The Green Health Movement in Brazil: Evaluation of Opportunities Based on a Bibliometric Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

• This study does not present clearly defined research questions, and the chosen topic has limited relevance in its current form. The study has important methodological and conceptual limitations that substantially constrain the validity of its main conclusions—especially those regarding the alleged scarcity of Brazilian research and the structure of the international “Green Health” field. The search strategy is very narrow, the bibliometric analysis is under-specified, and the use of “Green Health” as both a broad conceptual umbrella and a literal keyword produces a circular argument. The Brazilian section is based on non-systematic sources, making it more descriptive than analytical. Conceptually, One Health engages with human–animal–environment interfaces (especially zoonoses and AMR), whereas Green Health, as defined here, is more about sustainable infrastructures, resource efficiency, and green interventions. The overlap exists but is partial, and the paper tends to blur rather than clarify these distinctions. 
• The article addresses an underexplored topic, and its ambition to connect global bibliometric patterns with Brazilian institutional practice is unique. However, currently, it functions as an exploratory scoping effort rather than a definitive mapping of the Green Health field. To serve as a strong reference on the Green Health movement in Brazil, it needs a more rigorous and transparent methodological foundation, clearer conceptual boundaries, and a more cautious interpretation of bibliometric and Brazilian data.

Author Response

Reviewer 1 - comments

• This study does not present clearly defined research questions, and the chosen topic has limited relevance in its current form. The study has important methodological and conceptual limitations that substantially constrain the validity of its main conclusions—especially those regarding the alleged scarcity of Brazilian research and the structure of the international “Green Health” field. The search strategy is very narrow, the bibliometric analysis is under-specified, and the use of “Green Health” as both a broad conceptual umbrella and a literal keyword produces a circular argument. The Brazilian section is based on non-systematic sources, making it more descriptive than analytical. Conceptually, One Health engages with human–animal–environment interfaces (especially zoonoses and AMR), whereas Green Health, as defined here, is more about sustainable infrastructures, resource efficiency, and green interventions. The overlap exists but is partial, and the paper tends to blur rather than clarify these distinctions. 
• The article addresses an underexplored topic, and its ambition to connect global bibliometric patterns with Brazilian institutional practice is unique. However, currently, it functions as an exploratory scoping effort rather than a definitive mapping of the Green Health field. To serve as a strong reference on the Green Health movement in Brazil, it needs a more rigorous and transparent methodological foundation, clearer conceptual boundaries, and a more cautious interpretation of bibliometric and Brazilian data.

Reply

Dear Reviewer,

We would like to thank you for your invaluable contribution and the insights provided regarding our manuscript. Regarding the alleged scarcity of Brazilian research on Green Health, our findings were based solely on a survey of publications in relevant academic platforms and journals. We recognize that using this single criterion to validate research gaps in the field may be a limited approach. However, this was the resource available for an initial exploratory analysis aimed at better understanding the context of Green Health in Brazil. We appreciate the pertinence of your comment; consequently, we have now explicitly highlighted this limitation and the exploratory nature of the manuscript in the text.

We appreciate your observation regarding the conceptual differences between One Health and Green Health. We have incorporated a discussion of the nuanced distinctions between these themes throughout the text in order to clarify these differences for the readers. Thank you.

Reviewer 2 Report

Comments and Suggestions for Authors

Notes in the attached file.

Comments for author File: Comments.pdf

Author Response

Reviewer 2 - comments

1. The research proposal is interesting, especially given that Brazil is a country of continental dimensions.

Dear Reviewer,

We would like to thank you for the time dedicated to this review and for your valuable comments. 

However, I felt the authors failed to mention that Brazil also has a public healthcare system, and consequently, most Brazilian hospitals are also public. I believe this is important to provide better context for an international audience that will access the article.

We understand your observation. Therefore, we have included a note in the text (page 15, highlighted in yellow).

2. In the Methodology: why wasn't the term "hospitals" or "sustainability in hospitals" specifically added to the descriptors, given that this sector is one of the most impactful in the healthcare sector?

That is a valid observation. We did consider this possibility; however, since our primary objective was to evaluate—albeit in an exploratory manner—the extent to which the term and concept 'Green Health' is present in Brazilian research, we opted for a broader scope. Consequently, we excluded terms directly related to hospitals. Nevertheless, even with this approach, few articles were retrieved. We have taken this observation into account and have now included it as one of the study's limitations. We included this consideration in page 5 (highlighted in yellow).

