What will the current economic crisis mean for the health of the people of Northern Ireland? We review the experience of three major economic crises in the 20(th) century: the Great Depression (1929), the Post-communist Depression (early 1990 s) and the East Asian financial crisis (late 1990 s). Available evidence suggests that health is at risk in times of rapid economic change, in both booms and busts. However the impact on mortality is exacerbated where people have easy access to the means to harm themselves and is ameliorated by the presence of strong social cohesion and social protection systems. On this basis, Northern Ireland may escape relatively unscathed in the short term but as every crisis also provides an opportunity, this is an appropriate time for the Northern Ireland Executive to reflect on whether they are making a sufficient investment in the long term health of their population.