
Q
list mental health behavioural factors
A
- alcohol misuse
- physical activity
15
Q
mental health behavioural factors - alcohol misuse
A
there is a relationship between problem drinking and suffering mental illnesses. The casual factor of drinking is a depressant and those with depressive symptoms are more likely to develop alcohol misses as a result of it being a depressant
16
Q
mental health behavioural factor - physical activity
A
releases hormone type chemicals called endorphins that relieve stress and helps maintain ‘optimal’ mental health.
People who exercise may have lower levels of mental illness
17
Q
list mental health physical environment factors
A
- access to recreational facilities
- housing
18
Q
mental health physical environment factors - access to recreational facilities
A
regular physical activity releases endorphins to help maintain ‘optimal’ mental health.
not having access to facilities therefore may increase the risk of developing or maintaining an illness
19
Q
mental health physical environment factors - housing
A
living in overcrowded housing can increase psychological distress. Housing that is not adequate or secure can contribute to anxiety and stress
20
Q
list mental health social factors
A
- early life experiences
- low ses
21
Q
mental health social factors - early life experiences
A
loss of parent, divorce or adverse parenting styles may act as a trigger to mental illness
22
Q
mental health social factors - low ses
A
may have higher rates of mental illness due to higher rates of obesity, alcohol or drug misuse, poverty, lack of security causing anxiety and distress due to possible feeling of lack of control
23
Q
mental health direct costs
A
- 8.6% of health care expenditure approx 6.4 billion
- medication and counselling
- implementing health promotions
24
Q
mental health indirect costs
A
- loss of income if unable to work
- lost productivity/ social security payments
- paying for domestic services
25
mental health intangible costs
- increased feeling of hopelessness, stress, anxiety
- community: family/friends may have to take time to care for sufferer
- stress for family of sufferer
26
mental health - health promotion program
THE NATIONAL MENTAL HEALTH STRATEGY
program endorsed by federal,state and territory governments that aim to promote mental health and reduce the impact of mental illness in Australia
27
NHPA - asthma
a condition characterised by inflammation of the airways in response to certain 'triggers'. These may include: pollen, pet hair, smoke, physical activity.
When exposed to triggers, the airways narrow making it difficult to breathe
28
asthma - why is it an NHPA
- contributes significantly to overall burden of disease in australia
- suffered by approx 2.2 million
- one of the most frequent reasons for hospitalisation for children
29
list biological determinants - asthma
- genetic predisposition
| - excess body weight
30
asthma biological factors - genetic predisposition
people who have a family history of asthma are more likely to develop the condition themselves
31
asthma biological factors - excess body weight
research suggests that individuals who are overweight/ obese have a higher risk of developing asthma
32
list behavioural determinants - asthma
- smoking
33
asthma behavioural determinants - smoking
increases risk of asthma
| Exposure to tobacco smoke in the uterus and during infancy may lead to an increased asthma risk
34
list physical environment determinants - asthma
- housing
| - air quality
35
asthma physical environment - housing
housing that does not have adequate ventilation may increase indoor population and can increase the risk of asthma among inhabitants
36
asthma physical environment - air quality
air pollution is a risk factor for asthma,
| Those living in major cities or near industrial areas may increase risk
37
list social determinants - asthma
- low ses
| - early life experiences
38
asthma social - low ses
more likely to have asthma due to higher smoking rates and increased exposure to environmental tobacco smoking
39
asthma social - early life experiences
mothers who smoke during pregnancy may elevate their childs risk of developing asthma
40
asthma - direct costs
- 700 million on expenditure
- appointments
- hospital admissions
- pharmaceuticals eg. puffer/ ventilator
- individual co payments
- ambulance for severe attacks
41
asthma indirect costs
- lost income of carers to young asthma sufferers
- lost productivity and taxation revenue
- financial costs of parent having to stay home
42
asthma intangible costs
- missing school due to sleep disturbance s
- increased anxiety if attacks are frequent
- frustration of unable to participate in physical activity
- anxiety for parents of young sufferers
43
asthma - health promotion programs
- ASTHMA FRIENDLY SCHOOLS PROGRAM
- a joint initiative of Australian Asthma foundation, aiming to reduce potential triggers in school environment and provide education regarding management
44
NHPA - diabetes mellitus
a chronic condition in which the sufferer is unable to utilise blood glucose correctly.
