Plant-based foods in healthcare sustainability policy: a scoping review of policy tools, gaps, and implementation challenges

• Healthcare food procurement is a leverage point for health and emissions reduction. • Plant-based foods are rarely specified as explicit, measurable policy instruments. • Policy uptake is constrained by fragmented governance, industry influence, and weak evaluation. • Operational policy tools (procurement standards, defaults, targets) are largely absent but needed. Plant-based diets can improve health outcomes while reducing food-system environmental impacts. Healthcare organisations can influence dietary practices through food procurement, policy, and education, but the extent to which plant-based foods are embedded in healthcare sustainability policy remains unclear. Objective: To map evidence on the role of plant-based foods in healthcare sustainability policies aimed at reducing healthcare-related emissions. Methods: The review employed a scoping methodology guided by the PRISMA-ScR framework. A comprehensive search of peer-reviewed literature was conducted across major academic databases including Scopus, Web of Science, and PubMed. Studies were included if they addressed plant-based or sustainable foods, healthcare organisations, sustainability practices, and/or health policy frameworks. Inclusion criteria focused on articles published in English between January 2013 and February 2024. Data were charted and thematically analysed. Results: The search identified 2,640 records; 29 sources met inclusion. Evidence supports plant-based food strategies as a lever for health and sustainability, yet explicit integration into healthcare policy was limited and inconsistent. Where present, plant-based approaches were usually embedded within broader nutrition or sustainability initiatives rather than framed as a standalone policy lever. Policy leadership was most evident in the United Kingdom and Qatar; Australia and the United States were described as facing structural and political constraints, including fragmented mandates, industry influence, and limited monitoring and evaluation. Conclusions: Plant-based foods remain underrepresented in healthcare sustainability policy despite strong rationale for emissions reduction and health co-benefits. Clearer policy commitments, measurable targets, evaluation frameworks, and cross-sector collaboration are needed to translate evidence into scalable healthcare practice.