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Since 1997, more than 30 health-risk analyses were conducted using Russian data sets. These studies demonstrated that air pollution is the most important environmental contributor toward morbidity and mortality risk in Russia, with 90% of the total human health risk coming from the criteria pollutants total suspended particulate (TSP), SO2, and NO(x). This article contributes to the ongoing discussion of the magnitude of this health issue in Russia by providing an estimate of both the mortality rate attributed to airborne pollutants and the associated economic damages. The 90% confidence interval of mortality is 46,000-132,000, and the associated economic damages are between 2.6 and 6.5% of gross domestic product (GDP). The largest source of uncertainty in mortality is the concentration-response parameter, accounting for 50-60% of the total variability in the estimate. The point estimate of 87,000 implies that mortality due to airborne pollutants is threefold higher than reported due to tuberculosis, twofold due to transportation accidents, and about the same as that from suicide and homicide combined. By 2002 there was enough evidence regarding potential health hazard and air pollution exposure in Russia to start environmental management reform. In 2004 Russia officially adopted guidelines for health risk analysis associated with air pollution. The next step is to use this health-risk assessment approach as a lead for sensible reforms of the emissions-permit system and environmental finance.