Integrating ESG indicators into public health governance as a policy innovation for institutional accountability: a scoping review

Abstract

Objectives:

To examine how ESG indicators and related frameworks are being translated from corporate disclosure into public health governance.

Methods:

Following PRISMA-ScR and the PCC framework, we synthesized 25 studies and grey-literature documents to map definitions, implementation levels, governance uses, barriers, and research gaps. ESG integration was defined as the use of environmental, social, and governance indicators to support accountability, transparency, stakeholder engagement, sustainability alignment, and strategic control in health systems.

Results:

ESG-related frameworks may strengthen reporting practices, multisectoral coordination, and alignment with the Sustainable Development Goals when supported by leadership, technical capacity, harmonized indicators, and standardized reporting systems. However, the evidence remains heterogeneous and exploratory. Direct effects on governance performance, health outcomes, or equity are rarely demonstrated. Key gaps include unclear conceptual boundaries between ESG, CSR, SDG monitoring, and sustainability reporting, limited appraisal of reporting versus actual performance, measurement inconsistency, and under-representation of low-resource and Global South contexts.

Conclusion:

Future research should validate sector-specific ESG indicators and evaluate whether ESG integration improves accountability, equity, and sustainable public health governance.

Introduction

Environmental, Social, and Governance (ESG) frameworks have evolved as essential tools for promoting corporate sustainability and responsible business practices. The conceptual foundation of ESG integrates risk management, ethical corporate citizenship, and sustainable value creation [1]. ESG implementation involves various governance dimensions, including organizational settings, strategy, and implementation structures [2]. While developed economies demonstrate more robust ESG integration, emerging markets face challenges such as fragmented governance and limited institutional capacities [3]. ESG practices are increasingly incorporated into corporate governance frameworks, influencing board composition, executive compensation, and transparency practices [4]. The theoretical underpinnings of ESG research include sustainability of competitive advantage, compliance of social construction, and alignment of governance accountability [5]. Various ESG frameworks, such as GRI, PRI, and SASB, offer different approaches to sustainability reporting and implementation [6].

To avoid treating ESG as a generic synonym for sustainability, this review distinguishes between ESG as a corporate disclosure framework and ESG as a public governance instrument. In its original corporate use, ESG primarily organizes non-financial information on environmental risks, social responsibilities, and governance practices for investors, regulators, and stakeholders. In public health governance, ESG integration is instead understood as the deliberate incorporation of those indicators into stewardship, priority setting, planning, monitoring, reporting, and accountability processes.

This distinction guided the eligibility criteria. Studies on SDGs, CSR, sustainability metrics, and governance indicators were included only when they contributed to at least one ESG-relevant governance function: transparency, accountability, participation, equity, institutional control, risk management, or sustainability alignment. Thus, ESG-related evidence was mapped as an emerging governance architecture rather than as a single standardized measurement system.

The literature highlights significant gaps in public health governance, particularly in transparency, accountability, and strategic control mechanisms. Key challenges include weak policy implementation, limited cross-sector coordination, and inadequate understanding of accountability frameworks [7]. Corruption and lack of transparency in developing countries’ health services are major obstacles to effective service delivery [8]. The governance accountability problem (GAP) reveals a disconnect between ad hoc interventions and state responsibilities for health security [9]. Public-private partnerships in global health require improved transparency and accountability for better performance [10]. In rural settings, strong accountability towards management and partners often fails to extend to the public [11]. Enhancing citizen participation, improving human resource capacity, and adopting technology-based systems are proposed strategies to strengthen governance and accountability in public health [7, 12, 13].

The application of ESG principles to the public health sector is gaining traction as a strategic evolution of value-based healthcare [14]. ESG implementation in healthcare can contribute to sustainability goals, improve financial performance, and enhance risk management [15, 16]. While the healthcare industry has traditionally focused on social aspects, there is a growing emphasis on environmental considerations due to the sector’s significant carbon footprint [15]. ESG principles can serve as a framework for non-financial reporting in healthcare organizations, although adaptation to specific organizational missions is crucial [17]. The integration of ESG in healthcare aligns with the UN Sustainable Development Goals, particularly SDG 3 on health and wellbeing [18]. However, challenges remain in implementing ESG principles, especially in emerging markets and nonprofit organizations [16, 17].

The integration of ESG principles into public health governance and risk management is gaining strategic importance globally. ESG integration enhances governance quality, stakeholder trust, and institutional resilience [3]. It is crucial for achieving sustainability goals and offers potential economic benefits in healthcare [15]. ESG adoption improves risk management, operational efficiency, and corporate reputation [19]. Adding health considerations to ESG criteria (ESG + H) could catalyze the inclusion of health in financial decision-making [20]. An integrated population health risk management framework can facilitate evidence-based health policy development [21]. However, challenges remain, including inadequate tools and resources, particularly in emerging economies [22]. Effective ESG integration requires aligning with strategic planning, establishing robust governance frameworks, and fostering a risk-aware culture [23, 24].

The concept of good governance in health systems has evolved over time, encompassing principles such as accountability, transparency, participation, and effectiveness [25, 26]. It emerged from different disciplines, including economics, political science, and development studies [27]. Good governance is seen as crucial for improving health system performance and achieving better health outcomes [28]. Key milestones include the shift from social protection to health policy and governance paradigms [29], and the recognition of governance’s role in achieving health-related Millennium Development Goals [30]. Challenges in implementing good governance include measuring outcomes, adapting to local contexts, and bridging the gap between policy and practice [31, 32]. Various frameworks have been developed to assess health system governance, though only a few have been applied in practice [27].

Governance in public sector health systems involves multiple dimensions, with transparency and accountability emerging as key principles [10, 27]. These concepts are often interconnected and contribute to improved organizational performance and public trust [33]. Various frameworks have been developed to assess health system governance, drawing from disciplines such as economics, political science, and public management [27]. The TAPIC framework, for instance, identifies five domains: Transparency, Accountability, Participation, Integrity, and Capacity [34]. Challenges in implementing effective governance include weak policy execution, limited cross-sector coordination, and inadequate understanding of accountability frameworks [7, 35]. Strategies for improvement include digitalization of processes, enhancing community participation, and adopting complementary accountability approaches [7, 11]. Research in this field has increased, particularly since the rise of public sector governance as a focal point [36].

Recent research on ESG indicators in healthcare highlights their growing importance for sustainability and financial performance. Studies show that ESG implementation in healthcare management is crucial for achieving Sustainable Development Goals [15]. However, there’s a lack of consensus on defining sustainability and its impact on organizational performance across the three ESG pillars [37]. The relationship between ESG activities and firm performance varies between developed and developing economies [38]. Research gaps exist, particularly in social and governance measures [39]. The healthcare sector’s significant environmental impact necessitates urgent research to inform policy and practice [40]. Future research should focus on developing standardized sustainability metrics, revising infection control standards, and increasing federal funding for sustainability research in healthcare [18, 41].

