Tobacco kills nearly 6 million people each year, of whom more than 5 million are from direct tobacco use and more than 600 000 are non-smokers exposed to second-hand smoke (WHO, 2015). Tobacco is a major risk factor for at least two of the leading causes of premature mortality – cardiovascular diseases and cancer, increasing the risk of heart attack, stroke, lung cancer, cancers of the larynx and mouth, and pancreatic cancer, among others. In addition, it is a dominant contributing factor for respiratory diseases such as chronic obstructive pulmonary disease (US DHHS, 2014). Smoking in pregnancy can lead to low birth weight and illness among infants. Smoking remains the largest avoidable risk factor for health in OECD countries and worldwide.

The health burden related to harmful alcohol consumption, both in terms of morbidity and mortality, is considerable in most parts of the world (Rehm et al., 2009; WHO, 2014; OECD, 2015). Alcohol use is associated with numerous harmful health and social consequences, including an increased risk of a range of cancers, stroke, and liver cirrhosis, among others. Foetal exposure to alcohol increases the risk of birth defects and intellectual impairment. Alcohol also contributes to death and disability through accidents and injuries, assault, violence, homicide and suicide. The use of alcohol is estimated to cause more than 3.3 million deaths worldwide per year, and accounts for 5.1% of the global burden of disease (WHO, 2014). Health care costs associated with excessive drinking in the United States are estimated at USD 25.6 billion (Bouchery et al., 2011). In the Russian Federation, alcohol misuse was a major contributing factor to the sharp rise in premature mortality and decline in life expectancy during the 1990s (OECD, 2012). The use of alcohol also has broader societal consequences, accounting for large losses in work productivity through absenteeism and premature mortality, as well as injuries and death among non-drinkers (e.g. because of traffic accidents caused by drivers under the influence of alcohol).

Nutrition is an important determinant of health. Insufficient consumption of fruit and vegetables is one factor that can play a role in increased risk of morbidity (Bazzano et al., 2003; Riboli and Norat, 2003). Food insecurity, that is the inability to afford enough food for a healthy and active life, is also associated with adverse health effects (Seligman et al., 2010). Proper nutrition assists in preventing a number of chronic conditions, including cardiovascular disease, hypertension, type-2 diabetes, stroke, certain cancers, musculoskeletal disorders and a range of mental health conditions.

Obesity is a known risk factor for numerous health problems, including hypertension, high cholesterol, diabetes, cardiovascular diseases, respiratory problems (asthma), musculoskeletal diseases (arthritis) and some forms of cancer. The rise in overweight and obesity is a major public health concern, threatening progress in tackling cardiovascular diseases (OECD, 2015).

Children who are overweight or obese are at greater risk of poor health in adolescence, as well as in adulthood. Among young people, orthopaedic problems and psychosocial problems such as low self-image, depression and impaired quality of life can result from being overweight. Excess weight problems in childhood are associated with an increased risk of being an obese adult, at which point cardiovascular disease, diabetes, certain forms of cancer, osteoarthritis, a reduced quality of life and premature death become health concerns (Lobstein, 2010; Currie et al., 2012).