Europe Struggles With Health Workers Shortage But Fails to Address Demands for Decent Salaries
Nurses’ protest at the Christiansborg Castle Square, Copenhagen in 2021 demanding pay rises. The strike was one of several which have occurred across Europe in recent years to protest conditions in the sector. (Photo: via Danish Nurses' Organization)
Europe is running short of health workers – this seems to be the consensus of the day among various members and bodies of the EU, as well as health researchers. The European Commission and the European Observatory on Health Systems and Policies both agree that if the issue is not urgently addressed, problems like medical deserts and burnout in the health workforce will only grow.
The significance of this topic is so profound that Belgium, currently presiding over the Council of the EU, has included developing a common EU health workforce strategy among its presidency priorities.
Consensus also seems to exist on the main obstacles hindering the expansion of the health workforce. An aging population, a skills mismatch, and uneven geographical distribution of health workers are all identified challenges. What is curiously missing or is, at best, under-addressed is the chronic dissatisfaction of health workers with their working conditions, including salaries.
Over the past two years, the EU and its high-income neighbors have witnessed a massive wave of industrial action by nurses, doctors, lab technicians, and others, all demanding fair pay and recognition. These demands are referred to as “frictions” in reports, rather than being prioritized at the top of Europe’s agenda.
Not surprisingly, the persistent disregard for improving working standards in the health sector by health ministries has led to intense migration of health workers. Looking at the region alone, the substantial brain drain from South and East Europe towards the western and northern EU members cannot be ignored.
Romania, for example, trains an above-average number of nurses and physicians, but most move abroad as soon as they are cleared to work, leaving behind a struggling health system. In many non-core EU countries, the average age of physicians exceeds 55, posing a looming crisis as they approach retirement. In 2021, one-third of all doctors in the Czech Republic were older than 55, and in Slovakia, the average age of general practitioners was 57.
A crucial priority missing from the list, therefore, is the need to strengthen solidarity among EU members to prevent depletion of each other’s health systems.
The global perspective of this is even more significant, as high-income European countries increasingly rely on recruiting from other regions. While governments claim their international recruitment practices are “fair and ethical,” as German minister of health Karl Lauterbach put it, the practical implications often suggest otherwise.
Corinne Hinlopen, a global health advocate working at Dutch NGO Wemos, notes that European policy officers tend to downplay the impact of international health workers’ recruitment. “What they usually seem to mean [when they say that European countries’ recruitment has minimal impact on health systems in countries of origin] is that their own country’s recruitment is minimal compared to the total global health workforce size – but they do not seem to acknowledge that when you add it all up, it is indeed substantial.”
Another argument often cited by European officials is that some low and middle-income countries have a surplus of health workers, implying that international recruitment comes as a double win: the high-income country gets nurses at a fraction of the price that would take to train and employ them locally; the low or middle income country gets remittances.
But the situation is far more complex than that. In many cases, low and middle income countries simultaneously face health worker shortages and are unable to provide decent working conditions and salaries due to budget constraints and debt conditionalities.
“Low and middle-income countries will say that they are also investing in their health workforce – by which they normally mean: investing in training and education, but not in decent working conditions and salaries, so the push factor for health workers to seek their futures abroad is still immense,” Hinlopen says.
Is there a way for Europe to change course and staff its health systems without causing further harm to others? According to Hinlopen, yes. The first step would be acknowledging that the health workforce shortage is a shared challenge among EU member states, but also that it is a challenge on which the EU can act.
“We need to move from an international competition for skilled health workforce in crisis-ridden health systems towards a united effort to create working conditions for our health and care workers that enable them to deliver high-quality health care in Europe,” Hinlopen says, drawing upon a set of recommendations that will be published soon by the coalition Pillars of Health.
Of course, the trick there is that such a recommendation can only be implemented if there is a EU-wide decision to allocate more resources to health systems strengthening, including through existing mechanisms. “The thing is, these investments should not be so non-committal,” according to Hinlopen.
Instead, the investments in public health systems should be mandatory, obligating the governments to fulfill their responsibilities towards people’s health.
People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and to subscribe to People’s Health Dispatch, click here.
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