Glucose is the basic unit for energy and required by the body's cells to maintain normal function. When glucose is not being taken into cells, blood glucose levels are high and cells can not function properly
45
diabetes - type 1
pancreas does not produce enough (if not any) insulin to allow glucose from the body to the cells.
Believed to be a strong genetic link
46
diabetes - type 2
usually occurs in older, overweight individuals.
Pancreas can not produce efficiently use insulin
Being overweight is the greatest link
47
diabetes - gestational
As baby develops, hormones produced to assist in growth, however reduce impact that insulin has on blood glucose levels of mother. The mother may not be able to produce enough insulin to metabolise glucose, which may result in diabetes
48
Diabetes - why is it an NHPA
- leading contributor to BOD
- over 850 000 reported having it
- growing health problem
- type 2 influenced by modifiable risk factors
49
list biological determinants - diabetes mellitus
- genetic predisposition
| - body weight
50
diabetes mellitus - biological, genetic predisposition
people who have family members that are diabetic have a higher risk of developing over another individual, particularly type 1
51
diabetes mellitus - biological, body weight
being overweight is a risk factor for type 2.
| Exact relationship is not fully understood, however it is known to increase the risk of type 2
52
list behavioural determinants - diabetes mellitus
- dietary behaviour
| - tobacco smoking
53
diabetes mellitus - behavioural, dietary behaviour
eating energy dense or high fat diet can contribute to weight gain and is a risk factor of type 2 and gestational diabetes
54
diabetes mellitus - behavioural, tobacco smoking
smoking contributes to higher blood glucose levels and can lead to insulin resistance,
Smokers are more likely to develop type 2 diabetes
55
list physical environment determinants - diabetes mellitus
- access to recreation facilities
| - work environment
56
diabetes mellitus - physical environment, access to recreational facilities
if not accessible, individuals may not get the required amount of physical activity which can increase body weight and obesity contributing to type 2
57
diabetes mellitus - physical environment - work environment
an environment that does not promote incidental physical activity can increase risk of type 2 as it contributes to obesity
58
list social determinants - diabetes mellitus
- low ses
| - food security
59
diabetes mellitus - social - low ses
have higher rates of obesity which is leading cause of gestational and type 2
60
diabetes mellitus - social - food security
people who lack food security are more likely to eat energy dense, processed foods that can increase obesity, contributing to the risk of type 2 and gestational diabetes
61
diabetes mellitus - direct costs
community
- 1.5 billion on management and provided through medicare PBS and private health insurance
individual
- copayments for health services
eg, specialists and medication such as insulin and pump
62
diabetes mellitus - indirect costs
```
community
- social security payments
- lost productivity and taxation
individuals
- paying for carers
- lost income if unable to work
```
63
diabetes mellitus - intangible
- frustration about exercise and diet
- loss of self esteem
- anxiety of condition progressing
- family and friends experiencing anxiety over lifestyle changes or inability to manage
64
diabetes mellitus - health promotion program
THE LIVE LIGHTER CAMPAIGN
an initiative that promotes physical activity and healthy eating in an attempt to decrease obesity rates and associated chronic diseases such as diabetes
65
NHPA - dementia
is not a specific disease but a term used to describe over 100 conditions that are characterised by progressive and irreversible loss of brain function.
