Τhe State of Public Health: Challenges and Evidence-based Opportunities across the European Union

Abstract Background Public health systems across the European Union face growing pressure from aging populations, non-communicable diseases, health inequalities, and climate-related risks. While policy innovation is ongoing, there is limited comparative evidence on which interventions consistently deliver impact. This study addresses that gap by evaluating cross-country outcomes to guide health system reform under the European Health Union. Methods We applied the Confidence in Network Meta-Analysis (CINeMA) framework to assess public health strategies across 11 EU countries. Interventions were grouped into five domains: digital health, health equity, preventive public health, climate-resilient strategies, and mental health programs. Outcomes included unmet medical needs, NCD mortality, access to care, mental health service use, and climate-related illness. Confidence scores were derived using CINeMA's six evaluation domains and supported by hybrid AI text mining for bias and indirectness detection. Results Digital health and mental health programs showed the most consistent high-confidence effects, including unmet need reductions (-9.0% in Ireland, -8.2% in Germany) and higher service use (+12.0% in Sweden). Preventive and climate-focused strategies yielded benefits (e.g., -10.5% ER visits in Finland), though with higher heterogeneity. Equity interventions reduced access gaps (14.1% in Hungary) but often showed moderate imprecision due to uneven implementation. Conclusions Integrated governance linking digital tools, equity, and climate resilience is key to system preparedness. Several countries are already expanding preventive services and open-data tools, supporting the EU-wide adoption of CINeMA as a framework for transparent, evidence-based policymaking. These results are highly relevant to post-pandemic EU health strategy and provide scalable insights for policymakers, researchers, and practitioners. Key messages • To evaluate the rising non-communicable diseases and increasing environmental threats this study applied a hybrid Confidence in Network Meta-Analysis approach to policy data from 11 E. U. countries. • Analyzed access to care, mortality from non-communicable diseases, mental health service utilization, climate-related illness, and unmet healthcare needs correlated with equity-based policies.