Europe’s public healthcare systems have been considered among the best in the world for decades. Policymakers’ failure to address underlying structural weaknesses in most European healthcare systems exposes millions of citizens to avoidable life-threatening risks. The COVID crisis was the straw that broke the camel’s back in healthcare systems.
The underlying causes of the present crisis are well known to policymakers. A recent report by the World Health Organisation (WHO) argues that Europe’s fast-ageing population and ageing health workforce, a surge in chronic illnesses and the effects of COVID problems, labour market changes with increasingly complex worker mobility and migration, and governments’ under-investment in the sector could bring an imminent collapse in crucial areas of countries’ health systems.
One must add the haemorrhage of medical professionals taking early retirement as they can no longer cope with the stress of working long hours with often inadequate financial compensation. Xavier Lleonart, the general secretary of Doctors of Catalonia, a doctors’ union, says: “People say the best capital a company has is its human capital. The problem is that in health, the human capital has been systematically mistreated until it has said: enough is enough.”
Last winter, the healthcare crisis in Spain prompted overstretched frontline staff to take strike action. In Madrid, 200,000 people took to the streets to defend public healthcare against creeping privatisation.
The larger European economies face the most severe consequences of the current healthcare ticking time bomb. Despite historically high numbers of healthcare workers across Europe, national health systems are struggling to keep up with the rising demand for healthcare. Politicians are not telling people that if resources are limited, services have to be used wisely. Angela Hernandez, a surgeon practising in Madrid, argues that politicians are responsible for “explaining the situation to people. But because they do the exact opposite in Spain, they raise people’s expectations”.
In France, there are fewer doctors now than in 2012. More than six million people, including 600,000 with chronic illnesses, do not have a regular GP, and 30 per cent of the population does not have adequate access to health services. This critical situation also exists in other European countries.
In a third of countries in Europe, at least 40 per cent of doctors are aged 55 or over. Some older medical professionals are moving to the private sector, where working conditions are more favourable and pay higher.
In Germany, like in most other European countries, waiting lists for non-critical surgical interventions are getting longer, often depriving patients of the chance to improve their quality of life. More than 23,000 posts remain unfilled in Germany’s hospitals after several years of low recruitment and recent mass resignations, particularly in intensive care and operating theatres. Some medical staff say that the workload is so extreme that some were unable to take even a short break or go to the toilet. Some hospitals in Germany temporarily closed casualty departments due to a lack of doctors and nurses.
The WHO, in a recent conference held in Romania, issued the Bucharest Declaration as a response to the healthcare challenges faced by European countries. One of the WHO recommendations is to “improve the recruitment and retention of health and care workers”. The knee-jerk reaction of most healthcare policymakers is to recruit medical professionals from third countries. The obsession with relying on low-cost workers in many sectors has, unfortunately, also afflicted the healthcare system in Europe.
WHO also urges governments to “improve health workers supply mechanisms”. This implies making the medical professions careers more attractive to young people through enhanced training and better working conditions. Healthcare has also become more capital-intensive, making it mandatory for governments to invest in expensive medical equipment that helps better diagnose and treat most diseases.
At a time when most countries are redefining their economic strategies because of the changing geopolitical realities, adding resources to the healthcare sector will create more fiscal pressures. Still, the well-being of society must remain the top priority of political leaders, as this is what democracy is about.
The pandemic has revealed the fragility of health systems and the importance of a robust and resilient health workforce. The worst effects of COVID are probably behind us. But critically-essential health issues remain unresolved.
Hans Henri Kluge is the WHO regional director for Europe. He argues: “We cannot wait any longer to address the pressing challenges facing the health workforce. The health and well-being of our societies are at stake – there is simply no time to lose.”