European Health Union and Healthcare Workforce Mobility in Europe, 2020-2023

We present documents created with a certain participation of EIHSD and EIHSD activities dedicated to a European Health Union and healthcare workforce mobility in Europe.


This text is a call to strengthen the European Union’s powers in the field of public health policy in response to the COVID-19 pandemic. It emphasizes the importance of health and highlights the limitations of the EU’s current capabilities. The text suggests revising the European Treaties to give the EU more authority in public health matters, improve coordination among member states, and enhance the EU’s role in responding to health emergencies. It calls for discussions on these issues in the Conference on the Future of Europe.


This manifesto calls for the creation of a European Health Union (EHU) in response to the COVID-19 pandemic and other health threats. The EHU aims to prioritize the health and well-being of all Europeans, strengthen solidarity among member states, promote environmental sustainability, provide security, and involve citizens in health policy decisions. The manifesto outlines policies and measures, including revising EU treaties, enhancing research and collaboration, addressing health workforce issues, and establishing a Global Health Policy. It emphasizes principles such as well-being, precaution, respect for diversity, and solidarity in safeguarding health. The manifesto draws inspiration from the 70th anniversary of the Schuman Declaration and emphasizes the need for creative efforts to protect world health.


The Explanatory Memorandum provides additional context for the Manifesto for a European Health Union. It clarifies the purpose of the memorandum, explains the Manifesto’s three main issues, outlines the legal provisions related to health in the European Union, discusses the weaknesses exposed by the COVID-19 pandemic, and presents specific actions, mechanisms, and instruments for a European Health Union. It also explores different scenarios for achieving health and well-being in Europe, emphasizing the need for a strong political will and ambition in pursuing a European Health Union. Finally, it describes the actions that will follow the publication of the Manifesto, including translation into all official EU languages and presentation to national parliaments and European NGOs.


 THE EUROPEAN HEALTH UNION IS AN INITIATIVE WITH POTENTIAL TO SHAPE EUROPEAN POLITICS FOR DECADES TO COME, By: Vytenis Povilas Andriukaitis, In the publication “Dancing with elephants: New partnerships for health, democracy, business”, E UROHEALTH, Volume 26, Number 3, 2020, Special Issue, European Health Forum Gastein 2020.

Summary of the article. The article discusses the emergence of the European Health Union (EHU) as a significant initiative and its potential impact on European politics. It highlights the historical development of the health sector in Europe and its growing importance. The COVID-19 pandemic has brought health to the forefront of European policy discussions, leading to increased recognition of the role health plays in various aspects of society. The article presents different scenarios for the development of the EHU, ranging from utilizing existing instruments to amending European Treaties to strengthen the role of health policy. The author advocates for the ambitious scenario “c” that incorporates the EHU into the Treaty on European Union, emphasizing the need for deeper cooperation on health. The text concludes by emphasizing the transformative potential of the EHU but acknowledges that its realization will require time and effort.

 POLITICAL LEADERSHIP AND THE EUROPEAN HEALTH UNION: A WAY FORWARD FOR HEALTH AND WELLBEING, 17 Feb 2021 by Sciana. Vytenis Andriukaitis, WHO Envoy for the European Region, speaks with the Sciana Network.

The lecture, hosted by Sciana Chair Ilona Kickbusch and featuring former European Commissioner for health and food safety, Vytenis Andriukaitis, discussed the importance of political leadership in shaping a European Health Union (EHU). Andriukaitis shared insights from his career, highlighting the need for greater European cooperation on health and healthcare. He emphasized the challenges and obstacles to cooperation in the European Union (EU) and outlined three scenarios for developing the EHU, with a preference for incorporating it into the Treaty on the European Union. Andriukaitis called for stronger cooperation on health and urged European leaders to start debating the EHU to shape European politics for the future.

by Vytenis Povilas Andriukaitis, Gediminas Cerniauskas and Birute Tumiene on 14th January 2021, Social Europe,, or

The article discusses the emergence of the concept of a European Health Union (EHU) in response to the COVID-19 pandemic and highlights the increasing demand for European cooperation in the field of health. It points out the limited role of health in EU policies, despite growing public demand for better health services and the cultural importance of good health. The article argues that European solidarity in health is now crucial, given the failures of member states in managing the pandemic and other common health challenges. It calls for action to establish an EHU, offering three possible scenarios for its development, with the most ambitious being an amendment to the Treaty on European Union to provide concrete competences in health policy while preserving subsidiarity. The article emphasizes the need for European health policies based on common values and the benefits of deeper cooperation in health.


