Responsible
business for ahealthier world

ESG Report 2023

ESG Report 2023

About this report
Welcome to ZS’s 2023 Environmental,
Social and Governance (ESG) Report.
This report details our progress, performance andcommitments across our ESG priorities. Information
presented reflects our global operations during calendar
year 2023, unless otherwise noted.
We have structured the report around three pillars
that center us in working to deliver healthy, fair andsustainable outcomes for all:- Ethical operations for a better future

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

02

A letter to our stakeholders 

03

Our focus on inclusion and belonging

35

About ZS 

04

Enabling our people to grow and thrive

38

2023 in summary

06

Connecting with talent42

Our approach to ESG governance

07

ZS Cares 

46

Defining the issues that matter

08

Delivering equitable outcomes

09
10

Health equity for all people and communities

48

Our journey in numbers 

Our approach to health equity

49

2023: Our mission in action

50

ZS as thought leaders

51

Ethical operations 
for a better future

12

ZS’s approach to sustainability

13

Teams leading the way

52

Teams leading the way

15

Connecting leaders to address disparities

53

Making our local communities healthier places to live

59

Accounting for our climate impact

16- Equitable opportunities for an innovative workforce

Keeping ZS secure by design

23- Health equity for all people and communities

Acting with professional integrity

26

Appendix

61

We track and report progress against these pillars
with reference to the Global Reporting Initiative (GRI),
Sustainability Accounting Standards Board (SASB) and United
Nations (U.N.) Sustainable Development Goals (SDGs).

Risk management

28

Data collection and methodology

62

Strategic partnerships

64

GRI Index

66

SASB

74

Please note that statistics for employee data in this report
are rounded and may not sum to 100%. Additionally, ZS
leadership mentioned throughout the report refers to ZSers
who are principals, associate principals and managers.
In 2023, we received assurance on key internal processes
across the organization, including our climate impact.

Equitable opportunities for 
an innovative workforce

30

A strategic approach to DEI

31

Strengthening ZS in 2023

32

Teams leading the way

34

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

03

A letter to our stakeholders

Pratap Khedkar (he/him)

For 40 years, the patients andconsumers our clients serve
have been the inspiration for
our work.

1

Versus a 2019 baseline. Please note, an earlier version
of ZS's 2023 ESG report stated that we achieved 88%
renewable energy usage globally in 2023. However, arecalculation of our emissions data confirmed weachieved 93% renewable energy usage globally. The
version you see today reflects that updated change.

What started as a side business created by two
friends in 1983 has turned into a 13,000-personstrong firm working in 35 offices globally to help
improve health outcomes for all by partneringwith clients in and outside healthcare. With
this growth comes social and environmental
responsibility—a task that we do not take lightly.

This year, we’ve sustained our global
representation of women employees at ZS, as wellas underrepresented racial and ethnic minorities.
We know there’s more progress to be made inincreasing the representation of these groups,
as well as that of veterans, LGBTQIA+ individuals
and other diverse talent.

In 2023, we made strides toward greater
accountability for our environmental impact. We
gained approval from the Science Based Targets
initiative (SBTi) for our near-term greenhousegas emissions targets, and set our 2045 net-zerotarget, for which we are still awaiting approval.
We are approaching solutions head-on, effectively
decreasing Scopes 1 and 2 emissions by 63% andScope 3 by 57% while achieving 93% renewableenergy across our offices globally.1

Amid this progress, one thing has remained thesame—our commitment to translating passion
into tangible impact by fostering a healthier world
for all. In the past year alone, ZS delivered 731
patient health and equity projects and invested
over $5 million in partnerships through ourpatient health equity work and social impact
program, ZS Cares—many of which address
health disparities. Through our work, we haveaffected approximately 23 million potential lives.

As times change, so do we. Over 40 years, wehave evolved the diversity of our workforce toreflect the clients we serve and places where wework. This includes remaining steadfast in ourefforts to create an environment in which
women have the opportunity to lead the way
at every level of our firm.

ZS itself is proof that great things start fromhumble beginnings. We are proud of cultivating
ESG in our business from the ground up, andour journey will continue to move forward withstrategic intention and direction.

The climate crisis and the social disparities that
underpin it are complex challenges that require
us to draw on the values that guide ZS: Get it right,
do the right thing and treat people right.
The remarkable dedication of ZSers, coupled withthe trust of our clients and the support of ourpartners and suppliers, has made our journeypossible so far.
In our 2022 report, I invoked the wisdom of
Mahatma Gandhi. To draw on his words again:“If you want to change the world, start with yourself.”
Thank you to all the ZSers helping our firm get
it right, and to our clients, suppliers and local
communities for partnering with us to drive thechange we want to see in the world.
I look forward to continuing our work in 2024.

Pratap Khedkar
Managing Director and Chief Executive Officer

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

About ZS
Since 1983, we have worked side
by side with companies to drive
customer value and solve theirbusiness challenges. Our purpose,
vision and values bind our firm
together, guiding us to deliver
tangible impact and do what
we do best—use management
consulting, analytics andtechnology to improve healthoutcomes for all. We’re proud that,
more than 40 years later, we still
embody our values every day andin everything we do.

Our purpose

Our vision

Our values

We solve complex
problems to enable
our clients and theircustomers to thrive. We
work with companies inhealthcare, high tech,financial services andmore to bring ideas
to life, backed by ourstrategy consulting,analytics, platform andtechnology capabilities.

ZS partners withcompanies to improve
life and how we live it.
We transform ideas into
impact by bringing
together data, science,technology and humaningenuity to deliver
better outcomes for all.

In 1983, Andy Zoltners and Prabha Sinha founded ZS on threecore values—get it right, do the right thing and treat people right.

ZSer in Bengaluru

ESG leader Judith Kulich
in San Francisco

Get it right
We apply industry
expertise, leading-edge
analytics, technology andstrategy to bringbold ideas to life.

Do the right thing
Our commitment toethical behavior is whatallows us to approach ourwork and our clients—andeach other—with integrity.

Treat people right
We treat others with
dignity and respect,providing a supportiveand collaborative culturethat inspires real action.

ZSers in London

ZSer in Evanston

ZSers in Tokyo04

A year of action

ESG Report 2023

Ethical operations

Equitable opportunities

Health equity

Appendix05

ZS by the numbers
ZS is powered by passionate employees and trusting partners. Together, we work to makethe future of health accessible, compassionate and fair for all.

13,000+
ZSers globally35

1,200+

97%

clients served

global offices

repeat clients

1

passionate team

ZSer in India

A year of action

ESG Report 2023

2023 insummary
Our team of driven andinnovative ZSers work together
to do the right thing. In 2023, we
continued to take a values-led
approach to evolve our operations
while delivering results together
with our clients.
While we do not measure our success throughawards, we are honored to be recognized forour efforts to make a positive impact within
ZS and beyond.

Ethical operations

Best places to work

Fortune 2023
Best Workplacesin Chicago™

Equitable opportunities

Equality and diversity

Great Place to Work
Certified™: Germany,
India, Switzerland, U.K.
and U.S.

Avtar and SeramountTop 10 Best Companies
for Women in India

Built In’s Best Places to Work, U.S.;
Best Large Companies to Work For, U.S.;
Best Large Companies to Work For andBest Places to Work: Atlanta, Boston, Chicago,
Los Angeles, New York City, San Diego,
San Francisco, Seattle and Washington D.C.

Fairygodboss
Best Consulting
Companies for
Women

ClimateEarly careers
ZS received a B rating on climatechange from CDP, a testament
to the coordinated efforts
we are taking to reduce ZS’s
environmental impact.

Built In’s 2023 Moxie
Awards Womenin Tech Award

Human Rights Campaign
Equality 100 leader in
LGBTQ+ Workplace
Inclusion, with a
Corporate Equality
Index score of 100

Health equity

ZS achieves EcoVadis Silver
In 2023, we were proud to receive a Silver
rating from EcoVadis, the world’s largest
provider of sustainability ratings. The
Silver medal puts us in the top 15% ofcompanies that were rated by EcoVadis
in the last 12 months2 across themes ofEnvironment, Labor and Human Rights,
Ethics and Sustainable Procurement.
Compared to our last rating in 2022,
our score increased by 20 points, largely
due to our environmental progress. The
score is testament to our commitment
to responsible business practices andcelebrates the steps we have taken to
mitigate our climate impact, evolve
our operations and improve healthoutcomes for all.

2

Handshake Early Talent Awards

Appendix

The percentile rank of a company is calculated at thetime of scorecard publication and appears at the top of
the scorecard. It compares a company’s performancewith all rated companies in EcoVadis’s database over theprevious 12 months. The percentile rank is calculated
across all companies in all industries, not per industry.

06

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

Our approach to ESG governanceOver the last 40 years, we learned
that ESG is preeminent for thehealth of our people, our clients’business needs and our world.
That’s why we embed ESG from the top
down and look to three governing bodies—
the Shareholders’ Council, ESG Steering
Committee and ESG Core Team—and various
subcommittees to drive positive impact. They
ensure sustainable and responsible operations
are embedded throughout the firm, fromdriving and managing initiatives to mitigatingrisk and auditing areas of our business.

Shareholders’ Council

ESG Steering Committee

ESG Core TeamTo have the greatest impact, ESG must be driven fromthe very top of a business. At ZS, it starts with our
Shareholders’ Council: ZS principals, including ourCEO, outside advisors and an ESG sponsor, who areelected by their peers to serve three-year terms. The
members of the Shareholders’ Council serve as ourBoard of Directors, represent the best interests of ZSers
and fulfill ZS’s governance needs by providing guidance
and oversight.

The ESG Steering Committee is across-functional team of principals
who collaborate monthly to discuss
progress against our ESG strategy
and opportunities for advancement.
The committee develops andmanages initiatives that support our
ESG goals, oversees reporting anddisclosures and designs strategic,
data-driven approaches to keep uson track. It also works closely withother committees who govern ourrisk, compliance and legal policies toensure alignment.

The ESG Core Team executes
ESG programs and interventions
designed by the ESG Steering
Committee and approved by the
Shareholders’ Council. It works withcross-business leaders—including
in Legal, Compliance, Human
Resources, Finance, Marketing andCommunications—to drive holistic,
sustainable change at every levelof ZS and facilitate stakeholder
engagement across ZS’s material
issues. The core team, which
includes emissions experts, further
manages elements of our firm’s risk
using the Task Force on Climaterelated Financial Disclosures(TCFD) framework.

Supported by subcommittees and councils—including theDiversity, Equity and Inclusion Council; Risk, Complianceand Professionalism Committee; and Compensation
Committee, among others—the Shareholders’ Council
meets regularly and is tasked with delivering highlevel oversight of our ESG strategy, commitments
and operations.
Along with members of our C-suite, Legal team and
ESG Steering Committee, the Shareholders’ Council is
responsible for reviewing and approving our annual ESG
Report. ESG was classified as an emerging risk for ZS in
2023 and is continually monitored, with updates given to
the Shareholders’ Council for alignment.

This year, the ESG Steering
Committee has been engaged in theassurance of the greenhouse gas(GHG) emissions data presented inthis report.

07

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

AppendixDefining the issues that matter
During 2022, we reviewed
employee engagement data,
conducted client interviews andengaged ZS principals to gain aqualitative understanding of whatmatters most to our businessand stakeholders.
Based on this insight, we identified the most
relevant material issues, prioritizing fivecore topics.
In 2023, the ESG Core Team refined the topics
further by conducting desk-based research,creating an assessment framework andinterviewing ZS subject matter experts to evaluatevarious subtopics based on their impact acrossenvironmental, social and economic dimensions.
Subsequently, we prioritized material subtopics
based on their significance to ZS. In the coming
years, we will conduct a full double materiality
assessment and update our materiality matrix
annually to reflect ongoing trend analyses andinput from stakeholders. We will also consult
the SASB sectoral guidance and GRI as a basis
for defining our material topics, alongside the
10 global principles of the U.N. Global Compact.

HealthequityData security
and privacy

Diversity, equity
and inclusion

ClimateimpactEthics andtransparency

Reducing healthdisparities aroundthe world

Maintaining the safety,
security and privacy of
our assets

Fostering a culture
where every person
can thrive

Combating the negative
effects of climate change
and operating sustainably

Staying accountable
as we make progress

Prioritized subtopics

Prioritized subtopics

Prioritized subtopics

Prioritized subtopics

Prioritized subtopics- Access to healthcare
by addressing healthdisparities- Responsible use of
artificial intelligence (AI)- Diversity in theworkforce (recruiting,development andretention)- Greenhouse gas
emissions- Ethical and compliant
business practices- Renewable energy
transitions- Employee safety
and well‑being- Environmentally
responsible
supply chain- Ethical supply chain(including diversity)- Patient centricity- Community healthengagement- Risk management- Data privacy andcompliance- Inclusive leadershipand accountability- Bias-mitigation andequity audits- Corporate citizenship08

ESG Report 2023

A year of action

Ethical operations

Delivering equitable outcomesWe embrace an integrated ESG
approach to deliver healthy, fairand sustainable outcomes for all.
By acknowledging the intrinsic
overlap between the dimensions of
E, S & G, we cultivate a nuanced
understanding of sustainability
and responsibility and ensure ouractions drive meaningful impact.
Our work contributes to five SDGs:
3

Good health and well-being

7

Affordable and clean energy

10 Reduced inequalities
12 Responsible consumption and production
13 Climate action

Equitable opportunities

Health equity

Appendix

Ethical operations
for a better future
We work to build trust with our clients,
partners, colleagues and suppliers
by addressing the impacts of climatechange, ensuring data security andprivacy and staying accountable as we
make progress.
Read more on page 13

Equitable
opportunities
for an innovative
workforce
Our people are our mostvaluable asset. We prioritize
fostering a culture where every
ZSer uses their passions to drive
impact, receives support basedon their unique needs, feels
heard and respected and isenabled to thrive.
Read more on page 30

Health equity for all
people and communities
We work to understand and address
the social and environmental driversof health. We seek partnerships andopportunities that drive change, bringing
together stakeholders in healthcare andbeyond to tackle inequities.
Read more on page 48

09

A year of action

ESG Report 2023

Ethical operations

Equitable opportunities

Health equity

Appendix

10

Our journey in numbers
Throughout 2023, we continued our efforts in environmental sustainability, health equity, ethical andequitable practices and responsible governance. We have measured our impact over the last three years,
tracking key performance indicators across our ESG goals to drive continual improvement.

StatusUnderway
Ongoing
Complete

Ethical operations for a better future

3
4
5

Our goals

2019 (baseline)

2020

2021

2022

2023

Set science-based, near-term emission-reduction targets
by 2023

n/a

n/a

n/a

Submitted nearterm targets to the
SBTi for approval.

