Within societies, health and ill-health follow a social gradient: lower socioeconomic position, worse health. The slope of the gradient has varied over time. It is likely that social and economic circumstances play a role in this changing slope. Within Europe, differences in health between East and West have also varied in magnitude. The advantage in the West increased through the 1970s and 1980s. Although similar in their health trends up to 1989, the countries of central and eastern Europe have diverged quite sharply subsequently. It is again likely that changing social and economic fortunes account for these trends. There is evidence to support the role of psychosocial factors in relating to socioeconomic differences within and between countries.