International governance frameworks for transparency, accountability, and sustainability in health systems and public institutions include the World Health Organization (WHO), Global Reporting Initiative (GRI), and frameworks developed by the World Bank and United Nations Development Programme (UNDP) [42–44]. These frameworks emphasize principles such as strategic vision, participation, rule of law, transparency, responsiveness, equity, effectiveness, accountability, and ethics [42]. The GRI framework has been applied to assess sustainability in healthcare organizations globally [45]. Governance in global health operates across three spaces: global health governance, global governance for health, and governance for global health [12]. Transparency and accountability are crucial for assessing and designing governance in global health partnerships [10]. Anti-corruption measures, including community monitoring and fraud control, are essential for strengthening health systems and achieving universal health coverage [46].

Recent studies highlight the growing adoption of ESG principles in public governance domains outside healthcare. In education, universities are implementing ESG practices to promote sustainability and social inclusion [47, 48]. The integration of ESG principles into environmental education is being explored in the MENA region to address pressing environmental challenges [49]. In public administration, ESG considerations are enhancing government transparency, reducing debt, and attracting foreign investment [50]. The interplay between public and corporate governance in driving ESG engagement has been examined across multiple countries [51]. Some researchers argue for applying ESG principles to both public and corporate governance. In Brazil, the potential application of ESG principles in public administration is being analyzed [52]. These studies demonstrate the increasing relevance of ESG principles in various public governance domains.

Methods

This scoping review aims to explore the extent and nature of evidence on the integration of ESG indicators into public health governance, as a policy innovation for institutional accountability and control. Following the methodological framework proposed by Arksey and O’Malley [53] and refined by Levac et al. [54], and reported according to PRISMA-ScR guidelines [55].

A scoping review was selected because the evidence base is still emerging, conceptually heterogeneous, and composed of policy documents, conceptual papers, reporting studies, and empirical evaluations. The objective was therefore to map the range of frameworks, definitions, governance applications, implementation conditions, and knowledge gaps, rather than to estimate a pooled effect or determine intervention effectiveness. Consistent with scoping review methodology, a formal risk-of-bias assessment was not conducted; instead, the synthesis explicitly distinguishes conceptual claims, implementation experiences, reporting practices, and empirical outcome evidence.

In order to ensure methodological transparency and to precisely delineate the scope of the review, the inclusion and exclusion criteria were structured according to the PCC framework (Population, Concept, Context) recommended by the Joanna Briggs Institute for scoping reviews [56, 57]. This approach allowed us to systematically define the relevant population (e.g., public health institutions, health systems, and regulatory bodies), the core concept under investigation (i.e., the integration of ESG indicators, sustainability metrics, SDGs, or corporate social responsibility frameworks), and the context (e.g., public health governance, institutional accountability, and national or international policy settings) (Table 1).

Operationally, ESG integration was defined as the use of environmental, social, and governance indicators or ESG-related reporting logics within public health decision-making, monitoring, accountability, or institutional control. Broader SDG, CSR, or sustainability studies were included only when they addressed these functions in public health institutions, health systems, or policy settings.

Information sources and search strategy

A comprehensive search strategy was developed in consultation with an experienced research librarian to ensure the identification of all relevant sources of evidence. We searched the following electronic databases: PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase, and CINAHL, from inception to 29 July 2025. In order to capture additional evidence beyond peer-reviewed literature, we also searched relevant grey literature sources, including WHO Institutional Repository, OECD iLibrary, World Bank Open Knowledge Repository, UN Sustainable Development Goals Knowledge Platform, and Google Scholar (first 200 results). Reference lists of all included studies and relevant reviews were hand-searched to identify additional eligible documents.

The search strategy is provided in Supplementary Table S1.

To streamline the elimination of duplicates and facilitate the management of the records identified for inclusion, Rayyan software was used [58]. Three independent reviewers (P.C., D.V., and C.L.) were involved in the study selection process. Screening was performed in two sequential phases. In the first phase, two reviewers (P.C. and D.V.) independently examined the titles, abstracts, and keywords of all retrieved records to assess their alignment with the scope of the review. Records not meeting the inclusion criteria were excluded at this stage. Relevant review articles were also identified for citation tracking in order to uncover additional studies not indexed in the selected databases [59]. In the second phase, the same reviewers independently assessed the full-text articles against the predefined inclusion and exclusion criteria. Disagreements between reviewers were resolved by discussion and, when necessary, by consultation with the third reviewer (C.L.), who supervised the process and ensured methodological consistency across both phases. The entire selection process was documented using a PRISMA-ScR flow diagram.

Extracted information included study type, geographical scope, institutional level, ESG-related framework, ESG dimension, implementation level, accountability mechanism, reported governance outcome, enablers, barriers, and limitations. The synthesis was conducted in two steps. First, evidence was mapped descriptively according to the PCC framework. Second, an analytical matrix was developed to identify recurring ESG dimensions, governance functions, and evidentiary limitations across studies (Table 2). This approach was used to avoid inferring causal effects from studies that primarily provided conceptual, descriptive, or reporting-based evidence.

Results

Literature search

A comprehensive search of multiple electronic databases initially identified 343 records. The PRISMA flowchart (Figure 1) illustrates the stepwise selection of relevant publications throughout the review process. Following the removal of 131 duplicate records, 212 records remained for the screening stage. During this phase, 163 records were excluded for not meeting the predefined inclusion criteria. Consequently, 49 articles were retrieved for full-text eligibility assessment. In the final stage, 25 studies were included in the qualitative and quantitative synthesis.

FIGURE 1

General characteristics of the included studies

A total of 25 studies were included in this review, encompassing a broad range of methodological approaches, geographical scopes, and frameworks related to the integration of ESG indicators into public health governance (Table 3).

Given the broad inclusion criteria, the evidence base should be interpreted as a heterogeneous map rather than a set of directly comparable effectiveness studies. Studies differed by institutional level, theoretical foundation, indicator set, and outcome definition. Healthcare organizations and corporate healthcare actors tended to emphasize disclosure, environmental performance, and financial or reputational outcomes, whereas public health governance and health-system studies more often focused on accountability, equity, community participation, and policy alignment.

Policy analyses [60, 63, 68, 75, 83, 84] examined the role of national and regional governance mechanisms and voluntary reporting in driving institutional accountability. Other study [62, 85–89] provided evidence on how integrated governance frameworks, SDG monitoring, and participatory mechanisms contribute to improved governance outcomes across health systems.

Several qualitative studies [17, 64, 67, 90] explored ESG and CSR applications at the organizational and cross-sectoral level, with a focus on stakeholder engagement and social responsibility in healthcare settings. Quantitative and mixed-methods studies [61, 69, 70, 72–74, 82] investigated ESG adoption trends, reporting practices, and associations with institutional performance indicators such as financial stability, mortality reduction, and service delivery outcomes. Conceptual and theoretical contributions [65, 66, 78] highlighted the importance of structured ESG processing maps, disclosure frameworks, and integrated sustainability strategies to strengthen institutional accountability [17, 60, 62, 76–83].

Geographically, 11 studies had a global or multi-country focus, while 9 studies focused on Europe or the United Kingdom. Four studies examined African contexts, and four were based in Asia. Only one study each addressed the United States and Brazil, while three others did not specify a location.