Received approval from the SBTi on our near-term targets to achieve
the following by 2030:- Reduce absolute Scope 1 and 2 GHG emissions 48.8%- Reduce Scope 3 GHG emissions 55% per full-time equivalent (FTE)

Set a science-based, net-zero-emissions target by 2025

n/a

n/a

n/a

n/a

Submitted 2045 net-zero target to the SBTi for validation.

Reduce absolute Scope 1 and 23 GHG emissions 48.8% by 2030

4,137 tCO2e

17%

21%

29%

63%

Reduce Scope 3 GHG emissions 55% per FTE by 2030 4

7.98 tCO2e

60%

70%

51%

57%

Achieve 100% renewable electricity usage globallyby year-end 20305

16%

8%

9%

53%

93%

Establish a sustainable procurement function by the endof 2023

n/a

n/a

n/a

n/a

Hired a procurement leader to develop and oversee our sustainableprocurement function and strategy.

Require targeted suppliers to sign our Supplier Code of Conduct
and integrate it into key contracts by year-end 2024

n/a

n/a

n/a

n/a

Between June 1 and Dec. 31 2023, 39% of executed MSAs contained
our Supplier Code of Conduct.*Engage with key suppliers on emissions-reduction strategies

n/a

n/a

n/a

n/a

18% of our total supplier spend was allocated to suppliers that
underwent a sustainability assessment (ESG questionnaire).

We calculate Scope 2 emissions using market-based emissions.
Scope 3 emissions vary slightly from previous reports due to differences in FTE count methodology.
By year-end 2024, we will deliver select client services from offices powered by 100% renewable energy.

*

StatusIn 2023, ZS published its Supplier Code of Conduct and subsequently incorporated it into 39% of executed master service
agreements (MSAs) of that year. During the first quarter of 2024, 97% of executed MSAs contained our Supplier Code of Conduct,
underscoring our commitment to instituting a systemic framework for ensuring supplier compliance with our mandated standards.

A year of action

ESG Report 2023

Ethical operations

Equitable opportunities

Health equity

Appendix

11

Equitable opportunities for an innovative workforce6
Our goals

2019 (baseline)

2020

2021

2022

2023

Increase the representation of women and gender expansive7
ZSers globally

33%

33%

33%

35%

34%

Increase the representation of women within the ZS India
workforce to reach market levels

28%

27%

28%

32%

31%

Increase Black and Hispanic/Latinx representation within
the ZS U.S. workforce to reach market levels

2% Black
3% Hispanic/Latinx

2% Black
3% Hispanic/Latinx

2% Black
3% Hispanic/Latinx

3% Black
3% Hispanic/Latinx

3% Black
3% Hispanic/Latinx

Increase the overall diversity of principal, associate principal
and manager representation, including women globally andBlack and Hispanic/Latinx ZSers in the U.S.

27% women
1% Black
2% Hispanic/Latinx

28% women
1% Black
2% Hispanic/Latinx

28% women
1% Black
2% Hispanic/Latinx

29% women
1% Black
2% Hispanic/Latinx

28% women
1% Black
2% Hispanic/Latinx

Our goals

2019 (baseline)

2020

2021

2022

2023

Expand our work with clients and partners to advance
health equity globally

n/a

n/a

n/a

n/a

Delivered 731 patient health and equity projects in 2023
across 112 unique clients.

StatusHealth equity for all people and communities

Invested $5 million in partnerships that address health disparities.
Read more about our healthcare partnerships in action.

6
7*

Improve access to and quality of care for underserved
communities using strategic focus, insight, innovation,
cultural relevance, connection and measurement

n/a

n/a

n/a

n/a

~23 million potential lives impacted by our patient health andequity partnerships.*

Work with our clients and partners to expand representationin clinical development, including portfolio strategy,
clinical trial design and implementation

n/a

n/a

n/a

n/a

Read more in Health equity for all people and communities and how
ZSers work to increase patient voices and diversify clinical trials.

Support legislation and regulation that improves accessto healthcare and health equity

n/a

n/a

n/a

n/a

Read more about our partnership with the Healthcare
Leadership Council.

Read more about our healthcare partnerships in action.

Based on an analysis of market data and our deviation from it.
Gender expansive is an umbrella term for any expression of gender that falls outside of society’s current gender binary standards.
This number was determined based on  the estimate of people affected by our patient health and equity partnerships, including 200,000 adult Black women at risk for breast cancer in Illinois and California, ~2.5 million underserved children
are living with asthma in the U.S., 20 million patients are benefiting from American Heart Association programs, there are ~160,000 multiple myeloma patients globally and ~80,000 patients benefited from an anemia eradication program.

StatusESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

12

Ethical operations
for a better future
Sustainability starts from the inside by evolving our firm’s
operations. We are dedicated to embracing responsible
practices to reduce our environmental impact. Thesechanges make us resilient—enabling us to continue
delivering innovations and high value to our clients andother stakeholders, now and in the future.

In this section
ZS’s approach to sustainability

13

Teams leading the way 

15

Accounting for our climate impact

16

Keeping ZS secure by design 

23Acting with professional integrity 

26

Risk management

28

ZSer in Tokyo

ESG Report 2023

A year of action

Ethical operations

ZS’s approach to sustainability
We anchor our efforts in ourmaterial issues and the U.N. SDGs
to enhance the well-being ofindividuals and communities. By
doing so, we evolve our operational
capabilities, deliver long-term value
and meet our responsibility to treat
our employees, clients, suppliersand communities right.

ZS’s commitment to operating responsibly
is rooted in our material issues:

Climate impact
Combating the negative effects of climatechange and operating sustainably

Data security and privacy
Maintaining the safety, security and privacyof our assets

Ethics and transparency
Staying accountable as we make progress

Our work contributes to four SDGs:
3

Good health and well-being

7

Affordable and clean energy

12 Responsible consumption and production
13 Climate action

Equitable opportunities

Health equity

Appendix

13

ESG Report 2023

Our commitment to net zero
ZS is ahead of sustainability expectations set
for suppliers by the Health Systems Task Force,in part because of our commitment to reachnet-zero GHG emissions across our value chain
by 2045.8 We are awaiting approval from the
SBTi on this target.
In 2023, the SBTi validated and approved ournear-term GHG targets9—an important milestone
in our sustainability journey. These targets are
to reduce Scope and 1 and 210 GHG emissions by
48.8% and Scope 3 emissions by 55% per FTE11
by 2030, from our 2019 baseline year.12

A year of action

Ethical operations

At first glance, it may seem we met our short-termemission targets in 2023. However, our targets
are centered on reducing emissions from our2019 baseline year, which had nearly 100% inoffice attendance. Although our post-COVID-19
attendance is increasing year-over-year, manyof our emissions per FTE are still lower due toreduced attendance. Our short-term goal assumesa return to near 100% in-office attendance by
2030, as was the firm plan when our targets
were validated. It is crucial that we sustain lower
emissions levels well beyond 2030, especiallyas our operations expand and lead to increased
emissions due to workforce growth, global
footprint expansion and acquisitions. It is essentialthat we consistently mitigate and manage theexpected rise in emissions each year to effectively
maintain our reductions.

Equitable opportunities

The Task Force asks for suppliers to have a near-term target with the SBTi by 2025. We already have a near-term target approved
and have submitted a net-zero target to match the ambition of industry leaders. See more at: https://a.storyblok.com/f/109506/
x/7d3363a8b1/smi_suppliertargets.pdf
9
Scope 1 emissions are direct emissions from sources an organization controls, such as generators and owned vehicles. Scope 2
emissions are indirect, such as emissions from electricity, steam, heat or cooling. Finally, Scope 3 emissions occur in the value chainof a company, such as supplier emissions and business travel.
10
We calculate Scope 2 emissions using market-based emissions.
11
FTE is a carbon intensity ratio used to normalize carbon emissions against the number of full-time hours worked by employees
in a business.
12
The target boundary includes biogenic land-related emissions and removals from bioenergy feedstocks.
13
By year-end 2024, we will deliver select client services from offices powered by 100% renewable energy.
*
These numbers are compared to our 2019 baseline.

Appendix

14

A snapshot of our progress
In 2023, we continued to transform our operations. We:
Submitted our net-zero emissions-reduction
target to the SBTi

Achieved SBTi-approval on our validated
near-term emissions-reduction targets

Audited and assured our 2023 emissionsin accordance with the Greenhouse Gas
Protocol and ISO 14064-1

Developed an advanced emissionsallocation methodology for our clients

Obtained and maintained ourISO 27017:2015, ISO 27701:2019,ISO 27001:2013, ISO 14064-1, HITRUST CSF,
SOC 2 Type 2 and SOC 3 certifications

Launched QUEST—our tailor-made
RSA Archer platform

63%

reduction in ourabsolute Scope 1 and 2
GHG emissions*8

Health equity

57%

reduction in our Scope 3
GHG emissions* per FTE

93%
global renewable electricity
usage, our target is 100%
renewable by 203013

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Appendix

15

Teams leading the way
Improving health outcomesrequires passion, innovation, crossindustry partnerships and integrity.
Alongside the Shareholders’Council, ESG Steering Committee
and ESG Core Team, several
teams at ZS hold us accountablefor bringing responsible businesspractices to life.

The team also continually monitors the risklandscape, identifying and mitigating situations
that put our firm and clients at risk.

Legal team- The Quality Risk Management team, which
identifies and manages risks for our digital- andtechnology-related opportunities and projects

Our Legal team, led by the general counsel andchief risk officer, is responsible for monitoring theregulatory landscape and ensuring we mitigate
potential legal and reputational risks. Our lawyers
and legal professionals protect the firm’s interests
within the boundaries of the law while achieving
our business objectives. This includes overseeing
any contractual agreements and providing subject
matter expertise in the areas of employment,
corporate, privacy and intellectual property.

Risk management teams
Several teams further monitor emerging risks
within our firm, including:- Enterprise Risk Management, a new teamunder the chief risk officer’s mandate
dedicated to identifying and assessing risks
by emphasizing internal and external factorsthat may impact ZS- The Delivery Excellence Office, which helps
ZSers deliver risk management across client
programs to increase our partners’ confidence
in our work
- The IT Governance, Risk and Compliance(GRC) team, which shapes our internal risk
management, compliance and internal audit
best practices

Information Security teamThe Information Security team enforces our
corporate information security strategy—
including infrastructure, IT governance, risk
management and compliance—to protect ZS
against cyberattacks, phishing, data breaches
and information misuse. Information Security
also provides ongoing training and awarenessprograms internally to empower ZSers to handle
sensitive client information appropriately
and confidently.
Information Security partners with theInformation Security Working Group (ISWG),
which reviews existing and emerging threats
related to information security and provides
oversight to mitigate concerns. ISWG reports
to the Risk, Compliance and Professionalism
Committee and has a direct line to the
Shareholders’ Council.

ZS CaresZS Cares is our global social impact programthat sparks sustainable and responsible change.
Driven by the passion of our people, ZS Cares
enables ZSers to improve their communities
through volunteering, pro bono consulting,donation matching, nonprofit board service,client and industry partnerships and otheropportunities related to our ESG material issues.
Read more about ZS Cares.

In 2023, several ZS Cares teams implemented
responsible practices within their offices,
playing a critical role in our emissions-reduction
strategy. These have included a waste-diversionenhancement project, a sustainable cateringpilot in our San Francisco office and a plasticsreduction and elimination effort in our Pune
office. Local ZS Cares teams have also worked
on building sustainable communities, fromcleaning reservoirs near our Singapore office tovolunteering at a food co-op in London to offer
nutritious meals to people in need.
ZS Cares has further collaborated with our GRC
team to champion causes in India. These include
digital awareness and STEM (science, technology,
engineering and mathematics) cybersecurity
education for students of various ages. We also
donated laptops to ZS Cares-affiliated schools,
colleges and shelter homes to reduce e-waste
and improve access to technology for those fromlower-income backgrounds.

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Ethical operations

Equitable opportunities

Health equity

Appendix

16

Accounting for our climate impact
Climate change has vast anddisparate impacts on healthoutcomes, and we recognizethat action cannot wait. That’s
why ZS is committed to taking
clear, intentional steps to reduce
our climate impact, aligning ourenvironmental efforts with our
purpose as a business.
To guide our actions, we have establishedreduction targets for our Scope 1, 2 and 3
emissions. In 2023, we were proud to submit our
net-zero GHG target to the SBTi for validation
and approval, as well as successfully receiving
approval of our SBTi near-term targets.

Our SBTi targets
We are deeply committed to reaching netzero GHG emissions across our value chain
by 2045.
To do this, we have set near-term targets tofacilitate our journey. From a 2019 baseline
year, we commit to reduce:
Absolute
Scope 1 and 2
GHG emissions

48.8% 55%
by 2030

by 2030

90%

97%

by 204513

14

Scope 3 GHG
emissions per
FTE (full-time
equivalent)by 204514

These target boundaries include biogenic land-related emissions and removals from bioenergy feedstocks.

The 2023 GHG inventory shared throughout
this report has been externally audited andassured. Looking forward, we aim to continually
improve our emissions data sets and integrate
a common methodology across ZS for reporting
and tracking, so that our firm has a robust
measurement and audit infrastructure in place.

Our road to net zero
Reaching net zero is both a journey and a longterm commitment. We’re taking meaningful
steps to reduce our emissions while considering
our yearly growth and travel-intensive businessand supplier management models. In 2023, we
made strides in improving our data collection,
analysis and implementation planning, focusedon our office management, suppliers, employee
commuting, energy attribute certificates (EACs/
RECs) and efficient business travel practices forinternal and client purposes.

Measuring our 2023
carbon footprint
In 2023, we collaborated with an independent
third party and emissions-reporting expert tocalculate our 2019–2022 GHG emissions, in linewith the Greenhouse Gas Protocol and SBTistandards. Our 2023 GHG inventory has been
prepared with the same experts and has beenexternally audited and assured to ensure wehave the most accurate information possible
to support the implementation of our climate
strategy. By engaging external assurance andvalidating our emission data, we have successfully
attained verification of our 2023 GHG inventoryof our global offices and operations in alignment
with ISO 14064-1.
See our full GHG emissions by scope.

ESG Report 2023

A year of action

Ethical operations

Year

2019

2022

2023

2024

ActionSet our baseline

Submitted a 2030
science-basedtarget and achieved
measurable
reductions across all
Scopes (compared toour 2019 baseline)

The SBTi approved
our 2030 sciencebased target

Receive SBTi approvalof our net-zero target

2,955 tCO2e

1,532 tCO2e

29% absolute
reduction in
Scope 1 and 2
emissions (marketbased), compared
to 2019 baseline

63% absolute
reduction in
Scope 1 and 2
emissions (marketbased), compared
to 2019 baseline

Absolute Scope 1
and 2 emissions

Scope 3 emissions
per FTE

Renewableenergy4,137 tCO2e

7.98 tCO2e

16%

Submitted our
net-zero target for2045 to the SBTi,
for which we areawaiting approval

3.89 tCO2e

3.43 tCO2e

52% reductionin Scope 3 per
FTE, compared to2019 baseline

57% reductionin Scope 3 per
FTE, compared to2019 baseline

53%

93%

Continue implementing
local, regional andglobal initiatives foremissions reductions
Continue GHG data
accuracy throughour employee
commuting survey,
site manager survey,
new and streamlined
data collection
platform and traveltracking platform, which
includes improved
environmental metrics
Further integratesustainability
into procurement
and our suppliermanagement model

Achieve 100% renewableenergy for select client
services by year‑end

Equitable opportunities

Examining our operational
impact: Scope 1 and 2
Scope 1 refers to the emissions produced fromsources that are owned or controlled by ZS,
while Scope 2 is the indirect emissions from thegeneration of purchased electricity and cooling
consumed by our firm. Taken together, in 2023,
our Scope 1 and 2 emissions accounted for 3% of
our total emissions.