As brain function deteriorates, dementia interferes with normal behaviour patterns affecting
-memory
- language
- speech
-attention
-personality
66
Dementia - why is it an NHPA
- third most common cause of death
- contributing significantly to morbidity rates
- fourth largest contributor to burden of disease
67
list biological determinants - dementia
- age
| - genetic predisposition
68
dementia - biological determinants - age
advancing age is the greatest risk factor with rates increasing from ages 65+
doubling approximately every 6 years
69
dementia - biological determinants - genetic predisposition
those with a family history have an increased rate of suffering from dementia
70
list behavioural determinants - dementia
- lack of mental stimulation
| - alcohol consumption
71
dementia - behavioural - lack of mental stimulation
those who don't regularly utilise their memory, attention and problem solving abilities throughout middle age may experience increased rate of dementia
72
dementia - behavioural - alcohol consumption
can contribute to specific types including 'alcohol dementia' caused by excessive alcohol consumption over an extended period of time
73
list physical environment determinants - dementia
- transport systems
| - environmental tobacco smoke
74
dementia - physical environment - transport systems
not having access decreases opportunity to socialise with friends/family. Lack of stimulation increases chance of dementia
75
dementia - physical environment - environmental tobacco smoking
- exposure increase risk of CVD by clogging blood vessels and therefore increase risk of vascular dementia
76
list social determinants - dementia
- level of education
| - social exclusion
77
dementia - social - level of education
this with lower levels may be at higher risk due to less stimulating careers and opportunities
78
dementia - social - social exclusion
those who are less socially active than the rest of the population may experience increased rate of dementia
79
dementia - direct costs
- diagnosis and management, due to there not being a cure
- 60 million on medication through PBS
individual
- co payments on medication and appointments
80
dementia - indirect costs
```
community
- funded caring = 3 billion
- reduced productivity
- residential care funding
individual
- co payments on carer or residential services
- non formal carers of family
- carers may have to give up jobs
```
81
dementia - intangible costs
- range of emotions, anger, frustration, fear, despair
- may not be able to be involved in hobbies
- family fiends experience loss of remembering relationship and how the person is deteriorating
82
dementia - health promotion program
LIVING WITH MEMORY LOSS PROGRAM
Alzheimers Australia provides those in the early stages of dementia (and their family) with a tailored program that includes information and advice to support them
83
NHPA - cancer control
A diverse group of diseases in which some of the body cells become defective, begin to multiply out of control, may invade and damage tissue.
The uncontrollable growth of abnormal cells can pose threat to other body parts
84
types of cancer under cancer control
- breast
- colorectal
- lung
- melanoma
85
Cancer Control - why is it a NHPA ?
- 2nd highest leading cause of death
- many are preventable through lifestyle changes
- accounts for 29% of deaths
- contributes to the most YLL
- largest contributor to BOD
86
list biological determinants - cancer control
- genetic predisposition
| - body weight
87
cancer control - biological - genetic predisposition
some people are more likely to develop cancer and genetic/ family history can greatly influence certain cancers such as breast and prostate cancers
88
cancer control - biological - body weight
relationship between obesity and higher rates of cancer such as colorectal and breast cancer
89
list behavioural determinants - cancer control
- tobacco smoking
| - sun protection behaviours
90
cancer control - behavioural - tobacco smoking
contains chemicals that can contribute to cancer in majority of the body including lungs and throat
91
cancer control - behavioural - sun protection behaviours
over exposure to UV radiation without adequate protection e.g., hat or sunscreen can increase chance of developing skin cancer
92
list physical environment determinants - cancer control
- air quality
| - work environment
93
cancer control - physical environment - air quality
up to approx. 80 substances are found in air pollution are thought to increase risk of cancer including people living in industrial areas displaying higher rates
94
cancer control - physical environment - work environment
individuals who spend prolonged amounts of time working outdoors exposed to uv can increase risk of skin cancer or exposure to hazardous chemicals can increase chance of lung cancer
95
list social determinants - cancer control
- low ses
| - food security
96
cancer control - social - low ses
are more likely to have increased rates of cancer due to high rates of smoking and alcohol consumption which increases risk of having lung cancer
97
cancer control - social - food security
people who don't have access to nutritious foods may rely on processed foods.
