Abstract
BACKGROUND: Ten years after the launch of the Okanagan Charter, which called on universities to embed health promotion principles and values into their core strategies, this study investigates how Italian state universities have responded. By analyzing updated strategic plans, we assessed the integration of health and wellbeing principles into their policies, mission, vision, and programming, and identified good practices to be offered to the stakeholders. METHODS: A deductive content analysis was conducted on the strategic plans of 45 out of 61 Italian state universities. A multidisciplinary team developed a coding framework based on key health promotion themes: participation, wellbeing-centered mission and vision, psycho-physical, social, and organizational wellbeing, sustainability, and equity. Each plan was independently reviewed by three researchers randomly selected out of 12, and findings were synthesized narratively. RESULTS: 45 Italian state universities had updated strategic plans, most developed through top-down processes. Only 40% explicitly referenced wellbeing in their mission and vision. While 90% addressed sustainability, mainly energy-related, other aspects like mobility, waste, and food received less attention. Equity was widely considered: 89% promoted inclusion and gender equality, 58% offered tax relief, and 40% provided inmate education. Mental wellbeing was addressed in 64% of plans, social wellbeing in 60%, and healthy lifestyles in 42%. Collaboration with health services was rare, and preventive strategies were limited. The study identified a set of good practices, low-cost, actionable, and community-oriented, that can serve as practical tools to support the implementation of health promotion strategies in universities. CONCLUSIONS: Italian universities showed a growing but uneven commitment to health promotion. Despite frequent references to wellbeing, its integration remains partial and sectoral. This study identified key areas for improvement, such as participation, and highlighted a selection of good practices. These practices offer actionable and replicable models that, through advocacy, can support the development of healthier, more inclusive, supportive university environments. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-24809-3.