3. Results: Figures (No. 1, 2, 10 & 11) with screenshots from the computer screen. Suggestion: highlight only the main content of each piece of information. Ex.:

Thanks. We changed the images.

4. I don't see the need to mention the number of citations the authors receive, but rather the relevance of their findings. At times, it seems like a competition. It didn't sit well with me. Also, I didn't particularly see much sense in citing lines 294 and 295 and 298-300, which deal with animal health. What is the direct relationship to the article's title and purpose? Through research in the areas of food, health and sustainability, considering the issue of food as one of the items directly related to the investigated theme of "green health" (#7 of the Objectives of GGHH).

We agree with your observation. Indeed, highlighting the number of citations may not be the most appropriate approach. However, considering the Brazilian context—where the national agency responsible for evaluating graduate programs has recently begun to emphasize citation metrics—we initially opted to include these data. We are open to revising this according to your suggestions.

We mentioned this article because it was retrieved based on the search criteria adopted in our methodology—specifically through its association with the term 'One Health.' Since the 'One Health' concept is broader and more multidisciplinary than 'Green Health,' it often encompasses studies related to animal health that, in various ways, can impact human health

5. Specifically, I am aware of research projects in Brazilian hospitals on several topics that assess issues such as environmental footprints, waste, food purchases from family farms, etc., evaluating issues related to hospitals. I will cite the link to just two of them to show the breadth of the topic (one of them in your language):

https://periodicos.grupotiradentes.com/saude/article/view/11754

https://rsdjournal.org/index.php/rsd/article/view/13129

This is because issues such as this are discussed in lines 242-3 and 260-1. It is up to the authors to determine if any of them would agree with the article's proposal. It is merely a suggestion. Best regards.

Regarding the references, they have been incorporated into the text in accordance with your observations. We believe that these additions will significantly contribute to the overall quality of the manuscript. Thank you.

The new references are in page 2 and page 16 (highlighted in yellow).

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for submitting this manuscript examining the Green Health movement in Brazil through a bibliometric and institutional analysis. The topic is timely, relevant to the scope of Green Health, and the effort invested in data collection is evident. The paper has the potential to become a valuable reference for understanding the emergence of Green Health in Brazil and globally. However, several revisions are needed to strengthen conceptual clarity, methodological transparency, and analytical depth. Below, I address these issues by manuscript section, which shows precisely where revisions are required.

The first issue appears in the Introduction, particularly in the paragraphs beginning with “Over the last three decades, concepts associated with environmental sustainability…” and “Despite the convergence in some points addressed by the concepts of Planetary Health and One Health…”. In these sections, the manuscript introduces Green Health as a distinct concept, but the distinction remains mainly descriptive. While the text states that Green Health differs from One Health by emphasizing local application and infrastructure, this distinction is not clearly operationalized. As a result, when the paper later compares bibliometric outputs for “green health” and “one health,” the analytical rationale for this comparison is not fully established. To address this, the authors should strengthen the final part of the Introduction by explicitly defining Green Health as an analytical framework, clarifying its scale, primary actors, and types of interventions. A concise comparative explanation—possibly supported by a short conceptual table—would help anchor the study’s scope and justify the subsequent methodological choices.

A second issue is located in Section 2.1 (Literature review), particularly in the paragraph beginning with “The collection of academic documents and specific literature was carried out using the Scopus database…”. While the general approach is appropriate, the description of the search strategy lacks sufficient detail to ensure transparency and replicability. The manuscript does not clearly report the exact search strings used, the document types included, or how language and subject-area filters were handled. In addition, the justification for limiting the analysis to two keyword groups (“green health” and “one health”) is implied rather than explicitly stated. This becomes especially relevant given the emerging and sometimes overlapping terminology in this field. The authors should expand this subsection to clearly describe the search protocol, including the precise keywords and filters applied, and briefly acknowledge the limitations associated with terminology and database selection. Clarifying the rationale for using Scopus as the primary source would also strengthen the methodological foundation.

