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In the past few decades, major public health advances have happened in Europe, with drastic decreases in premature mortality and a life expectancy increase of almost 9 years since 1980. European countries have some of the best health-care systems in the world. However, Europe is challenged with unprecedented and overlapping crises that are detrimental to human health and livelihoods and threaten adaptive capacity, including the COVID-19 pandemic, the Russian invasion of Ukraine, the fastest-growing migrant crisis since World War 2, population displacement, environmental degradation, and deepening inequalities. Compared with pre-industrial times, the mean average European surface air temperature increase has been almost 1°C higher than the average global temperature increase, and 2022 was the hottest European summer on record. As the world's third largest economy and a major contributor to global cumulative greenhouse gas emissions, Europe is a key stakeholder in the world's response to climate change and has a global responsibility and opportunity to lead the transition to becoming a low-carbon economy and a healthier, more resilient society. Peer Reviewed Article signat per 44 autors/autores: Institute for Global Health (K R van Daalen MPhil, M Romanello PhD), Institute for Sustainable Resources (P Drummond MSc, D Scamman EngD), and Energy Institute (Prof I Hamilton PhD, H Kennard PhD), University College London, London, UK; Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK (K R van Daalen); Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany (Prof J Rocklöv PhD, Prof J C Semenza PhD); Department of Public Health and Clinical Medicine (Prof J Rocklöv, Z Farooq MSc, M O Sewe PhD, H Sjödin PhD) and Department of Epidemiology and Global Health (Prof M Nilsson PhD), Umeå University, Umeå, Sweden; Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain (C Tonne ScD, H Achebak PhD, J Ballester PhD, S J Lloyd PhD, C Milà MSc, Prof J C Minx PhD, Prof M Nieuwenhuijsen PhD, M Quijal-Zamorano MSc, Prof J M Anto MD); Universitat Pompeu Fabra (UPF), Barcelona, Spain (C Tonne, C Milà, M Nieuwenhuijsen, M Quijal-Zamorano, J M Anto); CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (C Tonne, C Milà, J C Minx, M Nieuwenhuijsen, J M Anto); BC3 Basque Centre for Climate Change, Bilbao, Spain (Prof A Markandya PhD); School of Government, University of Birmingham, Birmingham, UK (N Dasandi PhD); Data Science Lab, Hertie School, Berlin, Germany (Prof S Jankin PhD, H Bechara PhD, O Gasparyan PhD); Priestley International Centre for Climate, University of Leeds, Leeds, UK (M W Callaghan MPP); Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany (M W Callaghan); Energy Efficiency Group, Institute for Environmental Sciences (ISE), University of Geneva, Switzerland (J Chambers PhD); Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Venice, Italy (S Dasgupta PhD); Grantham Research Institute on Climate Change and the Environment, London School of Economics and Political Sciences (LSE), UK (S Dasgupta, Prof E J Z Robinson PhD); Barcelona Supercomputing Center (BSC), Barcelona, Spain (N Gonzalez-Reviriego PhD, B Solaraju-Murali MSc, Prof R Lowe PhD, M Lotto Batista MSc); Finnish Meteorological Institute (FMI), Helsinki, Finland (R Hänninen DSci, J Palamarchuk PhD, M Sofiev PhD); European Environment Agency, Copenhagen, Denmark (A Kazmierczak PhD); European Centre for Environment and Health, WHO Regional Office for Europe, Bonn, Germany (V Kendrovski PhD, O Schmoll Dipl Ing); Air Quality and Greenhouse Gases Programme, International Institute for Applied Systems Analysis, Laxenburg, Austria (G Kiesewetter PhD); Helmholtz Centre for Infection Research, Department of Epidemiology, Brunswick, Germany (M Lotto Batista); Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain (Prof J Martinez-Urtaza PhD); Oxford Martin Programme on the Future of Food and Nuffield Department of Population Health, University of Oxford, Oxford, UK (M Springmann PhD); Department of Electronics and Computer Science, Universidade de Santiago de Compostela, Santiago, Spain (J Triñanes PhD); Centre for Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK (Prof R Lowe); Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain (Prod R Lowe)

