As with any type of drug abuse, there are effects on a society that can be assessed using a couple of different approaches developed in the late 1970's by the United States Public Health Service. One is the cost of illness approach, which seeks to determine how much productivity is lost when an individual is unable to go to work, support him or herself, and generally function effectively in the economy. Cost of illness applies whether the discussion is centered on drug abuse, or even legal activities such as smoking, that have an impact on one's overall well being. Rising health insurance rates and medical costs fit into this framework, because one who is chronically ill, whether from drug related issues or other problems, will require more from the medical and health insurance institutions. Another approach, the External Social Cost Framework, seeks to quanitfy things such as earnings, which may be substantially lower for someone struggling with drug abuse, and situations such as traffic accidents and fatalities caused by persons under the influence, additional strain on the criminal justice system, and rate increases for collision insurance caused by people who make an inordinate number of claims or cause more than their share of problems for others on the road.