Still within the Methods section, the role of the Cochrane database, introduced in the paragraph beginning with “As this is a topic associated with health, the Cochrane database…”, requires clarification. Although its inclusion is reasonable, its contribution to the analysis remains limited and is not fully integrated into the results or discussion. The authors should either more clearly explain why Cochrane was consulted—such as to assess the penetration of Green Health concepts in clinical evidence—or reduce its prominence and explicitly frame it as a complementary check rather than a core data source.

Moving to the Results section, particularly Section 3.1 (Literature review), starting with “Based on the information and indicators generated by the Scopus database…”, the manuscript presents a large amount of bibliometric data in a clear and organized manner. However, much of the accompanying text remains descriptive, often reiterating what is already visible in the figures. For example, after presenting publication trends and disciplinary distributions, the analysis stops short of interpreting what these patterns imply for the development of Green Health as a research field. The authors should revise these paragraphs to more explicitly discuss why the observed trends matter, what they suggest about the field's maturity or fragmentation, and how Green Health compares structurally with One Health in terms of academic consolidation.

This issue is particularly evident in the discussion of the VOSviewer cluster analysis, beginning with the paragraph “Based on the Scopus bibliometric data and the VOSviewer map…”. While the identification of clusters is well executed, the interpretation relies heavily on citation counts and publication years. The analysis would be strengthened by assigning each cluster a more precise conceptual meaning and linking them more explicitly to substantive research themes or practical Green Health interventions. This would help the reader understand how these clusters reflect different strands within the Green Health landscape rather than simply networks of authors.

Section 3.2 (The Green Health movement in Brazil), beginning with “Table 2 shows the identification of PHS members in Brazil…”, is one of the manuscript’s strongest components in terms of empirical content. Nevertheless, the analysis remains descriptive mainly. The manuscript reports the number of participating institutions and initiatives but does not clearly articulate the criteria used to evaluate these efforts. As a result, the conclusion that Green Health practices in Brazil are modest and poorly integrated is plausible but not fully substantiated analytically. The authors should strengthen this section by explicitly stating the evaluative lens being applied—such as institutional integration, governance support, or linkage to research—and by discussing why existing initiatives remain fragmented despite policy frameworks and hospital engagement.

Within this same section, the discussion of the Complexo Pequeno Príncipe case study, introduced in the paragraph beginning with “Although Green Health is still an emerging movement, there are indications of its successful use in Brazil…”, would benefit from more precise analytical positioning. The case is well documented and informative, but its significance is not fully articulated. The authors should clarify why this case is exemplary—whether due to leadership, integration across multiple Green Health axes, or scalability—and briefly situate it within the broader Brazilian context to avoid presenting it as an isolated success without broader implications.

Finally, the Conclusions section, beginning with “Despite the existence of a movement towards Green Health by some healthcare institutions in Brazil…”, accurately summarizes the main findings but does not fully articulate the manuscript’s contribution. The conclusions essentially restate results rather than drawing out their implications for future research, policy, or institutional practice. The authors should expand this section to explicitly discuss how the study contributes to structuring Green Health as a research field, particularly in emerging economies, and how its findings could inform hospital management and public policy in Brazil.

In terms of structure and style, the manuscript is generally well written, though there is some repetition in the Introduction and Results sections. A careful tightening of these sections and consistent use of terminology would further improve readability, but no major stylistic overhaul is required.

In summary, this manuscript addresses an important and underexplored topic and demonstrates a substantial empirical effort. With revisions that strengthen conceptual framing, clarify methodological decisions, and deepen analytical interpretation—particularly in the Results and Brazil-focused sections—the paper has the potential to make a meaningful contribution to the literature on Green Health.

Author Response

Reviewer 3 - comments

Thank you for submitting this manuscript examining the Green Health movement in Brazil through a bibliometric and institutional analysis. The topic is timely, relevant to the scope of Green Health, and the effort invested in data collection is evident. The paper has the potential to become a valuable reference for understanding the emergence of Green Health in Brazil and globally. However, several revisions are needed to strengthen conceptual clarity, methodological transparency, and analytical depth. Below, I address these issues by manuscript section, which shows precisely where revisions are required.

Dear Reviewer, we are grateful for your complimentary remarks and your insights on the topic, particularly regarding the study's potential.

