Investing in health and health systems is especially important during times of crisis, such as the severe economic crisis and pandemic (H1N1) 2009 influenza. To address these issues, governments and policy-makers need information that is current, accurate, comparable and user-friendly.What were the trends in public health indicators over the last four years? What factors influence health, and what are the challenges for the future? What contribution can health systems make to improve population health in the WHO European Region? In addressing these questions, this report illustrates the wide-ranging reforms countries have undertaken to strengthen performance in four core functions of health systems: service delivery, resource generation, financing and stewardship.This report presents essential public health information to support countries in choosing sound investments in health. It should encourage the successful implementation of effective health system reforms and policies, and help countries improve their health systems performance to provide efficient, patient-centred, high-quality health care. The annex provides some of the data used in the analysis.