Introduction

GI multisociety strategic plan on environmental sustainability.

Despite having prevented public health center (PHC) dysfunction in response to COVID-19 during the first wave, public health nurses (PHNs) who play a central role in preventing COVID-19 and supporting community people were unable to share practical knowledge with other PHNs immediately. This report aims to introduce the development of novel sustainable public health care systems with regard to COVID-19 in Japan: task sharing, securing staff, and task shifting. A descriptive study. The Japan Ministry of Health, Labour, and Welfare enlisted good practices regarding resource allocation and developing full readiness for sustainable public health care systems in September 2020. Public health center developed systems for office support, infection control, hospital coordination, and outsourced inventory control. To reduce the workload of PHNs, a support team of three to four office workers developed a response manual for residents and a format for telephone consultations regarding COVID-19. Developing an infection control team and web-based system for hospital coordination decreased the workload of PHCs in each community to prepare for the pandemic. Public health center should consider managing limited human resources and focus on providing specialized care for COVID-19 patients. Task sharing, securing staff, and task shifting are crucial strategies for developing sustainable public health care systems.

BackgroundThe integration of artificial intelligence and Internet of Things (AIoT) technologies is transforming healthcare delivery systems globally. However, comprehensive evaluation frameworks are needed to assess AIoT technological impact on sustainable healthcare development across economic, organizational, and social dimensions.ObjectivesThis research investigates how AIoT technology affects sustainable healthcare development by examining the interconnections between individual economic viability, organizational responsibility, and social equity within the framework of Sustainable Development Goals (SDGs).MethodsA dual-methodology approach was employed combining factor analysis for quantitative assessment and triple-dimensionality method for qualitative evaluation. The study examined six inter-influence correlations across three dimensions using Social Learning Theory's triadic reciprocal determinism framework. Data analysis focused on healthcare professionals’ AIoT applications, institutional governance, and social equity outcomes.ResultsHealthcare professionals driving socially beneficial AIoT applications achieved the highest comprehensive weight (0.0927), indicating strong correlation between individual economic advantages and social equity outcomes. Medical healthcare professionals’ AIoT skills scored 0.0914, while responsible AIoT governance (healthcare professionals to gain the AIoT skills) achieved 0.0926. These findings validate bidirectional economic-organizational dynamics and demonstrate significant organizational-social equity integration with measurable reciprocal stimulation effects.ConclusionsAIoT technology represents a paradigmatic shift toward sustainable healthcare systems, creating self-reinforcing ecosystems where improvements in any dimension enhance outcomes across all areas. The study provides empirical validation that AIoT serves as a comprehensive catalyst for achieving “Good Health and Well-being” SDG targets while establishing economically viable and organizationally sustainable healthcare delivery systems.

The reprocessing of single-use medical devices (SUDs) has emerged as a strategic approach to enhance cost efficiency and sustainability in healthcare systems. This systematic review evaluates the effectiveness of SUD reprocessing in improving hospital resource management while maintaining patient safety standards. The study examines the entire reprocessing cycle, including cleaning, disinfection, sterilization, repackaging, and relabeling, which is conducted under strict protocols supervised by designated hospital committees. Our findings demonstrate that various SUDs—including cardiovascular catheters, laparoscopic instruments, staplers, and energy-based surgical tools—can be safely reprocessed, with clinical outcomes comparable to new devices. Economically, reprocessing yields substantial savings, reducing device costs by up to 50% and potentially saving a 200-bed hospital $600,000 to $1 million annually. In the United States alone, annual cost savings from SUD reprocessing are projected to exceed $2 billion by 2025. Beyond financial benefits, this practice significantly reduces medical waste, contributing to environmental sustainability in healthcare. The review highlights that successful implementation requires robust quality standards, regulatory compliance, and multidisciplinary oversight. While challenges exist, particularly in resource-limited settings, the evidence supports SUD reprocessing as a safe, cost-effective, and environmentally responsible strategy for modern healthcare systems.

Health systems worldwide are under pressure to simultaneously address rising costs, climate change, and health inequalities. This study proposes a new holistic policy for sustainable Primary Health Care (PHC) that combines the strategic use of Diagnosis Related Groups (DRGs) with environmental and finance sustainability practices. The model was developed through an extensive literature review and assessment of current policy frameworks such as Corporate Sustainable Reporting Directive and European Sustainability Reporting Standards (CSRD/ESRS), and aims to bridge the gap between clinical effectiveness, social protection, financial efficiency, and environmental responsibility. By moving away from the traditional, hospital-centered, one-dimensional focus of health care, the model reorients the health care system toward a multidimensional-holistic use of all available health resources, creating a resilient and sustainable health system that is aligned with environmental sensitivity and social protection under optimum financial efficiency. Integrating DRGs into PHC increases transparency and efficiency in resource allocation, reduces health inequities, and promotes financial sustainability. At the same time, the adoption of green health practices and the incorporation of those practices in the DRGS, such as the use of cost of energy and renewable energy and cost of waste and waste reduction practices, accelerates the achievement of the Sustainable Development Goals (SDGs). By improving preventive services, reducing avoidable hospitalizations, and establishing flexible, sustainable financing mechanisms, population health outcomes can be significantly improved. The findings suggest that a sustainable, adaptive, and dynamic PHC resilience system can serve as a central pillar for achieving health for all, reducing inequalities, strengthening social justice, and promoting planetary health, offering a transformative pathway to a greener and more equitable future for health care. These findings may inform health policy makers, sustainability officers, and primary care planners seeking to design integrated and accountable PHC systems.

