Aims: Socioeconomic health differences have been studied elaborately for many Western societies. Relatively little is know about the social variations in health in the former communist states of Eastern Europe. This study investigated socioeconomic health inequalities in Latvia. Methods: Cross-sectional analysis was undertaken of the 1999 Norbalt-II Living Conditions Survey, a random population-based sample in Latvia, and included males and females aged 25 to 70. Results: Lower educated subjects had higher rates of self-assessed poor health than those with tertiary education (men OR 2.21; 1.31 - 3.71 95% CI, and women OR 2.48; 1.74 - 3.54 95% CI). After adjusting for income, educational differences were significant only for women. Income differences were larger than educational differences in self-assessed poor health for both genders (OR of highest vs. lowest quintile for men: 5.10; 2.26 - 11.5 95% CI, women: OR 3.26; 1.92 - 5.51 95% CI). For longstanding health problems socioeconomic differences were smaller. After adjusting for income no educational differences were found, but income differences were significant (men: OR 2.06; 1.15 - 3.69 95% CI, women: OR 1.42; 1.12 - 2.63 95% CI). The economically non-active were in worse health than the (self-)employed subjects (men: OR 6.12; 3.65 - 10.3 95% CI, women: OR 2.79; 1.66 - 3.39 95% CI). Conclusions: Substantial social inequalities in self-assessed poor health and longstanding health problems exist in Latvia for both sexes. Inequalities by material circumstances, as measured by income, appear to be larger than educational differences. Economic activity was also strongly associated with health. There were no inequalities with regard to urbanization and ethnic differences were found only for long-standing health problems among women.