Synergising one health and environmental, social, and governance (ESG) standards: A scoping review

Abstract

Background

The Environmental, Social, and Governance (ESG) standards have recently gained prominence as a framework for assessing corporate responsibility and sustainability. Simultaneously, the One Health (OH) approach has emerged as a critical paradigm for addressing global health challenges. Despite their shared objectives of promoting sustainability and population well-being, ESG frameworks and OH principles have largely evolved in parallel.

Objective

This scoping review investigates the synergies between ESG principles and the OH approach. It aims to identify concrete actions that companies can implement to integrate OH principles into ESG standards.

Methods

A systematic search was conducted on Embase using eight distinct search strings in October 2024. Out of 394 articles on ESG and OH topics emerging from the initial search, 16 relevant ones were identified. We included only those articles meeting the following criteria: (i) English language; and (ii) focus on interventions or topics related to the implementation of ESG standards. Eligible studies included original research, such as descriptive, observational, and trial-based studies, with no geographical restrictions. To categorize topics, we used the United Nations One Health Joint plan of Action framework outlining 6 action tracks (ATs), each corresponding to a specific intervention area.

Results

From the analysis of the 16 articles we identified 6 key categories representing both the most discussed themes and the areas where ESG and OH show a connection. The 6 identified thematic areas were: 1. Sustainable choices; 2. Education initiatives; 3. Collaborations and partnerships; 4. New metrics; 5. Internal organizational actions; 6. Health security. All articles fit within at least one of the 6 ATs and within the 12 ESG standards but with an uneven distribution.

Conclusion

The findings highlight multiple intersections between OH approach and ESG standards, demonstrating that the corporate sector can effectively integrate OH principles into the ESG standards, thus creating opportunities for private sector contributions to facing major global health challenges.

1. Introduction

In recent years, the concept of sustainability has evolved beyond its traditional economic focus to encompass broader societal domains, including healthcare [1,2]. This evolution is driven by the growing recognition of the interconnections between environmental and human health and wellbeing, as reflected in the rise of the Environmental, Social, and Governance (ESG) standards [3,4]. A manifestation of this transformation is the integration of environmental sustainability principles into healthcare facility design and the growing emphasis on sustainability's role in preventive healthcare [[5], [6], [7], [8]]. This evolving perspective aligns with the broader transformation in the health paradigms. Historically, health assessments prioritized individual and population level preventive and therapeutic interventions. However, since the early 2000s, the One Health framework has gained prominence, emphasizing the intricate interconnections between human, animal, and environmental health [9]. This approach acknowledges human health as an integral component of planetary health, which encompasses environmental considerations. Despite the clear links between sustainability and health, their complex interdependencies present challenges for research and policy development. The ESG-related obligations for companies, however, presents a unique opportunity to align corporate strategies with holistic health perspectives [10].

This scoping review explore the intersections and synergies between the One Health framework and ESG initiatives, aiming to identify actionable interventions that companies can implement as part of their ESG strategies.

2. Methods

A scoping methodology was identified as the most appropriate approach for this study, given its suitability for mapping key concepts and identifying gaps in emerging or underexplored research fields. This aligns the study objectives of integrating OH into ESG strategies. The review was conducted over a four-month period, from September 2024 to January 2025, and followed a systematic process informed by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Adaptations were made to align the methodology with the unique objectives of this project, ensuring a rigorous and comprehensive assessment of the evidence base while facilitating the development of actionable insights.

2.1. Search strategy

To identify relevant peer-reviewed studies, three members of the research team (VV, PMP, and TS) conducted a systematic literature search using the EMBASE database. The search strategy focused on three key concepts central to the research: One Health, Industry, and ESG. These concepts were further expanded to include related terms such as Animal Health, Drug Industry, Ecology/Biodiversity, Planetary Health, and Benchmarking to ensure comprehensive coverage of the topic; the complete list of search terms is on Table 1 S1 Appendix.

Table 1.

Screening criteria.

