Principle 4

Active support to employment

"Everyone has the right to timely and tailor-made assistance to improve employment or self-employment prospects. (...) Everyone has the right to transfer social protection and training entitlements during professional transitions. Young people have the right to continued education, apprenticeship, traineeship or a job offer of good standing (...).

People unemployed have the right to personalised, continuous and consistent support. The long-term unemployed have the right to an in-depth individual assessment (...)."

- Principle 4 of the European Pillar of Social Rights

Let's get started!
4. People with gap and pencil

Active support to employment as a determinant of health

4. Wheelchair desk

Economic downturns, companies' restructuring, layoffs, labour market disruptions from digitalisation, climate change, and demographic changes all affect health and wellbeing, particularly among socioeconomically vulnerable workers. Active employment support is crucial to reducing unemployment risks and promoting economic and social stability, which are key to public health.  

Job search support, training, and lifelong upskilling do not only support financial security. They also enhance human potential and resilience, and build social capital by helping to address youth unemployment, early retirement, and workforce shortages, particularly in health, care, green, and digital sectors. Achieving full employment in the EU requires inclusive, health- and equity-focused policies that equip people of all ages, backgrounds, and regions for sustainable work. 

Public health actors can play a key role in ensuring population-wide inclusive, sustainable employment that supports physical and psychosocial health and wellbeing. 

Youth employment as a public health emergency

Youth unemployment and the relatively high rates of young people in the EU who are neither in employment, education, nor training (NEETs) (15% and 11.2% respectively) represent a public health emergency. It weakens social cohesion, reduces trust in public systems (including in healthcare services and health information), wastes human capital, and deepens social and health inequities.

Having meaningful work and an easy transition from learning to earning gives young people income, confidence, and independence. In contrast, being unemployed early in life can have long-term negative effects, increasing the risks of poor mental health like depression, anxiety, and loneliness. Unemployment also leads to chronic stress and health-harming coping strategies (such as alcohol and drug use, gambling, and gender-based violence), and poorer physical health in later life. These impacts are strongest in disadvantaged communities and regions.

This growing health and economic divide traps people in cycles of poverty and exclusion, putting pressure on health and social systems for years. With less early work experience, young people face weaker job and income prospects, leading to a wage penalty of up to 15% on an individual’s wages by the age of 42 years.  

Strong employment support and social protection are essential for public health, economic stability, and wellbeing. Investing in youth employment unlocks potential and builds more inclusive, healthy, and prosperous societies that give back to communities.

Both the Conference on the Future of Europe and the first-ever UN Declaration on Future Generations (as part of the 2024 Summit of the Future) emphasise the need to tackle youth unemployment, create decent jobs and livelihoods, and ensure universal, adequate, and sustainable social protection—especially for young women and vulnerable youth.

Youth employment as a public health emergency

Unlocking opportunities for health and care workforce: strategies for employment, retention, and transitions

The European region has more health and care workers than ever before. Despite this, the World Health Organization expects a shortage of 4.1 million healthcare workers in the EU by 2030, mostly due to the ageing, migration or resignation of the current healthcare workforce. The shortages are especially acute in rural, remote, and underserved areas, as well as in Eastern Europe. Beyond the supply, the demand for healthcare services has grown exponentially, mostly because of demographic changes and a growing burden of disease. This has added to Europe’s health workforce crisis. To meet the growing demand, EU27 healthcare workforce would need to increase by 30-33% between 2021-2071.

Tackling workforce challenges in the health and care sectors requires focused actions to boost employment, strengthen retention, and support smooth career transitions. This can be achieved by improving working conditions — especially mental health at work, work-life balance, and pay — as well as offering better career prospects and financial incentives for hiring, retention, and upskilling. These issues are often seen as barriers for young people and those thinking about changing jobs. By creating more opportunities for workers in this field, we can build a resilient, skilled, and sustainable workforce ready to meet future health needs.

