The health of populations is determined more by the social and economic determinants of health than by changes in technology, health services or short-term policy interventions. In the near future, there is likely to be a significant shortfall in energy supply, resulting in high energy prices and a reversal of many of the aspects of globalization that are currently taken for granted. If this happens, economic recession and restructuring could have a negative impact on health, not dissimilar to that experienced by the former Soviet Union when it attempted a rapid change in its economy. There is, however, the potential, through economic planning and sustainable development, to reduce the adverse effects of this change and use this opportunity to impact on a range of diseases which are, at least in part, caused by overconsumption, inequality and loss of community.