This article discusses the challenge of balancing free movement and addressing shortages in the healthcare workforce within the European Union (EU). It highlights the growing demand for health services and the role of international migration in meeting this demand. However, it also raises concerns about the impact of such migration on countries of origin and the need to strike a balance between mobility and ensuring universal health coverage. The text poses several questions related to this issue, emphasizing the importance of gathering data and implementing appropriate policies to address workforce shortages in healthcare. It also mentions the impact of the COVID-19 pandemic on these challenges and the need for coordinated efforts to train, recruit, and retain medical professionals.

A EUROPEAN HEALTH UNION, by Vytenis Andriukaitis, 2021, in the book ‘Our European Future: Charting a Progressive Course in the World’ by Foundation for European Progressive Studies (FEPS).

The book ‘Our European Future: Charting a Progressive Course in the World’ is the first high-quality book making proposals to the Conference on the Future of Europe, authored by 36 top experts and intellectuals and edited by FEPS President Maria João Rodrigues, with the collaboration of François Balate.

Summary of the article. The article discusses the impact of the COVID-19 pandemic on Europe and calls for the establishment of a European Health Union (EHU) to address health challenges. It highlights the weaknesses in existing mechanisms for collaboration among member states and emphasizes the need for stronger public action in healthcare cooperation at both the member state and EU levels. The author proposes scenarios for the development of the EHU, suggesting that the EU should prioritize the strengthening of health policy in the European Treaties and make health an explicit aim of the EU. The text calls for an ambitious approach, scenario C, to create a strong and genuine EHU to ensure the good health and longevity of Europeans through deeper health cooperation.


The ongoing health crisis has highlighted the limits of existing European integration policies, with their emphasis on the development of the internal market while marginalising what most Europeans consider most important: saving lives and promoting health and wellbeing.

The Social Democrat position paper of 12 May 2020 entitled ‘A European Health Union – increasing EU competence in health – coping with COVID19 and looking to the future’ has opened a new chapter in the European project.

With the pooling of European resources for the prefinancing of research and public procurement of vaccines proving to be more efficient in comparison to competitive bidding by the member states, Europeans will be the first to feel the benefits of a European Health Union (EHU). The potential scope for further actions within the EHU is vast, with some avenues for moving forward being clear. However, the risk of a return to a policy where the EU does not act remains.

The European Union should not be concerned simply with “a single market” and “an economic and monetary union”. The call for a more social Europe, for concrete progress towards the Sustainable Development Goals (SDGs) and the Green Deal, can no longer be dismissed. Health must be at the core of a renewed Social Europe.


The Resolution adopted during a discussion on the future of Europe emphasizes the importance of addressing contemporary challenges to security, human health, and environmental sustainability. It highlights the historical focus of European integration on the common market and calls for a shift toward greater cooperation in health issues through the creation of the European Health Union. The text proposes legitimizing the European Health Union in the EU Treaties by including it in the Preamble and Article 3 of the Treaty on European Union. This proposal will be presented to the Conference on the Future of the European Union for further consideration and debate.

EUROPEAN HEALTH UNION TO STRIKE THE BALANCE BETWEEN FREE MOVEMENT OF HEALTH WORKFORCE AND UNIVERSAL HEALTH COVERAGE. By Vytenis Andriukaitis, EIHSD. EURACTIV, Event Report, Dec. 2022 – Feb. 2023, Aged and overstretched: EU health workforce ‘under observation’.

The article discusses the central role of the health and care workforce in health policy debates, especially during the COVID-19 pandemic. It highlights discussions within the Conference on the Future of Europe (CoFoE) about strengthening healthcare systems and ensuring equal access to healthcare across EU member states. The article emphasizes the need for European health policy strengthening and addresses issues related to the free movement of health workers and universal health coverage. It also outlines various challenges and policy solutions related to healthcare workforce shortages, working conditions, gender equality, and more. Finally, it suggests potential ways to reform European health policy, including upgrading health to shared competencies between the EU and member states.

RETURNING TO THE ORIGINAL DESIGNS OF EUROPEAN INTEGRATION: CREATING EUROPEAN PUBLIC GOODS IN HEALTH, by Vytenis Povilas Andriukaitis and Erin Webb. In the publication “A moonshot for a true European Health Union: If not now, when?”, 2022 Eurohealth (28.3), 13 September 2022.

This special issue of Eurohealth provides a pre-reader for the 2022 European Health Forum Gastein, one of the leading health policy conferences in Europe bringing together a mix of public policymakers, civil society, researchers, and private sector representatives. The main theme of the 2022 edition focuses on the opportunity to co-create a true European Health Union and marks the 10th annual collaboration between Eurohealth and the EHFG.