Abstract and Title screening criteria
Category	Include	Exclude
Context	initiatives and studies carried out in every country about ESG-OH correlation also using other keywords	anything that does not relate to a possible ESG-OH correlation
Participants	Different industries sector companies, academy, no profit sector	Other
Literature type	papers, reviews, opinion paper, gray literature, report	articles not published in English; (ii) interventions or exposures involving intervention on other key terms excluding ESG
Date	2000–2024	<2000
Language	English/Italian	Other
Additional Full text screening criteria	References to ESG, topics related to OH and references to OH, industry references or topics relevant to industry	topics not applicable to industry, articles only about ESG

The database searches were conducted in October 2024 using a structured approach on the Embase platform, incorporating a combination of Medical Subject Headings (MeSH) and free-text terms. This process was carried out with the assistance of the 3Bi (Biella Biomedical Library) foundation to ensure accuracy and thoroughness. Boolean operators (AND and OR) were strategically employed to refine the search and maximize retrieval of relevant studies. No filters were applied to the search to maintain a comprehensive dataset.

2.2. Eligibility criteria and screening

We included only articles that met the following criteria: (i) written in English; and (ii) focused on interventions or topics related to the implementation of ESG standards. Eligible studies encompassed any type of original research, including descriptive, observational, and trial-based studies, with no restrictions on geographical settings (Table 1).

Articles were excluded if they met any of the following criteria: (i) not published in English; (ii) focused on interventions or topics unrelated to ESG standards; (iii) lacked quantitative information or sufficient details; (iv) were non-full-text publications such as letters to the editor, conference papers, commentary notes, expert opinions, or abstracts; and (v) were not published in peer-reviewed journals.

Screening was conducted by three independent reviewers to prevent deadlock situations in cases of conflicting assessments. The Cadima® software was utilized for screening. The eight search strings yielded a total of 394 articles; after duplicate removal, 304 unique articles remained. Each reviewer independently screened the titles and abstracts of these articles, categorizing them as relevant, not relevant, or potentially relevant. Articles deemed relevant by at least two out of three reviewers were selected for full-text review. Following this initial screening, 52 articles were selected for full-text review. Using the same criteria applied at the abstract level, 36 full-text articles were excluded, resulting in the inclusion of 16 articles (Fig. 1).

Fig. 1.

Review flow chart.

A search of gray literature yielded no relevant results. Additionally, an analysis of European legislation was conducted to examine in more detail ESG standards and the adoption of the European Sustainability Reporting Standards (ESRS).

2.3. Data extraction

To extract the data, the lead author (VV), with input from all co-authors, initially drafted an extraction table using Excel. This table was designed to capture both descriptive information for all included records and emerging themes identified during the preliminary review. Descriptive information encompassed title and authors of the article, keywords, brief summary of the article, link between ESG and OH that could be more or less explicit. A concept map was created in addition to this summary table to summarize the main topics covered by One Health.

2.4. Synthesis of results

Following data extraction, the lead author (VV) synthesized the evidence to collate, summarize, and report the findings effectively. The evidence was synthesized using two key approaches: (1) descriptive characteristics and (2) thematic analysis, categorized by the specific areas of work addressed. Table 2 provides a summary of the 16 articles.

Table 2.

Description of the selected studies.

