BackResilience is built, not assumed: sustaining the health and care workforce under pressure
At the EUSBSR Annual Forum 2026 in Tallinn, where resilience was largely discussed in terms of security, defence, and infrastructure, the session organised by the Coordinator for Policy Area Health – Northern Dimension Partnership in Public Health and Social Well-being, focused on a more fundamental issue: the people who keep systems running. The session Caring for those who care for us brought attention to the health and social care workforce, not as a supporting element of resilience, but as its core condition.
The PA Health session Caring for those who care for us brought attention to the health and social care workforce, not as a supporting element of resilience, but as its core condition. The discussion made it clear: systems cannot be resilient if the people within them are not.
The baseline is already fragile. The EU is facing a projected shortage of nearly one million health and care workers by 2030, while demand continues to grow. The workforce is ageing, and mental health indicators show sustained strain, with one in three professionals reporting anxiety or depression. This is not a workforce preparing for a crisis, but one already working under constant pressure.
“It is people who keep our societies functioning every day, especially during crises. Simply put, without physically and mentally well individuals, there is no resilient workforce, no resilient services, and ultimately, no resilient societies,” said Ülla-Karin Nurm from the NDPHS Secretariat / PA Health in her opening remarks. Addressing resilience in the Baltic Sea Region, she emphasised that it depends on people, shifting the focus beyond “hard” security such as critical infrastructure, stockpiles, and technical preparedness. A positive sign is that many of the challenges faced by frontline workers can be prevented through decisive leadership, stronger social support, stable working conditions, and greater autonomy at work. To support and sustain this workforce, PA Health is advancing several initiatives, including the SAFE project on retaining ageing workers, the EPIC project on crisis preparedness, and the BSR Mental Health Platform.
Moderated by Karolina Mackiewicz (NDPHS Secretariat/PA Health), the session challenged the idea that resilience can be expected from individuals. Mairi Savage from Karolinska Institutet reframed resilience as a multi-level capacity, shaped by teams, organisations, and systems rather than personal endurance alone. Her research within Apollo 2028 projects, pointed out that leadership and team climate have a greater impact on resilience than workload itself. Where teams function well, individuals recover and adapt. Where leadership is absent or environments are toxic, resilience erodes regardless of external conditions.
Karin Reinhold from Tallinn University of Technology brought this into the context of crisis management, where uncertainty, misinformation, and time pressure dominate decision-makings. In such environments, employees do not expect perfection, they expect clarity, honesty, and presence. Leadership becomes less about control and more about trust. Importantly, this trust is not built during the crisis itself, it is established beforehand, and determines how teams respond when pressure escalates.
From there, the focus moved to what resilience looks like in practice. Julia Mnich’s work with the Polish State Fire Service positioned psychological resilience as a form of infrastructure, something that must be trained, embedded, and maintained. Her approach integrates immediate support, continuous mental health training, and on-scene psychological stabilisation, treating resilience as a physiological capacity that can be developed over time.
Elena Bondar’s (Well-being Company) insights from Ukraine reinforced this shift from concept to capability. Evidence from organisations operating under sustained disruption shows that crisis plans alone do not determine outcomes. What matters is whether organisations have built decision-making structures, communication systems, and support mechanisms that function under pressure. A key insight is that most failures occur not at the onset of a crisis, but later, when exhaustion sets in and organisations are no longer able to sustain their response.
Taken together, these perspectives point to a set of implications for policy and practice:
- Resilience needs to be treated as a system property. It cannot be reduced to individual coping capacity, but must be understood and measured across teams and organisations. It cannot be reduced to individual coping capacity, but must be understood and measured across teams and organisations.
- Leadership is central. Not as a formal role, but as everyday practice, visibility, communication, and the ability to create psychological safety.
- Mental health is operational. It directly affects performance, decision-making, and retention, and should be embedded into organisational design rather than treated as support.
- Preparedness must extend beyond initial response. Systems need to function through prolonged disruption, not just absorb the first shock.
- Resilience requires deliberate structures. Decision protocols, communication systems, and workforce support mechanisms need to be built and tested in advance.
For the Baltic Sea Region, these insights carry immediate relevance. The region faces converging risks, from geopolitical tensions to infrastructure vulnerabilities, yet organisational readiness, particularly the human dimension, remains unevenly developed.
What emerged from the PA Health session is a shift in how resilience should be approached: less as an abstract goal, more as something that is systematically designed, practised, and sustained over time.
