The collapse of the former Soviet Union in 1991 has had enormous implications for health. Life expectancy in Ukraine took a rapid and unprecedented decline in the early 1990s mirroring the more widely documented decline seen in Russia and other Newly Independent States. Although this short-term impact on health has been well documented, little thought has yet been given to the longer term impacts of these changes. Of particular concern in this regard is the impact of trade liberalisation and foreign direct investment, particularly when the tobacco and alcohol industries are amongst the first to invest in a region whose high rates of premature mortality from alcohol and tobacco are already well documented.