This growing body of evidence from Russia had led to the findings highlighted in this slide.

However, until recently, most of the studies in this area have been ecological in nature there is still much uncertainty about the relative importance and inter-relationship between the factors that are thought to underpin the fall in life expectancy.

The proposed mechanisms by which these factors impact on health tie in with what we know about the determinants of health based largely on evidence from the west:

- the important impact of socioeconomic well being on health;

- that psychosocial stressors such as control over life and stressful life events have a negative impact on morbidity and mortality, their impact apparently buffered by social support.

As you might imagine, documenting inequalities in health was not top of the political agenda in Soviet Union and thus, the impact of socio-economic factors on health here is less clear than in the west. Similarly the impact of psychosocial stressors such as stressful life events comes largely from the west. We therefore wanted to examine these factors in Ukraine.