The nation states of the European Union face unprecedented challenges as a result of an ageing population, re-emergence of infection as a global threat, increased needs for social care and a growing burden of curing and caring for patients with cancer. As well as the health of European citizens being at stake there is a huge economic challenge in making rapid, affordable and effective interventions widely available. The concept of P4 Medicine has grown in stature; encompassing personalised, predictive, participatory and preventive medicine. Most emphasis has perhaps been put on personalised medicine, because it is so readily understood and because success should, in theory at least, be easy to measure. However, it would be a mistake to believe that personalised medicine alone can meet all the needs of Europe’s health economy: the development of new drugs for cancer, cardiovascular disease and dementia must be made faster, cheaper and more effective before personalising them: the design of effective interventions, for example to control obesity, needs some method to predict and choose the best intervention, rather than having to wait for 10 or 15 years to assess outcomes. Participation of patients in health must be more fundamental than simply personalising medicine; it must be about empowering citizens to be responsible and engaged in protecting their own health and the health and well-being of the communities where they live and work.