The frameworks and approaches adopted were heterogeneous. ESG-related instruments such as disclosure indexes, ESG paradigms, and processing maps were used in 12 studies [17, 61, 65–67, 69, 74, 78, 82]. SDG-based frameworks, including the WHO Europe SDG Roadmap and SDH action indicators, were reported in seven studies [60, 62, 63, 87–89]. Other approaches included governance indicators or mechanisms [84–86], CSR frameworks [73, 90], environmental sustainability indicators in HTA [64], and international reporting standards such as GRI, SASB, and TCFD [61, 82].

The majority of studies analyzed governance and accountability as their primary focus, including [60, 62, 63, 68, 70, 72, 84–88], while others concentrated on sustainability [64–66, 78], reporting and disclosure practices [17, 61, 69, 74, 82], and health outcomes or equity issues [72, 73, 89].

Across the included studies, recurrent enablers of ESG integration included robust governance structures, stakeholder engagement, and multisectoral collaboration. For instance, Bickler et al. [63] and Martins and Paes-Sousa [75] emphasized the relevance of standardized indicators in facilitating Voluntary National Reviews and improving institutional accountability. Conversely, data gaps [61, 82], inconsistent standards [69, 74, 82], limited resources, and regulatory weaknesses [74, 83] were commonly cited barriers. These challenges often limited the capacity of ESG frameworks to translate policy ambitions into measurable improvements in public health governance and outcomes.

Across the mapped evidence, environmental indicators were most often connected to sustainability reporting, procurement, emissions, resource use, and environmental criteria in health technology assessment. Social indicators were linked to equity, social determinants of health, community engagement, stakeholder participation, and workforce or patient-related responsibility. Governance indicators were linked to transparency, disclosure quality, compliance, leadership, institutional control, anti-corruption, and accountability mechanisms. However, the strength of evidence varied: most studies described frameworks, reporting practices, or implementation experiences, while few tested whether ESG integration produced measurable improvements in governance performance or health outcomes.

Results of characteristics referred to PCC framework

The 25 studies included in this review (Table 3) analyzed diverse populations, concepts, and contexts in relation to the integration of ESG indicators into public health governance. In terms of population, most studies [60, 63, 68, 75, 83, 84] focused on public health governance structures at the national or regional level, including governmental agencies, health ministries, and public health institutions. Others concentrated on organizational settings such as hospitals, health technology assessment bodies, and healthcare networks [17, 64–67]. Broader health systems and urban governance dynamics were addressed in studies [85, 88, 89], while other contributions examined populations indirectly through corporate, financial, or community health perspectives [69, 73, 74, 82, 90].

With respect to the concept, the studies examined a wide range of frameworks used to integrate ESG indicators, sustainability metrics, or related tools to reinforce institutional accountability. ESG-related frameworks such as disclosure indexes, paradigms, and processing maps were highlighted in several studies [17, 61, 65, 66, 69, 74, 78, 82]. Other studies focused on SDG-based frameworks, including the WHO Europe SDG Roadmap and SDH action indicators [60,62,63,87–89], governance indicator sets [84–86], CSR frameworks [73, 90], and environmental sustainability indicators, particularly in health technology assessment [64]. These frameworks were primarily applied for non-financial reporting, indicator mapping, and policy evaluation, and were often explicitly linked to institutional accountability outcomes.

The context of the studies was equally diverse. Eleven studies adopted a global or multinational scope [60, 62, 85, 87–89], whereas nine focused on European or UK settings [61, 63, 65, 66, 68, 83, 84]. African contexts were addressed in four studies [67, 74, 90], while another four were set in Asia [61, 73, 82]. Only one study each focused on the United States [73] and Brazil [72].

Overall, the findings across the three PCC domains indicate that ESG and related sustainability frameworks are increasingly being applied in varied health governance contexts and at different levels of institutional complexity. Studies consistently reported that effective integration of ESG indicators was facilitated by strong governance structures, standardized reporting frameworks, and multipartner collaboration.

Discussion

This scoping review synthesized evidence from 25 studies examining how ESG indicators and related frameworks are being integrated into public health governance. The results show that ESG frameworks are increasingly viewed as mechanisms for strengthening institutional accountability, promoting transparency, and aligning public health systems with global sustainability goals. However, the findings also highlight significant heterogeneity in approaches, levels of implementation, and reported outcomes.

These findings should therefore be read as evidence of the potential governance functions of ESG-related frameworks, not as proof of causal effectiveness. In particular, the review supports the proposition that ESG can structure accountability and reporting processes, but it does not demonstrate that ESG adoption alone improves population health outcomes or eliminates governance deficits.

Our findings align with prior analyses of governance frameworks in public health, which emphasize the need for standardized indicators and cross-sectoral collaboration. Several studies in this review [60, 63, 75] confirm that standardized frameworks such as the WHO Europe SDG Roadmap can help governments systematically monitor progress and reinforce accountability. These results mirror the conclusions of broader governance reviews [85, 88] which showed that structured evaluation frameworks support more transparent decision-making and better alignment of health system priorities with the SDGs.

At the organizational level, ESG tools such as disclosure indexes and processing maps [65, 66, 78] were associated with improvements in sustainability reporting and stakeholder engagement. These findings complement earlier corporate responsibility analyses [73, 90] which found that ESG and CSR approaches can create reputational and operational benefits for healthcare organizations. Nevertheless, the variability in adoption and reporting practices across contexts underscores the lack of harmonized standards [69, 82, 91].

Recent studies have examined the impact of ESG frameworks on healthcare organizations’ performance and accountability. Evidence suggests that ESG performance can positively influence financial performance, particularly in developed economies [38, 92]. The environmental pillar shows a concave impact on return on assets, while governance consistently predicts positive financial outcomes [92, 93]. ESG implementation in healthcare can contribute to sustainability goals and offer economic benefits [15, 94]. Local institutional ownership has been found to reduce toxic chemical releases and enhance firm performance through pollution abatement policies [95]. However, the relationship between ESG and performance varies across different contexts and measures [17, 18]. Overall, ESG frameworks appear to have a growing influence on healthcare organizations’ practices and outcomes.

Governance mechanisms in health systems have been shown to influence health outcomes in low- and middle-income countries through decentralization, stakeholder alignment, community engagement, and social capital strengthening [86, 96]. Key governance areas impacting healthcare quality include leadership, system design, accountability, financing, private partnerships, information systems, community participation, and regulation [97, 98]. Good governance enhances the efficacy of health expenditure and service delivery [99]. ESG frameworks can guide sustainable development in healthcare organizations [94], while the SDGs complement ESG standards by focusing on externalities [18]. Effective governance is crucial for translating resources into quality care [100]. In developing countries, non-governmental and international actors play vital roles in connecting global and local health governance [101]. A comprehensive framework for assessing health system governance includes principles such as strategic vision, participation, transparency, and accountability [42].

The evidence reviewed suggests that effective ESG integration depends on multiple enabling conditions. First, strong institutional leadership and political commitment are critical. Bickler et al. [63] and Martins and Paes-Sousa [75] illustrate how leadership can drive alignment between ESG metrics and national reporting obligations, such as Voluntary National Reviews. Second, legal and regulatory frameworks that mandate disclosure, such as the European Corporate Sustainability Reporting Directive (CSRD) analyzed by Zariņš and Siders [83] and Capobianco et al. [68], increase compliance and improve the quality of reporting in public health institutions.