Unlocking opportunities for health and care workforce

Inequality of opportunities, long-term unemployment and health

Long-term unemployment (over a year and longer) has serious health consequences, increasing risks of mental health issues such as depression and anxiety, chronic stress, and poorer physical health. It also leads to social isolation, worsens existing inequalities, particularly for those with fewer opportunities and lower social mobility. The relationship works both ways — poor health can make it harder to stay in work, while unemployment and financial hardship can further damage health. Overall, the longer a person is inactive, the greater the decline in their health.

In addition to young people, those most at risk include women, older workers, people with low skills, persons with disabilities, and those living in rural or remote areas. Migrants and ethnic or racial minorities also often face discrimination and barriers to fair, well-paid, and meaningful employment. Although women’s employment rates in the EU are at a record high, many still struggle to enter or stay in the workforce due to limited career opportunities and heavy informal or unpaid care duties. This so-called unpaid care penalty costs the EU an estimated €242 billion per year, highlighting the need for gender-equal policies to close the employment and pay gaps.

Unequal access to education, training, and social networks further deepens inequities, limiting opportunities for upward social and economic mobility, and trapping disadvantaged groups in vicious cycles of intergenerational poverty and exclusion.

Inequality of opportunities, long-term unemployment and health

Effective support to employment for diverse populations and people in situations of vulnerability

Timely and well-designed employment support benefits workers, businesses, the economy, and society as a whole. Proactive measures can help people in sectors affected by crises move into growing areas such as the green and digital industries, as well as essential services like health, long-term care, education, and social innovation. Key initiatives include: 

  • Hiring incentives and subsidised jobs: Financial support to encourage the recruitment of vulnerable groups such as low-skilled workers, migrants, young people, parents or carers returning to work, and people aged 55+.

  • Youth guarantee schemes: Ensuring that young people receive a job offer, education, apprenticeship, or training within four months of unemployment, especially targeting NEETs.

  • Apprenticeships, internships, and mentorship: Practical, hands-on training that leads to stable, long-term employment.

  • Work-life balance initiatives: Flexible hours and remote work options to help caregivers combine family and career responsibilities.

  • Gender-targeted training: Programmes in STEM, digital, and green skills, as well as leadership development for women.

  • Skills upgrading and retraining: Opportunities for older workers to refresh and expand their skills, especially in digital technology and healthcare.

  • Phased retirement: Allowing older employees to gradually reduce working hours while staying in employment.

  • Workplace learning programmes: On-the-job training to help workers build skills and experience.

  • Job search assistance: Support such as CV writing workshops, interview preparation, and personalised career counselling.

  • Workplace adaptation subsidies: Funding and training to make workplaces more accessible and inclusive for people with disabilities.

  • Community-based job placement: Tailored employment services for migrants and refugees facing barriers to entering the labour market.

  • Social support integration: Combining job placement with housing and healthcare assistance for the long-term unemployed.

  • Anti-discrimination programmes: Initiatives to combat hiring discrimination and ensure fair treatment of ethnic and racial minorities.

Effective support for diverse population
About principle 4

What does the EPSR Action Plan say?

The EPSR Action Plan sets out several overarching goals for EU Member States for Principle 4:

  • Increase employment: By 2030, at least 78% of those aged 20-64 should be employed, focusing on young, female and low-skilled workers vulnerable to labour market shifts and economic shocks. 

     

    • At least half the gender employment gap compared to 2019 in order to progress on gender equality and achieve the employment target on for the entire working age population.

    • Decrease the rate of young people neither in employment, nor in education or training (NEETs) aged 15-29 from 12.6% (2019) to 9%, namely by improving their employment prospects.

  • Reduce poverty and social exclusion: By 2030, lift at least 15 million people (including 5 million children) out of poverty or exclusion through an integrated, life-course approach tackling its root causes. 

  • Improve social impact assessments: Member States should use distributional impact assessments to ensure transparency in reforms’ and resource allocation effects on meeting the needs of diverse populations. 

  • Enhance digital skills: By 2030, at least 80% of those aged 16-74 should have basic digital skills to ensure inclusion and participation in the labour market and digital society. 

Where are we now?
P12_Youth jumping_light green

Where are we now?