100%

renewable energy by 203015

100%

refrigerant phaseout by 2040

100%

building electrification by 2040

Increase

our direct consumption of renewableenergy from the grid and onsite generationof renewable energy

Supportgreen energy development throughEACs as appropriate

Health equity

Appendix17

Our three main categories of Scope 1 emissions
are office natural gas, refrigerants and company
vehicles, while purchased electricity and coolingare our key sources of Scope 2 emissions. We arecommitted to reducing both Scopes 1 and 2 by
48.8% by 2030, with four subtargets guiding
our efforts.

Renewably powered operations
and energy efficiency
Our most significant initiative to reduce Scope
1 and 2 emissions is to achieve 100% renewableenergy by 2030. Last year’s reduction in marketbased Scopes 1 and 2 emissions was driven bymore of our offices procuring renewable energy
from the grid and ZS purchasing EACs.
Powering renewable energy initiatives in India
During 2022, our World Trade Center office in Pune,
India—our largest office globally by both square
footage and employee headcount—completed
its transition to 100% renewable energy. In 2023,
we further improved our sustainability in Pune bypowering our International Tech Park office with
100% renewable energy. Pune is responsible for up
to 25% of ZS’s electricity consumption annually andpreviously made up 40% of our worldwide carbon
emissions from electricity. This renewable energy
transition will save an estimated 1,170 metric tonsof CO2 emissions annually.
15

As part of our SBTi objectives, we set the goal to power 100%of our offices with renewable energy by 2030. To meet therequirements of select clients, we will deliver their services
from offices powered by 100% renewable energy.

ESG Report 2023

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Ethical operations

Innovative solutions for carbon reduction at ZS India
In early 2024, ZSers came together tocontribute ideas to actively reduce GHG
emissions in their workplaces.
ZSers submitted a diverse range of projects
and case studies, such as solutions for waste
management, energy efficiency and electricand hybrid taxi fleet transitions.

In recognition of our collective commitment
to sustainability, we were awarded theSustainability Champion Award for Innovation
in Responsible Recycling by MSME Chamberof Commerce and Industry of India, alongside
the runners-up award for Outstanding
Demonstration in Sustainability at the eighth
Workplace Excellence Conference & Awards
hosted by the Infrastructure, Facility, Human
Resource & Realty Association.

“ It’s incredible to see the pace at which environmental
requirements are speeding up from our clients and our people.
Our teams in India have wonderful ideas that we want to take backto all ZS offices and start making a difference for our organizationon our path to net zero.”Jennifer Gold, Global ESG Lead (she/her)

To deliver renewable energy services to our clients,
we set a goal that our India offices will accountfor 100% renewable energy from the grid andEACs by year-end 2024. ZS leases floors in multitenant buildings for our office spaces in India, andcontinually assesses new and existing leases foralignment with our sustainability strategy.
In partnership with an external vendor, we spent
four months gathering information and reviewing
our data through several working sessions,finalizing the renewable energy procurement
strategy for each of our India offices. In the shortterm, we are purchasing EACs for each building
to close the existing gap between renewables
sourced from the grid and achieving 100%
renewable energy. In the future, we will pursue
virtual power purchase agreements and open
access (offsite renewable) agreements.
A global approach to energy efficiency
Globally, 11 of our offices currently operate on
100% renewable energy from onsite sourcesor the grid, including Frankfurt, London, NewYork and Tokyo.16 An additional seven offices
globally, including those in the U.S. and our officein Toronto, procure some renewable energy
from the grid. Meanwhile, all ZS offices in the
U.S. are in LEED17-certified or ENERGY STARcertified buildings.

Health equity

Appendix

18

We are negotiating lease agreements acrossoffices to ensure the buildings we work in use
renewable energy sources.
For offices across Asia, Europe and North
America that are not procuring renewableenergy from the grid, we purchase EACs, whichenable us to track and document our renewableelectricity consumption. Through these actions,
we reached 93% renewable energy across ouroffice buildings in 2023.
As a professional services firm, we value faceto-face interactions with our colleagues. Given
our increased attendance in-office since thepandemic, our total electricity consumption
increased 37% year-over-year. We will continue
to find ways to make our offices more energyefficient, including investing in technologies
across our IT infrastructure, virtualization andpower management tools. This includes server
virtualization, data center optimization andextensive use of cloud platforms such as Amazon
Web Services and Microsoft Azure, as well as theuse of energy-efficient hardware. We have also
invested heavily in optimizing our data centers
by using advanced cooling systems.

The 11 offices operating on 100% renewable energy are Evanston, Tokyo, New York, Copenhagen, Frankfurt, Berlin, Pune
(two offices), London, Osaka and Zurich.
17
Leadership in Energy and Environmental Design, a rating system used to assess the environmental performance of buildings.
16

ZSers in India

Equitable opportunities

ESG Report 2023

A year of action

We continue to upgrade electrical systems andinvest in renewable energy globally, and plan toexpand our focus on energy by optimizing our air
conditioning systems and technology hub spaces
for efficiency.

Water and waste
We recognize water and sanitation availability isa global priority. While our water consumption
is limited to kitchens and washrooms, we
continually explore ways to educate ZSers aboutwater-conservation efforts.
2019(baseline)

202318Renewable energy(procured at source)

16%

43%

Renewable energy credits

0%

49%

Nonrenewable energy

84%

7%

Total electricity consumption

7,945
MWh

10,441
MWh

Certifiedfor ISO 14001:2015 (Environmental
Management) in Pune, New Delhi
and Bengaluru offices

18

Numbers may not round up to 100% due to rounding.

Ethical operations

ZSers are also proactive in finding ways toimprove their office’s waste management
practices. In 2023, we launched a campaign toeliminate single-use plastics in all our India offices
by switching to glass bottles for condiments andusing biodegradable cutlery. Similarly, at ourannual Americas principal, associate principal
and manager meeting, we asked ZSers to bring
their own reusable water bottles—reducing
unnecessary single-use plastic.
ZS has developed an e-waste disposal strategy
that ensures responsible disposal of electronicequipment, including partnerships with certified
e-waste-recycling companies to handle ourobsolete IT assets.
As part of an ongoing effort to increase theaccuracy of our Scope 1 and Scope 2 emissions
data, ZSers in Bengaluru, Buenos Aires, Chicago
and more are quantifying the collective waste of
their office procedures. This was complemented
by our local 2023 Waste Measurement
Improvement pilot, which assessed the feasibilityof improving waste data granularity. By evaluating
waste management practices and using datatracking capabilities shared through our office site
survey and pilot programs in Buenos Aires and
San Francisco (see right), we aim to develop waste
management guidelines and deploy them to all
our offices. This will help us navigate an inevitable
increase in waste generated due to higher
in-office attendance of our colleagues.

Equitable opportunities

Sustainable initiatives
powered by our people
ZSers are a vital force driving our ESG
journey and progress.
In our San Francisco office, ZSers promotea more sustainable workplace througha waste-diversion-enhancement projectand sustainable catering pilot. In 2023,
this focused on reducing emissions
associated with catered office meals,
decreasing single-use plastics andlandfill waste and increasing sustainable
packaging. Meals in the pilot used 100%
compostable and reusable cutlery anddishware and were sourced from vendors
who exclusively use recyclable andcompostable packaging.
Additionally, San Francisco ZSers havejoined a local service that connects
employees to free carpooling, shuttles
and more—enabling a lower-emission
commute to work. By treating sustainable
and responsible operations as a collective
endeavor, ZSers around the world cansuggest and develop solutions thatwork for them, with the support andencouragement of our firm.

Health equity

Appendix

19

ESG Report 2023

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Building operations

Employee commuting and business travel

We are working to improve how we measure
and track carbon emissions in each of our officespaces. This includes distributing an annual
survey to site managers to gather details
on sustainable commuting options, energy
consumption and use of refrigerants whileplanning accordingly for their phaseout, inalignment with our net-zero goal. Our surveys
also include details on waste management andlocal sustainability initiatives.

As mentioned, our global team values onsite
presence whenever possible with clients andcolleagues, contributing to higher business travelemissions. In fact, those emissions have nearly
doubled year-over-year from 2022.

Zooming in on Scope 3
Scope 3 is our greatest area of impact on
the environment, encompassing the indirectemissions produced because of ZS’s businessactivities. Our core categories of Scope 3
emissions are purchased goods and services,business travel, employee commuting and areas
such as waste generated in operations, capital
goods and upstream transportation.
In 2023, our Scope 3 emissions were 3.43 tCO2e
per FTE—a 57% reduction from our 2019baseline—and accounted for 97% of ZS’s total
emissions. We continued our focus on Scope 3
emissions, embedding relevant expectations into
our procurement strategy and implementing new
initiatives that reduce our indirect emissions.

To accommodate in-person interactions andsustainable modes of travel, we encourage
ZSers to use hybrid and fully electric vehicles(EVs) whenever possible. Our corporate
rideshare accounts for vendors such as Uberand Lyft prioritize EV options. Relatedly, we also
intentionally select office sites that are close toclients and offer ZSers convenient access to public
transit or eco-friendly modes of transportation.
We are in the formative stages of procuringhybrids and EVs from rental car suppliers inlocations that offer taxi services to employees,with an emphasis on India. Despite some recent
challenges, we continue to look toward our goalof achieving 100% EV usage in both our Pune and
New Delhi offices by 2030.

127,130 miles

travelled with electric vehicles by Pune ZSers,
preventing 46 tCO2e (equivalent to 8.9 homes’
electricity use for one year)

Equitable opportunities

Health equity

Appendix

20

Cutting meeting milage for responsible leaders
Reducing our business travel emissions isvital to the sustainability of our operations.
During the 2024 Americas regional leadership
meeting, ZS used a shuttle service toefficiently move attendees between the
airport and meeting space. This saved 1,390
one-way transfers, equating to about 7 metrictons of CO2. We also encouraged ZS client
teams to use the meeting to connect withlocal clients and cross-regional teams inperson, which avoided 1,232 flights, equating
to about 341 metric tons of CO2. While travelis an important way for our employees andclients to connect, we are committed toensuring this happens in an efficient andresponsible way.
Meanwhile, for our April 2024 EU leadership
meeting, we selected a venue largely
accessible by train to prevent unnecessary
air travel. We estimate that this change saved
34 metric tons of CO2e.

383 tCO2eestimated to have been saved“ By reducing reliance on gas-powered vehicles, encouraging the use of
public transit and incentivizing eco-friendly options such as electricvehicles, the EU leadership meeting this year aims to set a new
standard for environmentally conscious event planning, minimizing
our carbon footprint and contributing to a healthier planet.”
Luca Girardi, Meetings and Travel Assistant (he/him)

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Improving our understanding of ZS commutes
We continually work to make our emissions
data more accurate by capturing travel data
directly from ZSers instead of external emissions
benchmarks. In 2023, we introduced our employee
commuting survey to improve emissions
measurements while identifying opportunities for
low-emission travel.19 While our business travel(including commuting) emissions nearly doubled
year-over-year, our commuting survey foundthat ZSers’ traveling habits are more sustainable
than those found in public benchmark data. In
other words, ZSers typically and intentionally takegreener modes of transportation when travelingto and from the office. In the future, we aim to use
this data to plan commuter benefits programs
and office locations. We will carry out this survey
annually moving forward.

62%of respondents across our offices20 report using
lower-emission modes of transportation tocommute to our offices, including carpooling,
biking, walking, hybrids and EVs, andpublic transportation

19

ZSer in India

20

Health equity

Appendix

21

Managing supplier emissions
Supplier management makes up 60% of ZS’s
emissions-reduction potential and is a key
part of how we address Scope 3 emissions. While
our emissions from purchased goods and services
decreased 39% year-over-year, as did our spend
in this category, our sustainable procurement
practices did not lessen. We continued to partnerwith suppliers and held them accountablein operating sustainability. Effective suppliermanagement aims to foster strong relationships
to ensure responsible sourcing, reduce
environmental impact and promote ethicalpractices throughout the value chain.
We are advancing our approach to procurement
and improving processes to manage suppliersustainability, ethics and adherence to ZS’s
Supplier Code of Conduct. As just one example,
our travel team engages airline suppliers innegotiations to integrate sustainable aviationfuel options into contracts. We also use acarbon-insight technology to calculate carbon
output as part of our travel-booking tool. Thisequips ZSers with the information they needto make more sustainable choices during theirtravel booking journey.

As ZS India largely relies on a taxi fleet system, it has a separate mechanism in place to collect commuting data.
Except for Pune, Noida and New Delhi; see footnote above.

ESG Report 2023

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Ethical operations

We are also working on incorporating
sustainability criteria into our IT procurement
process. By choosing responsible IT solutions andsuppliers, we aim to build a more sustainablesupply chain and reduce the environmental
impact of our technology acquisitions.

In 2023, ZS launched our Carbon Credit
and Sustainable Aviation Fuel (SAF)
Strategy, which outlines best practices forpurchasing carbon credits aligned with the
SBTi, the Verified Carbon Standard andGold Standard, and ZS’s material issues.

Using offsets intentionally

We will only pursue high-quality carbon creditsthat are validated and verified, going beyond
what is required by law and ensuring that
adequate safeguards are in place to confirm
projects leave a permanent, positive impact
on the environment.

We recognize there are certain supply chain
impacts where emissions are unavoidable ordifficult to mitigate. As such, we look to highquality carbon credits as part of our long-term
net-zero strategy, in alignment with the GHG
Protocol and SBTi standards, to help offset
residual emissions.
At ZS, we are assessing how we can implement
the use of carbon credits in the future tooffset supplier emissions. We are proceeding
deliberately and thoughtfully in this process,prioritizing ethical considerations and taking thenecessary time to do things right.

B Rating

by CDP for Supplier Engagement in 2023;
an improvement from our 2022 rating of D21

Supplier Engagement Rating is a letter grade that indicates how effectively companies
are engaging their suppliers on climate change and influencing their supply chains.
22This percentage is calculated based on assets under management as of the year 2019.
21

Equitable opportunities

Health equity

Appendix22

Supplier spotlight: Aviva’s nature-based solutions
We are proud to partner with suppliers
who dedicate themselves to funding andsupporting carbon-reduction initiatives. One
example of this is Aviva, our U.K. private
health insurance provider.