Title	Author	Keywords	Summary	Reference
Journey from an Enabler to a Strategic Leader: Integration of the Medical Affairs function in ESG Initiatives and Values	Daniel Furtner	Medical Affairs; ESG and Health;	Connection between ESG (Environment, Social, Governance) criteria and human health. How environmental quality impacts physical well-being. Medical Affairs in the pharmaceutical industry play a pivotal role	[13]
One Health: Connecting Environmental, social and corporate governance (ESG) practices for a better world	Celso José Bruno de Oliveira	One Health; ESG; industry; private sector	Opinion paper: is the only real link between ESG and One Health in the scientific literature. The paper defines the One Health paradigm as a valid way to address the ESG concept. The importance of integrating public health with industry.	[14]
The Need for New Metrics in the Anthropocene Era	Paolo Vineis	climate change, regenerative economy, SDGs, co-benefits, ESG	It critiques current approaches that treat environment, economy and health separately and suggests the creation of more integrated metrics for assessing the impact of production activities on public health and the ecosystem	[15]
Microplastics in aquatic bodies: Assessing the role of governance mechanisms in industrial wastewater management	Babajide Oyewo	Wastewater recycling, water pollution, responsible industry policy	Evaluation of the link between governance mechanisms and industrial wastewater management; the presence of microplastics in water poses a growing threat to aquatic ecosystems	[16]
Rooftop greenhouses in educational centres: A sustainability assessment of urban agriculture in compact cities	Ana Nadal	Integrated Value Model for Sustainability Assessment Schools Multi-Criteria Decision Making Circular economy Vertical farming Rooftop greenhouse	To generate an assessment tool capable of selecting the best school building for the location of a sustainable rooftop greenhouse. The model's integrated approach, which considers the connection between environment, health, and society. Promotion of sustainable urban ecosystems and collective health	[17]
Sustainability Unleashed: driving positive impact in the pharma industry	Justin Schroeder	Pharma industry and ESG implementation	Focus on the environmental aspect of ESG, i.e. planetary health. Sustainability is recognized as a complex principle that often conflicts with profit in pharma industries. The authors suggest that pharma companies carry out a study of their emissions status and sustainability status in general.	[12]
Sustainability Measures are the key to meeting ESG commitments	Matthias Birkhoff	Pharma industry and ESG implementation	It talks about the experience of Aptar pharma and how this pharma industry is driving sustainability in concrete ways by incorporating sustainable innovation into the design of new products, particularly packaging and dispensers.	[18]
Building a Greener Supply Chain: Key considerations for cold chain	Scott Whyte	Cold chain and CO2 emission	The importance of thinking in terms of circularity and sustainability when approaching the cold chain	[19]
So far so good: maintaining the momentum of progress for sustainable policies	Michael Earl	Pharma industry and ESG implementation	This position paper discusses the commitment of pharmaceutical companies to sustainability. Many pharmaceutical companies claim to be committed to ESG, particularly in four areas: carbon footprint reduction, water sustainability, waste management and product packaging sustainability.	[20]
Advances in amelioration of air pollution using plants and associated microbes: an outlook on phytoremediation and other plant-based technologies	Anina James	Green architecture Phytoremediation Plant-microbe symbiosis ESG/SDG	Systematic review of the use of plants and microorganisms as tools to absorb major air pollutants. The article is written with a One Health perspective, and the link with ESG goals is clear	[21]
Equivalent biodiversity area: a novel metric for No Nett Loss success in Brazil's changing biomes	Glauber da Fontoura	Biodiversity Loss quantification	The article presents a technical discussion of the topic of biodiversity loss.	[22]
The inclusion of biodiversity into Environmental, Social, and Governance (ESG) framework: A strategic integration of ecocentric extinction accounting	Helen Kopnina	Biodiversity loss, Ecocentrism, ESG, factors Extinction accounting, Intermediate ecology	The importance of integrating biodiversity into ESG criteria to counter global biodiversity loss; The authors point out that traditional ESG criteria tend to favor an anthropocentric perspective	[23]
Transforming Pharmaceutical Manufacturing to Drive Sustainability and Cost Efficiency	Michael Astle	Carbon emission ESG sustainability	In the paper it is discussed the need to adopt more sustainable manufacturing practices in the pharmaceutical industry	[24]
The Role of Pharmaceutical Companies in Antimicrobial Stewardship: A Case Study	Elizabeth D. Hermsen	antimicrobial stewardship; antibiotic prescribing; antimicrobial resistance; One Health; industry.	This paper focus on the role of Pharma companies in addressing the problem of antimicrobial resistance AMR. Companies can support AMS improving surveillance and awareness about local resistance patterns, incentivizing responsible use of antimicrobials	[25]
Pharmaceutical effluent evokes superbugs in the environment: A call to action	Rehab A. Rayan	One Health, Public Health, Antimicrobial resistance, Superbugs, Antimicrobial stewardship, Pharmaceutical industry	The environmental impact of pharmaceutical waste and its role in antimicrobial resistance. The improper disposal of pharmaceuticals into water bodies leads to the proliferation of antibiotic-resistant bacteria	[26]
The role of pharmaceutical industry in building resilient health system	Kanika Saxena	AMR; active role of pharma industry in global health; pharma commitment; Merck & Co initiatives	AMR and how pharmaceutical companies can play a central role in addressing this important global health issue. Indeed, companies have important communication channels and relationships that put them in a facilitating position	[27]

For article analysis, we utilized the One Health Joint Plan of Action (OH JPA) and the ESG frameworks [11]. The OH JPA, a collaborative effort of the Quadripartite Organizations—the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), the World Organization for Animal Health (WOAH, formerly OIE), and the World Health Organization (WHO)—aims to mitigate impacts at the human–animal–plant–environment interface across global, regional, and national levels. The OH JPA outlines six action tracks (ATs), each corresponding to a specific intervention area within the One Health approach. Each AT includes a description and a set of activities aimed at implementing practical measures aligned with One Health principles (S2). The ESG framework provides European sustainability standards that organizations are expected to adhere to across environmental, social, and governance dimensions.

