If Frank Dobson provided the up-beat message, Richard Alderslade, regional adviser for partnerships in health at the World Health Organisation European regional office, came up with the gloom. He focused attention on the state of public health in the newly independent states of the Russian Federation where the average man has a life expectancy lower than the retirement age. The economic collapse in the Russian Federation has seen a 'catastrophic reduction' in life expectancy, and life in the newly independent states is 'sheer unadulterated misery', he said. The 150 million population will fall by 10 million over the next 10 years as a result of the socioeconomic and political changes. 'It is probable that such precipitous reductions in life expectancy are historically unparalleled. There has been a year- on-year reduction in gross domestic product of 15-20 per cent.'

Some 30-40 per cent of the deaths can be linked with social and economic factors, 30-40 per cent with lifestyle issues (there has been a huge rise in tobacco and alcohol use), and 10 per cent each with the increasingly sorry state of the health services and the contaminated state of the environment.

Things could be done, but WHO could not do them alone; it had to work with international organisations, including the World Bank. Public health leadership was vital.

'There is a growing public health competence within the EU.' WHO's goal must be to co-ordinate these contributions.