Another implication for practice is the need to strengthen technical capacity for data collection, analysis, and reporting. Several studies [61, 74, 82] emphasized that data gaps and inconsistencies undermine the ability of ESG frameworks to generate actionable insights. Capacity-building efforts must therefore be prioritized, particularly in low-resource settings, as highlighted by Hone et al. [72] and Ahen [90]. Finally, a culture of stakeholder engagement and participatory governance, documented in studies such as Mesa-Vieira et al. [89] and Brizolla et al. [67], is essential to ensure that ESG initiatives are responsive to community needs and foster shared accountability.

A recurring concern across the literature is the risk that ESG remains a reporting exercise rather than a mechanism for substantive institutional change. In public health, this distinction is particularly important because improved disclosure does not necessarily translate into better service quality, equity, or community accountability. Measurement inconsistency, lack of comparable indicators, weak data infrastructures, and fragmented regulatory requirements can generate symbolic compliance or selective reporting, especially when ESG adoption is voluntary or weakly linked to public oversight.

The review also highlights the need to examine ESG integration through the lens of structural inequalities. Low-resource governance environments may lack reliable data systems, technical staff, legal mandates, or financial capacity to implement sophisticated ESG reporting architectures. In these contexts, ESG tools should be adapted to avoid increasing administrative burden or widening inequities between well-resourced institutions and under-resourced public health systems. Practical implementation should prioritize a limited set of feasible, equity-sensitive, and locally validated indicators.

Recent research highlights the growing importance of ESG and sustainability reporting in corporate governance, particularly within the European Union. The Corporate Sustainability Reporting Directive (CSRD) and European Sustainability Reporting Standards (ESRS) are driving significant changes in non-financial disclosure practices [102, 103]. These frameworks aim to enhance transparency, stakeholder trust, and corporate accountability [83, 104]. While implementation challenges persist, including regulatory fragmentation and data reliability concerns [76, 105, 106], studies indicate that effective ESG reporting can improve financial performance and investor confidence [107]. The EU’s proactive approach in mandating sustainability reporting is setting global standards [108], with some countries adopting strict penalties for non-compliance [83]. Future research should focus on refining sector-specific impacts and standardizing reporting practices to ensure comparability and credibility across industries [106].

Successful implementation of ESG indicators in public health institutions requires multifaceted strategies. Key approaches include stakeholder engagement through participatory planning and adaptive program models [109], formation of technical coordination units [110], and clear communication channels [111]. Effective data systems for real-time monitoring and impact assessment are crucial [109], as is aligning efforts with organizational objectives [111]. Multi-sectoral collaboration is essential, involving diverse stakeholders and sectors to leverage combined strengths [112]. This approach can promote transformative change [113] and address complex health challenges [114–116]. Ethical considerations in stakeholder engagement should be guided by a unifying framework integrating core research principles [70]. Successful implementation can lead to improved health outcomes and recognition, as demonstrated by Assuta Medical Centers’ ESG initiatives [94].

This review revealed several strengths in the emerging literature. Many studies used mixed methods allowing for triangulation of findings across qualitative and quantitative data sources. There was also evidence of innovative applications of ESG indicators to public health contexts, including the integration of environmental criteria in health technology assessments and the use of community engagement frameworks in urban governance [111, 112].

However, important limitations persist. ESG integration remains inconsistent across settings, with many studies documenting fragmented adoption and reporting practices. Few studies rigorously evaluated the direct impact of ESG frameworks on health outcomes such as mortality or service quality. The majority of evidence came from high-income or European settings, with fewer contributions from low- and middle-income countries, limiting generalizability.

An additional limitation is that no formal critical appraisal was undertaken, consistent with the scoping review design. Consequently, conclusions about effectiveness are intentionally cautious and framed as hypotheses for future evaluation rather than definitive evidence.

Future research should focus on developing and validating standardized ESG indicators tailored for public health governance. Comparative analyses across different contexts could help identify best practices and contextual factors that facilitate successful implementation. There is also a need for longitudinal studies that measure the impact of ESG frameworks on institutional performance and health outcomes over time.

Moreover, deeper exploration of the social dimensions of ESG is warranted. While several studies addressed equity and participation, these aspects are often underrepresented compared to environmental and governance indicators. Strengthening the evidence base in this area will be critical for ensuring that ESG integration not only improves transparency but also contributes to more inclusive and equitable health systems.

This scoping review highlights the growing relevance of ESG frameworks as instruments for enhancing institutional accountability and sustainability within public health governance. The integration of ESG indicators, when supported by strong leadership, standardized reporting mechanisms, and multisectoral collaboration, can promote transparency, stakeholder engagement, and more effective alignment of health systems with global sustainability goals. However, the evidence reveals significant heterogeneity in implementation, persistent data and reporting gaps, and regulatory inconsistencies that limit the scalability and impact of these approaches across contexts. To address these challenges, efforts should focus on developing and validating sector-specific ESG indicators, harmonizing reporting standards, and strengthening technical and institutional capacity, particularly in low-resource settings. In addition, further research is needed to evaluate the long-term effects of ESG integration on health outcomes and system performance and to better capture the social and equity dimensions of sustainability. Strengthening these foundations will be essential to ensuring that ESG frameworks evolve from voluntary initiatives into effective tools for advancing transparency, accountability, and equitable health governance worldwide.

Overall, the contribution of this review is conceptual and policy-oriented: it clarifies how ESG can be reframed from a corporate disclosure logic into a public governance tool, while showing that this transition requires theoretical precision, validated indicators, and evidence on implementation and impact.

References

• 1.

  ЮйЧ. Reframing esg and csr: conceptual foundations, overlapping domains. An D Integrated Strategies. Viaeconomica. (2025) 142–50. 10.32782/2786-8559/2025-8-21

  • CrossRef
  • Google Scholar
  • View reference in article

• 2.

  MüllerRCaronM-ADrouinNLereimJAlonderienėRChmieliauskasAet alGovernance of ESG implementations: governance dimensions and their str uctural implementation. IJMPB (2024) 18:118–38. 10.1108/ijmpb-05-2024-0107

  • CrossRef
  • Google Scholar
  • View reference in article

• 3.

  BagaiFAM. Global ESG integration in governance: a systematic review of accountab ility frameworks, challenges, and strategic innovations. Jisem (2025) 10:303–20. 10.52783/jisem.v10i46s.8811

  • CrossRef
  • Google Scholar
  • View reference in article

• 4.

  SwathiG. Research themes and theoretical connections between corporate governan ce and ESG. EATP (2024) 3936–42. 10.53555/kuey.v30i5.3549

  • CrossRef
  • Google Scholar
  • View reference in article

• 5.

  AuAKMYangY-FWangHChenR-HZhengLJ. Mapping the landscape of ESG strategies: a bibliometric review and rec ommendations for future research. Sustainability (2023) 15:16592. 10.3390/su152416592

  • CrossRef
  • Google Scholar
  • View reference in article

• 6.

  WielechowskiMKrasuskiP. ESG concepts in business practice Characteristics and assessment of co mmon ESG frameworks. MSR (2024) 2024:9–26. 10.21858/msr.se.2024.01

  • CrossRef
  • Google Scholar
  • View reference in article

• 7.

