Dr Giorgio Cometto is a medical doctor with post-graduate studies in health policy, heath economics and health sector governance.
He has worked on health system development at national and international levels over the past 20 years, in humanitarian, post- conflict and development settings. He joined WHO Headquarters in 2010 and since 2017 he is the head of the unit responsible for the policies, norms and standards in WHO’s health workforce department.

Among the focus areas of his work, he facilitated the development of the WHO Global Strategy on Human Resources for Health, the WHO guideline on health policy and system support to optimize community health worker programmes, and WHO’s guidance on health workforce policy and management during COVID-19.

Although the global health workforce shortage is declining significantly – from 18 million in 2013 to 15 million in 2020 and projected at 10 million by 2030 – the data largely depict a pre-COVID-19 trend, and mask profound regional disparities: progress is slower in the African and Eastern Mediterranean regions and Small Island Developing States. Countries at all levels of socioeconomic development contend with issues related to education, deployment, retention and performance of their health workforce. Shortages, maldistribution, inequities, gender segregation and disparities in occupations, the negative consequences of health worker migration, and changing demographies, are among the key challenges. In most LMICs, the main driver of shortages is insufficient economic demand to create jobs and employ the health workers required to meet population health needs. The COVID-19 pandemic has further exacerbated pre-existing challenges, with profound impacts on health workers mental health and wellbeing.

This presentation will highlight the policy and investment decisions required to address the most prevalent health workforce challenges, including the need to:

• Optimize the health workforce through development and implementation of appropriate planning, education, regulation, management and retention policies.
• Protect the existing workforce and reduce turnover and attrition by offering decent work, adequate remuneration, and appropriate measures on health and safety.
• Harness the rising demand for health and care services by investing in more and better jobs.
• Strengthen the institutional capacity for health workforce governance, leadership, planning and finance.
• Target investments in health system capacity, health workforce education and jobs to rural populations and vulnerable groups to improve equitable access to care that is oriented towards primary health care.

George is the Executive Director of EHMA. He represents the voice of health management to many European and international bodies including the European Parliament, the European Commission, the World Health Organisation, Industry bodies, and community groups. George Chairs EHMA's webinar series, guides the coordination of the annual conference and has an active role in all EHMA's projects by providing high-level advice on health management matters.
 
Prior to joining EHMA, George was the Chief Executive Officer of a Scottish policy agency focusing on blood-borne viruses and sexual infections. He has managed multiple strategic policy and education collaborations with diverse stakeholder, worked as an education specialist for the International AIDS Society, served on the Board of Diabetes Australia and as an Advisor on its Medical Education and Science Council and as Principal Strategic Advisory to the Commissioner for Children and Young People, Scotland.

Healthcare settings, inherently dynamic and high-pressure, present unique challenges and opportunities to the maintenance of a healthy workforce. In the context of the conference theme – “Opportunities and challenges of health promotion to recruit and maintain a healthy workforce in health care settings” – this presentation by George Valiotis, Executive Director of the European Health Management Association, underscores the crucial and intertwined roles of leadership, power, and trust in navigating these complexities.
Leadership in healthcare must extend beyond clinical expertise to embody the essence of holistic health promotion. Leaders are tasked with crafting a vision that not only resonates with the objective of patient care but also emphasizes the well-being of healthcare professionals. As burnout and emotional exhaustion become more prevalent, transformational leadership—with its focus on motivation, empathy, and individual development—becomes paramount. Leaders who champion self-care, continuous learning, and open communication foster an environment conducive to both professional growth and personal well-being.
Power dynamics in healthcare are multifaceted, often shaped by hierarchy, specialization, and expertise. While these structures are necessary for clinical governance, unchecked power can exacerbate stress and impair inter-disciplinary collaboration. Decentralized decision-making and interdisciplinary teamwork can mitigate potential power imbalances, promoting mutual respect and joint ownership of patient outcomes.
Trust is especially salient in healthcare. It underpins the intricate web of interactions, from patient-caregiver relationships to inter-departmental collaborations. A workforce that trusts its leadership is more resilient, adaptive, and committed. Building this trust requires transparency in decision-making, acknowledgment of frontline challenges, and proactive measures to address concerns.
Managers in healthcare settings must strike a delicate balance that hinges on robust leadership, equitable power distribution, and steadfast trust. As the health sector grapples with the challenges of delivering excellent patient care and preserving the well-being of its workforce with increasing demand and diminishing resources, these pillars will be essential for success.
Attendees will leave this session with strategies tailored to the unique milieu of healthcare, poised to create workplaces that thrive in both health and harmony.

