Environmental sustainability, healthcare companies increasingly protagonists of 'circular health'

The theme of circular health was the focus of the fourth meeting of the 2025 edition of the DASP Network, which brings together top managers in the health sector and where public health companies contribute to a reinterpretation of the main theoretical frameworks, such as that on sustainability, through the lens of concrete experiences in the field.

The circular health model, in fact, makes it possible to reinterpret and integrate the three dimensions of sustainability (environmental, social and economic) by offering a systemic approach that is consistent with the mission of health companies. One of the main reasons for this is to read in an integrated way the interdependencies between the behaviour of individuals, the work of health companies and the choices of institutions and vice versa. This is a typical model for public health companies that offer services to individuals, participating in a broader system of institutions such as the regions and the entire SSN.
In addition, the issue of sustainability is not new for public health companies. Already in Borgonovi's (2005) studies on business economics, it was emphasised that sustainability - already declined into economic, social and environmental - was an implicit goal of institutions working for the collective well-being.

In recent years, sensitivity towards environmental protection has grown considerably, in parallel with the awareness of today's climate risks. In this context, sustainability cannot remain an implicit value, but requires more emphasis within strategic guidelines and decision-making processes (e.g. green procurement). International evidence shows that the global healthcare sector is responsible for approximately 4.6% of total greenhouse gas emissions (Oecd, 2024; Who, 2024).
According to Health Care Without Harm (2024), if the healthcare sector were a country, it would be fifth in global emissions, with the majority of emissions (over 70%) coming from supply chain and indirect processes. These figures make it clear that healthcare institutions are both part of the problem and part of the solution. In Italy, many public health companies are developing sustainability initiatives, often in the absence of precise regional guidelines.

However, the formalisation of projects and the presence of monitoring systems remain uneven: sustainability is often treated as a set of best practices rather than a structured corporate strategy. Nevertheless, a growing proactivity can be observed: green procurement criteria are adopted in purchasing processes, renewable energy sources are experimented with, the use of disposable materials is reduced and action is taken on hospital logistics. These actions not only reduce environmental impact, but also generate economic and social benefits. This is a further qualifying element of initiatives undertaken under the label of environmental sustainability: social and economic impact criteria are always linked to environmental ones. It is in this perspective that many examples of proximity of care can also contribute to the pursuit of sustainability criteria. As Agenas Commissioner Americo Cicchetti emphasised, 'sustainability thus becomes a lever for strengthening the public mission of healthcare companies'.

Another element that can be observed in corporate experiences is the fact that many of them are born from below, from an intrinsic tension to pursue collective interests and to interpret health as a common good. In the absence of explicit regional directives, many company managements choose to adopt environmental and social policies consistent with the principles of public responsibility, becoming a concrete expression of collective sensitivity. There is therefore a sort of widespread capacity for initiative: therefore, in addition to restoring an institutional and cultural frame of reference, it is necessary to valorise the set of these initiatives that are part of the design of environmental sustainability, precisely as an expression of public intervention on the issue of health.