Nature Trust, Aviva is reintroducing woodlandacross 3,000 hectares of land. This initiative is
projected to remove 1.4 million metric tons ofcarbon from the atmosphere throughout the
lifetime of these woodlands.

Fifty percent of Aviva’s total investment
and lending activities are dedicated tosupporting emissions-reduction efforts,22
with £100 million of funding committed tonature-based solutions for carbon capture.
Collaborating with organizations such as the
Wildlife Trusts, the Woodland Trust and theBy partnering with organizations who engage
in these kinds of environmental initiatives, we
can encourage environmental sustainability
across our value chain and reduce Scope 3
emissions as a result.

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix23

Keeping ZS secure by design
Cybersecurity is a shared
responsibility that extends beyond
ZS and clients to include the enduser’s experience. By placing
cybersecurity at the center of ourinnovations, we aim to be an agile,
adaptive and trustworthy leader in
information security.
Securing our firm and our clients
We take a multifaceted approach to information
security, including mandatory ongoing training
for ZSers, systems designed to meet ISO andInternational Electrotechnical Commission (IEC)
standards and ZS’s Information Asset Protection
Policy (IAPP), which applies to all confidential data.

Our IAPP is reviewed annually and sets out
ZS’s approach to keeping data protected. This
includes the safeguards we maintain to ensure
information and ZS systems remain secureagainst unauthorized use, loss, destruction andrelease. It also details our expectations that all
ZSers commit to legal and ethical informationhandling practices.

2023 brought numerous updates to theISSE, including:Due to our efforts, we had no substantiatedcomplaints in 2023 concerning breaches of client
privacy and no identified leaks, thefts or losses ofcustomer data.

- Focused research—using current requests
for proposals, requests for information andclient security questionnaires—to identify
opportunities to improve our information
security maturity

Embedding security throughout
our organization
ZS created the Information Security Strategy andExcellence (ISSE) Center in 2023 to further embedcybersecurity as an integral part of businessdelivery and client interactions—deepening
collaboration between our clients and the ZS
Information Security team.

- A new business information security officer role
to support collaboration between clients andthe ZS Information Security team
- An established operating model and toolkit forengaging key clients on cybersecurity- Workshops with ZS client leads to supportclient conversations involving ZS’s information
security maturity and best practices

31

ZS offices are ISO 27001,
27701 and 27017 certified

ZSer in Evanston

ESG Report 2023

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Ethical operations

ZS QuestZS QUEST, a workflow platform, marks
a significant stride in managing quality,
compliance, risk and security, helping us
to build client trust. It establishes robust
automated workflows to simplify and unify
quality practices, unified compliance (security
and privacy), risk management (from silos
to holistic systematic representation andreporting) and security.

100+

third parties have been onboarded
since implementation in 2023

1,400+

quality, risk and compliance assessments
have been completed so far using Quest
for our client-facing projects

The immediate impact on ZSers has
been enhanced Quality, Reliability andConsistency evaluations, streamlined policy
management and automated complianceacross 15 standards. Efficient third-party
risk management, information security
management system life cycle management
and audit automation have further bolsteredoperational efficiency and risk management
across our firm.

Equitable opportunities

In 2022, ZS also established the Application
Security Center of Excellence to ensure robust
security practices across our technologicalinfrastructure and software development life
cycles (SDLC).
The center supports both internal and client
application development environments, offering
on-demand support for any security requirement
while delivering best practice training for ZSers
and clients through our online training platform.
The center is focused on early detection ofcoding and infrastructure security issues
within the applications we design. Once built
by development teams, applications undergo athorough review process, including automatedand manual scans throughout the SDLC,
and receive the “Seal of Application Security
Governance Framework Compliance.”23 This
review process allows ZS to proactively identify
and address security gaps before we deliver
applications to our clients.

Health equity

Appendix“ With the Application Security
Center of Excellence’s help, weare able to have security practices
embedded in our pipelines whendeveloping and deploying an app.”
Personalize.AI Project Team

Data privacy
Several policies govern the use and protectionof personal information. These include ourPrivacy Policy, Global Data Retention Policy,
Data Protection Policy and IAPP.
ZS maintains a standard operating procedure
for assessing privacy, security and business
continuity risks for third-party vendors. This
includes business continuity practices to protect
ZS and our clients’ data. Read more about ourPrivacy Policy.

140+ apps

have been assessed by the center so far withproposed tailored security plans for each

23

24

The “Seal of Application Security Governance Framework Compliance” is a ZS certificate of completion thatassures a rigorous security process implemented in the building of client technologies and solutions.

ESG Report 2023

Reaching data security milestones in 2023
We continue to successfully pass surveillance
audits for ISO/IEC 27001:2013, ISO/IEC 27701:2019
and ISO/IEC 27017:2015 certifications, increasing
our certified offices from 28 to 31.
In 2023, we also attained:- SOC 224 and SOC 3 certifications- HITRUST CSF25 compliance in Connected
Health and HiSec
We are progressing toward HITRUST certificationand HIPAA Type 126 compliance for ZAIDYN
Connected Health in 2024, further fortifying ourcommitment to data security in the healthcare
sector. We also comply with China’s Multi-Level
Protection Scheme for our ZAIDYN products,
reinforcing our commitment to stringent security
standards in this crucial market.

Safeguarding AI solutions
At ZS, we integrate stringent security protocols
into all AI development and usage. Our AI
Advisory team, composed of internal experts,
monitors the evolving AI landscape to anticipate,evaluate and mitigate such risks. We also
equip ZSers with digital literacy training andrecruit individuals with the necessary skills for
AI development.

A year of action

Ethical operations

We closely evaluate any third-party AI tools before
incorporating them into our internal processes orclient-facing services. Using secure areas calledsandboxes, we experiment with third-party tools
using fabricated data to ensure confidential
information is not put at risk. Within the
sandboxes, we also perform security testing in a
protected space, giving ZS the ability to identify
and address any gaps.
To mitigate risks related to personal information,
we follow ZS’s data privacy framework alignedwith the General Data Protection Regulation(GDPR). This emphasizes data minimization,
anonymization and pseudonymization. Data
protection impact assessments are also
conducted for high-risk processing activities toensure compliance and data protection.

Equitable opportunities

We also deploy a mandatory data management
compliance course for all ZSers or contractors
who work on projects involving (or may work on
projects involving) U.S. prescriber-level data. The
course provides an overview of requirements andrestrictions that apply to using patient-level data.
Finally, all ZSers are required to complete Be Safe
Be Sure, an annual compliance cybersecurity
training where employees gain fundamental skills
and knowledge on data security, confidentiality
and privacy best practices to successfully protect
ZS and client data.

Health equity

Appendix

25

100%

of ZSers are required to complete the
Be Safe Be Sure cybersecurity training
SOC 2 and 3 are certifications that assess controls for various
Trust Services Criteria, including security, confidentiality,
availability, processing integrity and privacy.
25
The HITRUST CSF is a certifiable framework for regulatorycompliance and risk management, relating to organizational
processes and technical controls for processing, storing andtransmitting sensitive data.
26
HIPAA Type 1 is an independent assessment by an
American Institute of Certified Public Accountants auditorof design and implementation controls, in accordance withHIPAA requirements.
24

Investing in cybersecurity training
To promote a culture of risk management
and vigilance, we regularly train ZSers on new
security and privacy frameworks, standards
and requirements. In 2023, we launched Secure
Coding 101—a training course for team members
who support technology delivery. This hour-long,
self-guided course delivered secure coding skills
to more than 2,700 developers in 2023.

ZSer in India

ESG Report 2023

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Equitable opportunities

Health equity

26

Appendix

Acting with professional integrity
For every action we take anddecision we make, we commit toprotecting the people who workfor us by maintaining ethicalstandards and integrity within
our operations. Our responsible
business policies are key todriving this agenda throughout
our organization.

Living the ZS values

100%

At ZS, we do not tolerate harassment, violenceor discrimination. As an equal opportunity
employer, we are committed to providing
employment and advancement opportunities to
all ZSers, regardless of any personal characteristic
protected by applicable law.

of ZSers are required to complete training on
recognizing, preventing and reporting situationsof harassment or inappropriate behavior

ZS ensures ZSers and suppliers are prohibitedfrom engaging in any form of corruption andbribery. We provide policies and guidance on
a range of topics—from anti-corruption toenvironmental and social responsibility—that
apply to all directors, officers and colleagues. We
also flow these obligations through our supply
chain, by requiring agents, subcontractors andsuppliers to comply with our policies.

Labor and human rights

Managing a responsible
supply chain

96

vendor risk assessments initiated by
GRC to assess suppliers on privacy,
security and business practices

18%of our 2023 spend went to suppliers thatcompleted a sustainability assessment

Supplier spotlight:
Fostering diversity withSHI International Corp
ZS aims to support a community of diverse
suppliers. For over a decade, we haveworked with SHI, the largest minority- andwoman-owned business enterprise in the
U.S. Along with providing IT infrastructureand end-user computing to ZS, they
maintain a database of over 2,800 diverseowned businesses, using their influence
to uplift other underrepresented groups.
In 2023, SHI invited our chief information
officer to serve on their CIO Advisory
Board—allowing ZS to actively engage ina resilient and stable supply chain.

Read more about our Equal Employment Opportunity
Policy and Mitigating bias in hiring.

ZSers in Philadelphia

ESG Report 2023

Supplier Code of Conduct
Supplier requirements are defined in our
Supplier Code of Conduct—suppliers areprohibited from engaging in any form ofbribery or corruption, including that related
to environmental and social responsibility. After
publishing the code in Q2 2023—and between
June 1 and Dec. 23, 2023—we ensured that 39%
of executed master service agreements (MSAs)
contained the Supplier Code of Conduct. As of
April 2024, this number has increased already,with 97% of executed MSAs containing the
Supplier Code of Conduct.
For more on what we expect from our suppliers,
see Managing supplier emissions.

Inclusive sourcing and supplier diversity
In 2023, we hired an experienced procurement
leader to execute a robust supplier
diversity program.
We also used TealBook—a third-party tool—
to collect ZS’s internal spend data and analyze
the number of diverse- and minority-owned
businesses that we support in the U.S. andCanada. In 2024, we aim to expand this tocertified diverse suppliers outside of North
America and establish a spend-tracking system
within our procurement processes, reported
quarterly to our internal function leads andexternal clients.

Ethical operations

A year of action

14%of our total addressable spend was allocated tocertified diverse,28 disadvantaged29 and small30
business entities in both 2022 and 2023
27

Our strategies for ethics
and compliance
Our Risk, Compliance and Professionalism
Committee escalates discussions of risk to the
Shareholders’ Council so we can uphold thehighest standards of ethical and legal compliance.

Preventing fraud in our firm
Our Policy Against Bribery and Corruption
prohibits engagement in any form of dishonestor fraudulent conduct and applies to every
ZSer, providing guidance on anti-corruption andbribery. Additionally, our Policy on Insider Trading
provides guidance on personal investments andinsider trading.
ZS follows applicable laws wherever we operate,
including laws against fraud and corruption in the
many jurisdictions where we operate. Internally,
we take steps to prevent fraud and affirm ouranti-fraud compliance annually through our
Be Safe Be Sure training. One hundred percent of
ZSers—including members of our Shareholders’Council—are required to complete Be Safe

Equitable opportunities

Be Sure, and they are educated on additional,
related policies such as Conflicts of Interest
and Confidentiality.
ZS takes a risk-based approach to target areasof our business where fraud may be more
likely to take place. For example, controls andtraining exercises are used to test our Financeteam’s protections against fraud. Using theseassessments, we have put specific targetedtrainings and controls in place.

Speaking up at ZS
ZS’s policies and procedures, including ourWhistleblower Policy, Policy Against Harassment,
Policy Against Discrimination and Discipline Policy,
provide guidance to ZSers on maintaining a safeand respectful workplace and reporting concerns.
In addition to reporting concerns to a memberof Human Resources (HR) or the Leadership
Team, ZSers can also discretely report workplaceconcerns through our Speaking Up platform. The
Employee Relations team thoroughly investigatesall concerns raised and makes sure ZS takes
appropriate follow-up action.
Our Safe and Respectful Workplace training—delivered annually or biannually depending on
location—also reminds ZSers of the importanceof reporting harassment, discrimination andviolations of ZS values and policies. Principals,
associate principals and managers receive
additional training as an extension of Safeand Respectful Workplace.

Health equity

Appendix27

138

matters raised by ZSers through HR, ZS leaders
and the Speaking Up inbox were investigatedby the Employee Relations team in 2023

We have also added appropriate prompts to our
Ask ZS chatbot, allowing ZSers to easily locate the
Speaking Up platform when they need support.

Modern slavery: Prevention and action
We have zero tolerance for threats or acts of harm
or violence of any kind and expect all suppliers
to comply with our Global Modern Slavery
Statement (scroll to the bottom of the page).
Should we suspect a violation of any kind, we will
act immediately and address accordingly.

Addressable spend is the part of a company’s expenditurethat can be managed and optimized through procurement
strategies. Non-addressable spend, such as taxes,
intercompany payments and salaries, are excluded.
28
Businesses that are at least 51% owned, operated andcontrolled by an individual or group that has been historicallyunderrepresented. These include minority-owned businessenterprises, women-owned business enterprises, disabled
person-owned business enterprises and U.S. veteran-owned
business enterprises.
29
Businesses operating in a Historically Underutilized Business
Zone (HUBZone) as certified by the U.S. Small Business
Administration.
30
Businesses categorized as small based on revenue
and/or employees as determined by the U.S. Small Business
Administration’s classification standards.
27

ESG Report 2023

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Appendix

28

Risk management
Understanding our
climate-related risk

Identifying enterpriserisk in our firm

As of 2023, mitigating ZS’s climate impact andclimate-related risks and opportunities is part ofour risk function.

In 2022, we hired an external vendor to help us
identify our enterprise risks through interviews
with ZS principals and other core stakeholders.
These were prioritized into key risks that havebeen targeted throughout 2023 using risk cards,
which allow us to standardize and manage ourrisks at an enterprise level. The cards covered
areas such as a risk description, potential
impact, influencing factors, existing controls andproposed mitigation plans.

We measure and update our risks quarterly,
following the TCFD framework. The Enterprise
Risk Management team uses TCFD to assess
relevant risks and opportunities and applies
the results within the ZS Risk Management
Framework, which is used broadly acrossthe organization.
Our key ESG risk components include client
expectations, current and future talent, climatechange patterns, governance and regulation.
If we fail to account for these risks, we face
several potential impacts, including increased
or decreased business, breach of client legal
contracts, noncompliance with ESG regulations
and overall client perception.

