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Public health services are very broad and include services in the area of health protection, communicable disease surveillance, disaster preparedness and response, disease prevention services delivered to the community and individual and health promotion, also at community and individual levels. Policy frameworks at the regional and global level do not seek to approach this diversity of services within a single instrument. Nevertheless, over the past 10 to 20 years, there has been a substantial growth of public health policy statements, strategies and other policy instruments that WHO has developed on both the global and the European level, with a trend increasingly to use more legally binding instruments, in particular at the global level, such as the WHO Framework Convention on Tobacco Control and the International Health Regulations. At the same time the number of actors continues to increase, not least with the broader public health agenda of the European Union, and there is increasing pluralism and decentralization in Europe. There is, however, so far only limited evidence available on the relative effectiveness of different types of policy instruments, their impact and cost and a systematic review of possible gaps in the instruments available in response to the public health challenges for the Region in the 21^st century is now needed.

International instruments themselves are only part of the picture. Support given to countries to better address health at the national level is also vital. What activities can be most effective and how can WHO help to develop tools and instruments to assist countries? For example, legislation and regulation can be supported by fiscal measures. Intelligence on the effectiveness and cost-effectiveness of various measures is important for supporting their advocacy. Countries need to be able to assess their public health needs and the effectiveness of their public health services in addressing them and in promoting the health of their populations. WHO Europe’s Health for All strategy was an important tool in comprehensively assessing health status and needs. Tools and approaches to evaluate public health services are fashioned within the context of the developing policy environment and in light of existing policy frameworks, conventions and agreements (see links). Such evaluation work enables countries to identify strengths and weaknesses in their public health services and to devise strategies for investment and reform.