In an interview for VH1's "Heavy: The Story of Metal," Dio stated that the song is about the ability of each human being's ability to choose between doing good and doing evil, essentially that each person has "heaven and hell" inside themselves. When the song has been performed live by Black Sabbath, Dio or Heaven and Hell (band), it's usually stretched out with an extended guitar solo, audience participation, ad libbed lyrics and/or additional lyrics regarding angelic and demonic apparitions and personal judgment. There is also a bootleg version sung by Ian Gillan. Tony Martin also sang it many times live with Black Sabbath as well as with his solo band.
Keyboardist Geoff Nicholls, who was a session keyboard player the recording of this album, is said to have been responsible for this song's famous bass line. The bassline closely resembles some of the basslines used by the band Quartz, of which Nicholls was a former member.
"Heaven and Hell" was ranked #11 in Martin Popoff's book The Top 500 Heavy Metal Songs of All Time. Popoff put together this book by requesting thousands of metal fans, musicians, and journalists to send in their favorite heavy metal songs. Almost 18,000 individual votes were tallied and entered into a database from which the final rankings were derived.