first part of this volume lies in their effort to disaggregate the mortality problem across the NIS; to apply a diversity of perspectives, methodologies, and measures; and to seek a variety of patterns and comparisons.
In the past, information on the demographic and epidemiological dynamics in the NIS has been largely restricted; it was almost completely suppressed between 1975 and 1986. Access to such information increased with the opening up of Soviet society in the mid-1980s. Since that time, however, there has been an increasing awareness of the use of nonstandard definitions, classifications, and methods to estimate demographic parameters in the former Soviet Union. These unusual aspects of mortality data for the NIS have given rise to serious questions about the reliability and validity of the reported levels, trends, and causes of death in the NIS—questions that are addressed in several papers in the volume.
In addition to the above complications, the age and sex profiles of mortality in most of the European NIS are quite distinctive. Those profiles, characterized by low to moderate levels of infant and child mortality and relatively high levels of adult mortality, are not common elsewhere in the world. Therefore, they are addressed in several of the chapters. Causes of death underlying the profiles are examined in detail for Russia, where the needed data are available. The profiles of the northern NIS are not well represented in standard models of mortality in use throughout the world, making it difficult to use standard demographic models to assess the quality of mortality data for these countries, as well as to choose a model for estimating the number of years of life lost to premature mortality.
Epidemiological analysis of causes of death provides essential information on the characteristics of health status changes. Yet while the analysis of noncommunicable diseases suggests clues about lifestyles, it provides only a partial view of health priorities as it reflects immediate and not underlying or contributing causes. Another limitation of mortality analyses is that they fail to capture the sizable losses of healthy life due to disability. The paucity of information on disability and other nonfatal health losses in the NIS prevented authors in this volume from addressing that aspect of the problem.
Underlying the immediate causes of death are proximate determinants or risk factors that need to be analyzed. In general, cause-of-death analysis leads to interventions centered around medical care to reduce the case fatality of diseases or prevent complications of chronic diseases. Analysis of proximate determinants, on the other hand, suggests preventive interventions to reduce the incidence of disease. The second half of this volume is focused on some key proximate determinants of mortality in the NIS. The legacy from the Soviet Union included a widespread medical care system in which there was almost universal coverage, but disease prevention and health promotion, particularly as related to noncommunicable diseases and injury, remained a relatively low priority.
The health policy and planning implications of mortality patterns in the NIS have only recently begun to be widely analyzed. There is a particular need for reliable information to guide policy choices within the international health com-