The impact of economic conditions on mortality in a large transition economy is analysed using county level data (NUTS III) from post-communist Romania 1997-2014 and a fixed-effects model. Overall mortality, circulatory diseases mortality, neoplasms mortality and external cause mortality move counter-cyclically relative to economic growth. The long and severe transition impoverished a large share of the population and worsened public health. In the future, health will be even more sensitive to changes in economic conditions. Unemployment has little impact on mortality except for digestive diseases mortality. Health care availability, gender, education level, rural concentration and sector of employment significantly impact mortality rates. Policy measures should focus on the counter-cyclical nature of mortality and specific population subgroups in Romania.