Summary of the article: At the EU’s foundation, joint development and management of public goods was a fundamental element of European integration. Yet the past few decades have moved away from this original vision and towards Member State management of public goods. Now, especially in the context of COVID-19 and the war in Ukraine, the EU community is placing renewed attention on public goods, especially in health. Positive experiences at the EU level provide tangible examples of what works for European public goods in health.

MAIN FINDINGS AND RECOMMENDATIONS OF THE PROJECT “WORKING TOGETHER TO ADDRESS HEALTHCARE WORKFORCE MOBILITY IN EUROPE”. Duration 2020-2023. Implementing agency – European Institute of Health and Sustainable Development (EIHSD), Lithuania. Gastein, September 2023. The project was sponsored by the Open Society Foundations.

Coming in October 2023.  A EUROPEAN HEALTH UNION: A BLUEPRINT FOR GENERATIONS. Edited by: Vytenis Povilas Andriukaitis and Gediminas Cerniauskas. Authors: Issam Alsamara, Vytenis Andriukaitis, Richard Bergstrom, Helmut Brand, Gediminas Cerniauskas, Thibaud Deruelle, Corinne Hinlopen, Ilona Kickbusch, Mihály Kökény, Dominique Polton, Maurizio Scarpa, Markus Schneider, Annette Schrauwen and Birutė Tumienė.


RESEARCH METHODOLOGY. TIMING. 2021 02  09 – 04 06. OBJECTIVE. Find out Lithuanian medical workers‘ attitude towards leaving Lithuania and working abroad (motives, intentions and reasons to leave / not to leave Lithuania). TARGET GROUP.  Lithuanian medical workers (up to 55). SURVEY METHOD. Combined CATI and CAWI interview, using a standardized questionnaire which is agreed upon with the Customer. SAMPLE SIZE. 609 respondents (203 of general practitioners / residents, 202 of medical specialists / residents, 204 of nurses, midwifes). LOCATION. Lithuania.

Short summary of main conclusions:

  • Approximately one in ten medical professionals have experience working abroad.
  • Younger medical professionals are more inclined to consider working in another country, with intentions to leave decreasing significantly after the age of 45.
  • The primary driver for wanting to work abroad is salary, especially among nurses and midwives. Medical specialists, general practitioners, and residents also value professional growth opportunities, better working conditions, and positive coworker relationships.
  • Factors encouraging medical workers to stay in Lithuania include family support and perceived career development opportunities, especially among general practitioners, medical specialists, and residents. Nurses and midwives are less likely to see such opportunities and may be deterred by language skills and the prospect of accepting lower-skilled or lower-responsibility positions abroad.
  • Language challenges are relevant for medical professionals, particularly general practitioners, but less so for medical specialists.

HEALTH WORKFORCE DEMAND AND SUPPLY ACROSS THE EUROPEAN UNION. SUMMARY REPORT, May 2022. BASYS GmbH. Study financed by the EIHSD. The summary report in pdf format can be downloaded here:

This report examines imbalances in the supply and demand of the health workforce across the EU27 Member States. It utilizes various indicators to describe these imbalances, their causes, and future developments. The report presents country-specific comparisons and discusses factors influencing these imbalances, including labor force growth, migration, and working conditions. It also provides projections for health workforce supply and demand until 2030. The report emphasizes the need for standardized health labor accounting systems and the potential for productivity gains to alleviate workforce shortages. It concludes with roadmaps for achieving convergence and divergence of health workforce across EU27.


RESEARCH METHODOLOGY. TIMING. 2022 10 18 – 10 28. TARGET GROUP.  Lithuanian population (from 18 up to 75). SURVEY METHOD. Combined CATI and CAWI interview, using a standardized questionnaire which is agreed upon with the Customer. SAMPLE SIZE. 1009 respondents. LOCATION. Lithuania.

Shrot summary about support to Ukraine. The majority (58%) of Lithuanian residents support providing assistance to Ukraine in various ways. The Lithuanian public can be divided into three categories: those who have consistently supported Ukrainians (32%), those who helped at the beginning of the conflict (30%), and those who never provided support (32%). There is a willingness to help Ukrainians during the war (67%), but opinions differ on long-term prospects. About 33% believe efforts should be made to integrate Ukrainians in Lithuania, while others think it should be a short-term project with refugees returning to Ukraine after the war.

