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The WHO European Region has made great progress in reducing the burden of noncommunicable diseases (NCDs) by taking intersectoral action and strengthening health systems, two key commitments in Health 2020, the European health policy, and the Sustainable Development Goals. However, there are now opportunities to accelerate the process. This report provides pragmatic and actionable policy recommendations on how to strengthen health systems so that they can respond more effectively to the challenges posed by NCDs. The report is motivated by contextualized and multidisciplinary assessments of health system barriers to tackling NCDs in 12 countries in the WHO European Region. These assessments show that there are opportunities to bring about rapid improvements in NCD outcomes and reduce inequalities through a more comprehensive and better aligned health system response. In addition to the country assessments, the report draws on published literature, good practice briefs and expert experiences. The report focuses on selected areas of health system strengthening, including governance, continuous and integrated delivery of services (public health, primary care and specialist care), people-centredness, the health workforce, financing, medicines and information solutions. It identifies where action can be taken to strengthen the health system response to NCDs, taking account of resource constraints and placing special emphasis on vulnerable populations.