From Recognition to Reform: What Health and Care Workers Really Need

Every year from April 1-7, World Health Worker Week celebrates the people who deliver essential care and keep our communities safe every day. This year’s theme–Health Workers are VIPs–calls attention to the urgent need to accelerate reforms and investments that ensure every health worker is valued, protected, and equipped to thrive.

The health workforce sustains the systems that we rely on for our wellbeing, yet they are too often stretched thin, undervalued, and working within deeply unequal settings. Nowhere is this more visible than in the global care economy, where gender inequality, migration, and workforce shortages collide.

Across the world, the demand for health and care services is rising rapidly as populations age, while health systems, strained by severe workforce shortages, struggle to keep pace. Due to chronic underinvestment in the education, training, retention, resourcing, and support of health workers, these shortages are projected to worsen. According to the WHO, the world faces a predicted gap of 11 million health workers by 2030. This growing gap impacts how care is delivered.

At the same time, the cost of care has become a crisis of its own. The Organisation for Economic Co-operation and Development estimates that across 10 high-income countries, out-of-pocket costs for an older person with moderate needs could be over half of their income, with costs increasing for additional care needs. In the United States, institutional or nursing facility care averages approximately $100,000 per year, while home-based aging and disability care can cost between $69,000 and $288,000 annually. For families everywhere, care is increasingly becoming more financially out of reach.

This growing divide between rising care needs and rising costs is quietly transforming who provides care—and under what conditions. Across high-income countries, migrant workers have increasingly become the backbone holding this fragile system together. The WHO estimates that 23% of nurses in high-income countries are foreign-born. In the U.S., over 1 in 5 frontline nursing home workers and 1 in 3 home care workers are immigrants. They contribute to closing widening care gaps by helping systems maintain affordability and access and enabling older adults to age in place by offering the services needed for individuals to thrive at home.

But this reliance is deeply gendered and racialized. The care workforce is overwhelmingly female and disproportionately composed of women of color. In the U.S., 85% of home health aides are predominantly Black, Latina, and Asian women, often earning around $12 per hour and experiencing poverty at more than three times the rate of their white counterparts. Within this demographic, migrant women from the Global South often occupy the most precarious positions, frequently working through informal channels that exclude them from basic labor protections. 

The COVID-19 pandemic made these inequities impossible to ignore. Across the European Union (EU), migrant health care workers often took on the highest-risk roles, allowing their colleagues to shift to safer positions. Meanwhile, many of them in the EU and beyond, including in the U.S., still lack access to healthcare, social services, and safe reporting channels for abuse—often avoiding support altogether due to fear tied to immigration status.

These vulnerabilities are not accidental. They are the result of policy choices that undervalue care work and the women who perform it. We cannot build resilient health and care systems without addressing the inequities embedded within them. 

On the heels of World Health Worker Week, we call for urgent action to ensure that health and care workers are safe, protected, fairly supported, and paid:

• Create safe immigration pathways for care workers that provide access to formal employment, labor rights, and social protection—protections informal workers are currently denied.
• Move beyond symbolic commitments to enforceable labour protections. Prioritize ratification of ILO Conventions No. 189 and 97, paired with national implementation plans, dedicated budget allocations, and real enforcement mechanisms—particularly in feminised sectors.
• Treat care work as essential infrastructure: extend full labor rights to domestic and care workers; formalize care work through certification systems and employer accountability; and establish safe reporting mechanisms for abuse and gender-based violence.
• Guarantee core labor standards across the care sector, including a living wage, health and safety protections, social protection, the right to equality and non-discrimination, and the right to organise and bargain collectively.
• Increase domestic investment in health systems and frontline health workers, including both financial and non-financial support, to strengthen system capacity and expand reach—reducing the conditions that create dependence on an exploitable informal workforce in the first place.

Together, we can build a future where every health worker is truly treated like a VIP and equipped to care for our communities.