Introduction:
For many years, the severe shortage of health workers around the world has been identified by the WHO as one of the most critical constraints to achieving health and development goals [1]. Recently, the Standing Committee of European Doctors (CPME) officially requested concrete actions for retention and recruitment by the European institutions [2].

Doctors must have lawful working conditions and safe staffing levels. The pandemic has exacerbated existing problems (such as job strain, skill shortage, medical desertification, workforce & skill shortages) and raised new challenges, such as building emergency capacity. In this regard, for example, on 13 December 2023, the members of the HERA Civil Society Forum [ 3] – including Active Citizenship Networtk [4] - called for increased training of health workers to prepare for future health threats, particularly in light of the lessons learned from the COVID-19 pandemic [5].

Excessive workload, violence and verbal abuse against health workers - by colleagues, superiors, but also by users, citizens and patients, as also revealed by our survey that will be presented shortly - are on the rise, with devastating consequences on their mental and physical health. Medicine is losing its attractiveness as a life-long profession, and if we continue in this path, we will not have a functioning healthcare workforce [6]. Not to mention medical desertification - a topic that also Active Citizenship Networtk addressed at the European Parliament just a year ago - in an attempt to help reduce health inequalities [7].

From the point of view of citizens and patients, this situation undermines the right to health. The paradox is that, despite having common goals to achieve, health workers' associations and patient advocacy groups (PAGs) are not in contact with each other and do not proceed in a coordinated way.

In view of this scenario, Active Citizenship Network - the European branch of the Italian NGO Cittadinanzattiva [8]- decided to dedicate the annual celebration of the European Patients' Rights

 Day at the EU Parliament (anticipated on March 20th 2024 instead of the official date of April 18^th [9] due to the European elections) to the health workers' crisis, bringing together European Institutions, health workers' representatives, leaders of civil society and PAGs, consortium of EU- funded projects addressing the health workforce crisis, journalist, representatives of the Academies of Medicine and of the private sector, independent expert as Vytenis Andriukaitis, former European Commissioner for Health and Food Safety [10].

The event, titled “The key role of HCPs for a healthier Europe. Combining the protection of patients' rights with skills shortage, medical desertification and job strain” was kindly hosted by the Italian MEP Brando Benifei (S&D) [11] and organised with the MEPs Interest Group "European Patients' Rights & Cross-Border Healthcare" [12].

The political message, also framed in a pre-electoral context, emerged during the insightful discussions, was clear: citizens organization, patients’ advocacy groups, togheter with the associations of healthcare professionals call on European policy-makers to address the health workforce crisis by implementing solutions that prioritize the well-being of health workers, the main precondition for better protection of patients' rights across Europe. And it was relaunched a doctor/patient alliance based - although in the distinction of roles and responsibilities - on the mutual recognition of legitimate needs.

The crisis that health workers are going through undermines the objective of making national health services more resilient, as well as making vague the prospect of a European Health Union, proclaimed in 2020 by the President of the European Commission as the first point of her mandate, to the alarm of an already announced pandemic ("We need to build a stronger European Health Union") [13].

Therefore, for once, on the occasion of the celebration of the European Patients' Rights Day, PAGs & civil organisations were invited to confront each other not starting from the health needs we fight for in our daily lives, but from the needs that the health workforce feels it has to fulfil. Indeed, one aspect cannot presume the other.

The upcoming European elections offer the opportunity to ask the candidates, if elected, for a series of commitments on these issues, but it also imposes us to point out that the health of European citizens is, so far, completely out of the pre-election debate. The outgoing European Parliament was the one that cared most about the health of European citizens. It did so out of necessity, because of the pandemic; we wish the next European Parliament would do the same not out of necessity but out of choice.

We firmly believe that the health conditions of European citizens, as well as the working conditions of the health care professionals – yesterday heroes, today totally forgotten- deserve proper attention from those who will be called upon to take decisions representing European citizens. Neglecting the health workforce crisis jeopardizes current and future preventive and care options for citizens, progress in access to care, the high quality standards of healthcare facilities and, above all, mutual trust and dialogue between health professionals and the population.

Doctors, nurses and all the health workforce are essential within healthcare systems, ensuring the well-being of citizens and fostering trust in the system. Their support is paramount, for this reason, Active Citizenship advanced the proposal to establish of a Public Health Committee within the new European   Parliament   (alternatively,   the   reinstatement   of   the   Public    Health Subcommittee, established in Feb. 2023 within the ENVI Committee ) [14], and announced its commitment to re-establishing the MEPs Interest Group "European Patients' Rights & Cross-border Healthcare", for what would be its third mandate, a unicum of its kind. Not least because, in fact, this Interest Group, together with other Interest Groups on specific health issues, has acted as a kind of supplementary, adjuvandum action to multiply reflections, confrontations and proposals within the European Parliament. A concrete example to reduce the gap between European citizens and European Institutions, a distance that will be shortly measured with the European election planned in June 2024.

Figure 1: The save the date of the initiative organized at the EU Parliament on 20th March, 2024

Figure 2: Brussels, 20 March 2024, European Parliament. Brando Benifei, Member of the European Parliament - Group of the Progressive Alliance of Socialists and Democrats (S&D) together with the– journalist Mariam Zaidi, Mariano Votta, Director Active Citizenship Network and Vytenis Andriukaitis, former European Commissioner for Health and Food Safety, at the conference “The key role of HCPs for a healthier Europe. Combining the protection of patients' rights with skills shortage, medical desertification and job strain”.

Authors’ contribution:

Each named author has substantially contributed to conducting the underlying research and drafting this manuscript. Additionally, to the best of our knowledge, the named authors have no conflict of interest, financial or otherwise.

Acknowledgements:

The XVIII European Patients’ Rights Day was made possible by the unconditional support of Johnson & Johnson, Boehringer Ingelheim, Viatris, and received the attention of three media partners: Health Europa, TrendSanità-Policy and Procurement in HealthCare, and the peer-reviewed journal “Archives of Medical Research and Health Sciences”.