  Annisa PutriABellatrix LumbantobingSWasirR. Membangun transparansi dan akuntabilitas dalam tata kelola sistem kese hatan Indonesia. Klinik (2025) 4:294–303. 10.55606/klinik.v4i2.3986

  • CrossRef
  • Google Scholar

• 8.

  SenanayakeP. Closing the Knowledge Translation Gap Will Help to Improve Health Serv Ice Delivery (2006).

  • Google Scholar
  • View reference in article

• 9.

  ŠehovićAB. Identifying and addressing the governance accountability problem. Glob Public Health (2017) 13:1388–98. 10.1080/17441692.2017.1371203

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 10.

  ReichMR. The core roles of transparency and accountability in the governance of global health public–private partnerships. Health Syst and Reform (2018) 4:239–48. 10.1080/23288604.2018.1465880

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 11.

  Van BelleSMayhewSH. What can we learn on public accountability from non-health disciplines: a meta-narrative review. BMJ Open (2016) 6:e010425. 10.1136/bmjopen-2015-010425

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 12.

  KickbuschISzaboMMC. A new governance space for health. Glob Health Action (2014) 7:23507. 10.3402/gha.v7.23507

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 13.

  MurthyRK. Strengthening accountability to citizens on gender and health. Glob Public Health (2008) 3:104–20. 10.1080/17441690801900852

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 14.

  WardAHolmesMEWardILokmic-TomkinsZEastLLevett-JonesT. Environmental, Social and Governance principles in Australian publicly funded healthcare: an extension of value-based care. Aust Health Rev (2025) 49. 10.1071/ah24296

  • CrossRef
  • Google Scholar
  • View reference in article

• 15.

  MaerdanBRakhmatullayevaDZ. Impleentation of environmental, social, and governance (ESG) principles in healthcare company management: a comprehensive review. BTOUEcon (2024) 251–63. 10.48081/guvt8449

  • CrossRef
  • Google Scholar
  • View reference in article

• 16.

  TipurićDVlačićERadakIVučkovićA. Implementing ESG principles in pharma industry in emerging markets. Ekonomika Preduzeća (2024) 72:347–60. 10.5937/ekopre2408347t

  • CrossRef
  • Google Scholar
  • View reference in article

• 17.

  PraticiLSalvatoreFPFanelliSZangrandiAMiloneM. Using ESG paradigm as a basis for social reporting in nonprofit organizations: evidence from cases in healthcare. MD (2024) 63:586–609. 10.1108/md-10-2023-2012

  • CrossRef
  • Google Scholar
  • View reference in article

• 18.

  ConsolandiCPhadkeHHawleyJEcclesRG. Material ESG Outcomes and SDG Externalities: Evaluating the Health Car e Sector’s Contribution to the SDGs. Organ and Environ (2020) 33:511–33. 10.1177/1086026619899795

  • CrossRef
  • Google Scholar
  • View reference in article

• 19.

  AlmnadhehYSamaraHAlQudahMZ. Enhancing ESG integration in corporate strategy: a bibliometric study and content analysis. IJLMA (2025) 68:676–94. 10.1108/ijlma-10-2024-0385

  • CrossRef
  • Google Scholar
  • View reference in article

• 20.

  KrechRKickbuschIFranzCWellsN. Banking for health: the role of financial sector actors in investing i n global health. BMJ Glob Health (2018) 3:e000597. 10.1136/bmjgh-2017-000597

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 21.

  KrewskiDHoganVTurnerMCZemanPLMcDowellIEdwardsNet alAn integrated framework for risk management and population health. Hum Ecol Risk Assess An Int J (2007) 13:1288–312. 10.1080/10807030701655798

  • CrossRef
  • Google Scholar
  • View reference in article

• 22.

  RamrattanDMcCaskieACapodagliS. Conceptual framework for integrating ESG principles and risk managemen t: enhancing caribbean resilience and sustainability. WJEMSD (2025) 47:47. 10.47556/j.wjemsd.21.1.2025.3

  • CrossRef
  • Google Scholar
  • View reference in article

• 23.

  PavaniK. A study on risk assessment and financial management on ESG. Int J Res Publ Rev (2024) 5:3624–32. 10.55248/gengpi.5.0524.1229

  • CrossRef
  • Google Scholar
  • View reference in article

• 24.

  Omowonuola Ireoluwapo Kehinde OlanrewajuOluseyi DaramolaGBabayejuOA. Transforming business models with ESG integration: a strategic framewo rk for financial professionals. World J Adv Res Rev (2024) 22:554–63. 10.30574/wjarr.2024.22.3.1757

  • CrossRef
  • Google Scholar
  • View reference in article

• 25.

  WismarMErnstKSrivastavaDBusseR. Health Targets and (Good) Governance (2006).

  • Google Scholar
  • View reference in article

• 26.

  JafariFHajinabiKJahangiriKRiahiL. An analysis of good governance in the health system. J Clin Res Paramed Sci (2018). 10.5812/jcrps.88233

  • CrossRef
  • Google Scholar
  • View reference in article

• 27.

  PyoneTSmithHvan den BroekN. Frameworks to assess health systems governance: a systematic review. Health Policy Plan (2017) 32:710–22. 10.1093/heapol/czx007

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 28.

  LewisMPetterssonG. Governance in Health Care Delivery: Raising Performance. Washington, DC: World Bank (2009). 10.1596/1813-9450-5074

  • CrossRef
  • Google Scholar
  • View reference in article

• 29.

  SakellaridesCT. El valor de la salud y su “gobierno” en un mumdo globalizado posmodern o: el encuentro de la bella y la bestia (2003).

  • Google Scholar
  • View reference in article

• 30.

  KohlerJCMackeyTKOvtcharenkoN. Why the MDGs need good governance in pharmaceutical systems to promote global health. BMC Public Health (2014) 14:63. 10.1186/1471-2458-14-63

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 31.

  BoidinB. La ‘bonne gouvernance’ et les pays en développement: le cas des polit iques de santé au Gabon (2011).

  • Google Scholar
  • View reference in article

• 32.

  KarimMSZaidiS. Poor performance of health and population welfare programmes in sindh: case studies in governance failure. PDR (1999) 38:661–88. 10.30541/v38i4iipp.661-688

  • CrossRef
  • Google Scholar
  • View reference in article

• 33.

  NunesCGomesPSantanaJ. Transparency, accountability, and governance: a literature review in t he context of public hospitals. Rev Adm Pública (2023) 57:e2022-0238. 10.1590/0034-761220220238x

  • CrossRef
  • Google Scholar
  • View reference in article

• 34.

  GreerSL. Organization and governance: stewardship and governance in health syst ems. Health Serv Res Springer US (2018) 1–9. 10.1007/978-1-4614-6419-8_22-1

  • CrossRef
  • Google Scholar
  • View reference in article

• 35.

  CatalfoPVirgillitoDLeddaC. Work-related stress as a material ESG issue: a single-company case study on psychosocial risk, organizational health and business impact. Front Sustain (2026) 7:1882602. 10.3389/frsus.2026.1882602

  • CrossRef
  • Google Scholar
  • View reference in article

• 36.

