The evolving pattern of avoidable mortality

Life expectancy at birth in Russia is now over 12 years less than in western Europe.1 The reasons for this difference are complex, reflecting the impact of factors acting at different levels and dif-ferent points over the life course. One perspective is provided by the health field concept, which identifies four inputs to health: genetic predisposition; environmental circumstances; individual behaviour and lifestyle; and health services.2 Although a com-bination of environmental and lifestyle factors, in particular the social consequences of rapid transition and excessive alcohol consumption, superimposed on high rates of smoking and poor nutrition, are the major determinants of the burden of disease afflict-ing the countries of the former Soviet Union,3 it is also likely that timely and effective health care could ameliorate their effects