Towards an environmentally sustainable and resilient healthcare system: a roadmap for Italy

Healthcare systems face a dual challenge: they help protect population health, yet they also drive climate change through emissions, resource consumption, and waste — while climate change itself is straining healthcare services via extreme weather and growing disease burdens. In Italy, sustainability and climate-resilience efforts in healthcare are expanding but remain fragmented, lacking a unified national framework. This paper proposes a roadmap to guide Italy toward a more sustainable, climate-resilient healthcare system. It was built through a participatory process involving the SOSTERRETE network — a national workshop at the Istituto Superiore di Sanità, followed by structured discussions and two rounds of asynchronous consultation — synthesised into shared principles, strategic objectives, priority actions, best practices, and policy recommendations. The roadmap identifies critical policy gaps and sets out four strategic objectives: Establishing clear targets to cut healthcare emissions Embedding sustainability into health system planning and governance Improving tools to measure environmental impact and climate risk Promoting actions with combined health and environmental co-benefits Priority actions span energy and infrastructure improvements, waste and low-value care reduction, supply chain sustainability, climate-event preparedness, staff training, and accountability/monitoring systems. The paper concludes that Italy has an opportunity to shift from scattered initiatives to a coordinated national strategy — embedding sustainability into governance, financing, and evaluation to simultaneously reduce environmental impact and strengthen resilience, health outcomes, and equity.