As a result increased excess saturated fats and inadequate amounts of fruit/veg which can increase rate of colorectal, lung and prostate cancer
98
cancer control - direct costs
- 6% of health care expenditure
- medical treatment
- chemotherapy / radiation
- health promotion programs (community)
99
cancer control - indirect costs
- lost productivity/ taxation revenue if unable to work
- paid services e.g.. cleaning
- price of carers
100
cancer control - intangible costs
- pain and suffering
- anxiety and depression
- missing school or work
101
cancer control - list health promotion program
- quit
- screening programs
- movember
- sunsmart
102
cancer control - health promotion program - quit
joint initiative to reduce burden of cancer caused by tobacco smoking
support throughout quitting and promoting health benefits of quitting
103
NHPA- obesity
defined as having a BMI of over 30 or a waist measurement of 89 cm + for females or 102 cm + for males.
Obesity relates to carrying excess body weight in the form of adipose tissue
104
obesity - why is it an nhpa ?
- leads to a range of diseases e.g.. cvd type 2
- becoming more prevalent in society
- contributes to higher BOD
- rising epidemic in Australia
- highly preventable
105
list biological determinants - obesity
- age
| - hormonal disturbance
106
obesity - biological - age
metabolism slows and processes foods slower increasing amount of adipose tissue leading to obesity
107
obesity - biological - hormonal disturbances
leptin contributes to appetite and fat distribution.
| Increases obesity rates
108
list behavioural determinants - obesity
- lack of physical activity
| - consuming energy dense foods
109
obesity - behavioural - lack of physical activity
can lead to obesity when an individual also consumes more food than they are expected to burn which is limited if activity is bare or non existent
110
obesity - behavioural - consuming energy dense foods
highly processed foods which do not provide any nutritional benefit increases rate of obesity due to high content of fats
111
list social determinants - obesity
- food insecurity
| - low ses
112
obesity - social - food insecurity
those who cannot afford or have access to healthy, nutrient rich foods will turn to processed foods which increase obesity due to excess salt, sugar and fat consumption
113
obesity - social - low ses
people with lower ses have increased rates of obesity which may be linked to increase rates of alcohol and tobacco smoking rates etc.
114
list physical environment determinants - obesity
- access to recreational facilities
| - work environment
115
obesity - physical environment - access to recreational facilities
limited access to parks, bike paths, gyms can lead to a decrease in physical activity and can overall increase obesity
116
obesity - physical environment - work environment
one does that not provide incidental physical activity can increase risk of obesity
117
obesity - direct costs
attributed to other conditions
- ambulance eg. due to heart attack
- weight management plans
- weight loss medication
- health promotion programs (community)
118
obesity - indirect costs
attributed to other conditions
- heart attack may prevent them from working
- employ people for house duties
- lost productivity
- welfare/government payments
119
obesity - intangible costs
```
individual
- loss of confidence/ self esteem
- sleep disturbances due to excess weight causing breathing problems
- lack of energy
- adjustment to dietary requirements
community
- stress and anxiety of friends
- frustration if having to care for individual suffering from an obesity related disease
```
120
obesity - health promotion program
GO FOR 2 AND FIVE CAMPAIGN
aiming to increase fruit and vegetable consumption promoting an increase in nutrient rich foods rather than energy dense foods
2 = veg
5 = fruit
121
NHPA - arthritis and musculoskeletal conditions
conditions of the bones, muscles and other attachments such as ligaments tendons and joints.
There are over 100 conditions but the most common include:
osteoporosis, back problems, theumaroid arthritis, and juvenile arthritis
contributes significantly to BOD
122
arthritis and musculoskeletal conditions - why is it an NHPA ?
- leads to higher rates of morbidity
- account for approx. 5% ob of BOD in Australia
- osteoarthritis affected over 1 million australians in 2011 - 12
123
list biological determinants - A+MC
- gender
| - body weight
124
A+MC - biological - gender
females are more likely to develop musculoskeletal conditions especially after menopause due to the decline in oestrogen production which can lead to an increase in osteoporosis
125
A+MC - biological - body weight
being overweight puts excess strain on joints, which can increase chance of developing arthritis due to the additional body weight adding pressure on the joints
126
list behavioural determinants - A+MC
- poor dietary behaviours
| - lack of sun exposure
127
A+MC - behavioural - poor dietary behaviours
a diet lacking in nutrients required, particularly during adolescence and older age such as vital d and calcium may lead to a lower bone density.
