MILAN — Unlike many of us, Paolo's work routine has changed little in 2020. He wakes up before the first light of day in Northern Italy, takes the train to Milan, then the underground, then several buses as he visits a dozen elderly patients in their homes in the city's nearby suburbs.

But since the pandemic started, he's heard he is an "essential worker" and at high risk of becoming infected, as happened to many of his colleagues, but he has never been tested by his employer for the coronavirus. Even as the second wave of the pandemic batters Italy, Paolo only receives a handful of standard face masks a day — no gloves, visors, or higher-protection masks – and an €880 monthly paycheck.

Paolo's situation, as reported by Italian weekly L'Espresso on condition of anonymity for fears he would face retribution in the workplace, illustrates the hypocrisy of how an incalculable number of health workers are treated around the world. On the one hand, they have been called "heroes' and "essential." On the other, they lack the basic PPE to provide their best care safely, and their work is often underpaid and undervalued.

Like Paolo, more than 400,000 workers work little paid, high-risk health jobs with few guarantees or rights in Italy. They are nurses, but also assisted facility health workers, cleaners, home health workers. Some admit that they even avoid alerting their GP that they've come into contact with someone who tested positive because they fear they would lose their job – a decision that potentially puts their own patients at risk.

Their work is often underpaid and undervalued.

But the problem is widespread and persistent well beyond Italy. In the UK, a million health workers were paid less than the country's living wage while also being four times more likely to be on a zero-hours contract, according to a recent study. In the US, another study found that nearly 20% of care workers — including home health and personal care workers — live in poverty, while more than 40% rely on some form of public assistance. In the Philippines, nurses can make as little as $160 per month, forcing many to try their luck in Europe instead.

Many governments, including in France and Germany, have given bonuses to health workers during this global crisis. But few have tried to address the inherent structural problems the workers face. They are pushed into second-class jobs and zero-hours, zero-guarantee contracts, while the Western population ages and health care services become more starved of resources and enticed by cost-cutting operations.

An egregious example came from Bergamo, the city that first showed the world the horrors caused by the uncontrolled spread of the virus. Here, many doctors and nurses employed by public hospitals received a bonus for their effort in fighting the pandemic. But many of those privately employed in care homes and personal care jobs faced more responsibility, higher risk, and little recognition for their contribution. Like Paolo, in the face of regular risk of exposure to the deadly virus, their monthly pay stayed fixed at €800.