Enterprise Risk Management strategy
We maintain a robust Enterprise Risk
Management (ERM) strategy, led by our chief risk
officer, to manage all aspects of ZS risk (outsideof TCFD) that could impact ZS’s objectives andoverall performance.
In 2023, the ERM team conducted acomprehensive risk re-prioritization exercise byengaging with senior leadership members andidentifying an updated set of top risks for 2024.
These will become the focus of our 2024 risk
cards preparation and monitoring—allowing us
to manage our emerging and existing risks.
ZSer in India

ESG Report 2023

Outside of the ERM team, we promote shared
responsibility for risk awareness. This includes
encouraging all ZSers to identify and reportpotential risks, take ownership of mitigation
measures and seek leadership support todiscuss concerns.
We further established the Delivery Excellence
Office to support ZSers in sharing high-impact
outcomes with clients and delivering risk
management across our client programs. The
updates increase trust and confidence in ZS’swork, enabling our clients to feel confident thatZS will solve their most complex problems.

ZSers in India

A year of action

Ethical operations

Managing opportunities and risk
in digital technology
Digital technology is an integral part of ZS’s
service offerings, and we take several steps tosafeguard our digital technology delivery against
security flaws.
Our Opportunity Security Risk Assessment (OSRA)
is a collaborative risk assessment initiative that
identifies and proactively tackles risk. In 2023,
the program assessed 66 digital technology
opportunities to identify risks in client projects
and ensure security as we venture into newtechnological spaces.

Equitable opportunities

Health equity

Appendix

29

OSRA functions alongside our Risk Analysis
Questionnaire and quality and risk management(QRM) processes. In 2023, we revamped our QRM
program—which implements QRM processes
throughout the full technology delivery life
cycle—to version 2.0. This update focused on
identifying and managing risks for our digitaland technology-related client opportunities andprojects, facilitating communication between
leaders and the ZS Risk Management Office.

In 2023, we enhanced this team by incorporating
individuals with diverse expertise in risk
management, compliance and industry-specificknowledge. Our chief risk officer serves as apermanent member of the Risk, Complianceand Professional Committee, providing periodic
presentations to the Shareholders’ Council,
alongside participating in governance and risk
workstreams, including those of the QRM and
Delivery Excellence Office.

The Risk, Compliance andProfessionalism Committee

Managing risk through client vetting

The Risk, Compliance and Professionalism
Committee oversees and manages risk
management, regulatory and policy complianceand organizational professionalism.31 It meetsquarterly to address topics such as:- Risk management- Risk appetite- Compliance oversight- Policy development- Reporting and communication

31

To ensure that our clients align with our values,
we have implemented a support frameworkfor ZS principals, allowing them to assess client
financial health and legal and reputationalrisk. This includes education and training forprincipals, risk consideration reminders for
newly requested clients and ongoing reviews ofclient reputability.
Our vetting process for clients entails screening
watchlists, adverse media and keyword
associations using a third-party businessinformation and research tool. Going forward,
we plan to extend this framework to ZS vendors,
ensuring that our supply chain is as risk-secure
as our client pipeline.

The Risk, Compliance and Professionalism Committee and the Shareholders’ Council share an enterprisewide risk
inventory maintained by the Chief Risk Officer team. Together, they provide insights on risk collection, and conduct
biannual risk prioritization and risk re-prioritization exercises.

ESG Report 2023

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Appendix

30

Equitable
opportunities
for an innovative
workforceExceptional people are the power behind our vision. We
believe ZSers are most able to reach their potential when
they are heard and represented. To do this, we foster anenvironment of trust, accountability and belonging—one
that benefits our personal journeys at ZS and permeates
through to our client relationships and business practices.

In this section
A strategic approach to DEI 

31

Strengthening ZS in 2023

32

Teams leading the way34

Our focus on inclusion and belonging 

35

Enabling our people to grow and thrive

38

Connecting with talent 

42

ZS Cares

46
ZSers in Toronto

ESG Report 2023

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Equitable opportunities

A strategic approach to DEIDiversity, equity and inclusion(DEI) must be the backbone of
our firm. It ensures our people feel
seen, heard and understood, which
enhances their ability to addressclient challenges. By approachingproblems with diverse perspectives
and staying accountable as we
make progress, we can designtransformative solutions that
improve health outcomes for all.

ZSers in Buenos Aires

By working to empower our people, we
contribute to the following material issues:

Diversity, equity and inclusion
Fostering a culture where every person can thrive

Ethics and transparency
Staying accountable as we make progress

Our work contributes to two SDGs:
3

Good health and well-being

10 Reduced Inequalities

Health equity

Appendix31

ESG Report 2023

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Appendix

32

Strengthening ZS in 2023
In 2023, we continued to evolve DEI practices at ZS, empowering our people to drive impact
with clients, one another and their local communities. Our key highlights of the year include:

13,000+

100%

34%

100%

48%

65%

ZSers globally

women globally, 17% ofwhom were promotedof ZSers from racial and ethnic minorities
in Canada, the U.K. and the U.S.

2,243
ZSers promoted

32

32

18% of ZSers overall were promoted in 2023.

of ZSers have a designated professional
development coach to support their growthof ZSers have access to well-being services,
including 24/7 support through our
Employee Assistance Program

overall engagement rate

2,000+ZSers contributed 40,500+ hours
to volunteering and pro bono activities

ZSer in India

ESG Report 2023

Our DEI maturity
Paradigm, a DEI consulting firm, assessed our
DEI maturity in 2023 and scored ZS as above
average compared to over 100 companies. This
assessment highlighted our strengths in collecting
robust employee demographic data, integrating
DEI into our hiring practices, analyzing employee
experiences and implementing a dedicated
DEI budget. Going forward, we will continue toassess our DEI maturity and engage in practices
that make ZS a more diverse, equitable andinclusive workplace.
Progressing our DEI goals
Through the assessment, we learned our biggest
opportunity to create impact is by setting DEI
goals—with support from a third party—tomeasure progress and take accountability forour results.
In 2019, we defined a gender-parity goal—known
as “Commitment 0”—that set the stage for our DEI
journey. We’ve spent the past few years buildingon this goal and, in 2023, honed Commitment 0
further by refocusing on achieving parity acrosswomen and gender expansive ZSers. Additionally,
the DEI Council identified 10 other near-termgoals to improve DEI and external impact.
This year, we have prioritized opportunities
to improve representation across DEI goals
1, 2, 3 and 7.

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

Focus areas to achieve our DEI vision
Diversity

Inclusion and belonging

External impact

We will evolve the composition of ourworkforce to reflect the stakeholders weserve and the communities where we work

We will create a sense of belonging at ZS
by ensuring every ZSer feels valued andrespected, and that equity is ingrainedin our culture and practices

We will expand our contributions externally,so that our approach to DEI is recognized,
leveraged and sought after

1.	In India, ZS will reach market-level
representation of women within the
ZS India workforce.

4. 	ZS regional leaders will establish andexecute regional priorities within theirbusiness plans that align with ZS’s broad
DEI goals.

8. 	We will increase the number of DEI
opportunities and collaborations
with clients.

2.	In the U.S., ZS will reach market levels ofBlack and Hispanic/Latinx representation
within the ZS U.S. workforce.
3.	We will increase the overall diversity of ourleadership population, including women
globally, in addition to Black and Hispanic/
Latinx ZSers in the U.S.

5. 	We will clearly explain and strengthenbias-mitigation and equity strategies that
impact all aspects of ZSers’ journeys.
6. 	We will increase awareness of career andprofessional development opportunities.
7. 	We will consistently retain ZSers acrossall racial/ethnic demographics.

9. 	We will regularly report on DEI updates
firmwide, so ZSers are equipped to discuss
ZS’s progress and commitment externally.
10.	We will maintain and expand employer
brand recognition in the DEI space.

33

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Appendix

34

Teams leading the way
Our mission is to cultivate an
inspiring workplace that unifies
our people and provides themwith opportunities to thrive. Weview this as a collective effort,
with teams leading the way by
setting priorities and measuring
our progress.
Human Resources
Our dedicated team of HR professionals is criticalto enhancing each stage of a ZSer’s journey. HR
is at the front line of addressing our people’s
needs and designing a competitive rewards andrecognition program that provides meaningful,inclusive health benefits to ZSers and theirfamilies. Employee feedback—through regular
engagement surveys and other channels—guides
the HR team in delivering these comprehensive
benefits, programs and equitable careeradvancement opportunities, as well as ensuringwell-being and safe workspaces for all.

Within the HR team is the DEI Center of Expertise,a team of dedicated DEI practitioners responsible
for executing DEI priorities, driving inclusionand diversity through all aspects of our firm
and guiding our pursuit of equity within ouroperational practices and business norms.
HR is also heavily involved in our People andCulture Team (PACT), a cross-functional team of
ZSers who help ensure our culture and sharedcore values remain central to everything we do.
PACT includes leaders from across regions andbusiness and enterprise functions. From theprocesses that support ZSers to the expectations
that leaders set, PACT brings our values to life
and inspires functions across the firm to get
it right, do the right thing and treat people
right. Projects that PACT has supported include
analyzing and interpreting HealthCheck employee
feedback, supporting training programs thatmerge cultural considerations into leadership andperformance management.

DEI Council
Under the guidance of chief operating officer
Sandra Forero, our DEI Council works directlywith the Shareholders’ Council to create astrong sense of belonging for current and future
ZSers. Committed to fostering Diversity, Equity
and Inclusion at ZS, they set ZS’s DEI strategy
and prioritize actions and policies that attract,develop and empower individuals from diverse
backgrounds and experiences.

Collaborating closely with the DEI Center ofExpertise, the DEI Council drives impactful
initiatives that ensure equity and embed a cultureof belonging throughout ZS. This includes funding
seven Inclusion and Diversity Groups (IDGs) andworking with PACT to support our other employeeled Belonging Networks.

COO and DEI Council Chair Sandra Forero with fellow ZSers in Buenos Aires

ESG Report 2023

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Appendix

35

Our focus on inclusion and belonging
Being an inclusive organization is
integral to the health outcomes ofour employees and communities.
We strive to be a welcoming
space for our people and everyone
we work with, fostering aculture of impact, collaboration,
empowerment, empathy, respectand equity. Put simply, we
champion DEI because we treat
people right. It is the right thing
to do, and it will lead to betterbusiness outcomes for us andour clients.

100%of ZSers are required to complete Inclusion
at Work, our unconscious bias training

Inclusion at work
As ZS evolves, we need to invest in our greatest
strength: our people.
During 2023, we launched Inclusion at Work—a mandatory compliance training programthat equips ZSers with skills and knowledge tofoster an inclusive environment. The training
provides employees with the tools to understandand manage unconscious biases and create a
psychologically safe space for all. One hundred
percent of our people are required to complete
this training, and by doing so, are tasked with acollective responsibility to create a workplace
where everyone feels a sense of belonging.
This is the first section of a three-part compliancetraining series called Do Your Part, which
encompasses our Mitigating Bias in Hiring
training and our recurring Safe and Respectful
Workplace training.

The power of feedback
The ZS Stay Taskforce, launched in 2023
by the DEI Council, is another feedback
mechanism we implement to understandwhat makes our employees want to stay at ZS.
This year, the taskforce aimed to better
understand the experiences of our Blackand Hispanic/Latinx colleagues. In employee
surveys, we found a disproportionate number
of Black and Hispanic/Latinx ZSers reported
lower feelings of belonging and leave ZS
before completing two years of tenure.

Through the taskforce, we aimed to
identify drivers that contribute to gaps inrepresentation and learn how we can improvethe experiences of underrepresented
colleagues at our firm.
The taskforce conducted one-to-one
interviews and small-group listening
sessions for ZSers to share their individual
perspectives and experiences. The resultsof these sessions will inform new measuresand solutions to increase representation,
retention and engagement.

“Doing a targeted assessment allows ZS to better
understand the experience of our company culture
across the board and focus our efforts on supporting
those who aren’t having their needs met.”
Ebonee Anderson, Stay Taskforce Interview Lead and HR Inclusion and Diversity Specialist (she/her)Learn more about our efforts to foster belonging at ZS.

ESG Report 2023

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Health equity

HealthCheck survey
We take every opportunity to listen to ouremployees and understand how we can maketheir experiences better. That is why we regularly
conduct assessments on what makes our people
stay at ZS.
One of our key assessments is our annual
HealthCheck engagement survey, which measures
employees’ feelings of safety, support andbelonging. HealthCheck had a record numberof responses this year at 77%, higher than theprevious four years of distribution, with an overall
engagement score of 65%.

36

Appendix

In 2019, we noted gaps in levels of engagementwith our HealthCheck survey between men andwomen. To reduce this, Women@ZS and the DEI
Council launched an initiative, which aimed tolisten to women colleagues, understand theirbarriers to engagement and ultimately foster
inclusion. The research resulted in training
for ZS leaders on championing women in theworkplace, alongside a reduction in genderedengagement gaps. In 2023, we continued toreduce demographic differences in HealthCheck
responses with the help of initiatives such as the
Stay Taskforce.

HealthCheck survey trends+15+15 pointdifference
in engagementof veterans

+10

+5

65%

0

-5

-10

ZSers in Toronto

No difference
in engagementof women

No difference
in engagementof Black ZSers-7 point
difference
in engagementof LGBTQIA+-2 point
difference inengagementof Hispanic/
Latinx ZSers

overall ZS
engagement

ESG Report 2023

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Ethical operations

Championing pride and allyship at ZS
At ZS, our priority is to foster an environment
where every ZSer feels heard and respected
and is enabled to thrive. Allies like Ali Khanand the Empowering Allies and Champions(EACH) program are a vital part of sustaining
this culture of inclusion and belonging.
Launched in partnership with the Forté
Foundation, EACH combines opportunities
for education, interaction and personalreflection on the topic of diversity. This
program provides tools, frameworks andpeer support so that ZSers can take action
within their teams, their local offices and
ZS at large.

ZSers in India

As a core leader within EACH, Ali developed aninternal white paper to address allyship at ZS
and partnered with Pride@ZS to support theirevents in India, expanding the group by over
20% in just three years. Alongside associate
principal Rishu Batra, HR director Neha Arurand the Pride@ZS team, Ali has advocated forgender-neutral language across the firm andformalized a self-disclosure process for ZSers
who change their name, gender or both.
In doing so, Ali has contributed to forging asafe space for ZSers to connect with theircommunity, offer support and work toward
a common goal of DEI. Read more about
Ali’s role in championing allyship at ZS.

Equitable opportunities

Health equity

Inclusion and Diversity
Groups (IDGs)
IDGs are ZS-sponsored, employee-led groups
that build community and expand culturalawareness. These groups elevate the voicesof underrepresented ZSers and advise on DEIpriorities and approaches.