1. The first issue appears in the Introduction, particularly in the paragraphs beginning with “Over the last three decades, concepts associated with environmental sustainability…” and “Despite the convergence in some points addressed by the concepts of Planetary Health and One Health…”. In these sections, the manuscript introduces Green Health as a distinct concept, but the distinction remains mainly descriptive. While the text states that Green Health differs from One Health by emphasizing local application and infrastructure, this distinction is not clearly operationalized. As a result, when the paper later compares bibliometric outputs for “green health” and “one health,” the analytical rationale for this comparison is not fully established. To address this, the authors should strengthen the final part of the Introduction by explicitly defining Green Health as an analytical framework, clarifying its scale, primary actors, and types of interventions. A concise comparative explanation—possibly supported by a short conceptual table—would help anchor the study’s scope and justify the subsequent methodological choices.

We appreciate this insightful feedback. To clarify the conceptual boundaries for the reader, we have added a table on page 5 outlining the key differences between Green Health and One Health.

2. A second issue is located in Section 2.1 (Literature review), particularly in the paragraph beginning with “The collection of academic documents and specific literature was carried out using the Scopus database…”. While the general approach is appropriate, the description of the search strategy lacks sufficient detail to ensure transparency and replicability. The manuscript does not clearly report the exact search strings used, the document types included, or how language and subject-area filters were handled. In addition, the justification for limiting the analysis to two keyword groups (“green health” and “one health”) is implied rather than explicitly stated. This becomes especially relevant given the emerging and sometimes overlapping terminology in this field. The authors should expand this subsection to clearly describe the search protocol, including the precise keywords and filters applied, and briefly acknowledge the limitations associated with terminology and database selection. Clarifying the rationale for using Scopus as the primary source would also strengthen the methodological foundation.

Thank you for your comments regarding the need to clarify the search methodology. In order to include this information in the manuscript and ensure replicability, we have added a detailed description to Section 2.1 (highlighted in yellow).

3. Still within the Methods section, the role of the Cochrane database, introduced in the paragraph beginning with “As this is a topic associated with health, the Cochrane database…”, requires clarification. Although its inclusion is reasonable, its contribution to the analysis remains limited and is not fully integrated into the results or discussion. The authors should either more clearly explain why Cochrane was consulted—such as to assess the penetration of Green Health concepts in clinical evidence—or reduce its prominence and explicitly frame it as a complementary check rather than a core data source.

Once again, we thank you for your vigilant observation. The Cochrane database was used to assess whether the concept of Green Health is being discussed or addressed within clinical medicine or related fields. In this context, it served as a complementary source. The results obtained from this database demonstrate that there is still limited penetration of these concepts within clinical evidence. We mentioned this information in the text (page 5).

4. Moving to the Results section, particularly Section 3.1 (Literature review), starting with “Based on the information and indicators generated by the Scopus database…”, the manuscript presents a large amount of bibliometric data in a clear and organized manner. However, much of the accompanying text remains descriptive, often reiterating what is already visible in the figures. For example, after presenting publication trends and disciplinary distributions, the analysis stops short of interpreting what these patterns imply for the development of Green Health as a research field. The authors should revise these paragraphs to more explicitly discuss why the observed trends matter, what they suggest about the field's maturity or fragmentation, and how Green Health compares structurally with One Health in terms of academic consolidation.

Your observations were carefully considered. Consequently, we have included a discussion on the potential factors justifying the higher volume of publications regarding One Health (see page 7, highlighted in yellow).

This issue is particularly evident in the discussion of the VOSviewer cluster analysis, beginning with the paragraph “Based on the Scopus bibliometric data and the VOSviewer map…”. While the identification of clusters is well executed, the interpretation relies heavily on citation counts and publication years. The analysis would be strengthened by assigning each cluster a more precise conceptual meaning and linking them more explicitly to substantive research themes or practical Green Health interventions. This would help the reader understand how these clusters reflect different strands within the Green Health landscape rather than simply networks of authors.

Once again, we thank you for your observation. We apologize if the previous version was not sufficiently explicit; we have now updated the manuscript (page 12) to clearly define the conceptual ideas associated with each cluster. For instance, Cluster 1 represents highly-cited foundational publications, Cluster 2 focuses on mobility and urbanism, and Cluster 3 relates to public health.

