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Improvements in public health can be obtained by eliminating or reducing relatively minor risks which are more or less prevalent in populations. Much larger gains might be possible through even modest reductions of large hazards such as tobacco use. Policies and programmes to reduce tobacco consumption are more likely to be implemented and more likely to be effective if there is direct, disaggregated, and recent local evidence on the extent of tobacco use and its harms. Such evidence might usefully describe several indicators of the tobacco epidemic including the patterns of tobacco consumption by various sectors of the population, how these are changing, the extent of disease caused by tobacco (and how this is changing), as well as the economic costs of tobacco use, direct and indirect.
Public policy responses and advocacy must be based on detailed, reliable information about tobacco use and the extent of diseases caused by it. Just as crude prevalence or consumption figures are not helpful in focusing policy responses, indirect estimates of tobacco-attributable mortality are inadequate in populations where there are high background risks for major diseases caused by smoking. This is likely to be the case in Russia where recorded vascular disease mortality among men is among the highest in the world, and is a principal cause of their extraordinary risk of death, particularly in middle age.1 Estimates for 1990suggest that a man in Russia who reaches the age of 35has a 52% chance of dying before age 70,similar to the risk estimated for sub-Saharan Africa, and substantially higher than the average risk of death (30%) among middle-aged men in Western countries
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