Pathways to Sustainable Public Health Systems: Integrating Economic and Social Strategies

Public health system sustainability is increasingly challenged by rising costs, demographic change, urbanization, environmental stressors, and recurrent health emergencies, exposing limitations of traditional financing and delivery approaches. This narrative review critically synthesizes models that strengthen health-system sustainability by integrating economic and social strategies across diverse settings. We conducted a structured search of peer-reviewed and selected grey literature (2000 to present) across major databases and sources, and applied thematic analysis to extract mechanisms, enabling conditions, and reported system-level effects. The review maps six main model families: public–private partnerships, social enterprise approaches, health impact bonds and other outcome-based financing, value-based healthcare, technology and AI-enabled delivery, and community health financing. Across these models, recurring pathways to sustainability include diversified funding and risk-sharing, stronger accountability through measurable outcomes, improved service efficiency and continuity, and targeted strategies to reduce inequities in access. However, implementation is constrained by governance and regulatory complexity, data and verification requirements, capacity gaps, and risks of exacerbating inequities when incentives or coverage design are weak. Overall, the evidence suggests sustainability gains are most plausible when models are adapted to context, embedded within robust public stewardship, and paired with investments in information systems and equity safeguards, offering practical direction for policymakers seeking resilient, inclusive health systems aligned with global development goals.