5. Section 3.2 (The Green Health movement in Brazil), beginning with “Table 2 shows the identification of PHS members in Brazil…”, is one of the manuscript’s strongest components in terms of empirical content. Nevertheless, the analysis remains descriptive mainly. The manuscript reports the number of participating institutions and initiatives but does not clearly articulate the criteria used to evaluate these efforts. As a result, the conclusion that Green Health practices in Brazil are modest and poorly integrated is plausible but not fully substantiated analytically. The authors should strengthen this section by explicitly stating the evaluative lens being applied—such as institutional integration, governance support, or linkage to research—and by discussing why existing initiatives remain fragmented despite policy frameworks and hospital engagement.

Thank you for your observations. We have taken your point of view into account and explicitly stated the limitations of our study, which focused solely on the Scopus database. Accordingly, this in itself does not validate the absence of studies in Brazil regarding Green Health practices, at least concerning the explicit use of this specific term (see page 18, highlighted in yellow).

Thank you for your observations. Indeed, we had not previously discussed or argued why there is a lack of sufficient integration in Brazil despite existing laws. We have now included a brief argument addressing this point on page 17 (highlighted in green).

Within this same section, the discussion of the Complexo Pequeno Príncipe case study, introduced in the paragraph beginning with “Although Green Health is still an emerging movement, there are indications of its successful use in Brazil…”, would benefit from more precise analytical positioning. The case is well documented and informative, but its significance is not fully articulated. The authors should clarify why this case is exemplary—whether due to leadership, integration across multiple Green Health axes, or scalability—and briefly situate it within the broader Brazilian context to avoid presenting it as an isolated success without broader implications.

We have considered your observations and comments regarding the Pequeno Príncipe complex and have inserted a paragraph on page 16 (highlighted in yellow).

6. Finally, the Conclusions section, beginning with “Despite the existence of a movement towards Green Health by some healthcare institutions in Brazil…”, accurately summarizes the main findings but does not fully articulate the manuscript’s contribution. The conclusions essentially restate results rather than drawing out their implications for future research, policy, or institutional practice. The authors should expand this section to explicitly discuss how the study contributes to structuring Green Health as a research field, particularly in emerging economies, and how its findings could inform hospital management and public policy in Brazil.

We appreciate your valuable comments. We have included several sentences in the Conclusion to address your points, and we hope they meet your expectations. Thank you very much.

7. In terms of structure and style, the manuscript is generally well written, though there is some repetition in the Introduction and Results sections. A careful tightening of these sections and consistent use of terminology would further improve readability, but no major stylistic overhaul is required.

Thank you for your comments.

8. In summary, this manuscript addresses an important and underexplored topic and demonstrates a substantial empirical effort. With revisions that strengthen conceptual framing, clarify methodological decisions, and deepen analytical interpretation—particularly in the Results and Brazil-focused sections—the paper has the potential to make a meaningful contribution to the literature on Green Health.

We appreciate your precise observations. We believe that all of them will contribute to enhancing the quality of our study.

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The paper addresses a timely and relevant topic—the integration of environmental sustainability into healthcare systems—through the lens of Green Health, with a particular focus on Brazil. Its main contribution lies in providing a bibliometric overview of how the term Green Health has been adopted in academic literature and in contrasting it with the more established One Health concept.

However, while the topic is important and the manuscript is extensive, the study suffers from conceptual ambiguity, methodological limitations, and issues of focus and coherence. The conclusions drawn often exceed what the data can robustly support, and the manuscript would benefit from greater analytical depth and tighter structure.

• The paper does not sufficiently theorize “Green Health” as a distinct scientific construct.
• Green Health is often defined by exclusion (i.e., what it is not compared to One Health) rather than by a clear analytical framework.
• The distinction between Green Health, Environmental Health, Planetary Health, and Sustainable Healthcare remains blurred.
• At times, the manuscript conflates:
• “Green Health” as a term
• “Green Health” as a movement
• “Green Health” as a set of practices

• There is overreliance on terminology. The exclusive focus on the keywords “green health” and “one health” severely limits the scope.
• Many relevant studies in sustainable healthcare, green hospitals, environmental health management, and low‑carbon healthcare are excluded by design.
• As a result, the conclusion that Brazil has “little research on Green Health” is methodologically fragile.
• The manuscript is long and unevenly balanced.
• The Results section blends:
• Literature review
• Interpretation
• Policy discussion
• Case studies
  without clear separation.
• Several sections read more like a report than a focused academic article.
• The claim that Brazil lacks integration or leadership in Green Health is not fully supported by the bibliometric data alone.
• The absence of the term Green Health does not equate to the absence of research or practice.

