prevalence of smoking and clinical manifestations of and deaths from the disease. Other cancers (digestive organs, breast) also have a pronounced impact.

In Central Asia, in contrast, ischemic heart disease and cerebrovascular disease are responsible for just 13 percent of total potential years of life lost. Communicable diseases and maternal and perinatal causes constitute 53 percent of the total burden of mortality in these states: respiratory infections (among adults and children) account for 29 percent of the total mortality burden, followed by infectious and parasitic diseases (largely diarrhea, hepatitis, and tuberculosis) and perinatal causes at 15 and 9 percent, respectively. Communicable diseases—again consisting largely of respiratory infections—and perinatal causes account for only 11 percent of losses in the European region.

Together with cardiovascular disease, injuries are the predominant cause of adult death in the NIS. While standardized mortality rates for cardiovascular disease are substantially higher, injuries make a significant contribution to loss of life. In the European region, 24 percent of all potential years of life lost is due to injuries. Motor vehicle accidents and suicide are the biggest killers, representing 7 and 5 percent of the total burden of mortality, respectively. Homicide is also responsible for a significant number of premature deaths. In the states of Central Asia, injuries explain a smaller percentage of deaths (12 percent) than in the European states, with motor vehicle accidents and drowning dominating.

An analysis by Russian scientists adds an interesting element to the analysis of health priorities (Komarov et al., 1994). To complement an analysis of causes of death that present the largest burden to the working-age population of the NIS, they present an expert evaluation of losses of life that could be prevented taking into account the capacity of the Russian health system to prevent and control the main killers. With this approach, injury still emerges as a major mortality force in both the European and Central Asian NIS. For most states in Central Asia, respiratory disease dominates loss of working potential at 20 to 30 percent of losses (in all but Kazakstan), but injury is responsible for 18 to 35 percent of losses (in all but Tajikistan). In the European states, injury accounts for 35 to 50 percent of working potential losses, while cardiovascular disease is generally responsible for 10 percent. When one considers the capacity of the health care system, respiratory disease, considered to be largely manageable by existing health care, becomes a higher priority for preventing loss of working potential, while perinatal and congenital causes decrease in importance. Top health care priorities for many of the northern NIS are injury and cardiovascular disease, while those for the Central Asian states are respiratory disease, infectious and parasitic diseases, and injury.

Quality of Mortality Data

Anderson and Silver provide an overview of data quality issues, while the chapters by Kingkade and Arriaga, Murray and Bobadilla, and Shkolnikov, Meslé,



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