"How far are we in implementing climate change and health action in the WHO European Region?" This was the question addressed to representatives of WHO European Member States of the working group on health in climate change (HIC). Twenty-two Member States provided answers to a comprehensive questionnaire that focused around eight thematic areas (Governance; Vulnerability, impact and adaptation (health) assessments; Adaptation strategies and action plans; Climate change mitigation; Strengthening health systems; Raising awareness and building capacity; Greening health services; and Sharing best practices). Strong areas of development are climate change vulnerability and impact assessments, as well as strengthening health systems and awareness raising. Areas where implementation would benefit from further action are the development of National Health Adaptation Plans, greening health systems, sharing best practice and reducing greenhouse gas emissions in other sectors. At the Parma Conference in 2010, the European Ministerial Commitment to Act on climate change and health and the European Regional Framework for Action to protect health from climate change were endorsed by fifty three European Member States. The results of this questionnaire are the most comprehensive assessment so far of the progress made by WHO European Member States to protecting public health from climate change since the agreements in Parma and the World Health Assembly Resolution in 2008.