The serious environmental problems caused by decades of Communist mismanagement of natural resources in countries of Central and Eastern Europe have been brought to light in recent years. All environmental media, including air, water, food, and soil have been burdened with toxic chemicals. Large segments of the population have been, and are now being exposed to air pollution levels exceeding guidelines established by western countries and by international health organizations. This review focuses on epidemiologic evidence regarding health effects of poor air quality in Central and Eastern Europe. It appears that short-term high levels of air pollutants (primarily particulates and SO2) may increase mortality in sensitive parts of the population. Associations were also seen between air pollution levels and prevalence of respiratory diseases as well as lung function disturbances in adults and children. One study indicated that urban air pollution increased the risk of lung cancer. Several investigations pointed to strong interactions between risk factors. The poor scientific standard of the studies often makes it difficult to evaluate the findings. Several steps should be taken to develop environmental epidemiology in Central and Eastern Europe, including international collaboration in research projects and training.