Required Revisions:

1. Clarify the Conceptual Framework
• Provide a clearer objective/research aim and a sharper operational definition of Green Health.
• Explicitly justify why terminology-based analysis is valid.
2. Broaden or Justify the Search Strategy
• Either include related terms (green hospitals, sustainable healthcare, environmental health management)
  or clearly acknowledge the epistemic limits of the approach.
3. Strengthen Analytical Depth
• Move beyond publication counts to interpret drivers, barriers, and institutional dynamics.
4. Improve Structure and Focus
• Separate:
• Bibliometric results
• Brazilian case studies
• Policy discussion
5. Revise Language and Presentation
• Professional English editing is strongly recommended.
• Remove redundancy and advocacy tone.

Author Response

Dear Reviewer, we appreciate the time you have dedicated to this manuscript and your insightful comments. Our responses are provided in blue, directly below each of the suggested revisions.

1. Clarify the Conceptual Framework
   • Provide a clearer objective/research aim and a sharper operational definition of Green Health.
   • Explicitly justify why terminology-based analysis is valid.

Dear Reviewer, we appreciate your observation. Indeed, this study was based solely on a bibliographic and bibliometric survey, as it is an exploratory study aimed at establishing a baseline for the application of the Green Health concept in Brazil, where it is not yet widely disseminated. Using academically recognized databases, we chose to evaluate the prevalence of the term 'Green Health' in the Brazilian context. The bibliometry served as a 'research roadmap' to assess how academic production in Brazil is adopting this terminology, which is already well-established in the Global North. Based on your valuable feedback, we have incorporated this clarification into the manuscript (highlighted in blue line 25-27; line 129-130; line 486-489).

1. Broaden or Justify the Search Strategy
   • Either include related terms (green hospitals, sustainable healthcare, environmental health management)
     or clearly acknowledge the epistemic limits of the approach.
   • We have explicitly stated the study's limitations in the Conclusion section (line 486-489).
2. Strengthen Analytical Depth
   • Move beyond publication counts to interpret drivers, barriers, and institutional dynamics.

We appreciate the observation. We have included comments regarding what could be understood as barriers to Green Health practices in Brazil (line 437-451).

1. Improve Structure and Focus
   • Separate:
     • Bibliometric results
     • Brazilian case studies
     • Policy discussion

Thank you for the suggestion. We have restructured the document accordingly. The new sections are highlighted in blue throughout the manuscript. Thank you.

1. Revise Language and Presentation
   • Professional English editing is strongly recommended.
   • Remove redundancy and advocacy tone.

We made some changes :line 17-19, line 21-23, line 34-36, line 43-45, line 167-169, line 174-175, line 199-201, line 213-217, line 241-242,  line 460-463, line 472-476, line 502-508.

We have removed a sentence that could have been perceived as having an advocacy tone (please, see line 254).

Reviewer 3 Report

Comments and Suggestions for Authors

This manuscript presents a bibliometric and documentary analysis of the Green Health concept, focusing on its academic consolidation and institutional adoption in Brazil. Using data from the Scopus and Cochrane databases combined with VOSviewer visualization tools, the authors map publication trends, thematic clusters, institutional participation, and governance-related initiatives. The topic is timely and relevant, particularly in the context of sustainability, healthcare systems, and Global South research agendas.

Overall, the manuscript is well structured, methodologically transparent, and aligned with the scope of MDPI journals concerned with sustainability, environmental health, and health systems management. The study provides a useful descriptive contribution by highlighting the limited formalization of Green Health research in Brazil despite growing institutional engagement.

However, the manuscript would benefit from clearer conceptual positioning, stronger methodological reflexivity regarding the bibliometric strategy, and more disciplined separation between bibliometric evidence and interpretive or normative discussion.

Conceptual clarity of “Green Health”
The manuscript contrasts Green Health with One Health and Planetary Health, but Green Health is alternately treated as a conceptual framework, an applied management philosophy, and an umbrella term for sustainability practices in healthcare. The authors should clarify whether Green Health is being evaluated primarily as a terminological construct or as a functional practice domain that may exist even without explicit use of the term. This clarification is important given the keyword-based bibliometric approach.