For data extraction and analysis of the 16 selected articles, we developed a chart that cross-referenced the six AT from the OH JPA with the three ESG categories: Environmental, Social, and Governance. Key concepts related to the OH-ESG theme were identified, extracted, refined, and summarized for each article. These summarized concepts were then systematically entered into the chart, alongside the respective article titles from which the key terms were derived. The use of the cross table enabled us to identify the key themes that most initiatives and articles focus on, as well as areas that are underrepresented. Through this analysis, we identified six primary areas of interest that frequently emerge across the 16 articles reviewed: 1. Sustainable choices; 2 Educational initiatives; 3. Collaborations and partnerships; 4. New metrics; 5. Internal organizational actions; 6. Health security. Additionally, we developed a concept map representing how the 16 analyzed articles fit with these six identified areas of interest (S3 Fig. 1).

3. Results

3.1. Characteristics of included documents

The reviewed articles address topics that align with one or more of the six ATs outlined in the OH JPA. Simultaneously, they can also be categorized within the ESG framework, indicating a certain level of homogeneity between the topics covered in the quadripartite report and the existing literature. However, the distribution of topics across these dimensions is uneven.

Table 3 provides an overview of how the manuscripts and their respective topics are distributed across the ATs and ESG dimensions. Notably, AT 1 and 6 are the most frequently represented, corresponding to Governance (G) and Environmental (E) dimensions, respectively.

Table 3.

Matrix of the intersection between OH JPA Action tracks and the ESG framework.

	ESG framework
OH JPA Action tracks	Environmental	Social	Governance
AT 1 - Enhancing One Health capacities to strengthen health systems	[15]	[13] [27] [12]	[13] [12] [16] [14] [22]
AT 2 - Reducing the risks from emerging and re-emerging zoonotic epidemics and pandemics		[27]
AT 3 - Controlling and eliminating endemic, complex, neglected tropical and vector-borne diseases		[27]
AT 4 - Strengthening the assessment, management, and communication of food safety risks		[15]	[13]
AT 5 - Curbing the silent pandemic of AMR	[26]	[25]	[27] [25]
AT 6 - Integrating the environment into One Health	[13,[15], [16], [17], [18], [19],[21], [22], [23], [24]]		[13] [18] [19] [20]

AT 1, which focuses on “Enhancing One Health capacities to strengthen health systems,” is represented by seven articles, two of which span multiple categories. For instance, the article “Sustainability Unleashed: Driving Positive Impact in the Pharma Industry” [12] addresses both social and governance themes. It suggests that companies collaborate with local municipalities to provide consistent recycling guidelines, which fall under the social category, while also recommending the establishment of ESG-focused teams, aligning with corporate governance.

Similarly, the article “Journey from an Enabler to a Strategic Leader: Integration of the Medical Affairs Function in ESG Initiatives and Values,” [13] advocates for a patient-centered approach and the reduction of health inequities (Social). It also discusses business ethics, continuous medical education, and innovative partnerships with the private sector (Governance). This same article is categorized under AT 6, “Integrating the environment into One Health,” as it emphasizes the use of renewable energy, reduction of environmental impact (Environmental), and internal policies to minimize packaging materials (Governance).

Conversely, ATs 2 and 3, which address emerging and re-emerging zoonotic epidemics and pandemics, as well as endemic zoonotic, neglected tropical and vector-borne diseases, are the least represented: only one manuscript in each ATs 4 and 5, focusing on food safety and antimicrobial resistance (AMR), are mentioned in only a minority of articles: 2 articles in the AT-4 and 3 for the AT-5 The most frequently cited study in these tracks, “The Role of the Pharmaceutical Industry in Building Resilient Health System” (14) discusses the need for health security development to prevent future pandemics (AT 2 - Social), community education on vaccination (AT 3 - Social), and the management of antibiotic waste (AT 5 - Governance).

While corporate governance and sustainable initiatives are well discussed in the literature, issues such as antimicrobial resistance and zoonotic diseases receive limited attention with fewer practical recommendations despite their prominence in the quadripartite document.

