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Cover: Trends in life expectancy at birth for males in selected New Independent States and the European Union. Figure 2.3 in Health in Europe: The 1993/1994 Health for All Monitoring Report. WHO regional publications, European series, no. 56. World Health Organization, 1994.
COMMITTEE ON POPULATION 1994-1997
RONALD D. LEE (Chair),
Department of Demography, University of California, Berkeley
CAROLINE H. BLEDSOE,
Department of Anthropology, Northwestern University
* JOSÉ LUIS BOBADILLA,
Inter-American Development Bank, Washington, D.C.
JOHN BONGAARTS,
The Population Council, New York
JOHN B. CASTERLINE,
The Population Council, New York
KENNETH H. HILL,
Department of Population Dynamics, Johns Hopkins University
DEAN T. JAMISON,
Center for Pacific Rim Studies, University of California, Los Angeles
LINDA G. MARTIN,
RAND, Santa Monica, California
JANE MENKEN,
Population Studies Center, University of Pennsylvania
ROBERT A. MOFFITT,
Department of Economics, Johns Hopkins University
MARK R. MONTGOMERY,
The Population Council, New York
W. HENRY MOSLEY,
Department of Population Dynamics, Johns Hopkins University
ALBERTO PALLONI,
Department of Sociology, University of Wisconsin, Madison
ANNE R. PEBLEY,
RAND, Santa Monica, California
RONALD R. RINDFUSS,
Carolina Population Center, University of North Carolina, Chapel Hill
JAMES SMITH,
RAND, Santa Monica, California
BETH J. SOLDO,
Department of Demography, Georgetown University
MARTA TIENDA,
Population Research Center, University of Chicago
AMY O. TSUI,
Carolina Population Center, University of North Carolina, Chapel Hill
JOHN G. HAAGA, Director
BARNEY COHEN, Research Associate
CHRISTINE COSTELLO, Program Officer
TRISH DeFRISCO, Senior Project Assistant
JOEL ROSENQUIST, Senior Project Assistant
M. FAITH MITCHELL, Division Director
JANINE BILYEU, Division Administrative Associate
CONTRIBUTORS
BARBARA A. ANDERSON, Population Studies Center, University of Michigan
EDUARDO E. ARRIAGA, Center for International Research, U.S. Bureau of the Census, Washington, D.C.
*JOSÉ LUIS BOBADILLA, Inter-American Development Bank, Washington, D.C.
CHRISTINE A. COSTELLO, National Research Council, Washington, D.C.
W. WARD KINGKADE, Center for International Research, U.S. Bureau of the Census, Washington, D.C.
ALAN D. LOPEZ, Programme on Substance Abuse, World Health Organization, Geneva
FRANCE MESLÉ, Institut National d'Études Démographiques, Paris
CHRISTOPHER J.L. MURRAY, Center for Population and Development, Harvard University
ALEXANDER NEMTSOV, Institute of Psychiatry, Health Care Ministry of the Russian Federation, Moscow
RAJESH V. PATEL, Albany Medical College
THOMAS A. PEARSON, Mary Imogene Bassett Research Institute, Columbia University
JOHN P. PIERCE, Cancer Prevention and Control Program, University of California, San Diego
BARRY POPKIN, Carolina Population Center and Department of Nutrition, University of North Carolina, Chapel Hill
ALEXANDER PROKHOROV, M.D. Anderson Cancer Center, University of Texas
PEKKA PUSKA, Division of Health and Chronic Disease, National Public Health Institute, Helsinki
VLADIMIR M. SHKOLNIKOV, Institute for Forecasting the National Economy, Russian Academy of Science, Moscow
BRIAN D. SILVER, Department of Political Science, Michigan State University
VLADIMIR G. TREML, Department of Economics, Duke University
JACQUES VALLIN, Institut National d'Études Démographiques, Paris
SERGEI A. VASSIN, Institute for Forecasting the National Economy, Russian Academy of Science, Moscow
NAMVAR ZOHOORI, Carolina Population Center and Department of Nutrition, University of North Carolina, Chapel Hill
Contents
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Premature Death in the New Independent States: Overview |
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I |
Mortality Profiles |
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Mortality Levels, Patterns, Trends, and Quality of Data |
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Recent Trends in Life Expectancy and Causes of Death in Russia, 1970-1993 |
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Spatial, Age, and Cause-of-Death Patterns of Mortality in Russia, 1988-1989 |
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Issues of Data Quality in Assessing Mortality Trends and Levels in the New Independent States |
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Cause-of-Death Contributions to Loss of Potential Life |
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Mortality in the New Independent States: Patterns and Impacts |
Epidemiological Transitions in the Former Socialist Economies: Divergent Patterns of Mortality and Causes of Death |
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II |
Adult Health Interventions |
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Alcohol |
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Soviet and Russian Statistics on Alcohol Consumption and Abuse |
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The Anti-Alcohol Campaign and Variations in Russian Mortality |
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Tobacco |
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Mortality from Tobacco in the New Independent States |
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Cigarette Smoking and Priorities for Tobacco Control in the New Independent States |
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Tobacco Control Policy Strategies: Lessons from Western Developed Countries |
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Diet |
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Nutritional Risk Factors in the Former Soviet Union |
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Chronic Disease Prevention in the New Independent States: Finnish Experiences |
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Diet Modification and Food Policy Strategies: What Works? |
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Preface
With support from the Office of Health and Nutrition and the NIS Bureau of the U.S. Agency for International Development, the Committee on Population of the National Research Council organized two workshops to discuss premature death in the New Independent States and policies for controlling excess mortality. The Workshop on Mortality and Disability in the New Independent States and the Workshop on Adult Health Priorities and Policies in the New Independent States were held in September and November 1994, respectively. This volume includes an overview and revised versions of 13 of the papers that were presented; the workshop agendas are presented as appendices.
