POLICY PRÉCIS EuroHealthNet Making the link: Health ... · investment and innovation by bringing new ideas to bear on areas of speciﬁ c added value with regards to tackling social

The European Platform on Health and Social Equity (PHASE) is an advocacy and action oriented body for Eu-roHealthNet participants and a wider range of partners from relevant fi elds in public, private and voluntary sec-tors willing and able to work on addressing the wider de-terminants of health. PHASE aims to directly support and actively contribute to the EU policy framework for social investment and innovation by bringing new ideas to bear on areas of specifi c added value with regards to tackling social inequalities in health.

Our Policy Précis provide an easy-to-read analysis of a key policy area, outlining where progress can be made to ad-dress social and health inequities in Europe. The aim is to inform and help to improve international, national and local policies and practices within and beyond health sys-tems, in order to promote better health and well-being for all.

This series of summaries is updated and expanded with full references online at www.eurohealthnet.eu

Making the link In 2016 the 30th anniversary of the WHO Ottawa Charter for Health Promotion will be celebrated globally.1 States agreed and will confi rm again that ‘’The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services…The way society organizes work should help create a healthy society. Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable.’’

This Policy Precis suggests how health and care systems can become health promoting systems and can contribute often overlooked roles for job creation, quality of work and training, poverty reduction, wellbeing, health equity and sustainability.

In 2013 the EC stated: “All together, the green economy, the health and new technology sectors will create more than 20 million jobs in the years to come. Member States need to seize these opportunities, mobilise existing resources and stimulate their labour market in close cooperation with the social partners.“ 2

The EC Employment package includes plans to

• ‘’Improve health workforce planning and forecasting to match the demand and supply of health professionals better while off ering them long-term job prospects and stimulate exchange on innovative and eff ective recruitment and retention strategies for health workers.

• Support an increase in highly qualifi ed ICT labour and promote digital skills across the workforce.’’3

The primary responsibility of governments for health systems is well known. EU action shall respect the responsibilities of the Member States for the defi nition of their health policy and for the organisation and delivery of health services and medical care4. But evidence shows cooperation to overcome common needs, problems and inequities is valuable. EuroHealthNet Policy Precis on building people-centred and integrated health services shows benefi ts from such innovation and learning.

EuroHealthNetEuropean platform for Action on Health and S ocial Equity

POLICY PRÉCISMaking the link: Health promoting systems can

help inclusive employment in Europe

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The Situation

Healthcare as a whole is a highly labour intensive activity and one of the largest sectors in the EU. In 2010 there were around 17 million jobs in the healthcare sector, 8% of all jobs in the EU. The number of jobs in the sector increased by 21% from 2000-2010, creating 4 million new jobs. The situation has of course changed since then, with great variations between and within states.

Generally, it has been predicted that healthcare will remain a growing sector. According to the CEDEFOP skills forecasts5, even though employment growth will be much more modest compared to 2000-2010, a million new jobs are expected to be created 2010-2020. Crucially there will also be about 7 million additional job openings 2010-2020 due to replacement needs – so the scope for changes is strong. Around 200,000 job openings will be for lower qualifi ed people.6 This shows the importance of quality education and training, but also quality jobs and working conditions.

The healthcare workforce comprises: workers primarily delivering healthcare services; allied health professionals, public health professionals, health management, administrative and support staff . Many

people also work indirectly for the health and care sector in a wide range of support (catering, transport, cleaning), research or expert roles. Within public health and health promotion it has been that there are too few specialists but also include those with a partial role in improving health equity. It can be argued that the public health workforce also includes social workers and professionals from police to teachers and planners.7 That again off ers much scope for development.

