Understanding population health: lessons from the former Soviet Union.

The collapse of the Soviet Union was a massive natural experiment that has provided many insights that help our understanding of the determinants of population health. This paper identifies a series of lessons learnt from this experience: (1) Rapid transition can damage health. (2) When undertaking comparative research, it is essential to have a common understanding of what different terms mean in different places. (3) When looking at exposures and outcomes, it is important to appreciate that the delay between exposure to a risk factor and the appearance of disease can range from almost none to several decades. (4) Contrary to the views of some commentators, modern healthcare has made a substantial contribution to the health of populations in industrialised countries. (5) Science can flourish only where it is free from ideology. (6) Public health and basic science achieve most when they work together. (7) Without functioning democracy, the outlook for better health is poor.