3.2. Description of identified thematic areas

The analysis of the selected studies indicated some recurring themes. As a result, six new thematic categories were created to encapsulate the core content: 1. Sustainable choices; 2. Education initiatives; 3. Collaborations and partnerships; 4. New metrics; 5. Internal organizational actions; 6. Health security.

In analyzing the six newly identified categories, we first assessed their frequency of mention across the reviewed articles. The theme of “sustainable choices” emerged as the most frequently discussed, appearing in 12 out of 16 articles. “Education Initiatives” and “collaboration/partnerships” followed, each being cited in 5 articles, while “internal company organization” and “new metrics” were addressed in 3 articles. The theme of “health security” was the least represented, appearing in 2 articles (Fig. 2). Notably, one article covered five of the six thematic areas, while seven articles focused on only a single category (Fig. 1 S2 Appendix).

Fig. 2.

Frequence of identified categories in analized literature.

3.3. Sustainable choices

A recurring theme in the literature is the pursuit of sustainable choices, examining how activities impact the environment and identifying actionable strategies to mitigate these effects. Key areas of focus include the circular economy [15,18], waste management [13], emission reduction [18,19], and wastewater management [16,20,26].

Corporate policies addressing carbon emissions, water sustainability, waste management, and green chemistry are frequently highlighted [20]. Additionally, companies can combat air pollution [21], invest in renewable energy, reduce waste through recycling, and promote equitable water use [13].

Digital solutions, such as virtual and hybrid conferences, have the potential to significantly reduce corporate travel and its environmental impact [13]. Further sustainable measures include the adoption of renewable materials in pharmaceutical manufacturing [13], investment in resource-efficient technologies for water recycling and wastewater reuse, and efforts to minimize contaminated water discharge, which contributes to AMR challenges [16].

Urban agriculture emerges as another promising theme [17,21]. It can take traditional forms like private gardens, community gardens, and city farms or technological forms such as green walls, and rooftop gardens. These practices support local food production, reduce the carbon footprint of food transport, minimize air pollution, and foster community engagement.

Packaging innovation is another frequently discussed topic [13,[18], [19], [20]], emphasizing reduced material use [13], recyclability, and reusable designs for lower environmental impact [18]. In addition, companies can also promote sustainable lifestyles by, for example, offering seasonal products, reducing relibirkance on beef, and decreasing food waste [13,15,18].

3.4. Education initiatives

Education and promotion emerge as critical themes in the literature, highlighting the role of companies in fostering learning and awareness to drive positive health and sustainability outcomes. Internally, companies can prioritize continuing medical education (CME) for their workforce [13]. Supporting CME not only enhances employee expertise but also contributes to better clinical outcomes, aligning with ESG governance principles [13].

The studies reviewed provided examples of companies implementing innovative educational initiatives. For instance, a manuscript showed how Johnson & Johnson has developed a distance learning system to facilitate employee training and professional development [27]. Similarly, Pfizer has launched a digital health app and invested in education programs on immunizations for communities, promoting better public health outcomes. GSK has also played a pivotal role in this domain by implementing large-scale health worker training programs in India and Africa, aiming to strengthen healthcare delivery in underserved regions [27].

High levels of antimicrobial resistance threaten population health and food security. Developing novel antimicrobials and promoting their responsible use to curb the spread of resistance. The pharmaceutical industry can address this issue by developing novel antimicrobials and promoting responsible use to curb the spread of resistance [25]. Educational campaigns for veterinarians and farmers also emerge as effective tools [25].

In addition to health-focused education, companies are increasingly prioritizing sustainability related training. Staff training on sustainable practices can promote employee well-being while aligning corporate operations with sustainability goals [24]. By equipping their workforce with knowledge about green practices, companies can foster a culture of environmental responsibility and advance their broader ESG commitments.

3.5. Collaboration and partnership

Effective integration of the One Health approach into ESG strategies necessitates robust multisectoral collaboration and strategic partnerships. The inherently interdisciplinary nature of One Health underscores the need for coordinated efforts across corporate, academic, and governmental domains [14]. The COVID-19 pandemic demonstrated the potential of synergistic collaborations to expedite vaccine research, production, and distribution.