The EU research project on Health Professional Mobility and Health Systems (PROMeTHEUS) provides evidence, from 17 European countries, that there is an undersupply of certain health professionals in rural and sparsely populated areas, for example in Denmark, Finland, France, Germany, Romania, and an oversupply in some urban areas, such as in Germany or Belgium.8 Evidence from some countries shows an increasing turnover in the health professions. Low pay, but also non-fi nancial factors such as long working hours, stress or diffi cult work life balance constitute reasons for health and care workers to leave their jobs. WHO Europe has noted ‘’Policy tools that risk undermining health system goals include: reducing the scope of essential services covered; reducing population coverage…. and attrition of health workers caused by reductions in salaries.” 9

Without further measures to meet these challenges, the EC estimates a potential shortfall of around a million healthcare workers by 2020, rising to two million if long term care and ancillary professions are taken into account, as they should be. We know that improvements in quality of work, particularly for people in lower occupational groups, contribute to a signifi cantly healthier and more productive Europe. EuroHealthNet studies such as DRIVERS10, publications in which we were involved11, processes from WHO Europe12 and the EC13 provide copious evidence about needs and challenges on employment issues within and beyond health systems – and what can be done.


POLICY PRÉCIS Making the link: Health promoting


Learning by example

Wellbeing and health training and jobs

EuroHealthNet visited Newcastle in England to study its innovative approach to investing in wellbeing, linking local needs to public health approaches, including jobs and training. That included wellbeing apprenticeships, some linked to the city football club.14

NHS England is creating apprenticeships for health. The National Skills Academy for Health works with UNISON trade union to place Apprenticeship Project Workers in areas where apprenticeships are not so well established.15

In Scotland Health & Wellbeing advisors are delivering a service in relation to public health priority areas: Alcohol, Tobacco, Obesity and Mental Wellbeing. The advisors have a key role to play in the ‘’employability pipeline’’.16

An innovative health promoting community health service

Angered Hospital serves a challenging area of 100,000 people in Gothenburg, in Sweden, of whom 65% are not of Swedish origin. EuroHealthNet facilitated a stimulating study visit there, particularly learning about Doula and Health Guide initiatives within a Health Promoting Hospital framework which off ers health and labour market benefi ts, particularly for people who may be excluded or vulnerable.17

EU actions for health and safety at work

Quality employment includes quality health and safety measures, which should mean suffi cient training, skills and posts to implement them18. EuroHealthNet supported the EU OSHA healthy workplaces campaign. Helping health promotion workers

The CompHP Project has developed standards and an accreditation system for health promotion practice, education and training that will positively impact on workforce capacity to deliver public health improvement in Europe.19

These are just some examples among many. EuroHealthNet is keen to learn and publicise more good examples of health systems promoting wellbeing and employment, particularly for young and excluded people.


systems can help inclusive employment in Europe


Pathways to progress

Health systems tackling poverty and exclusion

Tackling unemployment not only consists of creating jobs. Health systems can help tackle poverty at work – a key factor in ill-health and inequality20 and in populations.

The Kings Fund policy centre has published a helpful report explaining why and how this can be done, which EuroHealthNet recommends is taken up21. It also publishes on tackling discrimination and improving diversity in modern health systems.22

Gender equity

The participation of women in the workforce has historically been signifi cant and is increasing. Overall, there are more than 13 million women working in healthcare. In many States the intake of women to medical schools is now over 50%. However, so far, this growing feminization of the healthcare workforce has not always been properly refl ected in measures to improve the reconciliation of professional and private life.

Moreover, although skill levels are relatively high and working conditions are often demanding (for instance, night and shift work), overall wage levels in the health and social services sectors tend to be lower than in other sectors of the economy. EuroHealthNet is among those urging concrete actions at all levels to improve conditions, leadership, opportunities and equal rights for all in health and care systems.23

Green jobs in health systems

Health has a vital role to play in transitions to the new resource effi cient economies. As the EC employment package states: ‘Green jobs’ will only be sustainable if they also integrate safe, healthy and decent working conditions. They should not only be good for the environment but also for workers.24. The headline EU 2020 goals also include objectives and actions towards greening health systems.25

EU opportunities and support

The EU Joint Action on Forecasting Health Workforce Needs brings together States and some professional organisations to share good practice and to develop methodologies on forecasting health workforce and skill needs, workforce planning methods and migration trends of health professionals.26

