| Summary: | The USSR came to an end in 1991, after almost 75 years ofexistence. Over the preceding • decade, it had become apparent that, in terms of health, the USSR had been a failure. Life expectancy was steadily declining, at a time when life expectancy in the west had been increasing rapidly. After the USSR broke apart, the decline in life expectancy accelerated rapidly. It continues to decline, except in the three Baltic republics that joined the European Union in 2004, where it is now improving. This thesis brings together a body ofwork that has sought to understand the low life expectancy in this region and the changes that have taken place since 1991. It begins by describing the evolving pattern ofmortality in this region, looking at changes over time. It continues by exploring how mortality is patterned by social factors, noting how those who are least advantaged have suffered most. The main part ofthe thesis examines some ofthe main risk factors: nutrition and physical activity; the environment; infectious disease; tobacco; and alcohol. The traditional Soviet diet is high in fat and low in micronutrients. The adoption ofhealthy diets is constrained by both prevalent beliefs about what a healthy diet is as well as high levels offood insecuri!y. Smoking rates among men are high and, unlike in the west, are not falling. Traditionally low rates among women are increasing rapidly in many countries, a change that has been accompanied by aggressive marketing by international tobacco companies. However alcohol emerges as the most important reason for the rapid decline in life expectancy in the 1990s, due largely to the pattern ofheavy episodic consumption, which drives deaths from injuries, cardiovascular disease, and alcohol poisoning. Finally, the legacy ofthe Soviet health system has prevented the delivery of health care that couId prevent many premature deaths.
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