Today’s sustainability challenges have major implications for human health and health care. At the same time, the way health care is organized and conducted has major sustainability implications. Sustainable health and sustainable health care approaches in research, which engage with health and sustainability as intertwined phenomena, feature increasingly prominently in various literatures, i.e., (i) literature based on the premise of ‘(un)healthy environments result in (un)healthy people’ (e.g., planetary health); (ii) literature on the implications of ecological change for the sustainability of healthcare systems; and (iii) literature on healthcare systems’ sustainability in view of a range of socio-economic factors. However, an integrative elaboration of the manifold relationships between health and sustainability challenges in these literatures is currently lacking. This review paper therefore maps how these three literatures represent intertwinements between health and sustainability challenges, as well as their suggestions to address these challenges. In addition, we explore which themes and questions are pertinent, meaning they have remained largely unaddressed. By performing a qualitative mapping review, we find that calls for structural attention to inequality, to in-and exclusion, and to stakeholder needs and perspectives cut across these three literatures. Furthermore, we identify three cross-cutting key questions that require future research attention. First, how do divergent ideas on what is and divergent ideas on how can that be known give rise to different health- and sustainability visions and pathways? Second, what do abstract problem statements and solutions presented in agenda-setting work look like in practice in specific and diverse empirical contexts across the globe? And third, how are diverse health and sustainability dynamics historically and spatially interconnected? Moreover, we observe that some voices have so far remained largely silent in scientific debates on health and sustainability intertwinements, namely non-expert voices such as patients and citizens, voices from a variety of social scientific and humanities disciplines, voices from relevant domains beyond (environmental) health, and voices from the global South (from non-experts, social scientific and humanities researchers and domains beyond health). We conclude that a focus on inclusive and equitable engagement with intertwined health- and sustainability challenges is imperative. This requires moving away from developing universal knowledge to address generic problems, to foregrounding plurality in terms of problem statements, knowledge, solutions, and the values embedded therein.

Introduction: Over the last decade, the emergence and spread of personalized medicine (PM) have defined a substantial revolution in healthcare. In principle, healthcare system sustainability is challenged by the investments required for research and development, as well as the adoption of PM techniques in routine clinical care. The “Integrating China in the International Consortium for Personalized Medicine” (IC2PerMed) EU-funded project aims to integrate China into the “International Consortium for Personalized Medicine” (ICPerMed). IC2PerMed aims to align the EU and China’s research agendas in this field to enable a swift development of approaches in the EU and China with strong leverage upon EU-Chinese collaborations. Methods: Within this project, we first mapped relevant policies on PM in both the EU and China, and then we involved European and Chinese experts in PM in workshops and Delphi surveys in order to identify relevant priorities for the implementation of PM in sustainable healthcare. Results: As a result of this process, we identified nine overarching priorities, each addressing specific aspects of the sustainability of healthcare systems and PM implementation, with the main goal of supporting policymakers in integrating PM approaches in the EU and China. Discussion/conclusion: The implementation of PM in health systems is appealing in terms of improved accuracy in diagnostics, treatment, and prevention of disease, as well as reduction of the side effects resulting from inefficient use of drugs. Research, development, and implementation of needed techniques require time and resources that can slow the adoption of PM in healthcare systems. The nine priorities we identified address some of the most critical points, trying to lay the foundations for a comprehensive approach.

BackgroundThe healthcare sector is a major contributor to climate change and there are international calls to mitigate environmental degradation through more sustainable forms of clinical care. The UK healthcare sector has committed to net zero carbon by 2040 and sustainable healthcare is a nationally mandated outcome for all UK graduating doctors who must demonstrate their ability to address social, economic, and environmental challenges. Bristol Medical School piloted successful Sustainability in Quality Improvement (SusQI) workshop, but identified challenges translating classroom learning into clinical practice. This paper aims to identify and address those challenges.MethodsWe conducted five focus groups that identified and iteratively explored barriers and facilitators to practice among medical students, comparing a range of experiences to generate a conceptual model. We then combined our findings with behaviour change theory to generate educational recommendations.ResultsStudents that applied their learning to the clinical workplace were internally motivated and self-determined but needed time and opportunity to complete projects. Other students were cautious of disrupting established hierarchies and practices or frustrated by institutional inertia. These barriers impacted on their confidence in suggesting or achieving change. A minority saw sustainable healthcare as beyond their professional role.ConclusionsWe present a series of theoretically informed recommendations. These include wider curricular engagement with concepts of sustainable clinical practice; supportive workplace enablement strategies such as workplace champions and co-creation of improvement goals; and time and headspace for students to engage through structured opportunities for credit-bearing project work.

