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      Noncommunicable disease mortality in the Russian Federation: from legislation to policy Translated title: Mortalité par maladies non transmissibles dans la Fédération de Russie: de la législation à la politique Translated title: La mortalidad por enfermedades no transmisibles en la Federación de Rusia: de la legislación a la política

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          Abstract

          Political, social and economic transitions that occurred as a result of the regime change in Eastern Europe and the Russian Federation from the late 1980s to the early 1990s led to a sudden increase in mortality across the region, with more than 80% of deaths being attributable to preventable causes, such as cardiovascular disease, lifestyle factors and injuries. The Russian Federation has experienced some of the most dramatic population declines in the world. Countrywide health reforms have been implemented, although they continue to ignore the impact of the epidemic of noncommunicable diseases (NCDs) in the Russian Federation. Improvements in mortality patterns in the Russian Federation are possible only with the broader engagement of organized nongovernmental groups within the civil society that is strongly supported by Federal legislation to address NCDs. We discuss the Russian Federal legislation germane to the prevention and control of NCDs in the light of the current mortality crisis and suggest possible policy responses to this crisis.

          Translated abstract

          Les transitions politiques, sociales et économiques qui se sont opérées en Europe de l'Est et dans la Fédération de Russie sous l'effet du changement de régime entre la fin des années 1980 et le début des années 1990 ont conduit à une augmentation brutale de la mortalité dans l'ensemble de la région, avec plus de 80 % des décès imputables à des causes pouvant faire l'objet d'une prévention, telles que les maladies cardiovasculaires, les facteurs liés au mode de vie et les traumatismes. La Fédération de Russie a vécu certains des plus forts déclins de population enregistrés dans le monde. Des réformes de la santé ont été mises en œuvre à l'échelle du pays, mais elles continuent à ignorer l'impact de l'épidémie de maladies non transmissibles (MNT) dans la Fédération. Face à ces maladies, seul un engagement plus large de groupes non gouvernementaux organisés au sein de la société civile, bénéficiant d'un fort soutien de la législation fédérale, pourrait améliorer les schémas de mortalité russes. L'article examine la législation fédérale actuelle se rapportant à la prévention et à la maîtrise des MNT à la lumière de la crise de mortalité vécue à ce jour et propose des réponses politiques possibles à cette crise.

          Translated abstract

          Las transiciones política, social y económica que trajeron consigo los cambios de regímen en Europa oriental y la Federación de Rusia entre finales de los años ochenta y principios de los noventa produjeron un aumento súbito de la mortalidad en toda la región; más del 80% de esas defunciones son atribuibles a causas prevenibles, como las enfermedades cardiovasculares, factores relacionados con el modo de vida y los traumatismos. La Federación de Rusia ha sufrido una de las disminuciones de población más marcadas registradas en el mundo. Aunque se han implementado reformas sanitarias en todo el país, éstas siguen ignorando el impacto de la epidemia de enfermedades no transmisibles (ENT) en la Federación de Rusia. Sólo será posible mejorar las pautas de mortalidad en este país si se logra una participación amplia de grupos no gubernamentales organizados dentro de la sociedad civil, con el sólido respaldo de una legislación federal contra las ENT. Examinamos la legislación de la Federación de Rusia relacionada con la prevención y el control de las ENT a la luz de la actual crisis de mortalidad, y sugerimos posibles respuestas de política ante esa crisis.

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          Most cited references83

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          Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what?

          According to published data, between 1984 and 1994 mortality rates in Russia initially underwent a rapid decline followed by an even steeper increase. In 1994, male life expectancy at birth was 57.6 years, having fallen by 6.2 years since 1990. There has been concern that such striking fluctuations in mortality are an artefact, although, among other factors, alcohol consumption has been implicated. We analysed the age-specific and cause-specific patterns of mortality decrease and increase by use of data from a newly reconstructed mortality series for Russia so that we could examine the plausibility of various explanations for the mortality trends. All major causes of death, with the exception of neoplasms, showed declines in mortality between 1984 and 1987 and increases between 1987 and 1994. In relative terms, these tended to be largest for the age-group 40-50 years; surprisingly, they were of the same magnitude among women and men. The largest declines and subsequent increases in proportional terms were observed for alcohol-related deaths and accidents and violence. However, pronounced effects were also seen for deaths from infections, circulatory disease, and respiratory disease. No substantial variations were seen for neoplasms. The stability of mortality from neoplasms in contrast to other causes over the period 1984-94 largely precludes the possibility that the changes in life expectancy are mainly an artefact, particularly one due to underestimation of the population. Although factors such as nutrition and health services may be involved, the evidence is that substantial changes in alcohol consumption over the period could plausibly explain the main features of the mortality fluctuations observed. These results provide a major challenge to public health in Russia and to our understanding of the determinants of alcohol consumption and its role in explaining mortality patterns within and between many other countries.
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            Globalisation and the prevention and control of non-communicable disease: the neglected chronic diseases of adults.

            The growing global burden of non-communicable diseases in poor countries and poor populations has been neglected by policy makers, major multilateral and bilateral aid donors, and academics. Despite strong evidence for the magnitude of this burden, the preventability of its causes, and the threat it poses to already strained health care systems, national and global actions have been inadequate. Globalisation is an important determinant of non-communicable disease epidemics since it has direct effects on risks to populations and indirect effects on national economies and health systems. The globalisation of the production and marketing campaigns of the tobacco and alcohol industries exemplify the challenges to policy makers and public health practitioners. A full range of policy responses is required from government and non-governmental agencies; unfortunately the capacity and resources for this response are insufficient, and governments need to respond appropriately. The progress made in controlling the tobacco industry is a modest cause for optimism.
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              Causes of declining life expectancy in Russia.

              Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. Mortality and natality data from the vital statistics systems of Russia and the United States. Russia, 1990-1994. Entire population of Russia. Mortality rates, life expectancy, and contribution to change in life expectancy. Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.
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                Author and article information

                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra, Genebra, Switzerland )
                0042-9686
                November 2004
                : 82
                : 11
                : 872-880
                Affiliations
                [01] San Francisco CA orgnameUniversity of California orgdiv1Institute of Global Health USA
                Article
                S0042-96862004001100013 S0042-9686(04)08201113
                115da7ea-afe6-4194-bdf3-5336b142304b

                History
                : 29 September 2003
                : 24 March 2004
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 42, Pages: 9
                Product

                SciELO Public Health

                Self URI: Full text available only in PDF format (EN)
                Categories
                Policy and Practice

                Fédération de Russie,Federación de Rusia,Política de salud,Tabaquismo,Promoción de la salud,Reforma en atención de la salud,Legislación sanitaria,Enfermedades cardiovasculares,Enfermedad crónica,Russian Federation,Health policy,Smoking,Health promotion,Health care reform,Legislation, Health,Cardiovascular diseases,Chronic disease,Politique sanitaire,Tabagisme,Promotion santé,Réforme domaine santé,Législation sanitaire,Maladies,Cardiovasculaire,Maladie chronique

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