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--> Premature Death in the New Independent States José Luis Bobadilla, Christine A. Costello, and Faith Mitchell, editors Committee on Population Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1997
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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council. This project was supported by the Office of Health, U.S. Agency for International Development. Any opinions, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for the project. Library of Congress Catalog Card No. 97-67217 International Standard Book Number 0-309-05734-5 Additional copies of this report are available from National Academy Press, 2101 Constitution Avenue N.W., Box 285, Washington, D.C. 20055. Call 800-624-6242 or 202-334-3313 (in the Washington metropolitan area), http://www.nap.edu Printed in the United States of America Copyright 1997 by the National Academy of Sciences. All rights reserved. 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.
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--> 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 * Deceased
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--> 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 * Deceased
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--> Contents Preface vii Dedication ix 1 Premature Death in the New Independent States: Overview José Luis Bobadilla and Christine A. Costello 1 I Mortality Profiles Mortality Levels, Patterns, Trends, and Quality of Data 2 Recent Trends in Life Expectancy and Causes of Death in Russia, 1970-1993 Vladimir M. Shkolnikov, France Meslé, and Jacques Vallin 34 3 Spatial, Age, and Cause-of-Death Patterns of Mortality in Russia, 1988-1989 Sergei A. Vassin and Christine A. Costello 66 4 Issues of Data Quality in Assessing Mortality Trends and Levels in the New Independent States Barbara A. Anderson and Brian D. Silver 120 Cause-of-Death Contributions to Loss of Potential Life 5 Mortality in the New Independent States: Patterns and Impacts W. Ward Kingkade and Eduardo E. Arriaga 156
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--> 6 Epidemiological Transitions in the Former Socialist Economies: Divergent Patterns of Mortality and Causes of Death Christopher J.L. Murray and José Luis Bobadilla 184 II Adult Health Interventions Alcohol 7 Soviet and Russian Statistics on Alcohol Consumption and Abuse Vladimir G. Treml 220 8 The Anti-Alcohol Campaign and Variations in Russian Mortality Vladimir M. Shkolnikov and Alexander Nemtsov 239 Tobacco 9 Mortality from Tobacco in the New Independent States Alan D. Lopez 262 10 Cigarette Smoking and Priorities for Tobacco Control in the New Independent States Alexander V. Prokhorov 275 11 Tobacco Control Policy Strategies: Lessons from Western Developed Countries John P. Pierce 287 Diet 12 Nutritional Risk Factors in the Former Soviet Union Barry Popkin, Namvar Zohoori, Lenore Kohlmeier, Alexander Baturin, Arseni Martinchik, and Alexander Deev 314 13 Chronic Disease Prevention in the New Independent States: Finnish Experiences Pekka Puska 335 14 Diet Modification and Food Policy Strategies: What Works? Thomas A. Pearson and Rajesh V. Patel 355 Appendix Workshop Agendas 375 Index 381
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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-
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--> 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
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--> 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
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--> 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
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