Any attempt to describe public health in Europe faces the twin problems of defining Europe and of dealing with the diversity of health and health systems it contains. Health status varies considerably between countries. In some, health is improving, with substantial decreases in heart disease in many western and central European countries. In others, especially in the former Soviet Union, there is concern about the rapid increase in tuberculosis and AIDS. A national analysis does, however, conceal a substantial variation within countries, between regions, and between social classes. The responses to these threats to health are also diverse. A few countries have developed effective mechanisms to design and implement appropriate policies but, in many countries, the public-health community is weak. In particular, public health has largely failed in its role as an advocate of the health of the population. There are, however, many encouraging signs that this may change in the future.