Objective: This research sought to describe the strategies employed to address food security and safety within Indonesian healthcare environments, with a particular emphasis on the principles of sustainable healthcare. In light of the multifaceted challenges presented by climate change, it is imperative for hospitals and other healthcare facilities to not only guarantee the nutritional adequacy of their food services but also to implement rigorous measures to prevent foodborne illnesses.Material and Methods: This qualitative study comprised semi-structured interviews with 11 participants, including healthcare facility managers and nutritionists from seven hospitals and four community healthcare centres (PUSKESMAS). The interviews aimed to gather participants’ insights regarding the role of food security and safety in achieving sustainable healthcare. The data were analysed using NVivo 12 software.Results: Healthcare sustainability depends heavily on ensuring adequate nutrition and preventing food insecurity. However, recent statistics show that only 22.11% of sustainable health facilities meet food security standards, whereas food safety standards are met by 62.1%. Conclusion: The findings suggest that food security plays a crucial role in supporting sustainable healthcare practices. Institutions striving for long-term sustainability appear to prioritise achieving food security as a fundamental objective. These insights underscore the need to incorporate food-related considerations into comprehensive sustainability strategies within the healthcare sector.

There is increasing awareness among stakeholders in healthcare that the present day reforms in this sector need to be structured around financial, environmental and social sustainability. This arguably serves as a motivation to investigate ways to incorporate sustainable development measures into their planning cycles, and furthermore to implement these plans through delivery of sustainable services. Use of Modeling & Simulation (M&S) is essential for such planning as it provides the stakeholders with a tool to experiment with alternative strategies and to evaluate the resultant simulation output in terms of both productivity-related criteria and sustainability-related metrics. This paper presents a hybrid M&S approach for sustainability analysis that relies on both Discrete and Continuous elements for the purpose of modeling strategic and operational aspects of the underlying healthcare system. An existing case study is discussed through the lens of the proposed new Hybrid Simulation Framework for TBL Modeling (HSF-TBL).

BackgroundThis study aims to analyze the green transformation processes of existing hospitals and the sustainable design principles of newly constructed healthcare facilities in Türkiye. Given the healthcare sector’s significant environmental impacts—including high energy consumption, carbon emissions, water management challenges, and waste recycling issues—this research investigates strategies to minimize these impacts and support the transition toward sustainable healthcare systems within the national context.MethodsA qualitative research design was employed, involving in-depth interviews with 24 healthcare managers from both public and private hospitals across Türkiye. Participants were selected using criterion and maximum variation sampling techniques, supplemented by snowball sampling to identify relevant stakeholders. Data were analyzed using MAXQDA 2020 qualitative analysis software to extract key components of sustainable healthcare facilities.ResultsThe analysis revealed several critical environmental challenges facing existing hospitals in Türkiye, such as the lack of sustainable infrastructure leading to excessive energy consumption, inefficient waste management systems, suboptimal water use, and limited initiatives aimed at reducing carbon footprints. In contrast, newly designed healthcare facilities demonstrate solutions including the integration of solar panels and renewable energy systems, implementation of water recycling, adoption of green roof designs and natural ventilation, and the expansion of smart energy management technologies. Healthcare managers highlighted that the main barriers to green hospital transformation include high costs, structural limitations of existing buildings, and insufficient managerial support.ConclusionTo effectively advance green transformation in the Turkish healthcare sector, it is recommended to establish sustainable architectural standards for new hospital buildings, develop financial and managerial frameworks to incentivize the green transformation of existing facilities, and accelerate the transition to carbon-neutral healthcare systems through targeted policy and strategic initiatives. The widespread adoption of green practices in healthcare institutions is critical for environmental sustainability and public health. Efficient resource management, waste control, and environmental awareness programs are essential to align healthcare institutions in Türkiye with Sustainable Development Goals (SDGs).Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-026-14160-7.

