This article argues that the health-related Millennium Development Goals do not appropriately address the challenges faced by the countries of Eastern Europe and Central Asia. By ignoring adult mortality, their achievement would result in relatively small gains in life expectancy. To achieve greater impact, policies in this region must supplement the classical Millennium Development Goals with indicators of adult health, in particular cardiovascular diseases and external causes of death. In addition, countries, with support from the international community, must improve the quality of vital registration data to enable more accurate estimation of the disease burden.