Deficiency of protein can also lead to low bone density
all can lead to osteoporosis
128
A+MC - behavioural - lack of sun exposure
vitam d deficiency is a growing concern for elderly.
It can lead to low bone density, bone pain, muscle weakness with an increased rate of osteoporosis and falls and fractures
129
list physical environment determinants - A+MC
- access to recreational facilities
| - transport systems
130
A+MC - physical environment - access to recreational facilities
lack of access to parks, gyms, bike paths can decrease physical activity and contribute to obesity and arthritis.
The excess weight can contribute to excess pressure on joints and lack of weight bearing access can decrease bone density and therefore osteoporosis is increased
131
list social determinants A +MC
- food insecurity
| - low ses
132
A+MC - social - food insecurity
lack of access to nutrient rich foods which contain the vitamins to maintain bone strength/ health
can lead to an increase in osteoporosis and osteoarthritis if nutrients are lacking to provide HARD TISSUE FORMATION to protect bones and joints
133
A+MC - social - low ses
may not have the educational knowledge relating to healthy food intake and value of health from nutrients to decrease chance of developing arthritis and musculoskeletal conditions for deficiencies
134
A+MC - direct costs
- copayments for doctors/ specialists
- gym, to strengthen bones
community
- medicare contributions
- pbs for medication
135
A+MC - indirect costs
- loss of income due to loss of mobility
- carers/other support
- transport if loss of mobility
136
A+MC - intangible costs
- anxiety over prospect of falls fractures
| - missing out on social experiences due to loss of mobility
137
A+MC - health promotion program
ARTHRITIS AUSTRALIA
a 'non government' program that aims to reduce the prevalence and impact of the musculoskeletal conditions throughout peer support strategies
138
NHPA - injury prevention and control
the term injury relates to the adverse effects on the human body that may result from a range of events.
Injuries may be accidental: falls, poisoning, drowning, sport
or injuries could be intentional: suicide, attempted suicide and violence
139
IP+C - why is it an NHPA ?
- responsible for 7% BOD
- 6.3% of deaths in 2012
- MAIN CAUSE OF DEATH FOR THOSE UNDER 45
- most injuries can be prevented
- incur significant costs
140
list biological determinants - IP+C
- age
| - gender
141
IP+C - biological - age
loss of bone mass in elderly makes people more likely to sustain fractures compared to younger individual
142
IP+C - biological - gender
males have higher levels of testosterone which is contributing factor to higher levels of risk taking such as speeding, alcohol, drug misuse and acts of aggression which contributes to higher rates of injuries among males
143
list behavioural determinants - IP+C
- risk taking behaviour
| - alcohol use
144
IP+C - behavioural - risk taking behaviour
men are more likely than women to take risks and therefore have higher rates of injuries. However any form of risk taking behaviour increases risk of injury
145
IP+C - behavioural - alcohol use
people affected by alcohol often take unnecessary risks that can result in higher rates of injuries.
eg: drink driving, swimming while intoxicated
146
list physical environment determinants - IP+C
- work environments
| - transport
147
IP+C - physical environment - work environments
- aspects of the work environment can contribute to the risk of injuries.
Machinery associated with farming and mining are examples of causes of sport injuries e.g.. back strain
148
IP+C - physical environment - transport
poor road quality, lighting and signage can impact on risk of injuries
149
list social determinants - IP+C
- socioeconomic status
| - social exclusion/ isolation
150
IP+C - low ses
those of lower ses are more likely to be injured.
may be a result of :
- lower levels of education
- types of occupation
- lack of financial resources to ensure cars are safe etc.