  LyrioMVLLunkesRJTalianiETC. Thirty years of studies on transparency, accountability, and corruptio n in the public sector: the state of the art and opportunities for fut ure research. Public Integrity (2018) 20:512–33. 10.1080/10999922.2017.1416537

  • CrossRef
  • Google Scholar
  • View reference in article

• 37.

  RahatNSahniSNasimS. Mapping sustainability practices in the healthcare sector: a systemati c literature review and future research agenda. Int J Consumer Stud (2023) 48:e12997. 10.1111/ijcs.12997

  • CrossRef
  • Google Scholar
  • View reference in article

• 38.

  KaliaDAggarwalD. Examining impact of ESG score on financial performance of healthcare c ompanies. JGR (2022) 14:155–76. 10.1108/jgr-05-2022-0045

  • CrossRef
  • Google Scholar
  • View reference in article

• 39.

  RobinsonSMcIntoshMG. A literature review of environmental, social, and governance (ESG) in commercial real estate. J Real Estate Lit (2022) 30:54–67. 10.1080/09277544.2022.2106639

  • CrossRef
  • Google Scholar
  • View reference in article

• 40.

  ShermanJDThielCMacNeillAEckelmanMJDubrowRHopfHet alThe green print: advancement of environmental sustainability in health care. Resour Conservation Recycling (2020) 161:104882. 10.1016/j.resconrec.2020.104882

  • CrossRef
  • Google Scholar
  • View reference in article

• 41.

  Berniak-WoźnyJRatajM. Towards green and sustainable healthcare: a literature review and rese arch agenda for green leadership in the healthcare sector. IJERPH (2023) 20:908. 10.3390/ijerph20020908

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 42.

  SiddiqiSMasudTINishtarSPetersDHSabriBBileKMet alFramework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy (2009) 90:13–25. 10.1016/j.healthpol.2008.08.005

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 43.

  BaldwinCUhlmannV. Accountability in planning for sustainable water supplies in South East Queensland. Account Planning Sustainable Water Supplies South Eas T Qld Aust Planner (2010) 47:191–202. 10.1080/07293682.2010.508205

  • CrossRef
  • Google Scholar
  • View reference in article

• 44.

  KohlerJCBowraA. Exploring anti-corruption, transparency, and accountability in the wor ld health organization, the united Nations development Programme, the World Bank group, and the global fund to fight AIDS, tuberculosis and malaria. Glob Health (2020) 16:101. 10.1186/s12992-020-00629-5

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 45.

  MacudaM. Conformité des pratiques de reporting en matière de développement dura ble avec le cadre de la Global Reporting Initiative: Une analyse du s ecteur mondial de la santé. RIELF (2023) 8:27–48. 10.18559/rielf.2023.2.2

  • CrossRef
  • Google Scholar

• 46.

  VianT. Anti-corruption, transparency and accountability in health: concepts, frameworks, and approaches. Glob Health Action (2020) 13:1694744. 10.1080/16549716.2019.1694744

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 47.

  BenetonNSFerreiraWJTargaMdos SCezarVRS. Sustainability, social inclusion, and governance: analyzing ESG practi ces at an urban public university in São Paulo, Brazil. Rev Ambiente Água (2025) 20:1–16. 10.4136/ambi-agua.3016

  • CrossRef
  • Google Scholar
  • View reference in article

• 48.

  FinattoCPFuchsPGAguiar DutraARGuerraJBSde A. Environmental, social, governance and sustainable development goals: p romoting sustainability in universities. IJSHE (2023) 25:1121–36. 10.1108/ijshe-11-2022-0361

  • CrossRef
  • Google Scholar
  • View reference in article

• 49.

  OwojoriOMAnwanaE. Integrating ESG principles into environmental education: opportunities and challenges in the MENA region. J Sustain Dev L Policy (2024) 15:224–60. 10.4314/jsdlp.v15i2.9

  • CrossRef
  • Google Scholar
  • View reference in article

• 50.

  DebA. Environmental, social, and governance (ESG) through the lens of public administration: a systematic analysis of literature review. SSRN J (2024). 10.2139/ssrn.4762863

  • CrossRef
  • Google Scholar
  • View reference in article

• 51.

  KuzeyCAl-ShaerHKaramanASUyarA. Public governance, corporate governance and excessive ESG. CG (2023) 23:1748–77. 10.1108/cg-01-2023-0028

  • CrossRef
  • Google Scholar
  • View reference in article

• 52.

  AugustoMC. A nova governança pública e os princípios. ESG Context (2023) 3. 10.58899/tce-go.v3i6-art09

  • CrossRef
  • Google Scholar
  • View reference in article

• 53.

  ArkseyHO’MalleyL. Scoping studies: towards a methodological framework. Int J Social Res Methodol Informa UK Limited (2005) 8:19–32. 10.1080/1364557032000119616

  • CrossRef
  • Google Scholar
  • View reference in article

• 54.

  TriccoACLillieEZarinWO’BrienKKColquhounHLevacDet alPRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med Am Coll Physicians (2018) 169:467–73. 10.7326/m18-0850

  • Pubmed Abstract
  • CrossRef
  • Google Scholar
  • View reference in article

• 55.

  PetersMDJMarnieCTriccoACPollockDMunnZAlexanderLet alUpdated methodological guidance for the conduct of scoping reviews. JBI Evid Implementation (2021) 19:3–10. 10.1097/XEB.0000000000000277

  • CrossRef
  • Google Scholar

• 56.

  PollockDPetersMDJKhalilHMcInerneyPAlexanderLTriccoACet alRecommendations for the extraction, analysis, and presentation of results in scoping reviews. JBI Evid Synth Ovid Tech (Wolters Kluwer Health) (2022) 21:520–32. 10.11124/jbies-22-00123

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 57.

  rayyan. (2024). Available online at: https://www.rayyan.ai/ (Accessed June 22, 2026).

  • Google Scholar

• 58.

  BriscoeSBethelARogersM. Conduct and reporting of citation searching in Cochrane systematic reviews: a cross‐sectional study. Res Synth Methods (2020) 11:169–80. 10.1002/jrsm.1355

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 59.

  Working Group for Monitoring Action on the Social Determinants of Health. Towards a global monitoring system for implementing the Rio Political Declaration on Social Determinants of Health: developing a core set of indicators for government action on the social determinants of health to improve health equity. Int J Equity Health (2018) 17:136. 10.1186/s12939-018-0836-7

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 60.

  Al AmoshHKhatibSFA. COVID-19 pandemic, ESG performance, and sustainability disclosure in the European healthcare sector: do GRI guidelines matter?Bus Strat Dev (2025) 8:e70128. 10.1002/bsd2.70128

  • CrossRef
  • Google Scholar

• 61.

  BennettSJessaniNGlandonDQiuMScottKMeghaniAet alUnderstanding the implications of the Sustainable Development Goals for health policy and systems research: results of a research priority setting exercise. Globalization and Health (2020) 16:5. 10.1186/s12992-019-0534-2

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 62.

  BicklerGMortonSMenneB. Health and sustainable development: an analysis of 20 European voluntary national reviews. Public Health (2020) 180:180–4. 10.1016/j.puhe.2019.10.020

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 63.