Justification and limitations of the bibliometric search strategy
The decision to restrict the Scopus search to the exact terms “green health” and “one health” is methodologically defensible, but its implications should be discussed more explicitly. The conclusion that Green Health research in Brazil is scarce reflects limited terminological adoption rather than necessarily limited substantive research. This limitation should be clearly acknowledged in the Methods section to avoid misinterpretation.

Interpretive scope of bibliometric findings
In several sections, publication counts, citation metrics, and network structures are linked to broader claims about institutional maturity, policy commitment, or governance capacity. While these interpretations are plausible, bibliometric data alone cannot fully substantiate them. The authors should more clearly frame such statements as contextual interpretations rather than direct conclusions derived from the data.

Integration of institutional case examples
The institutional examples (e.g., PHVS participation, hospital initiatives, and governmental programs) are informative but currently function mainly as illustrative narratives. The manuscript would benefit from explicitly linking these cases back to the bibliometric findings, particularly regarding the gap between applied practice and academic consolidation.

Minor Revision

The manuscript presents a solid and relevant descriptive contribution supported by appropriate bibliometric methods. The recommended revisions focus on conceptual clarification, methodological transparency, and interpretive discipline rather than additional data collection or reanalysis.

Author Response

Dear Reviewer, thank you for your valuable comments. Our responses are provided in blue, directly below each of your comments. We appreciate the time you dedicated to reviewing our manuscript.

Conceptual clarity of “Green Health”
The manuscript contrasts Green Health with One Health and Planetary Health, but Green Health is alternately treated as a conceptual framework, an applied management philosophy, and an umbrella term for sustainability practices in healthcare. The authors should clarify whether Green Health is being evaluated primarily as a terminological construct or as a functional practice domain that may exist even without explicit use of the term. This clarification is important given the keyword-based bibliometric approach.

Thank you for this insightful observation. We have integrated it into the manuscript, explicitly clarifying the study's limitations for our readers. Thank you. Please, see line 130-132 (highlighted in purple).

Justification and limitations of the bibliometric search strategy
The decision to restrict the Scopus search to the exact terms “green health” and “one health” is methodologically defensible, but its implications should be discussed more explicitly. The conclusion that Green Health research in Brazil is scarce reflects limited terminological adoption rather than necessarily limited substantive research. This limitation should be clearly acknowledged in the Methods section to avoid misinterpretation.

Thank you again for your comment. We have incorporated our study's limitations throughout the manuscript and noted that the infrequent use of the term 'Green Health' does not inherently imply a lack of scholarly production on the topic. Please, see line 129-130, line 455-458 (highlighted in blue), line 496-499 (highlighted in blue).

Interpretive scope of bibliometric findings
In several sections, publication counts, citation metrics, and network structures are linked to broader claims about institutional maturity, policy commitment, or governance capacity. While these interpretations are plausible, bibliometric data alone cannot fully substantiate them. The authors should more clearly frame such statements as contextual interpretations rather than direct conclusions derived from the data.

The requested information has been incorporated into the manuscript (lines 140-141). Thank you.

Integration of institutional case examples
The institutional examples (e.g., PHVS participation, hospital initiatives, and governmental programs) are informative but currently function mainly as illustrative narratives. The manuscript would benefit from explicitly linking these cases back to the bibliometric findings, particularly regarding the gap between applied practice and academic consolidation.

We acknowledge your point. Nevertheless, while there are signs of research related to the Green Health concept in Brazil, we did not find any academic literature in our selected database that offered a basis for correlating these cases. Yes, we understand that this represents an opportunity for emerging discussions. This exploratory analysis served, initially, to establish a baseline for verifying the level of adoption of the term 'Green Health' within the Brazilian academia. What we observe are indications that Green Health practices are being implemented in certain hospitals (or networks) and addressed in some postgraduate programs. However, the terminology remains fragmented. This makes it difficult, among other things, to explicitly link bibliometric results with specific hospital and governmental initiatives in Brazil. For this reason, we encountered difficulties in explicitly connecting these points and chose to remain conservative in our reporting to avoid being speculative.