151
IP+C - social exclusion/ isolation
those who are socially excluded may not have people to take when required. This can increase the risk of mental health issues and injuries from self esteem
152
IP+C - direct costs
```
individual
- copayments for medical treatments
- copayments for pharmaceuticals
- ambulance transport
community
- medicare contributions with surgery
- aids eg. wheelchair
- health promotion program e.g. work safe
```
153
IP+C - indirect costs
individual
- payment for house services due to injury
- transport costs if unable to drive
community
- insurance agencies
- lost productivity if unable to work
- welfare payments /taxation loss if unable to work
154
IP+C - intangible
- mental health issues as injuries are unpredictable
- frustration of learning new tasks e.g. walking
- deaths from injury cause anguish among family and friends
155
IP+C - health promotion program
NATIONAL SLIPS + FALLS PREVENTABLE PROJECT
a federal government program that provides resources to health professionals and consciousness about preventing falls among the elderly
156
NHPA - cardiovascular health
refers to the health of the heart and blood vessels.
| The aim of this NHPA is to promote cardiovascular health in the entire population, not just those with CVD
157
cardiovascular health - why is it an NHPA ?
- 3.1 million reported having a chronic condition (20011 -12)
- highest recorded was hypertension with 9.5% of people
having it
- 2012, cvd accounted for 30% of deaths
- many determinants contributing to CVD are preventable and modifiable
- CVD costs healthcare system $7.7 billion
158
list biological determinants - cardiovascular health
- body weight
| - blood pressure
159
cardiovascular health - biological - body weight
being overweight usually places greater strain on heart and increases risk of hypertension and high blood cholesterol
160
cardiovascular health - biological - blood pressure
high blood pressure is an indicator that the heart is already working harder to pump the blood and increase risk of heart attack and stroke
161
list behavioural determinants - cardiovascular health
- tobacco smoking
| - excessive alcohol consumption
162
cardiovascular health - behavioural - tobacco smoking
increases blood pressure and contributes to plaque build up on artery walls
163
cardiovascular health - behavioural - excessive alcohol consumption
alcohol contains high amounts of kilojoules. If they are not used it increases chance of becoming overweight and consequentially the risk of CVD increases
164
list physical environment determinants - cardiovascular health
- access to recreational facilities
| - work environment
165
cardiovascular health - physical environment - access to recreational facilities
if an individual lacks access to recreational facilities such as gyms, bike paths, they may not exercise as much
This may increase risk of obesity and CVD
166
list social determinants - cardiovascular health
- food insecurity
| - low ses
167
cardiovascular health - social - food insecurity
if an individual cannot afford or access a healthy food supply they may rely on processed foods which can contain high levels of: fat, sugar, salt and low fibre contributing to obesity and CVD
168
cardiovascular health - social - low ses
people with lower ses are more likely to be overweight and are therefore more likely to be suffering from CVD
Also have higher rates of smoking which increases rates
169
cardiovascular health - direct costs
individuals
- ambulance transport in case of heart attack
- patient co payments for medication to lower blood pressure
- copayments for doctors/ specialists
community
- health promotion program e.g., live lighter
- medicare contributions
- PBS for medication
- private health insurance for hospitals etc
170
cardiovascular health - indirect costs
individual
- changes to living conditions eg. if wheel chair is required
- social / financial changes eg. having to hire someone for domestic duties
community
- lost productivity
- cost of carers
- social security/ government payments if not working
171
cardiovascular health - health promotion program
GO FOR 2 AND FIVE
a joint program of the federal, state and territory governments supported by organisations that promote the consumption of two swerves of fruit and five vegetable per day
172
general examples of direct costs ( individual and community)
```
INDIVIDUAL
- ambulance transport
- diagnostic tests
- doctor / specialists
- surgery/ hospital
- medication
COMMUNITY
- health promotion programs
- costs funded through PBS
```
173
general examples of indirect costs (individual and community)
```
INDIVIDUAL
- loss of income
- employing hired help
- transport costs
COMMUNITY
- loss of productivity
- loss of taxation revenue
- social security payments
- welfare
```
174
general examples of intangible costs (individual and community)
INDIVIDUAL
-pain and suffering
- stress
- loss of self esteem
COMMUNITY
- loss of participation in community activities
- emotional impacts on friends and family