  BobiniMCicchettiA. Integrating environmental sustainability into health technology assessment: an international survey of HTA stakeholders. Int J Technology Assess Health Care (2024) 40:e64. 10.1017/s0266462324000631

  • CrossRef
  • Google Scholar

• 64.

  BoscoFDi GerioCFioraniGStolaG. How to manage sustainability in healthcare organizations? A processing map to include the ESG strategy. Journal of Public Budgeting, Accounting and Financial Management. Emerald (2024) 36:636–59. 10.1108/jpbafm-04-2023-0065

  • CrossRef
  • Google Scholar

• 65.

  BoscoFDi GerioCFioraniG. La sfida della sostenibilit\` a nelle organizzazioni pubbliche ad alta intensit\` a di conoscenza. Un modello per integrare le logiche ESG all’interno delle corporate strategies delle organizzazioni sanitarie. MECOSAN Franco Angeli (2024) 47–75. 10.3280/mesa2023-128oa18591

  • CrossRef
  • Google Scholar

• 66.

  BrizollaMMBSallaNMda CGGrasselLR. Contribuiç∼ ao dos programas de compliance nas iniciativas de ESG em tr^ es Cooperativas do Sistema Unimed. Desenvolvimento em Quest∼ ao. Editora Unijui (2024) 22:e16112. 10.21527/2237-6453.2024.60.16112

  • CrossRef
  • Google Scholar

• 67.

  CapobiancoMQureshiAMartinPTorelliFCousinsF. HPR195 assessing the adoption of sustainability criteria within national healthcare procurement policies in Europe. Value in Health (2022) 25:S268. 10.1016/j.jval.2022.09.1323

  • CrossRef
  • Google Scholar

• 68.

  DossaJV. Can sustainability pay off? Evaluating ESG disclosure and financial outcomes in Chinese's health care firms. Bus Strat Dev (2025) 8:e70061. 10.1002/bsd2.70061

  • CrossRef
  • Google Scholar

• 69.

  FrazerSWetterbergAJohnsonE. The value of integrating governance and sector programs: evidence from Senegal. (2021) 10.3768/rtipress.2021.rb.0028.2109

  • CrossRef
  • Google Scholar

• 70.

  FusheiniAEylesJGoudgeJ. The social determinants of health and the role of the health care system: a case study of the significance of good governance in public hospitals in South Africa. Health (2016) 8:1288–306. 10.4236/health.2016.812131

  • CrossRef
  • Google Scholar

• 71.

  HoneTRasellaDBarretoMAtunRMajeedAMillettC. Large reductions in amenable mortality associated with Brazil’s primary care expansion and strong health governance. Health affairs. Health Aff (Project Hope) (2017) 36:149–58. 10.1377/hlthaff.2016.0966

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 72.

  JainPJainBDeeEC. Corporate social responsibility framework: an innovative solution to social determinants of health in the USA. J Racial Ethnic Health Disparities. Springer Sci Business Media LLC (2023) 11:7–22. 10.1007/s40615-022-01493-2

  • CrossRef
  • Google Scholar

• 73.

  KehindeSKassimIRAkintoye. Value relevance of ESG accounting disclosure: evidence from SubSaharan africa public health companies. Int J Scientific Management Res (2023) 06:55–72. 10.37502/ijsmr.2023.6405

  • CrossRef
  • Google Scholar

• 74.

  MartinsALJomuloP-SR. The paradox of growing technical capacities with low global governance: a review of Voluntary National Reviews’ SDG health-related indicators. Globalization and Health (2024) 20:50. 10.1186/s12992-024-01051-x

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 75.

  MoldovanFBlagaP. Organizational governance assessment of healthcare facilities for sustainable development. In: MoldovanLGligorA, editors. The 15th International Conference Interdisciplinarity in Engineering. Cham: Springer International Publishing (2022). p. 326–47. 10.1007/978-3-030-93817-8_32

  • CrossRef
  • Google Scholar

• 76.

  ParidhiRKumarR. ESG practices and financial stability in emerging market healthcare companies: insights amidst the COVID ‐19 pandemic. Thunderbird Intl Bus Rev (2024) 66:505–24. 10.1002/tie.22398

  • CrossRef
  • Google Scholar

• 77.

  PizziSCaputoFVenturelliA. Accounting to ensure healthy lives: critical perspective from the Italian National Healthcare System. CG (2020) 20:445–60. 10.1108/cg-03-2019-0109

  • CrossRef
  • Google Scholar

• 78.

  RoschnikSLomaxRTennisonI. The transformation to environmentally sustainable health systems: the National Health Service example in England. Lakartidningen (2019) 116.

  • Pubmed Abstract
  • Google Scholar

• 79.

  ScottKJessaniNQiuMBennettS. Developing more participatory and accountable institutions for health: identifying health system research priorities for the Sustainable Development Goal-era. Health Policy Plan (2018) 33:975–87. 10.1093/heapol/czy079

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 80.

  WójtowiczKWójtowiczJ. Exploring ESG disclosure: what? And why? A study of leading European public hospitals. JoFFL (2024) 3:139–56. 10.18778/2391-6478.3.43.08

  • CrossRef
  • Google Scholar

• 81.

  WuX. Sustainable development and ESG initiatives in the pharmaceutical industry: a case study of johnson and johnson medical corporation. AEMPS (2024) 71:233–41. 10.54254/2754-1169/71/20241506

  • CrossRef
  • Google Scholar

• 82.

  ZariņšKSidersE. Corporate sustainability reporting in public healthcare institutions: relevance, challenges, and legal perspectives. ETR (2025) 1:611–21. 10.17770/etr2025vol1.8664

  • CrossRef
  • Google Scholar

• 83.

  CylusJSicilianiL. How do health systems and health contribute to the sustainable development goals?Eur J Public Health (2024) 34:ckae144.627. 10.1093/eurpub/ckae144.627

  • CrossRef
  • Google Scholar

• 84.

  AllenKCWhitfieldKRabinovichRSadruddinS. The role of governance in implementing sustainable global health interventions: review of health system integration for integrated community case management (iCCM) of childhood illnesses. BMJ Glob Health (2021) 6:e003257. 10.1136/bmjgh-2020-003257

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 85.

  CicconeDKVianTMaurerLBradleyEH. Linking governance mechanisms to health outcomes: a review of the literature in low- and middle-income countries. Social Sci and Med Elsevier BV (2014) 117:86–95. 10.1016/j.socscimed.2014.07.010

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 86.

  DamianiGPettinicchioVMarkovicRRosiL. Strategies and measurement for global health governance assessment: a 5-years mixed review. Eur J Public Health (2019) 29:ckz186.110. 10.1093/eurpub/ckz186.110

  • CrossRef
  • Google Scholar

• 87.

  NejatianAArabMTakianAAshtarianK. Social accountability in health system governance: a scoping review. Iranian J Public Health Knowledge E DMCC (2024) 53:35–47. 10.18502/ijph.v53i1.14681

  • CrossRef
  • Google Scholar

• 88.

  Mesa-VieiraCGonzalez-JaramilloND\’ iaz-R\’ iosCPanoOMeyerSMenassaMet alUrban governance, multisectoral action, and civic engagement for population health, wellbeing, and equity in urban settings: a systematic review. Int J Public Health (2023) 68. 10.3389/ijph.2023.1605772

  • CrossRef
  • Google Scholar

• 89.