Dr. Cristina Aguzzoli, physician in charge of Health Promotion at the Health Directorate of the Regional Authority for Coordination of Health Trust - ARCS - in Friuli Venezia Giulia, coordinates the HPH network of Friuli Venezia Giulia Region (Italy) since 2003, which became the leader of the Italian HPH networks in 2022.

As a specialist in Hygiene and Preventive Medicine with a Master in Psychoneuroimmunology at the La Sapienza University of Rome, she cooperates with Harvard Medical School, Institute of Lifestyle Medicine, Open Academy of Medicine in Venice and National Institute of Health.  She promotes training courses dedicated to the Wellbeing and health promotion for patients, operators and citizens.

Since 2020, she leads "Taking care of those who care", a regional project born during the pandemic with the goal to recover the psycho-physical well-being of the staff.

For years, she focused the continuous comparison on the issues of individual and organizational empowerment as a teacher and consultant about biopsychosocial well-being, stress management and life skills.

Author of numerous scientific works, including the book "100 questions on stress management" (2018), she is among the editors and authors of the Report 21/4 of the National Institute of Health "Wellbeing and stress management according to the Biopsychosocial model: focus on school, university and health ” published in 2021.

Allostatic load is the "wear and tear on the body" that accumulates when an individual is exposed to repetitive or chronic stress. Interpreting the "burden of disease" in a period of emergency, keeping the keys to reading health promotion active, implies knowing how to evaluate the allostatic load. The allostatic load can manifest itself through the adoption of "fixed behaviors", those more or less conscious behaviors that will then be difficult to bring back to their own state prior to the stressful period, even when the threat has passed. Prolonged high concentrations of cortisol over time can cause damage to the hippocampus, with decreased neurogenesis, increase amygdala alertness, impair memory and cognitive performance, and negatively interfere with future adaptation to other stressors. Allostatic load may manifest as “medically unexplained symptoms-M.U.S.” (https://mus.global/), recently recognized as the signal of related low-grade chronic inflammatory stress.

This is one of the main issues we addressed in collaboration with the Italian National Institute of Health during the 2020 pandemic, in order to quickly read the health needs of the staff and activate a rapid psychophysical recovery strategy. The 96,5% of the staff participating in a 2020 survey involving HPH members in Friuli Venezia Giulia Network, showed us the presence of M.U.S. We set up immediately a new method of reading the allostatic load of personnel, through a software for the analysis of medically unexplainable symptoms in correlation with the objective, but non-invasive analysis of parameters describing the activation of the two arms of the stress system (nervous and endocrine) in order to activate fast psychophysical recovery and avoid chronicization of symptoms.

The HPH Network Project "Care for those who take care of us", developed a specific regional workline answering to the HPH Standard 4 and to standards supplement for resilience at the workplace  realized by our network.  Goals: 1) to overcome the basic dichotomy that refers stress exclusively to the psychic and emotional aspects excluding the physical ones and metabolic aspects; 2) to fill the gap in the scientific update in order to link medically unexplained symptoms to the persistent activation of chronic low-grade inflammation, the lowest common denominator of most chronic degenerative diseases; 3) to drive personalized lifestyles strategy for M.U.S. reduction and fast recovery of wellbeing.

The new interpretation of the M.U.S., as an epiphenomenon of chronic persistent low-grade inflammation and the biopsychosocial approach that allows to guide its reduction up to abatement, through a correct and personalized lifestyle, determines a very important qualitative leap in the approach to chronicity as well as the recovery of well-being and staff motivation. We are applying this model through continuously updated multi-professional teams, who work for the well-being of their colleagues and are very close to the teams dedicated to risk management. Self-assessment and continuous improvement through new skills of self care are essential to restore therapeutic strength to the context and therefore regenerate trust between healthcareworkers and patients.