Introduction and background

Although the term 'Europe' is regularly taken to include only the 28 countries of the European Union (often expanded to include Norway and Switzerland), the European region of WHO comprises 53 countries, home to nearly 900 million people (table 1). The countries vary in size, languages, political systems, economic situations and cultural backgrounds. WHO information on the region is included in reports on the UNECE region (United Nations Economic Commission for Europe) or incorporated in the group of high-income countries.1 ,2

Western European countries and early members of the European Union have had the advantage of relatively long political stability, established health systems and well educated more affluent populations. They have been at the forefront in innovative research and development in all fields, especially in health topics, leading to many improvements for their own populations. Though many aspire to the standards of living, welfare and health of the Nordic countries there is, and always has been, inequity in health and wealth between and within European countries. The affluence and accessibility of many of these countries has led to mass influxes of migrants and asylum seekers, including children. However, many host countries are unable to offer the care and support needed. Due to recent economic crises many health gains have been lost. Some WHO European Member States now need WHO's assistance themselves for health systems reforms. …