In terms of attracting migrants with specific skills to Lithuania, doctors are mentioned as the most needed (58%), followed by IT specialists, scientists, teachers, and construction workers (32% each). The most necessary form of help for Ukrainians is assistance with employment (79%), followed by free school meals (47%), free health care (40%), and the right to live in Lithuania (36%). Regarding language education for Ukrainian children, 49% believe that migrantgs should have the opportunity to learn the language of their choice in schools, while 27% think they should learn the Lithuanian language. Opinions on free medical treatment for Ukrainians vary, with 35% supporting it only for those with refugee status or war injuries, 21% supporting it for all Ukrainians, and 18% linking it to paying taxes in Lithuania.

Time to Strengthen the EU’s Public Health Policy Powers Manifesto for European Health Union Webinar. Webinar, September 24 2020, 13:00-15:00 CET,

Better health is one of the deepest desires of Europeans, health emerged as the most important sectors of the modern economy, but, until recently, health was almost ignored by mainstream European policy. Because of COVID-19 health is finally a big political issue and this creates a generational opportunity to place health at the center of European cooperation. Europe is ripe to transform itself from being the institute that cares just about free movement of goods, people, services and capital to the Union where well-being and health of all residents matters as the European Health Union.

The recent decision to reduce budget of EU4Health programme by 75 percent is a clear indication that a gap between the role of European Union in health expected by European citizens and the appetite of European political elites to work together for health will not disappear just because of humane suffering caused by the health emergency. Concerned Europeans (citizens, patients, health workers, academics, journalists, artists, organizations) should work hard for the European Health Union. The webinar is about rational for Europe doing more for health and actions towards the European Health Union. The webinar is about the Manifesto for a European Health Union.

Trends of Health Workforce Migration in the European Union. Webinar, 02 February 2021, 15.00-16.30 CET,

In the webinar was discussed the increasing importance of the health sector in European nations and its growth in the 21st century. It highlights the rising demand for healthcare services and the challenges associated with it, including labor migration, it also addressed the unequal distribution of health workers in Europe, need for the standardized training, and safeguarding the rights of healthcare workers.

Healthcare workforce (HWF) policies and regulation on global, EU and MS levels. Webinar of 2021, 30 March 2021, 15.00-16.40 CET,

In the webinar was discussed the growing international migration of medical professionals, particularly within Europe. It highlights the historical context of labor mobility in Europe, especially after the fall of the Iron Curtain, and the trend of doctors migrating from Eastern European countries to Western European nations. It emphasized the benefits and challenges of this migration, including the strain on countries of origin and the need to balance the interests of both source and destination countries.

Discussion about the problems of workers in the medical sector in Lithuania and the European Union, webinar on May 25 2021, 2:00 – 3:40 p.m. Recording in Lithuanian is available on Youtube:

Experts discussed the medical problems of Lithuania and the European Union (hereinafter referred to as the EU) and look for solutions. Ignas Zokas, director of “Spinter tyrimai” presented the conclusions of the study/representative survey on the emigration expectations of Lithuanian doctors. Dr. geneticist of Vilnius University Hospital Santaros Clinics. Birutė Tumienė reviewed the changing trends of foreigners studying medicine in Lithuania before and after the COVID-19 pandemic. Partner of the European Institute of Health and Sustainable Development dr. Gediminas Černiauskas analyzed the need for medical workers in Lithuania and the European Union. Vytenis Povilas Andriukaitis, the special envoy of the World Health Organization for the European region, presented the trends in the EU with the emphasis on a European Health Union.

Modelling of pull and push factors of HWF mobility taking into account impact of COVID-19 pandemic. Webinar on  27 April 2021, 15.00-16.40 CET,

The webinar is focused on healthcare workforce mobility, considering factors that push individuals to move and factors that attract them to new places. with a focus on improving allocation and training. The text outlines the topics covered in two previous webinars and mentions that the third webinar will focus on modeling factors related to healthcare personnel mobility, considering the impact of the COVID-19 pandemic. Conclusions from the webinar will be disseminated after its completion. The webinar format includes a panel of speakers with various perspectives on health workforce mobility and COVID-19.

European Health Policy as for the Start of the Conference on the Future of Europe. Webinar on the 25th June 2021, from 15.00-16.30 CET on Teams’ environment, Recording of the webinar on Youtube:

The webinar is an integral part of a 3-year project “Working Together to Address Health Workforce Mobility in Europe”. Up to 12 webinars to address the unequal distribution of the health workforce in Europe, to participate in designing of policies to support regions that have difficulties in attracting health workers as well as promoting training and education of health professionals to common standards, coupled with measures to safeguard the rights of health workers from the rest of the world. are foreseen by the project. An emphasis of the fourth webinar was an assessment of factors that in midterm perspective likely will affect European and global health policy.