  AhenF. Strategic Corporate Responsibility Orientation for Sustainable Global Health Governance: Pharmaceutical Value Co-protection in Transitioning Economies (2015).

  • Google Scholar

• 90.

  VirgillitoDLeddaC. AI-mediated participation and people sustainability: a socio-technical case study in healthcare shift scheduling. Systems (2026) 14:168. 10.3390/systems14020168

  • CrossRef
  • Google Scholar

• 91.

  CandioP. The influence of ESG score on financial performance: evidence from the European health care industry. Strateg Change (2024) 33:417–27. 10.1002/jsc.2594

  • CrossRef
  • Google Scholar

• 92.

  ElKRNasrallahNToumiA. ESG and performance in public health-care companies: the role of discl osure and director liability. CR (2022) 33:203–21. 10.1108/cr-12-2021-0174

  • CrossRef
  • Google Scholar

• 93.

  BergerRWeissY. Environmental, social, and governance implementation in healthcare org anizations: a case study of Assuta medical Centers. The Isr Med Assoc Journal : IMAJ (2022).

  • Google Scholar

• 94.

  KimIWanHWangBYangT. Do shareholders have a say on corporate social responsibility decision s? Evidence from toxic release data. SSRN J (2013). 10.2139/ssrn.2283134

  • CrossRef
  • Google Scholar

• 95.

  VirgillitoDCatalfoPLeddaC. How are workplace policies, organizational dysfunction, and lack of accommodations for employees with endometriosis associated with fertility-related needs, absenteeism, and productivity in the workforce? A scoping review. Int J Ind Ergon (2026) 114:103970. 10.1016/j.ergon.2026.103970

  • CrossRef
  • Google Scholar

• 96.

  GeorgeJJackSGauldRColbournTStokesT. Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review. BMJ Open (2023) 13:e073669. 10.1136/bmjopen-2023-073669

  • CrossRef
  • Google Scholar

• 97.

  VirgillitoDCatalfoPLeddaC. Wearables in healthcare organizations: implications for occupational health, organizational performance, and economic outcomes. Healthcare (2025) 13:2289. 10.3390/healthcare13182289

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 98.

  MurshedMAhmedA. An Assessment of the Marginalizing Impact of Poor Governance on the Ef Ficacy of Public Health Expenditure in LMICS (2018).

  • Google Scholar

• 99.

  KcAWaiswaPKinneyMV. Research on high quality health care needs to move beyond what to how. The Lancet Glob Health (2023) 11:e803–4. 10.1016/s2214-109x(23)00209-7

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 100.

  SavianoMSciarelliFRinaldiAAlowanouGG. Healthcare and SDGs Governance in Light of the Sustainability Helix Mo del: Evidence from the African Continent. Sustainability (2019) 11:1203. 10.3390/su11041203

  • CrossRef
  • Google Scholar

• 101.

  FornasariTTraversiM. The impact of the CSRD and the ESRS on non-financial disclosure. Symphonya Emerging Issues Management (2024) 117–33. 10.4468/2024.1.07fornasari.traversi

  • CrossRef
  • Google Scholar

• 102.

  HummelKJobstD. An overview of corporate sustainability reporting legislation in the E uropean union. Account Europe (2024) 21:320–55. 10.1080/17449480.2024.2312145

  • CrossRef
  • Google Scholar

• 103.

  MataceraATolaFTarantinoMGianvincenziMMosconiEM. A comparative analysis of European sustainability reporting practices: the role of ESG standards and SDG’s in enhancing effectiveness. Jlsdgr (2024) 5:e01918. 10.47172/2965-730x.sdgsreview.v5.n02.pe01918

  • CrossRef
  • Google Scholar

• 104.

  FrecautanINita (Danila) A. Who is going to win: the Eu esg regulation or the rest of the World? – a critical review. AUOES (2022) 31:109–20. 10.47535/1991auoes31(2)011

  • CrossRef
  • Google Scholar

• 105.

  PratiwiAPEdehFO. The role of ESG disclosure in corporate performance and investment dec ision-making. Ijat (2024) 2:1–14. 10.61194/ijat.v2i1.476

  • CrossRef
  • Google Scholar

• 106.

  PrimecABelakJ. Sustainable CSR: legal and managerial demands of the new EU legislatio n (CSRD) for the future corporate governance practices. Sustainability (2022) 14:16648. 10.3390/su142416648

  • CrossRef
  • Google Scholar

• 107.

  CamilleriMA. Corporate Social Responsibility Reporting in Europe. CSR, Sustainability, Ethics and Governance. Springer International Publishing (2016). p. 21–41. 10.1007/978-3-319-21641-6_2

  • CrossRef
  • Google Scholar

• 108.

  OsamikaDYeboah ForkuoAYetunde MustaphaAChinonso ChianumbaESaturdayKL. Systematic review of global best practices in multinational public hea lth program implementation and impact assessment. IJAMRS (2024) 4:1989–2009. 10.62225/2583049x.2024.4.6.4249

  • CrossRef
  • Google Scholar

• 109.

  JindalDRoyAAjayVSYadavSKPrabhakaranDTandonN. Strategies for stakeholder engagement and uptake of new intervention: experience from state-wide implementation of mHealth technology for NC D care in Tripura, India. gh (2019) 14:165–72. 10.1016/j.gheart.2019.06.002

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 110.

  ChukwurahNIgeABIdemudiaCAdebayoVI. Strategies for engaging stakeholders in data governance: building effe ctive communication and collaboration. Open Access Res J Multidiscip Stud (2024) 8:057–67. 10.53022/oarjms.2024.8.1.0045

  • CrossRef
  • Google Scholar

• 111.

  SalunkeSLalD. Multisectoral approach for promoting public health. Indian J Public Health (2017) 61:163–8. 10.4103/ijph.ijph_220_17

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 112.

  KuruvillaSHintonRBoermaTBunneyRCasamitjanaNCortezRet alBusiness not as usual: how multisectoral collaboration can promote tra nsformative change for health and sustainable development. BMJ (2018):k4771. 10.1136/bmj.k4771

  • CrossRef
  • Google Scholar

• 113.

  GlandonDMeghaniAJessaniNQiuMBennettS. Identifying health policy and systems research priorities on multisect oral collaboration for health in low-income and middle-income countrie s. BMJ Glob Health (2018) 3:e000970. 10.1136/bmjgh-2018-000970

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 114.

  VirgillitoDLeddaC. The impact of organizational dysfunction on employees’ fertility and economic outcomes: a scoping review. Administrative Sci (2025) 15:416. 10.3390/admsci15110416

  • CrossRef
  • Google Scholar

• 115.

  VirgillitoDLeddaC. Personalized AI for workplace health promotion: performance management and healthcare worker engagement through digital analytics. Front Public Health (2026) 13:1718474. 10.3389/fpubh.2025.1718474

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 116.

  SalernoJColemanKJJonesFPetersES. The ethical challenges and opportunities of implementing engagement st rategies in health research. Ann Epidemiol (2021) 59:37–43. 10.1016/j.annepidem.2021.04.009

  • Pubmed Abstract
  • CrossRef
  • Google Scholar