During the last 25 years of the Cold War, life expectancy in Central and Eastern Europe fell behind that in the West, opening up a `life expectancy gap' between East and West. The decline was unprecedented, and the situation deteriorated even further immediately after 1989, the year of political liberalization. This text considers the determinants of health in its exploration of the life expectancy gap. It examines the contributions of environmental pollution, adverse lifestyle choices, inadequate health care services, and the stresses of the social and economic environment both before and after political liberalization. The picture that emerges is much more complex than has been conveyed in the media. The primary role of the social and economic environment is highlighted, but the subsidiary role of other health determinants is affirmed.