The National Research Council Committee on Population has a sustained interest in changes in mortality profiles among developing countries. In the late 1980s, the committee organized a workshop to analyze the measurement of adult mortality in developing countries. In 1991, a workshop was held to discuss the policy and planning implications of the epidemiological transition in developing countries, and a volume of selected workshop papers was published. In 1992, the committee convened a small group of experts to examine measures for controlling noncommunicable diseases. The present volume builds on these previous activities, with a regional focus on the New Independent States.
The volume is organized in two parts, following the sequence of the two workshops: the first deals with the magnitude, trends, and causes of premature death, while the second addresses the proximate determinants of the diseases and injuries that cause the greatest number of premature deaths and measures for their reduction. The overview presents the basic concepts used to structure the vol-
ume, provides contextual information on the New Independent States, and summarizes the main findings of the chapters that follow.
Health policymakers of the New Independent States and international health organizations interested in the social development of the region are an important audience of this volume. With them in mind, discussions of the quality of the data and methods used to estimate mortality are included in many chapters because of the uncertainty surrounding the availability and reliability of vital statistics in the region. Demographers and epidemiologists will also find these sections useful. This volume should be of interest as well to health specialists and decision makers in other middle-income countries where chronic diseases and injuries are increasing in their importance on the public health agenda.
The committee wishes to thank the Office of Health and Nutrition of the U.S. Agency for International Development for supporting the workshops. Catherine Gordon, Julie Klement, Petra Reyes, and James Sheppard of USAID provided both insight and support for the project. A planning meeting, at which the foundation of the workshops was developed, included José Luis Bobadilla, Nicholas Eberstadt, Robert Emery, Ward Kingkade, Julie Klement, Ronald Lee, Christopher Murray, Barry Popkin, Scott Radloff, Petra Reyes, James Sheppard, Brian Silver, Beth Soldo, and Anatoly Zoubanov. We are especially grateful to the workshop participants, who were responsible for the papers, presentations, and discussions. José Luis Bobadilla chaired the meetings. Yuri M. Komarov provided valuable guidance on the NIS perspective at the meetings. The committee is grateful to Christine Costello, John Haaga, and Faith Mitchell for their time and effort in developing the workshops and this volume. Christine Costello organized the original planning meeting, and Susan Shuttleworth provided administrative assistance. Trish DeFrisco, Paula Melville, and Joel Rosenquist ably performed logistical tasks for the workshops and administrative tasks for the project. Gregory Ioffe helped with translations and editing of several papers, as well as contributing to the workshop discussions. Rona Briere edited the volume for greater clarity; Tracy Armstrong, Janine Bilyeu, and Christine McShane prepared it for publication.
RONALD D. LEE, CHAIR
COMMITTEE ON POPULATION
José Luis Bobadilla
1955-1996
This volume is dedicated to our colleague José Luis Bobadilla, who died as it neared completion.
José Luis Bobadilla Fernandez was born in Mexico City. He received his medical and surgical degree from the Universidad Nacional Autónoma de Mexico in 1978, and a Master of Science in Community Medicine and Ph.D. in Health Care Epidemiology from the London School of Hygiene and Tropical Medicine in 1986. He served as chief of the Health Statistics Department in the Mexican budget and planning agency during and for a short time after his medical studies. From 1984 till 1991 he worked at the Center for Research in Public Health at the Instituto Nacional de Salud Publica (INSP) in Mexico City, first as a researcher and then as center director. He was also a professor in the medical faculty of the Universidad Nacional Autónoma. In 1991 he went to the World Bank as senior health specialist, and in March 1996 he joined the Inter-American Development Bank as principal health specialist.
José Luis had an exceptionally active career as scholar, teacher, and policy adviser. He wrote his doctoral dissertation on the quality of perinatal medical care in Mexico City, and for years was one of the leading researchers in the neglected field of perinatal mortality in developing countries. Much of his work dealt with evaluations of the effectiveness of antenatal, obstetric, and neonatal
health care. He was one of the first to document the harmful effects of inappropriate use of obstetric interventions. With colleagues at the INSP and the World Bank, he wrote several important analyses of the epidemiologic transition in Latin America. He was a coauthor of the influential 1993 World Development Report, Investing in Health , and in recent years was one of the leaders in both developing and applying new ways to use mortality and disability statistics and cost-effectiveness analysis for health planning in developing countries.
José Luis was a particularly energetic and constructive member of the National Research Council's Committee on Population and its Panel on Reproductive Health. He valued professional and public service and was a member and fellow of many special committees and associations. His tragically early death was mourned by friends he had made among colleagues all over the world, in an astounding number of different institutions and policy and research networks. He combined an ability to carry out research and an ability to discern the important points for health policy in a way that very few can equal. We particularly remember him as a friend who always steered the discussion toward important topics, never losing sight of the goal: to make a difference in public health.
RONALD D. LEE, CHAIR
COMMITTEE ON POPULATION