Webinar was moderated by a professional moderator Joe Lynam from BBC. Panel of 4 speakers represented the following perspectives:

  • Ana-Carla Pereira, European Commission. Porto Social Summit and its impact on deepening the implementation of the European Pillar of Social Rights at EU and national level.
  • Ilona Kickbusch. Global Health Summit: the background, deliverables, likely outcomes.
  • Jonathan Cohen. Global and European health policy from the perspective of a major international charity.
  • Dr Vytenis Andriukaitis. European Health Union as seen by the European Institutions. The reflection on the presentations during the opening session of the Conference on the Future of Europe.

Discussion on the future of Europe “Voice of the Lithuanian public in creating the European Health Union”. Webinar on 10th of October 2021. Recording in Lithuanian on Youtube:

Former member of the European Commission responsible for health and food safety, Vytenis Andriukaitis and member of the European Parliament Juozas Olekas propose to establish a European Health Union. This, in their opinion, is determined by the expectations of Europeans regarding health care and the treaties of the European Union that do not meet them. European health policy and proposals for a conference on the future of the European Union were discussed today in the discussion “For a European Health Union” organized by the European Institute for Health and Sustainable Development. The participants of the discussion emphasized that the health issues of Europeans cannot be postponed for the future. Europe must recover and not be like a terminally ill person, and be able to compete with the largest countries in the world. The conference participants prepared a resolution.

The speakers’ proposals to legitimize the European Health Union and include it in the preamble and the third article of the Treaty on European Union will be submitted to the Conference on the Future of the European Union and published on the debate platform. May 9 The conference on the future of Europe that has started aims to discuss the challenges and priorities facing European citizens and the EU. The European Parliament, the Council and the European Commission have committed to listen to Europeans and take into account the recommendations made during the year.

Reconciling freedom of movement of labour with universal health coverage in the European Union. Workshop on May 16-17, 2022.

The workshop focused on imbalances in the health workforce across European Union member states and utilized data from various sources. It discussed indicators related to health workforce size, structure, and migration, emphasizing the need for a standardized indicator system to inform health workforce policy and address workforce shortages. The workshop concluded that a limited number of health workforce indicators should be used to assess access to healthcare across the European Union, with one such indicator being healthcare workforce volume per capita, adjusted for need.

Evidence based policies that work for optimal allocation of health personnel across the European Union. Webinar on 28 March 2022.

Discussion in webinar highlights the impact of COVID-19 and the war in Europe, emphasizing the need for European solidarity and cooperation. It discusses the importance of the European Health Union (EHU) in promoting peace and cooperation. The text also mentions the need for pan-European cooperation in addressing health workforce imbalances and ensuring the equitable distribution of health personnel across Europe.

Media partnership. A round table discussion “European Health Union – not wishful thinking, but a reflection of Europeans‘ real concerns”, February 21st, 2022. Organised by: The EIHSD and the FEPS. Location. Hybrid. Brussels Network Office – International Press Centre, 1 Bd Charlemagne // 2nd floor.

The objective of the event. To facilitate a discussion around how current European health policy corresponds to the expectations of European citizens and how to create a European Health Union and establish it in the Treaty on European Union. Policy proposals. All speakers unanimously supported the notion of a stronger European health policy. Europeans are asking the block to do more for health and this is a must for MS and European institutions. A European Health Union (EHU) is evolving because of Europeans’ real concerns. The question what is a road map towards EHU is up to debates. Joseph Figueras and Ilona Kickbusch are indicating health related policies in line with current wording of European treaties as more pressing. Vytenis Andriukaitis and Maria Rodrigues are calling to have explicit references related to EHU in the Treaty on European Union.

Challenges that the ageing and tired European workforce is facing could be addressed. Conference on the 30th November 2022. Organized by the EIHSD in collaboration with European Parliament member Juozas Olekas, FEPS and the Pan-European media network specialized in EU policies (EURACTIV – publicity assistance of the conference). Meeting – live event in Brussels EU parliament facilities combined with on-line WEBEX environment.

The objective of the event. Investment in the health workforce is one of the best buys in public health. The main objective of the event is to identify how to balance the free movement of workers as a fundamental principle of the European internal market with the assurance that equitable accessibility of health services will be provided (medical deserts irrigated) across all European regions including those of workforce source countries and to discuss the policies, strategies, and actions that most meaningfully contribute to the solution of the existing health and care workforce-related problems on national and European levels.

On a basis of the conference material and event report EIHSD with support of EURACTIV prepared an article into how the challenges that the ageing and worn-out European workforce is facing could be addressed.

Detailed information is on EURACTIV webpage, or it may be downloaded directly from this page here: Aged and overstretched – EU health workforce ‘under observation’