Background Cardiovascular disease and diabetes remain the leading causes of premature mortality in Europe, despite longstanding political commitments and the availability of cost-effective preventive interventions. As the global public health community approaches the 40th anniversary of the Ottawa Charter for Health Promotion, persistent gaps between prevention principles and implementation require renewed policy focus. Analysis This policy brief synthesises evidence from international reports and European initiatives to examine why prevention efforts for cardiovascular disease and diabetes have not achieved sufficient scale or impact. It highlights the role of obesity, diabetes, and early-life risk exposure in shaping cardiovascular risk, alongside fragmented surveillance systems and continued reliance on reactive, treatment-centred care. While current policy frameworks demonstrate ambition, implementation and accountability remain inconsistent. Policy Options Priority actions include em
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