Liver diseases have become a major health threat across Europe, and the face of European hepatology is changing due to the cure of viral hepatitis C and the control of chronic viral hepatitis B, the increasingly widespread unhealthy use of alcohol, the epidemic of obesity, and undiagnosed or untreated liver disease in migrant populations. Consequently, Europe is facing a looming syndemic, in which socioeconomic and health inequities combine to adversely affect liver disease prevalence, outcomes, and opportunities to receive care. In addition, the COVID-19 pandemic has magnified pre-existing challenges to uniform implementation of policies and equity of access to care in Europe, arising from national borders and the cultural and historical heterogeneity of European societies. In following up on work from the Lancet Commission on liver disease in the UK and epidemiological studies led by the European Association for the Study of the Liver (EASL), our multidisciplinary Commission, comprising a wide range of public health, medical, and nursing specialty groups, along with patient representatives, set out to provide a snapshot of the European landscape on liver diseases and to propose a framework for the principal actions required to improve liver health in Europe. We believe that a joint European process of thinking, and construction of uniform policies and action, implementation, and evaluation can serve as a powerful mechanism to improve liver care in Europe and set the way for similar changes globally. Liver disease: at the heart of public health challenges for Europe in the 21st centuryEarly civilisations considered the liver the source of the soul before modern medicine and culture elevated the heart to the centre of life.1 Although cardiovascular disease remains the leading cause of death and disability in Europe, liver disease continues to gain importance and is now the second leading cause of years of working life lost in the region.2 Compared with the liver, no other single organ is affected by a range of diseases for which control and prevention are dependent on such a wide array of complex public health policies. Full-Text PDF An urgent challenge for Europe: from tackling liver diseases to protecting liver healthThe liver is an amazing organ. It is the largest solid internal organ and has more than 500 vital functions, such as breaking down toxic substances and waste products, storing energy and vitamins, and producing and regulating hormones. The liver can also regenerate itself if at least 25% of healthy liver remains. Yet, the liver is neglected by individuals, health professionals, governments, policy makers, and international agencies. The Lancet Commission on liver disease in the UK, published in 2014 with annual progress reports, drew attention to the poor provision of services for liver diseases in the UK and made recommendations for improvement. Full-Text PDF