The withdrawal of USAID and PEPFAR funding from Africa has been contentious, raising questions about the sustainability of healthcare and development interventions, particularly among vulnerable populations. This study evaluates the socioeconomic and health impacts of this shift, with emphasis on service delivery gaps, economic burden, and government and civil society response mechanisms. Employing a mixed-methods approach, the research employs surveys, interviews, and secondary data analysis to assess the impact on healthcare infrastructure, economic stability, and mortality. Informed by Dependency Theory, the study reviews earlier research on foreign aid dependency and sustainability of donor-funded programs. Preliminary results indicate that funding withdrawal has led to HIV/AIDS treatment interruptions, maternal health care services, and immunization programs and also the loss of employment in donor-funded projects. Although some governments and NGOs make attempts to look for alternative sources of funding, vulnerabilities such as poor domestic resource mobilization and governance constraints still persist. The research indicates that African governments should pay greater attention to domestic health financing through taxation, public-private partnerships, and regional mechanisms while strengthening healthcare resilience through capacity building and decentralized mechanisms. In addition, reaching new donors and investing in community-based healthcare and technology-based solutions is essential in maintaining core services. While the removal of aid is a problem, it also presents a chance for African nations to reconsider development finance policy and achieve self-reliance. This debate highlights the necessity for active policy responses to offset adverse effects and ensure continuity in public health and socioeconomic progress.

Sustainability is a broad and debated subject, often difficult to be defined and applied into real projects, especially when dealing with a complex scenario as the one of healthcare. Many research studies and evaluation systems have handled this topic from different perspectives, but many limits and criticalities still have to be overcome to properly cope with actual needs. The Sustainable Healthcare project has been developed through three main phases: a deep study of the state of the art, unraveling pros and cons of available sustainability scoring systems; an accurate analysis of the stakeholders network and their needs; the realization of an objective evaluation framework, through scientific methods, as the ANP. The newly developed evaluation system takes into consideration all the three pillars of sustainability, analyzing social, environmental and economic sustainability through a set of criteria, specified by measurable indicators. So the system identifies both global sustainability and specific critical areas, pointing out possible strategic solutions to improve sustainability. The evaluation is achieved through technical analyses and qualitative surveys, which eventually allow to quantitatively assess sustainability, through a sound scoring method. This study proposes an innovative evaluation method to determine the sustainability of a hospital, already existing or in the design phase, within the European context. The Sustainable Healthcare system overcomes some of the current evaluation systems' limits by establishing a multidisciplinary approach and being an easy-to-use tool. This protocol is intended to be of support in the identification of the main hospital's weaknesses and in setting priorities for implementation of the solutions.

Affordability is one of the main determinants of healthcare access. People with low socioeconomic status are less able to receive appropriate healthcare. To optimise healthcare in an equally and equitably accessible way, universal health coverage is a direction to achieve this goal. Countries should focus on provision of accessible, affordable, safe, quality and essential healthcare services for all people, and this is one of the targets of SDG 3. Undoubtedly, healthcare financing determines the provision and model of service delivery in healthcare. In Hong Kong, all individuals have adequate treatment under the dual-track healthcare system. However, the general public is facing long waiting time for public healthcare services. Japan, the second longevity in the world, pursues universal health coverage by the establishment of employee-based and community-based social health insurance, and nearly all Japanese citizens are covered. Nevertheless, ageing societies are threatening the health insurance system. This chapter will compare different healthcare financing models in the Asia-Pacific region and identify how sustainable and equitable healthcare financing can be accomplished to ensure social and financial risk protection in terms of accessibility and universal health coverage leading to healthy lives and well-being for all at all ages.

This article examines the instruments used to attract private sector participation in the financing and provision of healthcare facilities in Ukraine, focusing on their growing relevance amid systemic reform, fiscal constraints, and the need to modernize public health infrastructure. The topic is grounded in the urgent necessity to ensure sustainable healthcare financing, increase the efficiency of medical services, and establish resilient mechanisms of public-private cooperation. The paper identifies a wide spectrum of tools, including financial incentives, concession models, investment guarantees, public procurement reforms, and institutional support programs. These instruments are analyzed in the context of their capacity to stimulate innovation, reduce operational costs, and enhance the quality and accessibility of healthcare services. Special attention is paid to the challenges of implementation, such as legal fragmentation, insufficient strategic planning in healthcare institutions, and a low level of trust between state actors and private investors. The importance of aligning public health objectives with investment strategies is emphasized, as well as the need for a stable regulatory environment that ensures transparent governance and balanced risk distribution. The article underlines the value of international best practices and suggests pathways for their adaptation to Ukraine’s socio-economic context, considering regional disparities and post-war recovery imperatives. The necessity of fostering effective dialogue between government institutions, private stakeholders, and civil society is recognized as a crucial condition for the success of public-private partnerships. The study contributes to a deeper understanding of how institutional innovation, capacity development, and evidence-based policy can drive investment and transformation in the health sector. This research is aimed at scholars, policymakers, health administrators, and private actors interested in sustainable healthcare development and the promotion of inclusive public service delivery models.