communicable diseases, the main causes of excess adult mortality in the European NIS are cardiovascular disease and injuries.

This volume describes in depth these reversals in the health of the NIS populations. Specifically, what are the trends, and what causes them to change? What, if anything, can be done about the adverse trends noted above? Chapters 2 through 6 examine the evidence for declining life expectancy in the NIS to determine the magnitude of the decline and the extent to which it is attributable to statistical rather than substantive issues. These chapters explore the nature of the decline—the extent to which it represents a new and sudden change in health conditions or the continuation of an existing trend, whether it is produced by change in one disease pattern or in several, whether it has affected all age groups or selected subpopulations, and whether it has affected all of the states equally. Chapters 7 through 14 examine possible causes for the large number of excess deaths in the NIS. They focus on three key health behaviors—alcohol consumption, tobacco consumption, and diet—and describe preventive health interventions in these three areas that have proven effective in other industrialized countries. Thus, the volume is organized to present a logical progression from mortality patterns by age, sex, and cause of death, to risk factors, to interventions, rather than an exhaustive treatment of any one topic.

This volume brings together the perspectives of several fields of the health and social sciences. Demography, epidemiology, political science, economics, public health, nutrition sciences, and other disciplines all have a contribution to make to our understanding of health changes in populations and to the identification of control measures to mitigate premature mortality. Consolidation of these various perspectives can serve as an important aid to decision makers, who often find it difficult and time-consuming to absorb the main conclusions of scientific research from one discipline, let alone several. Furthermore, cross-disciplinary analysis often identifies new hypotheses, research needs, and information gaps, leading to different findings from those obtained by a single discipline.

Understanding mortality profiles in the NIS and what is producing them is important for at least four reasons. First, there is genuine interest in reducing the suffering and losses of those who die prematurely and their families. Second, economic development in the region is probably hindered by the premature loss of working adults. Third, the NIS experience undoubtedly offers lessons that can help other middle-income countries avoid the re-emergence of premature death. And finally, it is to be hoped that information and knowledge will stimulate more research and action from decision makers to address the problems examined in this volume.

Contributions of the Volume

Assessment of mortality trends in the NIS is much more complex than a straightforward reading of reported death rates. The richness of the papers in the



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