Europe’s health systems continue to face immense public health challenges in a rapidly changing geopolitical environment. Epidemiological and demographic shifts, rising defence and climate related expenditures, high and/or growing economic inequality, and rapid technological change are putting European welfare systems under significant pressure. Without coordinated adaptation and transformation, these pressures risk deepening health inequalities and undermining the sustainability of care. As countries work to recover from recent crises and prepare for future challenges, strengthening health system effectiveness, accessibility and resilience has become even more urgent. The State of Health in the EU initiative, funded under the EU4Health Programme, continues to serve as a key source of evidence and inspiration for policy-makers, researchers and citizens across Europe.

This Synthesis Report draws together insights from the latest 2025 Country Health Profiles to take stock of current reforms and highlight how countries are addressing four major interconnected health system challenges: preventing non-communicable diseases (NCDs), strengthening primary care, accelerating digital health transformation, and promoting affordable access to pharmaceuticals and innovation. These challenges cut across all Member States, calling for both national action and collective European solutions.

In this edition, a renewed focus is placed on how countries are responding to these challenges – exploring the policy approaches and reform pathways shaping health systems across the European Union (EU). The report shows that Member States are stepping up primary prevention through stronger public health policies, reforming primary care to become more integrated and people-centred, investing strategically in digital health infrastructures, and redesigning pharmaceutical policies to improve affordability and sustainability in line with key EU legislations such as on Health Technology Assessment (HTA) and the European Health Data Space (EHDS). Primary care remains a crucial gateway to the health system, yet challenges such as general practitioner (GP) shortages and accessibility concerns, including the affordability of medicines, persist. Short- to medium-term digital innovation can help improve coordination and efficiency, while in the longer term, effective public health policies can help ease the burden on primary care. Together, these efforts demonstrate the creativity, determination and solidarity of European health systems in adapting to complex health, economic and demographic pressures and their commitment to build a strong European Health Union. Importantly, the report also shows how health systems can contribute to the competitiveness of the EU. It highlights innovation through pharmaceutical Research and Development (R&D) and investment in health-related information and communication technologies (ICT) as well as the potential to generate higher overall economic output from improved population health.

P.12 Reform area 1: Stepping up prevention of non-communicable diseases - Summary: Non-communicable diseases (NCDs), such as cancer, cardiovascular diseases (CVDs), diabetes and chronic respiratory diseases, are the leading causes of preventable illness and death in the EU. Their growing prevalence, including among young people, places increasing strain on individuals, health systems and economies. In response, countries have intensified multisectoral policy actions in recent years to address behavioural risk factors, including strengthening taxation and regulatory policies related to harmful alcohol consumption, (un)healthy diets, and consumption of tobacco and nicotine products, alongside efforts to promote physical activity...

P.19 Policies to tackle harmful alcohol use are being strengthened in many Member States, but cultural and economic factors limit progress in some countries. Harmful alcohol consumption places a significant burden on health systems. It is estimated that on average across EU countries 2.6% of total annual health care spending is related to treating diseases caused by harmful alcohol consumption (OECD, 2021). Across the EU, alcohol control policies focus on taxation and pricing, marketing restrictions, and restrictions on availability. Many countries are integrating these measures into comprehensive national strategies to reduce alcohol-related harm (OECD, 2021)...