Considering the trade-offs of environmental, social, and governance risk in digital health

Introduction Digital health innovations are increasingly recognized as cost-efficient and scalable solutions to improve healthcare delivery and accelerate progress toward the Sustainable Development Goals (SDGs). However, limited research has examined these technologies within broader socio-economic and sustainability contexts, particularly regarding Environmental, Social, and Governance (ESG) risks and potential trade-offs. Methods This narrative review integrates digital health within an environmental, social, and governance (ESG) framework. Literature on digital health, sustainability, and ESG-relevant risk was identified through searches of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, supplemented by reference-list screening and purposive inclusion of policy and institutional reports; searches were last updated in May 2026. Eligible sources addressed digital health technologies and engaged with at least one ESG domain. Sources were synthesised thematically across the environmental, social, and governance domains, and a conceptual framework was developed to support evaluation of ESG-related trade-offs in digital health implementation . Results The review highlights that digital health solutions, while offering significant benefits in accessibility and efficiency, may exacerbate health inequalities, increase environmental burdens through energy consumption and carbon emissions, and raise governance concerns related to ethics, data privacy, and regulation. The findings emphasize the interdependence of ESG factors and demonstrate that isolated evaluation of these dimensions can lead to incomplete or misleading conclusions. A preliminary framework is proposed to guide the systematic assessment of ESG trade-offs in digital health interventions. Discussion Integrating ESG considerations into digital health innovation is essential to ensure sustainable and equitable healthcare outcomes. The proposed framework provides a foundation for evaluating the broader impacts of digital health technologies, though further research is needed to develop standardized metrics and a comprehensive ESG taxonomy. Incorporating ESG principles into policy and implementation strategies will enhance the long-term effectiveness and societal value of digital health solutions.