Shifting the paradigm: from sustainable to regenerative healthcare

Abstract

Abstract Issue seven of the nine planetary boundaries have already been transgressed. The 2026 Lancet Countdown confirms that current efforts are insufficient and reversing previous gains, with 12 of 20 health-climate indicators at record levels. Net-zero strategies in healthcare cannot restore the ecological conditions upon which population health depends. The Healthcare Doughnut (HCD), developed within the EU Horizon Europe Caring Nature project, defines a safe operating space for health systems by integrating planetary boundaries with the Quintuple Aim. Current health systems already operate outside this space. Description while sustainability focuses on reducing harm, the regenerative approach aims to restore degraded ecological and social systems. Drawing on the HCD and systems thinking, we conceptualise health systems as initiators of regenerative feedback loops that, in interaction with policies, markets and communities, generate cascading benefits across environmental, social and health domains. Results regenerative healthcare reframes the aim of health system management from “do no harm” to actively regenerating the ecological and social environments hospitals operate in. Across the eight HCD impact domains (buildings, energy, waste, pharmaceuticals, water and sanitation, food, transport, supply chain), management decisions become drivers of restorative dynamics, generating self-reinforcing loops that act on multiple transgressed planetary boundaries while reducing disease burden and pressure on health systems. Lessons regenerative healthcare offers a double benefit: ecosystems restoration and improved population health, supporting long-term system resilience. Health systems are well positioned to initiate cross‑sector actions. Key policy levers include regenerative criteria in public procurement, HTA frameworks that capture restorative co‑benefits, and governance mechanisms linking healthcare with food policy, urban planning and ecological stewardship. Key messages • Net-zero healthcare is necessary but insufficient. Planetary boundaries already exceeded require health systems to move beyond sustainability towards regenerative policies. • Regenerative healthcare can trigger self-reinforcing loops delivering a double benefit: ecosystem restoration and improved population health, strengthening long-term health system resilience.