To mitigate future public health crises and environmental challenges, it is imperative to establish resilient partnerships between the private and public sectors [27]. As Olivera et al. assert, while ESG frameworks are traditionally propagated vertically along supply chains, the most transformative impacts are realized through horizontal collaborations that integrate expertise from industry, government, and academia. Dismantling bureaucratic barriers and embedding One Health principles within these cooperative frameworks can optimize outcomes and enhance systemic resilience.

Corporate entities can engage with local communities to promote circular economy initiatives [27], implement No Net Loss strategies for biodiversity conservation [22], and collaborate with sustainability experts to drive progress [24]. Such partnerships play a pivotal role in developing scalable, science-driven ESG solutions that align with the One Health paradigm, thereby ensuring long-term societal and environmental benefits.

3.6. New metrics

Establishing standardized KPIs across industries is another critical step—for example, measuring and reporting CO2 emissions as a key environmental metric [13]. The ESG rating system suffers from a lack of standardization, which limits its effectiveness. To address this, Greer et al propose to introduce new metrics focusing on circularity, climate change, biodiversity and health [15]. Establishing standardized KPIs across industries is another step that could be taken. For example, for environment it could be measuring and reporting CO2 emissions [13].

Another manuscript highlighted that, although the introduction of ESGs was a step forward, even health is an overlooked dimension in ESG standards, so this should be a new metric [13,15]. Companies can influence health outcomes through different ways, such as promoting healthy lifestyles and offering plant-based food options in their cafeterias [15].

Most manuscripts prioritize human stakeholders—such as employees, communities, and consumers—over non-human stakeholders, including wildlife, ecosystems, and biodiversity (28). This narrow focus undermines the holistic perspective required for a One Health approach. Proposed solutions include metrics such as biodiversity footprint, habitat destruction rates, and species loss assessments, along the adoption of extinction accounting indicators to better capture the impact of human activities on biodiversity and extinction risks [12,[14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26]]. Moreover, applying the circular economy principles could significantly mitigate biodiversity loss [15].

3.7. Internal company organization

The internal organization of companies plays a key role in the successful implementation of ESG standards. Several studies emphasize the link between corporate governance structures and sustainability outcomes highlighting for instance the positive impact of gender diversity in boards of directors in waste management, including wastewater recycling initiatives [20].

Another key element is the establishment of dedicated working groups or task forces within a company [12]. These groups would be responsible for initiating, monitoring and managing projects with clearly defined and measurable results [20]. At the same time transparency, communication and collaboration within the organization and with stakeholders are equally crucial with maximizing contributions to the achievement of the SDGs by 2030 [27].

3.8. Health security

Health security is another critical issue emerging from the literature, emphasizing the importance of creating resilient health systems in line with the principles of corporate social responsibility. The WHO recommends that each country formulates a National Health Security Action Plan comprising a comprehensive set of practices and policies, in which the pharmaceutical industry is one of the main actors to achieve these goals [27]. This entails strategies that align with CSR principles, highlighting the role of the pharmaceutical industry in promoting resilient healthcare systems [27] and suggesting the need for a transformation from a product-centered to a patient-centered business model [13].

Key pillars of health security include diversity, equity and inclusion, particularly in clinical research. Ensuring equitable access to health services and products for all individuals, regardless of socio-economic or geographic barriers, is key to promoting health security. The COVID-19 pandemic highlighted the importance of health security, bringing to light the central role of the pharmaceutical industry and the private sector in safeguarding global health [27].

Health security is also intrinsically linked to the United Nations SDGs, particularly SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 17 (Partnerships for the Goals). Strengthening health security contributes to achieving these global targets by promoting health equity, fostering inclusive healthcare policies, and encouraging international cooperation to address health challenges.

4. Discussion

The results of this scoping review show significant intersections between the One Health and ESG frameworks, highlighting both areas of synergy and gaps that require further attention. The analysis of the literature reviewed through the One Health lens, together with the practical actions recommended by the One Health Joint Action Plan (OHJPA) [2], demonstrates how the focus remains uneven, with a predominant emphasis on environmental sustainability and corporate governance, and little attention to critical public health issues such as antimicrobial resistance, zoonotic disease mitigation and pandemic preparedness.

The parallels between a One Health approach and ESG standards are notable. Both emphasize multidisciplinary approaches, integrating diverse areas of interest and encouraging horizontal collaboration while reducing siloed, vertical approaches. Just as OH seeks to take a holistic view of humans, animals, and the environment, so ESG extends across environmental sustainability, social responsibility, and governance structures. Another key point of convergence is their shared ultimate goal: promoting sustainability, health, and harmony between human activity and the environment.

