The research team, led by Pierluigi Catalfo and Daniele Virgillito with colleagues Giuseppe Messina and Caterina Ledda, conducted the review following PRISMA-ScR guidelines and the Joanna Briggs Institute’s Population-Concept-Context framework. From an initial pool of 343 records, the researchers screened out 131 duplicates and 163 records that failed to meet inclusion criteria, ultimately synthesizing 25 studies and grey-literature documents published up to July 2025. The scope was deliberately broad, encompassing policy analyses, quantitative panel studies, qualitative case studies, and conceptual frameworks drawn from databases including PubMed, Scopus, Web of Science, Embase, and CINAHL, supplemented by grey literature from the World Health Organization, OECD, World Bank, and United Nations repositories.

What makes this review conceptually significant is the distinction the authors draw between two fundamentally different uses of ESG logic. In its original corporate form, ESG primarily organizes non-financial information about environmental risks, social responsibilities, and governance practices for investors, regulators, and other stakeholders. In public health governance, however, the authors define ESG integration as the deliberate incorporation of those indicators into stewardship, priority setting, planning, monitoring, reporting, and accountability processes. This reframing positions ESG not as a synonym for sustainability but as an emerging governance architecture—one that could structure how health institutions demonstrate transparency, engage stakeholders, and align their operations with the United Nations Sustainable Development Goals.

The mapped evidence reveals a striking asymmetry across the three ESG pillars. Environmental indicators—covering emissions, resource consumption, waste, green procurement, and environmental criteria in health technology assessment—were the most consistently documented, appearing in organizational healthcare studies, procurement policies, and sustainability assessments. Governance indicators, including transparency, disclosure quality, compliance, anti-corruption measures, and institutional oversight, were frequently reported across policy and health-system literature. Social indicators, by contrast, remain underdeveloped: while they theoretically link ESG to equity, social determinants of health, community engagement, and fair distribution of health-system benefits, they were less consistently operationalized and rarely evaluated through longitudinal or intervention designs.

Geographically, the evidence base is heavily skewed. Eleven of the 25 studies adopted a global or multi-country focus, while nine concentrated on European or United Kingdom settings. Only four studies examined African contexts and four were based in Asia, with single studies each addressing the United States and Brazil. This concentration in high-income settings means that the review’s conclusions carry an important caveat: low-resource and Global South contexts—where governance challenges such as corruption, weak policy implementation, and fragmented institutional capacity are often most acute—are dramatically underrepresented in the literature on ESG-style accountability frameworks.

Several studies within the review point to tangible governance benefits when ESG-related frameworks are properly implemented. Research on the WHO European SDG Roadmap across 20 countries showed that standardized indicators can facilitate Voluntary National Reviews and improve institutional accountability. In England, the National Health Service’s Sustainable Development Unit demonstrated how carbon reporting and board-level sustainability plans can embed environmental performance within national health governance. A quasi-experimental study across 110 communes in Senegal found that integrated governance improved health service access and quality, while an observational regression analysis of 1,622 Brazilian municipalities associated strong health governance with lower amenable mortality. These findings suggest that structured, indicator-based governance mechanisms can produce measurable improvements in health system performance.

Yet the review’s most important conclusion is a cautionary one: the evidence remains heterogeneous and exploratory, and direct effects on governance performance, health outcomes, or equity are rarely demonstrated. Most studies described frameworks, reporting practices, or implementation experiences rather than testing whether ESG integration actually produced measurable improvements. The authors explicitly frame their findings as evidence of the potential governance functions of ESG-related frameworks, not as proof of causal effectiveness. This distinction matters enormously for policymakers tempted to view ESG adoption as a shortcut to better health systems.

A recurring concern throughout the literature is the risk that ESG becomes a reporting exercise rather than a mechanism for substantive institutional change. 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 what the authors call symbolic compliance or selective reporting, particularly when ESG adoption is voluntary or weakly linked to public oversight. The review also flags unclear conceptual boundaries between ESG, corporate social responsibility, SDG monitoring, and sustainability reporting as a persistent source of confusion that undermines rigorous evaluation.

The enabling conditions for successful integration are nonetheless becoming clearer. Strong institutional leadership and political commitment emerge as critical factors, as illustrated by studies showing how leadership can align ESG metrics with national reporting obligations. Legal and regulatory frameworks that mandate disclosure—such as the European Corporate Sustainability Reporting Directive and the European Sustainability Reporting Standards—appear to increase compliance and improve reporting quality in public health institutions. Technical capacity for data collection, analysis, and reporting is equally essential, as data gaps and inconsistencies repeatedly undermine the ability of ESG frameworks to generate actionable insights. Finally, a culture of stakeholder engagement and participatory governance ensures that ESG initiatives remain responsive to community needs rather than serving as administrative box-ticking.

The review’s authors argue that future research should focus on developing and validating sector-specific ESG indicators tailored for public health governance, conducting comparative analyses across different contexts, and pursuing longitudinal studies that measure the impact of ESG frameworks on institutional performance and health outcomes over time. They also emphasize the need to examine ESG integration through the lens of structural inequalities, warning that sophisticated reporting architectures could widen gaps between well-resourced and under-resourced public health systems if not carefully adapted. For now, the message is clear: ESG frameworks offer a promising conceptual bridge between corporate accountability tools and public health governance, but transforming that promise into measurable improvements in transparency, equity, and population health will require validated indicators, harmonized standards, and a far more inclusive evidence base than currently exists.

Subject of Research: Integration of ESG indicators into public health governance for institutional accountability

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

Article References: Integrating ESG indicators into public health governance as a policy innovation for institutional accountability: a scoping review. (n.d.). https://doi.org/10.3389/phrs.2026.1609720

Image Credits: AI Generated

DOI: 10.3389/phrs.2026.1609720

Keywords: ESG, public health governance, institutional accountability, sustainability reporting, health systems, Sustainable Development Goals, transparency, scoping review, health equity, corporate social responsibility, multisectoral collaboration, health policy