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The impact of alcohol consumption on trends in the European health situation is analysed. Particular attention is given to the impact of alcohol on the widening of the East-West health gap in Europe. It is concluded that between 1950-75 the negative health impact of a rapid increase in per capita alcohol consumption in most European countries was hidden behind a strong positive development in many other socio-economic determinants of health. Between 1980 and 1995, health trends have been more closely parallel to trends in alcohol consumption. Changes in alcohol consumption explain a significant proportion of changes in life expectancy, particularly in the newly independent states of the former Soviet Union. Public health policy on alcohol, as part of a general development of public health policies outside the health sector, is important in reducing the East-West health gap and sustaining the positive health trend in western Europe.