Violence against healthcare workers: a health system approach and international comparative study

BACKGROUND: Violence against healthcare workers is a global health problem threatening healthcare workforce retention and health system resilience in a fragile post-COVID ‘normalisation’ period. There is an urgent need for action to make violence against healthcare a greater priority. Our novel contribution to the debate is a comparative health system and policy approach, aiming to explore major trends and identify policy gaps. METHODS: We have chosen a most different systems comparative approach concerning the epidemiological, political, and geographic contexts. Brazil (under the Bolsonaro government) and the United Kingdom (under the Johnson government) serve as examples of countries that were strongly hit by the pandemic in epidemiological terms while also displaying policy failures. New Zealand and Germany represent the opposite. A rapid assessment was undertaken based on secondary sources and country expertise. RESULTS: We found similar problems across countries. A global crisis makes healthcare workers vulnerable to violence. Furthermore, insufficient data and monitoring hamper effective prevention, and lack of attention may threaten women, the nursing profession, and migrant and minority groups the most. There were also relevant differences. No clear health system pattern can be identified. At the same time, professional associations and partly the media are strong policy actors against violence. CONCLUSIONS: All countries in our sample failed to respond effectively to growing violence and improve the prevention and protection of healthcare workers. Much more involvement from political leadership is needed; attention to the political dimension and all forms of violence are essential. Violence against HCWs is and will remain a problem long after the pandemic subsides. If political action is not taken, healthcare workers will have an additional reason to leave their profession and workplace, thus reinforcing the healthcare workforce crisis. KEY MESSAGES: • Getting prevention of violence against healthcare workers and effective protection right, enhances the retention of the existing workforce and will attract new generations of healthcare workers. • Governments must prioritise developing feasible and effective policy responses to tackle the risk factors that healthcare workers face at the workplace and on social media.