Accessibility @IDGs sit within a larger ecosystem of ZS Belonging
Networks (known as employee resource groups
elsewhere) that work independently to advancetheir unique missions and collaboratively to bringabout change within ZS.
Our seven IDGs are touchpoints for ZSers toconnect, inspire one another and amplify voices
for change. They receive an annual budget
to create opportunities for connection andeducation at local and regional levels, helping ourpeople realize their full potential. As our groups
grow and strengthen, so too do the opportunities
for all ZSers to learn valuable skills for inclusion
and allyship.

Veterans @Appendix37

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Enabling our people to grow and thrive
We invest in resources tailored toempower our smart, passionate
and driven thinkers—ensuring
they have unbiased access to theopportunities they need to thrive.

Professional development coaching

Professional development

Integrating new hires into our culture

At ZS, ongoing learning is an integral part of ourculture. When we are recruiting new talent, welook for individuals who embrace innovation
and a learning mindset, and we offer a rangeof programs to encourage their curiosity anddevelop their professional skills.

Promotions and paths to leadership
Our people deserve every opportunity to gain
leadership skills. We provide all ZSers with accessto leadership opportunities, facilitate mentorship
throughout their career journeys and invest in
programs and partnerships that make the pathto leadership clear.

ZSers perform better and more confidently when
they have a trusted advisor on their side. Fromtheir very first day, ZSers are connected with aprofessional development coach who supports
their growth through regular one-on-one
meetings and group gatherings.

An understanding of our business, skills for
project readiness and alignment with our sharedvalues are vital components for our people tosucceed in their roles. Recently onboarded ZSers
are enrolled into our New to ZS program, a global
initiative with regional nuances designed toclarify role expectations and encourage continual
development. Through it, new joiners areequipped with the tools for long-term success.

Advancing careers throughMilestone training
At every stage in their career, ZSers are challenged
to deepen their skills and advance their corecompetencies. From associate consultant toprincipal, we train ZSers for these professional
milestones, so they are challenged and growthroughout their professional development.

When ZSers are promoted and enter a newchapter of their journey, we provide Milestone
training to equip our people with the tools to
succeed in a new role. The training teaches
participants professional frameworks associatedwith their level that build trust and establish
influence, with specific learnings for each stage.

2,243

ZSers were promoted in 2023

399,218

hours of training in total werecompleted by ZSers in 2023

1,245

hours of training were completed by
701 ZS contractors and interns in 2023

ZSers in India

Appendix38

A year of action

ESG Report 2023

Supporting employee well-being
Our priority is to advance health outcomes foreveryone—including our team. We promote ZSer
well-being through a generous benefits package
and strong support systems. The package isdesigned to make our employees feel inspired,empowered and motivated to perform at theirbest and cultivate a performance-driven culture
where excellence, determination and a sharedsense of purpose propel us forward.
Through HR-funded initiatives, we ensure ZSers
have equal access to the programs and mental
health support they need. With offices aroundthe world, local regulations and market standards
inform benefit designs in each country—ZS goes
above and beyond requirements to treat ourpeople right.
Learn more about our comprehensive benefits
packages by clicking on the regions where we
operate on ZS.com.

New and enhanced benefits in 2023
We regularly evaluate our benefits program tomeet the evolving needs of our people. In the
U.S. and India, groups such as the Human Rights

33

Our other standard benefits include health insurance,
Employee Assistance Program emotional health and personal
support, parental and sick leave benefits in line with regional
standards, life insurance and supplemental death benefits.

Ethical operations

Campaign (HRC) Foundation and Avtar conduct
external assessments of our benefits offerings
to ensure they are inclusive and competitive. We
also work with a set of regional DEI experts toensure we receive ongoing guidance and regional
expertise on how to format benefits for our ZSers.
Along with our standard benefits,33 we introduceda range of country-specific benefits in 2023,
tailored to ZSers in each of our regions (see below).

Equitable opportunities“I think all the time of how grateful
I am for ZS’s generous support incaring for my family member, andthe Benefits team’s personal help
and guidance through that very
difficult time.”
ZS New York Principal

Argentina

Enhanced health and life insurance, childcare reimbursement, employee discount programand enhanced vacation policy

Brazil100% coverage of dependent health and dental insurance premiums and enhanced life insurance

CanadaGym discounts, enhanced Bright Horizons childcare program, coverage for gender-affirmation
services and Milk Stork program

China

Enhanced health and critical illness insurance

Germany

Introduced life insurance

JamaicaEnhanced health and accident insuranceJapan

Enhanced accident insurance and additional disability insurance

Singapore

Enhanced health insurance and military leave

U.K.

Enhanced disability benefit

U.S.

Enhanced Bright Horizons program, enhanced Alfac benefit, enhanced vision benefits, coveragefor travel expenses (in instances when a covered member must travel at least 100 miles from theirhome to receive medical services).

GlobalEnhanced Employee Assistance Program benefit, enhanced bereavement leave and added
ACI Specialty Concierge Program

Health equity

Appendix

39

RecognizeZS: Our employee
recognition platform
We celebrate ZSers who go above andbeyond through several avenues—
including RecognizeZS. Throughout
2023, more than 9,000 ZSers used the
RecognizeZS platform to acknowledge
and appreciate their colleagues.
To enhance the experience and reward
ZSers’ impact, we made several
updates to the platform this year,
including giving ZSers the option tosend e-cards or awards to congratulate
colleagues for embodying ZS corevalues, living our cultural hallmarks
and fostering well-being. The systemfurther allows ZSers to easily accessrecognitions and commendations,enabling them to provide tangible
examples of their achievements duringperformance reviews and personal
development sessions with their personal
development coach.

5,100+

e-cards were shared with fellow ZSers
this year, while 45% of active ZSers
received one or more of the nearly
10,500 monetary awards shared in 2023

ESG Report 2023

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Occupational health and safety

Earning Equality 100 for
LGBTQIA+ benefits
We commit to helping every ZSer
thrive and bring their authentic talents
to ZS for meaningful careers andpersonal fulfillment.
This year, we made purposefulimprovements to our LGBTQIA+
benefits offerings, expanding support
for transgender and gender expansive
colleagues by introducing medical
insurance coverage for several genderaffirming care options. The HRC
Foundation recognized our efforts byawarding ZS a perfect score, Equality 100,in their annual Corporate Equality Index—
a leading report that evaluates corporate
policies and practices on LGBTQIA+
workplace equality in the U.S.
We are proud that this perfect scoreemphasizes ZS’s ongoing dedication to
LGBTQIA+ workplace equality.
Read more about ZS’s recognition
as an Equality 100 Leader.

At ZS, we view health and well-being holistically,
and our benefits are designed to support
ZSers’ safety.
Prioritizing stress management and workload
management at ZS is crucial for a healthy andsustainable work environment, employee
well-being and our ability to deliver high-quality
services to clients. Knowing the high-pressure
nature of our industry—and that overworked
employees may be more prone to accidents
and health issues—we provide resources forstress management and mental health support,
including regional benefits and 24/7 support
through our Employee Assistance Program.
To prevent occupational injuries and illnesses,
we also provide ergonomic mice, keyboards,
chairs, desks and headphones to ZSers whorequest them.
Our five India offices across Pune, New Delhi,
Noida and Bengaluru are ISO 45001 certified for
Occupational Health and Safety Management
Systems. These offices are also ISO 45003
certified for Psychosocial Health and Safety at
Work, covering 100% of workers, contract staff,
clients, visitors and suppliers working from ouroffices in India.

Equitable opportunities

Health equity

Appendix40

ISO 45003

In 2023, we became the first organization inIndia to achieve an ISO 45003 certification,
recognizing the role of ZS in protecting thephysical and psychosocial health of our staff

ZSer in Philadelphia

ESG Report 2023

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Compensation and pay

Belonging Networks for employee safety and well-being
Two employee-led Belonging Networks at
ZS—known as employee resource groups
elsewhere—are Healthy Minds@ZS and Lifeand Family@ZS.
Healthy Minds@ZS aims to support all ZSers
with their mental health. One of several
internal initiatives sponsored by the groupis Mental Health Stories. Developed during
the COVID-19 pandemic, the initiative aims
to give ZSers a space to communicate theirunique mental health experiences, with themission of reducing stigma and barriers toseeking support.

ZSers in London

Meanwhile, Life and Family@ZS assists
ZSers in managing their personal and careerdevelopment during each stage of life, fromcaretaking, home ownership and marriage
to fertility, adoption and pregnancy loss.
In 2023, Life and Family@ZS brought ZSers
together from across the world to build
community around shared experiencessuch as infertility and grief. With the help ofWomen@ZS and HR, they also sponsored a
new Parenthood Program in India to support
ZSers in navigating their parenting journeys.

Conducting annual compensation reviews ispart of our dedication to an equitable workforce.
It ensures every ZSer has equal opportunity to
thrive and innovate at our firm.
Our pay philosophy is:- Merit-based: We pay for the performance thatis expected of ZSers based on their level andjob description. We use a competency modelas the basis for measuring ZSers’ performanceand progression.
- Competitive: We leverage external benchmarks
and compare against talent competitors toensure our total compensation package iscompetitive by role, level and country. We
aim to keep our pay bands at the top half ofthese benchmarks. For certain roles with nicheskills, we aim to be in the top quartile. We also
evaluate turnover data, exit interview data andinternal intelligence from our hiring efforts tokeep pace with competitors.

Health equity

Appendix

41- Fair: We ensure fairness and consistency byregularly auditing our compensation data toensure ZSers receive equal compensation for
performing equal work. Our audits are rigorous,
and ZS complies with applicable laws andregulations regarding pay disclosures, such as
the U.K. Gender Pay Gap.
In 2023, ZS worked with an external partner to
audit pay practices across various levels andregions at ZS. Once we accounted for legitimate
differences in pay—such as role, job leveland prior experience—the audits showed nostatistically significant differences in pay basedon gender and race and ethnicity. We plan tocontinue and expand these audits in the future.

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Appendix42

Connecting with talent
Whether connecting with more
women and veterans or reaching
students from historically Black
colleges and universities (HBCUs),
we continually expand ourpartnerships to attract historicallyunderrepresented talent in
our industry. 34

Mitigating bias in hiring

DEI partnerships

We focus on equity in hiring processes to ensure
a consistent, inclusive process that brings
diversity to our workforce. To do this, we evaluate
industry and market data to attract individuals
from diverse backgrounds and sponsor equity
initiatives to make our talent attraction process
as objective as possible.

Diverse partnerships connect us withnew, passionate talent. Some of our
key partners include:- Ideal hiring process: ZSers involved in thehiring process are equipped with the skills theyneed to make objective candidate evaluations.
In 2023, we provided a required, custom-built
Mitigating Bias in Hiring e-learning coursethat trains ZSers on how to mitigate biases
throughout the entire hiring process.
- Recruiting diverse talent: We invest in school
partnerships and external talent organizations
to increase representation at our firm and reach
exceptional, yet often overlooked, students.

ZS SEED and TMCFZS SEED is our multiyear, early-career
micro-internship program that provides
a hands-on consulting experience forstudents at HBCUs. One of our key
partners, Thurgood Marshall College Fund
(TMCF), connects us with these students.
Through the program, 20 currently
enrolled sophomores and freshmen
participate in a multiday ZS SEED
Immersion program and work side byside with ZSers to deliver on client needs.
Students are then invited back for the
Apprenticeship phase, a 10-week paidsummer program where they cycle
through three roles at ZS, working withcoaches and mentors along the way.
By the end of the program, students
should have a clearer idea of how
ZS can allow them to meet theirprofessional goals while leveraging
their unique talents.

34

ZS is an equal opportunity employer and is committed to providing equal employment and advancement opportunities
without regard to any class protected by applicable law. ZS complies with all applicable employment practices laws.

Learn more about ZS SEED.

ESG Report 2023

ZSers in Shanghai

A year of action

Ethical operations

Our 2023 representative diversity
Although we invested heavily in DEI initiatives
and worked toward our goals in 2023, ourrepresentative diversity remained the sameas in 2022.

Equitable opportunities

Overall representation:
Gender (global)35- Representation of Black, women and
LGBTQIA+ ZSers was unchanged from2022 to 2023

Health equity

Appendix

Overall representation:
Race and ethnicity (U.S.)

Asian 36%

Women 34%

White 37%

Men 64%

Black 3%

Gender expansive <1%

Hispanic/Latinx 3%

Prefer not todisclose <1%

Multi-ethnic 3%
Middle Eastern/
North African 1%

No response 1%- Women and gender expansive ZSers
globally—both overall and at the leadershiplevels—decreased by 1%

Native/Indigenous <1%
Other—not listed 18%
Prefer not to disclose 1%- Black and Hispanic/Latinx ZSers eachstill make up 3% of our U.S. workforce
Several factors contributed to a lack of
year-over-year variance, including limited
hiring efforts, attrition and low ZSer
participation rates in voluntary demographic
data disclosures. Our continued focus on
recruitment and retention efforts in 2024
will prove vital to achieving our goals.

35

43

Overall representation: LGBTQIA+(Canada, India, U.K., U.S.)

Please note that statistics for employee data are rounded and may not sum to 100%.

Overall representation:
Veteran (Canada, U.S.)

LGBTQIA+ 2%

Yes 1%

Not LGBTQIA+ 67%

No 57%

Prefer not
to disclose 2%

Prefer not todisclose 1%

No response 30%

No response 42%

ESG Report 2023

A year of action

Increasing representationin leadership

Leadership representation:
LGBTQIA+ (Canada, India, U.K., U.S.)

One of our DEI goals is to increase leadershipdiversity, to ensure the decision-makers at
the table resemble the clients, consumers andcommunities we serve. Similar to overall diversity,
ZS’s principal, associate principal and manager
representation of women globally and racial andethnic diversity in the U.S. remained largely flatfrom 2022 to 2023.

Gender representation of key
governing bodies: Women (global)
Shareholders’Council 9%
C-Suite 38%
Regional
Managing
Principals 17%
OfficeManaging
Principals 36%

Ethical operations

Equitable opportunities

Leadership representation:
Veteran (Canada, U.S.)

LGBTQIA+ 1%

Yes 1%

Not LGBTQIA+ 30%

No 37%

Prefer not todisclose 1%

Prefer not todisclose <1%

No response 68%

No response 63%

Leadership representation:
Race and ethnicity (U.S.)

Leadership representation:
Gender (global)30
Asian 34%

Women 28%

White 37%

Men 71%

Black 1%

Gender expansive 0%

Hispanic/Latinx 2%

Prefer not todisclose <1%

Multi-ethnic 1%
Middle Eastern/
North African <1%
Native/Indigenous <1%
Other—not listed 25%
Prefer not to disclose 1%

No response <1%

Health equity

Appendix

44

Empowering diversity
with the Black andHispanic Alliance (BHA)
Summer Series
The BHA Summer Series aims to enhancediversity, foster inclusion and empower
professional development among Blackand Hispanic or Latinx ZSers.
The series focuses on affirmation,
meaningful connection and personal
growth, providing professional
development opportunities. By offering
tactical solutions for career successand creating spaces for community
engagement, the series aims to increase
the retention of Black and Hispanic or
Latinx employees at ZS by ensuring they
have the resources and tools for success.
Aiming to inspire Black and Hispanic or
Latinx ZSers to get excited about their
future at ZS, the series contributes to amore inclusive organizational culture,embodying our commitment to diversity
and inclusion.

