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Tobacco is one of the public health disasters of the 20th century. It is the single most important cause of preventable death in the world and with spiralling rates of tobacco consumption world wide it is estimated that the number of deaths attributed to tobacco each year will increase from 3M in 1990 to 10 M by 2030. Moreover, the burden of these deaths will gradually shift from high to low and middle income countries so that by 2030, 7 out of 10 of these deaths will be in low income countries.

The situation in the former Soviet Union is particularly worrying. Not only is the risk of dying from tobacco in middle aged males approximately twice as high in the former socialist than other OECD countries (as shown here), but between 1965 and 1995 mortality from tobacco increased in the former socialist countries whilst declining elsewhere.