The Social Scoreboard measures progress on the Principles of the EPSR. Linked to the Principle 4 on active support to employment, the Scoreboard outlines that in the EU in 2023:

  • The unemployment rate was 6.1% among the total EU population, with 2.1% of all unemployed long-term, while young people aged 15-29 not in employment, education or training (NEETs) at 11.2%. 

  • Basic or above basic digital skills among EU population aged 16-74 stood at 55.6%.

  • 8.3% of employed individuals were in-work poor, meaning earning an income that is below the poverty threshold, despite having a job. 

Other sources tell us that:

What are public health actors doing?
4. Man and arrow

What are public health actors doing?

12. Umbrella

The following actions taken by public health actors at (sub)national level can support the implementation of EPSR principle 4.

Healthy Working Wales

Fair work is essential for health and wellbeing, just as good health supports work and the economy. However, not all jobs benefit health. What matters is fair work and support pathways into good employment. Fair work ensures workers are fairly rewarded, heard, secure, able to progress, and work in a healthy, inclusive environment where their rights are respected. 

Businesses and employers play a vital role in expanding access to fair work, contributing to a more equal, prosperous, and sustainable Wales. Public Health Wales has created and hosts a Healthy Working Wales portal, offering guidance and support on fair work and workplace wellbeing at local and regional agencies levels. In addition, the Healthy Working Wales team joined forces in creating a new service with Employee Health and Disability team to help employers and managers provide better support to disabled people and those with health conditions in the workplace.  

Healthy Working Wales

The Netherlands – Return to work

The Trimbos Institute in the Netherlands developed guidelines to design sustainable policies and practices to support working-age people with mental ill-health or suffering from occupational psychosocial conditions to (re-)gain resistance, recover, return to work (Return@Work programme), but also to support their individual job placement arrangements. In 2024, Trimbos Institute gained the status of a WHO/Europe Collaborating Centre on Well-being in the Workplace.

Netherlands – Return to work

Finland – Work Ability Programme

The Finnish Work Ability Programme aims to increase employment by supporting unemployed individuals to regain ability to work. Instead of focusing on incapacity, it strengthens people’s ‘readiness to work’, functional capacity, and employability by: 

  • Helping unemployed individuals with partial work ability and long-term unemployed find and retain jobs. 
  • Preventing long-term unemployment and physical and psychosocial incapacity for work. 
  • Improving labour market participation for vulnerable groups. 

From a public health perspective, via the involvement of health professionals such as the Finnish Institute of Occupational Health (FIOH) and the Finnish Institute for Health and Welfare (THL) the programme trains professionals to enhance client employability by focusing on building their health resilience. Training focuses on: 

  • Integrating work ability support into social and health centres. 
  • Expanding subsidised employment for those facing the greatest challenges. 
  • Strengthening professional skills. 
  • Evaluating project impact and service coordination. 

The Ministry of Economic Affairs and Employment leads the programme with the Ministry of Social Affairs and Health, THL, and FIOH. By 2023, €17 million in grants had been awarded to 22 regional projects integrating work ability services into social and healthcare centres.  

Finland – Work Ability Programme

Norway – Individual Placement and Support for people experiencing mental illness

Individual placement and support (IPS) is a proven vocational rehabilitation model designed to help people with mental illness gain and maintain competitive employment. It integrates employment support within mental health services, following key principles: rapid job search, personalised and needs-responsive counselling, and ongoing, comprehensive, and individualised support. Unlike traditional methods, IPS shifts from ‘train and place’ to ‘place and train’, ensuring individuals secure jobs first and receive tailored stigma-free support thereafter. The IPS ‘wrap-around’ team consists of an employment specialist, a benefit advisor, and a health professional, all integrated within the clinical team providing mental health treatment for service users. 

Norway’s Directorates of Health and Labour and Welfare collaborate to implement IPS nationally, addressing relatively high sickness absence and disability benefit rates. By promoting workforce inclusion and reducing stigma, IPS enhances both mental wellbeing and economic participation, fostering a healthier, more inclusive society. 

Norway – Individual placement and support

Croatia - Mental health prevention in times of crisis among the employment service workforce

The COVID-19 crisis has significantly increased mental stress for Public Employment Service (PES) staff, impacting their wellbeing, work ability, and efficiency. To safeguard their health and sustain service delivery, integrating mental health support has become essential. 