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45

Retention at ZS
Empowering women as future leadersCompanies with an inclusive culture are six
times more likely to be innovative.36 At ZS,
we empower women to use their skills in
leadership positions, as we believe this isvital for building a strong, innovative andequitable future.
In 2023, ZS formed a taskforce designed toincrease gender representation among ZS’s
leadership team. The taskforce found thatmany long-tenured, successful principals
coach other principals, who are mostly maledue to our current gender ratios. To counteract
that trend, the taskforce—in partnership with
Women@ZS and the DEI Council—launched

an initiative that encourages long-tenured
principals to expand their coaching roster
to support more managers and associate
principals. The hope is to eliminate any
barriers to advancement and create morediverse representation in senior principals’coaching rosters.
Additionally, Women@ZS, one of our IDGs,
continued its Path2Principal (P2P) program,which equips managers in India with the skills
for a leadership role at ZS.
Read more on how Women@ZS empowers managers
as future leaders.

“ My biggest takeaway from P2P
was that I am not alone. Thereis a huge community within
ZS that I can lean on to discuss
my personal and professional
dilemmas. The program catered
to our development needs andaddressed biases, helping us todevelop holistically.”
Pavithra Kannan, Associate Principal,
ZS Bengaluru (she/her)

We work hard to mitigate bias during the hiring
process. However, hiring cannot improve diversity
alone—we must also emphasize retention andinternal pipeline progression of ZSers.
Women at ZS, for example, have had historicallyhigher attrition rates compared to men, aproblem reflected throughout the professional
services industry. However, years of interventions
driven by HR and Women@ZS have helped bridge
the gap in retention rates. We saw a sevenpercentage point decrease in attrition of women
between 2019 and 2023, which brought it on a parwith the average 2023 overall ZS attrition rate.
We are now using lessons learned fromthis work to close the attrition rate gap forunderrepresented minority ZSers. This will
include ongoing tracking, improved datacollection and intentional interventions suchas the ZS Stay Taskforce.

36

P2P participants in India

Deloitte (2018) “The Diversity and Inclusion Revolution,”
Deloitte Review. Accessible at: DI_Diversity-and-inclusionrevolution.pdf (deloitte.com). Accessed on: 01/22/2024.

ESG Report 2023

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Appendix

46

ZS Cares
Having started out as a small,office-level effort in 2016 driven
by the passion of a few ZSers, ZS
Cares has grown into our global
social impact initiative. It unites
ZSers to give back to causes theycare about that contribute to ourfirmwide ESG priorities.
Donation matching
Our global Donation Match Program matches
ZSers’ monetary donations and volunteer time,37
allowing ZSers to double their impact for causesthat matter.

~$825,000

raised by ZSers for 450+ causes through theDonation Match Program during 2023

37

Up to an annual maximum of $2,000 (USDor local equivalent) per ZSer.

ZS Cares by the numbers
In 2023:2,000+ZSers contributed 40,500 hours
to volunteering and pro bono
consulting efforts

1,650

ZSers served 7,000 hours volunteering
across our local communities on
ZS Cares Day

81%

of ZSers agree that ZS cares
for the community around it

ZSer in Trinidad and Tobago

Letting communities leadthe way with Mist
Throughout the year, our Pride@ZS teamcollaborated with Mist LGBTQ Foundationin India. Aligning with our commitments
to DEI and health equity, volunteers
assisted in organizing a medical campand distributed pre-exposure prophylaxis(PrEP)—a drug used to reduce anindividual’s risk of contracting HIV.
Additionally, during a Diwali celebrationin November, Mist fostered connections
with over 200 members from the Hijra(transgender and intersex) sex worker
community in Budhwar Peth, India’s thirdlargest red-light district. Workshops withPanna Guru, a Hijra community leader,shed light on the struggles of sex workers,
galvanizing ZS’s commitment to support
marginalized communities in receiving
the care they deserve.

ESG Report 2023

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Nonprofit Board Service Playbook

Partnering with Working for Women™ to address barriers
for women in the workforce
Over the last five years, Working for Women (W4W) and ZS’s partnership has focused on
helping women from marginalized communities grow their economic power by connecting
them to jobs, investing in training and education and addressing barriers that women face inthe workplace.
Highlights from our work in 2023 include:
Expanding the W4W Negotiation Skills
Workshop programming with multiple W4W
nonprofit partners to engage over 400
women across the U.S.—100% of participants
reported increased confidence and tangible
tools and tips gained from the workshop

Supporting W4W’s efforts with CareerCircle(nonprofit partner) to pilot an upskilling
program to enable women to attain jobs ingrowing fields such as data analytics

Developing a learning module for Women’s
Way (nonprofit partner) to serve as an online
Gender Wealth Gap resource for dispelling
myths around wealth inequality for womenDeveloping and hosting a panel series,
Health Equity is Women’s Equity, tohighlight and promote dialogue on theunique health challenges women face

Serving on the board of a nonprofit is a valuable
way for ZSers to advance their skills andknowledge while embracing opportunities tosupport their communities. Our Nonprofit Board
Service Playbook guides ZSers who are interested
in these opportunities, or who already contribute,to deliver value to the organizations they serve.

Making a difference on ZS Cares Day
To further our social impact, we proudly organize
our annual global day of volunteerism—ZS
Cares Day. In 2023, 1,650 ZSers around theworld volunteered to deliver healthy, fair andsustainable outcomes for their communities.

“ Since that initial day when I attended the informational session, myjourney has been nothing short of transformative. The impact on
my life, both personally and professionally, has been profound.”CareerCircle Pilot Program Participant

ZSers in São Paulo

Health equity

Appendix

This year’s projects included supporting
health check-up camps with the Seva Arogya
Foundation and Jeevan Stambh Foundation,
planting trees in Jamaica for Bellevue Hospital,
providing Chicago children with winter clothing
through Cradles to Crayons, making children’s
dreams come true with Make-A-Wish Brazil andcollaborating with the International Coastal
Cleanup Trinidad and Tobago chapter.
Read more about ZS Cares Day 2023.

47

A year of action

ESG Report 2023

Health equity
for all people andcommunities
Reducing health disparities globally requires cross-sector
partnerships and collaboration. ZS serves as a connector
across the healthcare industry, facilitating partnerships toimprove health outcomes for all people, all around the world.

In this section
Our approach to health equity

49

2023: Our mission in action

50

ZS as thought leaders

51

Teams leading the way

52

Connecting leaders to address disparities

53

Making our local communities healthier places to live

59

Ethical operations

Equitable opportunities

Health equity

Appendix48

ESG Report 2023

A year of action

Ethical operations

Our approach to health equity
We work with leaders acrosssectors to forge partnerships,
understand the social
determinants of health (SDOH)
and promote patient centricity38
within healthcare. By addressing
disparities through inclusive
research and building humancentered solutions, we—alongside
our clients and other industry
experts—can support the complex
needs of patients, consumers
and communities.

Our goal of advancing health equity contributes
to the following material issues:

Health equity
Reducing health disparities
around the world

Diversity, equity and inclusion
Fostering a culture where
every person can thrive

Data security and privacy
Maintaining the safety, security
and privacy of our assets

Our work contributes to two SDGs:
3

Good health and well-being

10 Reduced Inequalities

38

Having an organizational culture, business practices andcapabilities that put patients at the heart of decisions, meetpatient needs as articulated by patients themselves and drive
business outcomes.

Equitable opportunities

Health equity

Appendix49

ESG Report 2023

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50

Appendix2023: Our mission in action
Leveraging our expertise, strategic
partnerships, innovative problemsolving, proprietary AI solutions
and robust analytics capabilities,
we delivered progress toward ourhealthcare mission. This year, we
continued our progress toward
our targets.

We have:
Expanded our work with 112
unique clients and partners
to advance patient healthand equity globally

Worked with our clientsand partners to expand
representation in clinicaldevelopment, including portfolio
strategy, clinical trial design
and implementation

Improved access to and qualityof care—particularly forunderserved communities—
through strategic focus, insight,
innovation, cultural relevance,
connection and measurement,
affecting approximately 23 million
potential lives39

Supported legislation andregulation that improves
access to healthcare
and health equity

12

$5M

We delivered:17+

therapeutic areas where we partner with our clientsto address health equity:
This number was determined based on the fact that ~200,000
adult Black women are at risk for breast cancer in Illinois andCalifornia, ~2.5 million underserved children are living withasthma in the U.S., 20 million patients are benefiting from
American Heart Association programs, there are ~160,000
multiple myeloma patients globally and ~80,000 patients
benefited from an anemia eradication program.
40
Per the Companies Act 2013 in India, ZS is required to invest
2% of our net profits on corporate social responsibility(CSR) activities. In 2023, we spent ₹ 7.56 Cr (or $900,000)
on India CSR activities. Read more in our 2023 India social
responsibility report.
39

Autoimmune disorders

Infections (non-HIV/hepatitis)

Cancer/oncology

Musculoskeletal disorders

Cardiovascular andcardiac disorders

Neurological disorders

Diabetes

Psychiatric disorders

Eye disorders
Gastrointestinal disorders
Hematology disorders
HIV/HBV/HCVOrphan/rare diseases
Respiratory disorders
Skin disorders
Urology disorders
Others731

patient health and equity(PHE) projects in 2023,
across 112 unique clientspractice areas, including
marketing, clinicaldevelopment and supply
chain and manufacturing40

invested in partnerships
through our patient
health equity work andsocial impact program,
ZS Cares—many of which
address health disparities

ESG Report 2023

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Equitable opportunities

ZS as thought leaders
In collaboration with our clients,
nonprofit partners and fellow ZSers,
we innovate to improve humanhealth. We use advocacy, researchand targeted interventions to work
toward a more equitable healthcare
landscape for all—sharing ourknowledge to accelerate progress.
We invest in thought leadership initiatives toraise awareness of the most pressing challenges
in healthcare, inspire innovation and share bestpractices to accelerate patient-centric, equitablecare in our industry. Our work spans mediums,
from white papers on health equity to our PatientCentricity Podcast. In 2023, we published a rangeof thought leadership pieces on topics including:- Social and environmental factors influencing
health outcomes- The evolving potential of AI in reducing
data biases in life sciences- Patient centricity as a vital componentof healthcare innovation

A selection of our thought
leadership pieces
Driving Patient Outcomes ThroughHealth Equity Partnerships
You Can’t Improve What You Can’t Measure:
Measuring Patient Outcomes in Life Sciences
ZS data and research experts lead anemia
mitigation in India
Living with myeloma: Patient advocate Yelak Biru’s story
Scaling smart solutions with AI in health
The business imperative for health equity
in life sciences: Repairing the patient journey
Discussing the rise of patient-centricity in life sciences
Think health equity doesn’t impact pharma
marketing? Think again
ZSers Dajzsa and Avery advocate
for patient health equity
ZS works toward a universal healthcare language

ZSer in Philadelphia

Health equity

Appendix51

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Appendix

52

Teams leading the way
We believe in creating a future forhealthcare that is more connected,
accessible and quality-driven. To
do this, we prioritize health equity
in our research, innovations andsolutions—an approach that is
ingrained across our operations
and driven by two teams.

Patient Health andEquity Accelerator
Across ZS, our work is grounded in making ameaningful difference for patients and theirexperiences of healthcare. The Patient Healthand Equity Accelerator is a team of experts
who embody ZS’s health equity work anddeepen our understanding of current disparities.
Using cross-ecosystem partnerships andinnovative problem-solving, the team supports
our healthcare practice and therapeutic areas
by leveraging ZS solutions to improve patient
experiences and broaden access to care.

Recognizing the diverse challenges womenencounter across various regions anddemographics, we identified an opportunity toenhance our ability to assist clients with women’s
health issues. As a result, in 2023, we established
the Women’s Health Expertise Hub. This initiative
aims to foster broad and inclusive perspectives
on women’s distinct experiences within
healthcare systems.

ZS Cares
As part of our global social impact program,
ZS Cares, we partner with nongovernmentalorganizations who—like us—strive to address
the drivers of health inequities. Throughindustry partnerships, pro bono and low bono41
consulting, volunteering efforts, donation
matching and more, ZSers apply their knowledge,
skills and passions as a force for good to improvehealth outcomes in their communities.

Women’s Health Expertise Hub
Since 2022, ZS has delivered more than 700
projects for conditions that disproportionately
affect women—such as autoimmune conditions,
osteoporosis, migraines and multiple sclerosis—
in addition to the more than 100 projects on
women’s reproductive health.

41

Low bono consulting is a business model where consulting services are provided at a reduced
or discounted rate to clients who may not be able to afford traditional consulting fees.

ZSers volunteering in Pune

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53

Connecting leaders to address disparities
We develop programs and pioneer
solutions that improve access tocare and medicine for vulnerable
populations. We partner with ourcolleagues and clients, sharing andevolving our expertise to create
positive change together.
To demonstrate our dedication to this mission,
we signed the World Economic Forum’s Zero
Health Gaps Pledge in 2023 and the Healthcare
Leadership Council’s Pledge in 2022, along with
developing a guide for life sciences companies
on how to quantify and approach health disparities.
We are consistently unlocking new opportunities
to bring life sciences leaders together to shareknowledge, facilitate connections and make apositive impact on patients’ lives. Twice a year,
we hold our Patient Centricity Advisory Boards,
where leaders address the intersections ofpatient centricity and health equity.

Additionally, in the summer of 2023, the Patient
Health and Equity Accelerator launched a seriesof health equity roundtables with clients acrosspharmaceutical and medtech companies, giving
them an opportunity to share their successes
and challenges in advancing health equity. Topics
included compliance, measurement of healthequity initiatives, team structure and funding,and health equity for marketers. Our clients
also identified common challenges across theirorganizations, including clarity on ownership andaccountability, measurement and communicationof impact, embedding health equity into
core business, budget constraints and theprioritization and focus of health equity efforts.
Given the appetite from participating clients tocontinue engaging with other industry leaders, wewill continue the roundtable series to provide an
ongoing forum for connection and innovation.

5

health equity roundtables heldwith healthcare leaders in 2023

Future of Health Survey
In January 2024, we published our Futureof Health Survey. It highlights research
conducted in 2023 on healthcare providers
and more than 9,500 healthcare consumers
across six major markets— China, Germany,
Japan, Sweden, the U.K. and the U.S.
One of the key findings showed that
healthcare must be accessible, affordable
and equitable.
The survey demonstrated that the industry’s
thorniest problems will require collaborationfrom every healthcare stakeholder, as wellas governments.