Companies often implement ESG standards in a vertical manner [1]. This review shows that these standards could also be applied more horizontally through partnerships, community engagement, advocacy and a focus on sustainable choices. The six identified areas where One Health and ESG can intersect provide a framework to integrate neglected topics like zoonoses and AMR through awareness campaigns, health security measures, and innovative public-private partnerships.

The concept of sustainable choices emerges as a dominant theme across scientific literature. This reflects a growing recognition of the need to adopt environmentally responsible practices that align with both One Health and ESG priorities. Key focus areas include circular economy models, wastewater management, carbon emissions reduction, and responsible sourcing of raw materials. Corporate engagement in sustainable agriculture, urban farming, and biodiversity conservation is also highlighted as a means of mitigating environmental impact, promoting public health benefits, reducing emissions from food transportation and sustaining local ecosystems.

Training emerges as an important but underutilized component of ESG strategies. In particular, training could cover both continuing medical education to improve employees' sustainability and public health skills and the implementation of awareness-raising campaigns on vaccinations and the responsible use of antibiotics. However, only five studies reviewed mentioned corporate training initiatives, highlighting the need for greater investment in training programs. Targeted educational initiatives for veterinary and agricultural professionals could be particularly effective in addressing the risks of AMR and zoonotic diseases, two areas currently neglected in the ESG discourse.

Despite the near absence of literature directly linking ESG and One Health, all identified articles align with at least one of the six tracks of action of the Joint One Health Action Plan, demonstrating that although ESG-OH intersections are not always immediately apparent, they are diverse and significant.

Cross-sectoral collaboration is crucial to strengthening One Health-oriented ESG initiatives, especially in responding to health crises. Although ESG strategies are often implemented vertically within corporate supply chains, a greater emphasis on horizontal collaborations could improve impact.

A major challenge in aligning ESG with One Health is the absence of standardized metrics to assess health and environmental impacts. The literature calls for integrated assessment tools that consider biodiversity loss, circular-economy adoption and health outcomes including extinction accounting, biodiversity footprint analysis and health impact assessments [15,23].

Companies with dedicated sustainability teams, ESG task forces and interdepartmental working groups are better positioned to implement effective initiatives. In addition, the gender diversity of boards of directors appears to influence ESG outcomes, making them more likely to promote innovative environmental and social policies, including better waste management and water recycling.

Despite its significance, health security is the least represented theme in the literature. The pharmaceutical sector has a unique role in advancing global health security through equitable healthcare access, strengthened health systems, and pandemic preparedness. However, these areas remain marginal within the current ESG frameworks. Health security aligns closely with the United Nations SDGs, particularly SDG 3 (Good Health and Well-being) and SDG 17 (Partnerships for the Goals). Companies should leverage their expertise to support national health security strategies, ensuring that ESG commitments extend beyond environmental sustainability to encompass broader public health objectives.

In conclusion the intersections between OH and ESG are several and highlight the possibility for companies, not only pharmaceutical ones, to apply the OH approach to ESG standards. This union would ensure mandatory reporting related to ESG, and on the other hand enable private sector companies to contribute effectively to address contemporary challenges related to population health, climate change, and sustainability.

CRediT authorship contribution statement

Valentina Vegro: Writing – review & editing, Writing – original draft, Investigation, Formal analysis, Data curation. Pier Mario Perrone: Writing – review & editing, Investigation, Formal analysis. Tindara Scirocco: Writing – review & editing, Investigation, Data curation. Sara Laura Ferrari: Writing – review & editing, Data curation. Alice Baratelli: Writing – review & editing, Data curation. Giuliano Gargioni: Writing – review & editing, Visualization, Supervision, Methodology. Mario Raviglione: Writing – review & editing, Visualization, Validation, Supervision, Project administration. Fabrizio Tediosi: Writing – review & editing, Visualization, Validation, Supervision, Project administration, Conceptualization.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

This review was conducted as part of a broader research project on developing a framework for integrating One Health principles into the Environmental, Social, and Governance (ESG) strategies of biomedical companies, supported by the Zoé Foundation and Zambon italy.

Appendix A. Supplementary data

Supplementary material: Reaserch string and action track analysis.

Data availability

we have attached all reaserch string in supplementary file