The EC DG SANTE has recently published an overview and guide of how health is and may be supported by new EU structural and social funds (ESIF) in states and regions.27

The EU funding programme Erasmus for All provides support for cross-border education and training for health students and workers. More promotion could help raise the visibility of these programmes in the health sector.28

EuroHealthNet’s Technical Working Group on Health Systems (TWIG-HS) was established to support its members’ and partners’ work to re-orientate health systems to promote health equity and wellbeing. It will encourage active communication and exchanges on EU, national, regional and local policies and projects. To become involved contact Ingrid Stegeman [email protected]



The publication of EuroHealthNet Policy Precis is supported by the European Commission, through the Programme for Employment and Social Innovation (EaSI 2014-2020). This publication does not necessarily refl ect the position or opinion of the European Commission

For general information please contact: EuroHealthNet Offi ce

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References, Sources and Links 1 www.who.int/healthpromotion/conferences/

previous/ottawa/en/

2 ec.europa.eu/archives/commission_2010-2014/andor/headlines/news/2012/04/20120418_en.htm

3 Communication 173 (2012) Towards a jobs rich recovery.

4 euwiki.org/TFEU#Article_168

5 www.cedefop.europa.eu/en/events-and-projects/projects/forecasting-skill-demand-and-supply/data-visualisations

6 www.cedefop.europa.eu/en/events-and-projects/projects/forecasting-skill-demand-and-supply/data-visualisations

7 www.euro.who.int/__data/assets/pdf_fi le/0003/271074/Facets-of-Public-Health-in-Europe.pdf

8 www.euro.who.int/en/about-us/partners/observatory/activities/research-studies-and-projects/prometheus

9 www.euro.who.int/en/data-and-evidence/evidence-informed-policy-making/publications/2012/health-policy-responses-to-the-fi nancial-crisis-in-europe

10 health-gradient.eu/fair_employment/

11 www.euro.who.int/__data/assets/pdf_fi le/0003/271074/Facets-of-Public-Health-in-Europe.pdf

12 www.euro.who.int/en/about-us/partners/observatory/publications/policy-briefs-and-summaries/addressing-needs-in-the-public-health-workforce-in-europe

13 ec.europa.eu/health/workforce/events/

ev_20150617_en.htm

14 www.newcastle.gov.uk/sites/drupalncc.newcastle.gov.uk/fi les/wwwfi leroot/your-council-and-democracy/appendix_3_commissioning_for_improved_wellbeing_and_health_2014-15.pdf

15 hee.nhs.uk/our-work/developing-our-workforce/talent-care/workstreams/apprenticeships

16 www.eastayrshireworks.co.uk/advice/location/43/nhs-health-wellbeing-programme

17 www.angeredsnarsjukhus.se

18 www.healthy-workplaces.eu/all-ages-splash-page/ 19 www.iuhpe.org/index.php/en/comphp 20 www.apho.org.uk/resource/item.aspx?RID=114918 21 www.kingsfund.org.uk/sites/fi les/kf/fi eld/fi eld_

publication_fi le/tackling-poverty-research-paper-jrf-kingsfund-nov14.pdf

22 www.kingsfund.org.uk/publications/making-

diff erence-diversity-inclusion-nhs?utm_source=The%20King%27s%20Fund%20newsletters&utm_medium=email&utm_campaign=6585667_The%20Weekly%20Update%2017%20December%202015&utm_content=publicationimage&dm_i=21A8,3X5J7,FLX6O8,E4T24,1

23 ec.europa.eu/justice/gender-equality/ 24 ec.europa.eu/social/main.jsp?catId=89&langId=en&

newsId=1270&moreDocuments=yes&tableName=news

25 ec.europa.eu/health/europe_2020_en.htm 26 healthworkforce.eu/ 27 www.esiff orhealth.eu/Mapping_report.htm

28 www.esiff orhealth.eu/Mapping_report.htm
