The Fifth Ministerial Conference on Environment and Health, organized by WHO/Europe and hosted by Italy, is the latest milestone in the European environment and health process, now in its twentieth year. Focused on protecting children's health in a changing environment, the Conference set Europe's agenda on emerging environmental health challenges for the years to come. The Parma Declaration is the first time-bound outcome of the environment and health process. The 53 Member States in the WHO European Region set clear targets to reduce the harm to health from environmental threats in the next decade. Safe urban settings, locally sourced food and use of ecomaterials contributed to the first ever low-carbon-footprint conference on environment and health organized by WHO/Europe. More than ever, children's health is at risk from a changing environment. The health effects of environmental risk factors - inadequate water and sanitation, unsafe home and recreational environments, lack of spatial planning for physical activity, indoor and outdoor air pollution, and hazardous chemicals - are amplified by recent developments such as financial constraints, broader socioeconomic and gender inequalities and more frequent extreme climate events. They pose new challenges for health systems to reduce deaths and diseases through effective environmental health interventions.