Conclusions and Recommendations

The serious health and mortality situation in the NIS deserves policy and scientific attention. In none of the states has mortality reduction kept up with the reductions seen in most of the developed world during the last 20 years.

It is beyond the scope of this discussion to provide a comprehensive overview of the data needs in each of the NIS countries. Instead, we have focused on interpreting reported levels and trends in mortality in the region. Consistent with this focus, we make some recommendations here for data collection and improvements in data quality that would strengthen the ability of policymakers to monitor and interpret mortality trends in the region.

As we have indicated, the overall high mortality rates in the NIS, both in the aggregate and by cause, are grounds for concern and action. But because of poor data quality, interventions to improve health conditions that would also improve data quality would be likely to produce equivocal results. For example, efforts to reduce infant mortality rates in Central Asia could also produce more complete reporting of infant deaths. Interventions that were actually lowering infant mortality could lead to apparent increases in infant mortality (or to a slower decrease in infant mortality than was actually occurring)—and perhaps to premature abandonment of policies and programs that were actually working. The same thing could happen in Russia, in which generally lower data quality in some of the predominantly non-Russian regions (e.g., Chechnya, Ingushetia, Daghestan, Balkaria) could disguise actual improvements in infant mortality if these improvements were accompanied by more complete registration of births and infant deaths.

Improvements in the accuracy of reporting of ages of the base population and of the deceased, or more complete registration of deaths, would also be likely to occur if there were a concerted effort to reduce adult mortality. The reported adult mortality rates would probably show a smaller reduction (and possibly even an increase), even while actual adult mortality rates were declining.

Thus, addressing the issue of data quality and building in standards for evaluating program success are essential if one hopes to obtain a realistic picture of program efficacy.

Addressing Data Quality in Russia and the European NIS Countries

Following improvements in mortality among Russian adults between 1980 and 1990, the situation deteriorated at least until 1993. Close attention to changes in mortality in Russia in the post-Soviet era is warranted. The deterioration has been more serious for men than for women. More data that would allow examination of recent mortality trends in Russia and elsewhere in the European NIS countries by age, ethnic group, and cause of death would be very worthwhile.

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