However, with increased workloads during crises, prioritising mental health can be challenging. To address this, the Croatian PES, through its Department for Staff Development and Training, introduced accessible mental health support, such as psychological counselling services provided by PES psychologists (career guidance counsellors and trainers), as well as a 24/7 online course on the CES e-learning platform, offering guidance on managing mental health. 

The high engagement and positive feedback from PES staff highlight the strong demand for such initiatives. Ensuring mental wellbeing among employment service professionals not only supports their health but also enhances their ability to assist job seekers effectively, serving as an inspiration for other countries and sectors to take example of.  

Croatia - Mental health prevention for the employment service workforce
What EU tools are out there?

EU tools that help implement Principle 4

There are EU policies and instruments that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 4.

More information about the EU institutions and programmes is available on EuroHealthNet's Health Inequalities Portal.

Youth Employment Support initiative
Youth Employment Support initiative

In 2020, to mitigate the negative impact of the COVID-19 pandemic for young people, the Commission adopted the Youth Employment Support communication. The Youth Employment Support is built around four strands that together provide a bridge to jobs for the next generation: 

  • The Reinforced Youth Guarantee is a commitment by all EU Member States, via the adoption of the Council Recommendation, to ensure that all young people under 30 receive a quality offer of employment, continued education, apprenticeship, or traineeship within four months of becoming unemployed or leaving education. This initiative emphasises tailored, individualised support, offering guidance, crash courses, or boot camps when upskilling is needed. It aligns with local labour market trends and leverages opportunities from the digital and green transitions. All countries have submitted and are implementing their National Youth Guarantee Plans to support young people effectively. 
  • Apprenticeships equip young people with skills while strengthening various sectors. The renewed European Alliance for Apprenticeships supports SMEs, fosters national coalitions, and boosts social partner involvement. 
  • ALMA (Aim, Learn, Master, Achieve), an active inclusion initiative for the most disadvantaged young people, which includes the opportunity to gain work experience in another EU Member State. 
Council Recommendation on a fair transition to climate neutrality
High-level Group on the future of social protection and of the welfare state in the EU
EU Joint Employment Reports
Council Recommendation on access to social protection
Council Recommendation on Effective Active Support to Employment (EASE)
Read about EU funding and contact points

Available resources

For more supportive policy instruments on the topic, consult our other flashcards:

More information about the EU institutions and programmes is available on EuroHealthNet’s Health Inequalities Portal.

Available EU funding

Available EU funding

Contact points for further assistance

Contact points for further assistance

Technical resources

Technical resources
EU map blue

Have your say

Would you like to share promising policies or practices carried out by your public health institute, which support the implementation of this EPSR principle?

Feel free to reach out to our EuroHealthNet colleague Silvia Ganzerla.

What's next?

Read more flashcards
Back to the home page

About EuroHealthNet

Building a healthier future for all by addressing the determinants of health and reducing inequalities.

EuroHealthNet is the Partnership of public health agencies and organisations building a healthier future for all by addressing the determinants of health and reducing inequalities. Our focus is on preventing disease and promoting good health by looking within and beyond the health system.

Structuring our work over a policy, a practice, and a research platform, we focus on exploring and strengthening the links between these areas.

Our approach focuses on integrated concepts to health, reducing health inequality gaps and gradients, working on determinants across the life course, whilst contributing to the sustainability and wellbeing of people and the planet.

Visit our website to learn more about us
Subscribe to receive our updates
Venn diagram new colours dark background
EN V Co-funded by_WHITE Outline

EuroHealthNet is co-funded by the European Union. However, the information and views set out on this website are those of the author and do not necessarily reflect the official opinion of the European Commission. The Commission does not guarantee the accuracy of the data included on this website. Neither the Commission nor any person acting on the Commission's behalf may be held responsible for the use which may be made of the information contained therein.

eurohealthnet.eu  |  health-inequalities.eu  |  eurohealthnet-magazine.eu

Copyright © 2024 European Pillar of Social Rights Flashcard Tool

Scroll to Top