IntroductionDecision-makers initially had limited data to inform their policy responses to the COVID-19 pandemic. The research community developed several online databases to track cases, deaths, and hospitalizations; however, a major deficiency was the lack of detailed information on how health systems were responding to the pandemic and how they would need to be transformed going forward.ApproachIn an effort to fill this information gap, in March 2020, the European Observatory on Health Systems and Policies, the WHO European Regional Office and the European Commission created the COVID-19 Health System Response Monitor (HSRM) to collect and organise up-to-date information on how health systems, mainly in the WHO European Region, were responding to the COVID-19 pandemic.FindingsThe HSRM analysis and broader Observatory work on COVID-19 shone light on a range of health system challenges and weaknesses and catalogued policy options countries put in place during the pandemic to address these. Countries prioritised policies on investing in public health, supporting the workforce, maintaining financial stability, and strengthening governance in their response to COVID-19.OutlookCOVID-19 is likely to continue to impact health systems for the foreseeable future; the ability to cope with this pressure, and other shocks, depends on having good information on what other countries have done so that health systems develop adequate policy options. In support of this, the country information on the COVID-19 HSRM will remain available as a repository to inform decision makers on options for actions and possible measures against COVID-19 and other public health emergencies. Building on its previous work on health systems resilience, the European Observatory on Health Systems and Policies will sustain its focus on analysing key issues related to the recovery from the pandemic and making health systems more resilient. This includes policy knowledge transfer between countries and systematic resilience testing, aiming at contributing to an improved understanding of health system response, recovery, and preparedness.Contribution to the literature in non-technical languageThe COVID-19 Health System Response Monitor (HSRM) was the first database in the WHO European Region to collect and organise up-to-date information on how health systems were responding to the COVID-19 pandemic. The HSRM provides a repository of policies which can be used to inform decision makers in health and other policy domains on options for action and possible measures against COVID-19 and other public health emergencies. This initiative proved particularly valuable, especially during the early phases of the pandemic, when there was limited information for countries to draw on as they formulated their own policy response to the pandemic. Our perspectives paper highlights some key challenges within health systems that the HSRM was able to identify during the pandemic and considers policy options countries put in place in response. Our research contributes to literature on emergency responses and recovery, health systems performance assessment, particularly health system resilience, and showcases the Observatory experience on how to design such a data collection tool, as well as how to leverage its findings to support cross-country learning.

As the Covid-19 crisis deepens, some researchers have argued for the widespread routine use of face masks in community settings, despite acknowledged gaps in the evidence base for the effectiveness of such a measure. We argue that such calls are premature, and risk neglecting important potential harms and negative consequences, known and unknown. We identify potential unintended consequences at multiple levels, from individual-behavioural to macrosocial, and suggest that it is far from clear that the benefits of widespread uptake of face masks, whether encouraged or enforced by public authorities, outweigh the downsides. Finally, we make the case for caution in communicating unequivocal messages about the scientific evidence for face mask use to policy, practitioner and public audiences, given continued scientific disagreement on the question.

2020/2021, b = −0.133) across the five-year span in both datasets. Using a subset of n = 111 German participants surveyed over two waves, we found the indirect effect confirmed over time with identity leadership (at T1) predicting team identification and, in turn, burnout, three months later. Finally, we explored whether there could be a “too-much-of-a-good-thing” effect for identity leadership. Speaking against this, we found a u-shaped quadratic effect whereby ratings of identity leadership at the upper end of the distribution were related to even stronger team identification and a stronger indirect effect on reduced burnout. Do leaders who build a sense of shared social identity in their teams thereby protect them from the adverse effects of workplace stress? This is a question that the present paper explores by testing the hypothesis that identity leadership contributes to stronger team identification among employees and, through this, is associated with reduced burnout. We tested this model with unique datasets from the Global Identity Leadership Development (GILD) project with participants from all inhabited continents. We compared two datasets from 2016/2017 (n = 5290 28 countries) and found very similar levels of identity leadership, team identification and burnout across the five years. An inspection of the 2020/2021 data at the onset of and later in the COVID-19 pandemic showed stable identity leadership levels and slightly higher levels of both burnout and team identification. Supporting our hypotheses, we found almost identical indirect effects (2016/2017, b = −0.132 20 countries) and 2020/2021 (n = 7294