This chapter describes the state of health of people on the island of Ireland and identifies some of the main opportunities and challenges for public health against a backdrop of remarkable social and political change. Responding effectively to the wide and varied nature of public health challenges on the island raises critical issues, many of which feature internationally. In Ireland the most important are political leadership and policy coherence; support for policy implementation including a widely shared agenda and sustainable public health system; and building knowledge. The chapter looks at the different ways in which the South and North handle policy on public health and poverty, while acknowledging that a much wider range of policy responses is needed to address the wider determinants of health. Growing levels of cooperation on the island are also described. During the period 1989–1998 mortality on the island compared unfavourably to Europe.