The Soviet Union collapsed in 1991, precipitating immense political, economic and social changes-a transition to democracy (albeit imperfect), a sudden transfer from a command to a market economy, and the destruction of the Soviet socialist infrastructure on which the population had relied. The enormous and largely negative immediate effect of these developments on health has now been well documented, but relatively little thought has yet been given to their long-term impact on health.1 Of particular concern in this regard are the overwhelming changes to the region’s tobacco industry, most notably, the rapid and unregulated entry of the multi-national and transnational tobacco companies (TTCs) and the privatization of the state-owned tobacco monopolies, in many cases under immense pressure from the international fi nancial community.2 Not only is the detrimental effect on health from tobacco enormous, killing one in every two of its long-term users, but the former Soviet Union (FSU) had the highest rate of premature mortality of any part of the European region even before the political transition.3