The new(ish) EU commissioner for health and animal welfare, Olivér Várhelyi, will undoubtedly face immense and pressing challenges in his new role. Most EU countries are facing identical demographic changes: an ageing population, and an ageing and shrinking health workforce, which is also overworked and undervalued. To say that this does not bode well for access to healthcare for EU citizens would be an understatement.
Unattractive working conditions in the healthcare sector make it difficult for countries to recruit and retain their health workers. Dissatisfied health workers turn elsewhere in search of better working conditions, job opportunities or salaries: another city, region — or even another country altogether.
The richer countries in northern and western Europe often attract health workers from less affluent countries in southern or eastern Europe. OECD data shows that over the past decade, high-income countries such as Germany, UK, Switzerland and Norway increasingly rely on doctors and nurses trained abroad.
Countries like Romania, Slovakia and Hungary, on the other hand, are affected by ‘brain drain’ of their health workers to other countries.
And some numbers stay under the radar. For example, a conservative estimate suggests that in Germany, there are around 300,000 foreign care workers in the country’s 24-hour live-in care sector, of which many come from east Europe.
The geographic imbalance of health workers affects access to healthcare across the EU. It worsens health inequalities in and between regions and countries, specifically harming rural communities.
These disparities clash with the EU’s ambition for shared prosperity and cohesion across its member states.
And while experts have been sounding the alarm about health workforce shortages for years, it was especially during Covid-19 that countries experienced how health systems can fail due to insufficient health workers.
Recruiting foreign health workers, while potentially worsening staff shortages in other countries, is a mere ‘quick fix’ to a chronic problem. EU member states should work towards structural solutions that benefit everyone.
Instead of fishing for scarce health workers in the same pond, EU member states should invest in their own health workers: ensuring strong health systems that can retain their health workers with attractive working conditions, training and career opportunities.
This is where the new commissioner for health can play a pivotal role. To ensure structural solutions, he must spearhead united European action.
First, the commissioner should ensure that member states know how to better use existing EU instruments to address their health workforce shortages.
This knowledge is currently lacking among member states. For example, certain EU funding sources, like the Recovery and Resilience Funds and European Structural and Investment Funds, can help member states provide better working conditions for their health workforce.
Second, the new commissioner should support member states with understanding the full picture. Where are health workers migrating to, and why? Where are the areas with limited availability of health workers, the so-called medical deserts? Member states could use answers to these questions to inform solution-oriented policies.
This requires systematic data collection and monitoring, which is currently lacking.
Third, the commissioner should ensure an inclusive approach by inviting more non-state actors, such as health professionals’ associations, in policy discussions about the health workforce crisis. Civic space has been decreasing because of fluctuating interest from member states. But the value of non-state actors is indispensable due to their proximity to local problems and communities. By giving them a voice, in national research and advocacy for example, they can bring essential insights to the table.
To effectively address their national health workforce shortages, EU member states should take united action on the above steps, supported by the commissioner.
The last thing the EU needs is inward-turning member states that resort to the quick fix of competing for each other’s’ scarce health workers, without reflecting on the consequences of their actions on access to healthcare in other countries.
If anyone should know this, it's the new commissioner, given that his home country, Hungary, is disproportionally hit by the out-migration of health workers.
The demographic changes happening across Europe — an ageing population plus an ageing and shrinking health workforce — are the ‘perfect storm’ to exacerbate health inequalities in EU countries.
But is not too late to turn the tide. The commissioner therefore has a crucial and timely responsibility. He should do everything in the remit of his mandate to lead the way and avert the crisis. For the benefit of all.
Mariëlle Bemelmans director of Wemos, a Netherlands-based public health NGO that has led two European partnerships on addressing health worker shortages in Europe.
Mariëlle Bemelmans director of Wemos, a Netherlands-based public health NGO that has led two European partnerships on addressing health worker shortages in Europe.