In five of the countries polled, nearly 50% of
respondents said they feel like the healthcare
system “doesn’t care about people like me.”Within this number, we see respondents of allraces, ages, incomes and health conditions
Healthcare frustrations are universal in all six
major economies, as consumers are 50% lesslikely to feel cared for after a visit than theirdoctors believe
In the U.S., Black and Hispanic/Latinx individuals
are more likely to avoid care due to hassle, costand a fear of unexpected healthcare bills
Consumers keep moving toward convenience,
resulting in fragmented healthcare journeys“ It’s not fair that people have to choose between their healthand financial stability. It’s important for government andhealthcare providers to work together to find a solution thatmakes healthcare affordable and accessible for everyone.”
Future of Health Survey respondent in the U.S.

ESG Report 2023

Ensuring our partners
put patients first
Throughout their treatment journeys, patientscan face a range of challenges driven by SDOH,
including financial burdens, limited access to careand difficulty understanding health information.
By taking a patient-centric approach, life sciencescompanies can deliver interventions that
effectively reach underserved communities, fromprevention through diagnosis and treatment.
We assist our clients in capturing patients’ voices
and making patient centricity a core focus by:- Defining their patient centricity strategies toimprove capabilities, resources and incentives
that meaningfully focus on patient outcomes- Connecting patient needs and business
impact through a culture shift that enables
organizations to recognize and respectindividual patient needs- Introducing a diverse and representative
patient voice across the product life cycle- Helping to design products and services forpatients, with the foundation of a patientcentric strategy, mindset and capabilities

300+

ZSers engaged with the Patients as People
Co-Lab 121 times on solutions, initiatives
and offerings during 2023

A year of action

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Equitable opportunities

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Appendix54

Seeing patients as people
Our Future of Health Survey found thatthe healthcare system must learn from theexperiences of the people who use it most—patients with chronic conditions like autoimmune
disease, cancer, cardiovascular disease,respiratory disease and obesity.
It is for reasons like this that we created thePatients as People Co-Lab to better integratepatient perspectives in our solutions. The
Co-Lab consists of 25 patients living with various
long-term health conditions, such as multiple
myeloma, multiple sclerosis and focal segmental
glomerulosclerosis, who share their perspectives
on ZS’s products and thought leadership.
In 2023, we grew the initiative to include six
patient advocates in oncology, women’s health,rare disease and immunology, to learn more
about their experiences with the healthcare
system and pharma.
ZSers are encouraged to use the Co-Lab toshare patient stories in internal meetings, advise
market research and commissioned work andinspire thought leadership pieces with patientperspectives at their heart. In 2023, more than
300 employees directly engaged with Co-Lab
partners, and ZS completed 31 projects in total—
double the number we completed in 2022.

Catalyzing patient-centered healthcare with ZAIDYN
To deliver the best possible patient outcomes,
we must streamline a fragmented healthcare
ecosystem. We aim to do this with ZAIDYN
Connected Health—a suite of solutions thatleverage data from across the healthcare
ecosystem to transform patient outcomes.
The ZAIDYN Connected Health framework
consists of three solution areas: HealthInsights, Patient Engagement and Connected
Research. It marks an important milestone
in advancing ZS’s vision of patient-centeredhealthcare. In 2023, a market leader in
infectious disease approached ZS for help
in reinvigorating its brand portfolio in
response to health inequities. The company

aimed to identify latent demand across
U.S. geographies at the ZIP code level andassess healthcare gaps. Our implementationof the ZAIDYN Care Gap and Health Equity
solutions allowed the company to inform its
health equity initiatives using data-backed
visual insights, alongside engaging withdisadvantaged patient communities.
As we move forward, we plan to encourage
broader client outreach, leveraging the early
feedback we’ve received to enhance theimpact ZAIDYN Connected Health can have.
Learn more about ZAIDYN health equity
interventions.

A year of action

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Reinventing and measuring
patient centricity
To help our clients quantify and demonstrate theimpact of patient-centric efforts in a compliant
way, ZS developed Patient Outcome Impact™
(POI™) metrics that bring a standardized andmultidimensional approach to understanding,assessing and measuring patient impact. POI uses
healthcare outcomes data, intervention data andpatient segment data to holistically evaluate theimpact of an organization’s effect on patients. By
using our approach, life sciences organizations
can ensure that their future investments put
patients first.
Going forward, we aim to broaden POI
measurement to all non-promotional activity
measurement, enhancing the patient-focused
impact that life sciences can bring to the world.
By benchmarking progress across areas ofculture, governance, capability and cross-industry
collaboration, organizations can improve patient
centricity—with ripple effects across the entire
healthcare ecosystem.
Read more on how we are bringing patient-led
business models to life.

Ethical operations

Equitable opportunities

Leadership and culture

Structure and practices

Where patients fit in the organization’s
overarching strategic development plan

How a company structure
affects patient centricity

Strategic
visionCulturalmindsetBusinesspractices

Governance anddecision-making

Health equity

Appendix

55

Data-informed solutions
Using advanced analytics, predictive modelingand AI capabilities, we help our clients makedata-driven, informed decisions, exploringnew dimensions of the healthcare business togenerate greater value from digital initiatives.
In doing so, we transform ways of working,accelerating progress and forging connections
across the healthcare ecosystem to shape thefuture of health.
Learn more about our focus on digital transformation.

Portfolio andpipeline strategy

Resourcing

Key performanceindicators

Education anddevelopment plan

Data, analytics and technology

Cross-industry collaboration

The company’s approach to capturing,acquiring and working with patient data

Identifying partners to ideate, foster, pilot
and implement patient-centric initiatives

Knowledge
management andinsight sharing

Healthcare
ecosystem
partnership

Learn more about rethinking patient-centeredinvestments with POI.

Data and analytics
strategy

Technology

Regulatory
roadmap andengagement plan

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Equitable opportunities

Finding the intersectionsof health equity and AI

Improving health outcomes with AI
In 2023, we released a report with the World
Economic Forum. This report emphasized
the need for multilateral stakeholder
collaboration on AI solutions—building trustand confidence in providers, patients, policymakers and business leaders.
Informed by an analysis of over 400 AI
use cases and interviews with 50 global

healthcare leaders, the report concludes thatto maximize the impact of AI in healthcare,data must be plentiful and representative; AI
solutions must be designed with transparency
and inclusivity in mind; and applications
must be scalable. However, even with thesestrong foundations, trust hinges on theimplementation of ethical AI policies.

AI holds the potential to revolutionize disease
detection and close health equity gaps. AI may
democratize the accessibility of healthcare
information while customizing healthcare content
across language, education and literacy levels.
In the same way, AI tools may act as healthcoaches for patients and clinical trial participants,
optimizing quality of care and targeting
patient outreach.

Health equity

Appendix

While the opportunities are endless, it is essentialthat healthcare providers ensure AI does notexacerbate existing biases and disparities.
This can be done through AI ethics and riskmitigation frameworks, understanding data bias
and constructing guardrails in analytical andtraining approaches.

Read more in our joint report.

ZS guidelines for artificial intelligence
ZS follows five key principles for responsible AI design and deployment:“Delivering on the promise of AI to contributeto more equitable global health requires
collaboration across sectors, borders andcorporate walls. This report is an important step
we’re taking to usher in a new era of innovation,
collaboration and better healthcare for all.”Pratap Khedkar, Managing Director and Chief Executive Officer

Reliability
AI systems must be accurate andreliable, prioritizing minimization ofnegative impacts and ensuring humanintervention when necessary

Privacy
Data collection and utilizationmust be done responsibly, withefforts to minimize data usage
and protect personal information

Transparency
The logic and methodologies behind AI
decisions should be clear and accessible,
promoting trust and understanding

Security
AI systems should be safeguarded
against unauthorized access or misuse
to maintain trust and reputation

Fairness
Bias is avoided by constant monitoring of
inputs and outputs to ensure AI systems do
not discriminate

56

ESG Report 2023

A year of action

Data-driven solutions for SDOH
Social determinants of health, or SDOH, is arelatively new area of research that explores
how social conditions affect patient healthoutcomes. To bring clarity to this burgeoning field,
we designed the Risk Propensity Framework—a data solution that establishes consistentdefinitions of SDOH.
The framework includes more than 800 variables,
which are processed into an analysis-readydatabase that organizations can use to explore
the influences of SDOH on healthcare access,decisions, delivery and outcomes. It considers
14 types of risk scores across four social
paradigms (see below).

By combining SDOH data and applying it to custom
models in our Patient Analytics Cloud, we havealready started using the tool to help clients:- Adopt standardized SDOH data inbusiness practices- Predict health outcomes in aparticular community- Quantify health inequalities- Identify barriers to care access and delivery- Understand clusters of historicallydisadvantaged patient populations- Acquire and analyze SDOH data

Risks tohealthcare
accessBehaviorrisks

Community
and social risks

Socioeconomicrisks- Healthcare
access- Behavior
and lifestyle- Family instability- Food insecurity- Housing- Coverage- Mental health- Immigrant
integration- Access totransport- Digital adoption

42

Ethical operations- Racial segregation- Exposure toviolence- Financial- Education andawareness

Office of Health Equity: Differences in Cardiovascular Disease Mortality & Home-Based Cardiac Rehabilitation

Equitable opportunities

Health equity

Appendix

Using machine learning to tackle health disparities
At ZS, we are using AI and machinelearning to improve care for populations
disproportionately impacted bycertain diseases.
In 2023, we received second place at the
FDA-sponsored Veterans Cardiac Healthand AI Model Predictions (V-CHAMPS)
Challenge, which required teams to develop

and evaluate AI and machine learningmodels to predict cardiovascular
health-related outcomes in veterans—a demographic more likely to develop
cardiovascular risk factors.42
Through the potential of AI, we aim to
reduce healthcare disparities for those
disproportionately at risk of disease.

57

ESG Report 2023

Healthcare partnerships in action
We are partnering with industry experts andleaders to build a future that is patient-centered,connected and equitable. By working withfoundations and institutions across a range ofhealth conditions, we aim to empower healthcare
providers with detailed insights, solutions andanalytics—enabling them to put patients first.

American Heart Association (AHA)
and CKM patient experience
The AHA hired ZS to build a better understandingof the full range of experiences and SDOH
challenges for people living with cardiovascularkidney-metabolic (CKM) syndrome.
Using mobile ethnography survey methodology,
ZS collected qualitative data on patients with
CKM, including the SDOH factors that could
lead to disparities in healthcare and healthoutcomes. Based on this qualitative data,
combined with secondary data analysis, thePatient Health and Equity Accelerator teamdeveloped eight archetypes of CKM patients
based on patients’ levels of awareness of theirconditions, engagement in their care and SDOH
factors for the AHA. The AHA and ZS shared thesedraft archetypes with patients in a live workshop
to solicit input, ensuring that the archetypes
accurately represented the breadth of patients’experiences and needs.

A year of action

Ethical operations

Enhancing patient experience with theInternational Myeloma Foundation (IMF)
In 2023, we began a partnership with IMF,
supporting their “Think Big Vision” to improve
the quality of life for all myeloma patients whileworking toward prevention and cure. ZS created astrategic roadmap, including prioritized initiatives,
data and AI strategy, capability maturity,
architecture and integration blueprint, a valuerealization framework and a strategic narrativefor executive communication. We are alsoenhancing IMF’s patient and care partner support
system by integrating a custom patient-facing
chatbot on their online platform.

Unconscious bias in pediatric asthma
with Montefiore
Pediatric asthma is a condition with racial, ethnic
and socioeconomic disparities, affecting patients’quality of care. In 2023, ZS partnered with The
Children’s Hospital at Montefiore in New York to
identify bias in the treatment of patients with thiscondition. We surveyed over 300 U.S. physicians,
revealing that socioeconomic factors havesome impact on patients’ health and ability to
get treatment.

Equitable opportunities

Health equity

Appendix

58

Shrimad Rajchandra Love and Care

Healthcare Leadership Council (HLC)

Since 2022, ZS and Shrimad Rajchandra Love
and Care (SRLC) have partnered to reduce theincidence of nutritional deficiency anemia in rural
South Gujarat, India. ZS worked with SRLC as partof their Scientific Advisory Committee, identifying
protocols and key performance indicators andtaking proactive action to close the gaps in
SRLC’s current anemia-eradication program. Asof year-end 2023, the partnership has impacted
39,000 people.

HLC is a coalition of chief executives from within
the healthcare system in the U.S. Together, they
aim to ensure accessible, affordable and highquality care for people in the U.S.

Partnering with the University of Chicago
to improve the experience of women who
are underserved
The University of Chicago recently developed theChicago Alternative Prevention Study (CAPS), a
research program that assesses how personalizedbreast cancer prevention screening supports
women at high risk. It is designed to be inclusiveof women of color—a population where breast
cancer risk is understudied.
With the goal of expanding this trial to new sitesof care across the U.S. in 2024, ZS assisted byunderstanding requirements and limitations of
the university’s existing trial communications.
From there, ZS developed proto personas,
website architecture and content designed
to address anxieties while providing clear,practical information.

In 2022, HLC sought ZS’s expertise to develop acomprehensive report on understanding andaddressing health disparities. Moving into 2023,
HLC built on this research with ZS, working withother member companies to diversify clinical
trial recruitment, achieve greater diversity in thehealthcare workforce and address SDOH.
ZS further supports HLC in its lobbying activities
to create a more equitable and inclusive
healthcare system that prioritizes the needsof underserved communities. For example, in
2023, HLC shared its response to the Centers for
Medicare and Medicaid Services’ proposed rule torevise the Medicare hospital inpatient prospective
payment system (IPPS) for FY2024. Additionally,
HLC staff discussed its letter to the Office of the
National Coordinators proposed rule on healthdata, technology and interoperability, alongsidesoliciting feedback on the National Institutes of
Health Clinical Trial Diversity Act.
Through HLC’s efforts, we and other members
champion advocacy that shapes government
policies, resource allocation and public awarenessof health disparities.

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

59

Making our local communities healthier places to live
ZSers are passionate, purposedriven people who invest theirtime and expertise into causesthat align with our ESG material
topics. Through ZS Cares,
ZSers are empowered to apply
their unique skills to a range ofinitiatives as a force for good in
our local communities.

Certifiedfor ISO 26001:2010 (Social Responsibility) in
Pune, New Delhi and Bengaluru offices

Partnering with 3rd Street Youth Center
3rd Street Youth Center & Clinic, a nonprofit in
Bayview Hunters Point (BVHP), San Francisco,
was established in 2005 to address the lackof opportunities for young residents in thisunderserved community. Offering holistic
services such as healthcare, therapy and housing
support, the organization aims to provide youth
with essential resources for a better future.
In early 2023, ZS set out to support 3rd Street
through a pro bono project that would enable
them to better understand the funding landscapeand develop a targeted value story to support
outreach and communication efforts. ZS’s projectprovided actionable recommendations forengaging with private donors, including unpacking
their decision-making and identifying activation
strategies across the donor engagement life cycle.

Community health by the numbers

40,500+hours spent on social impact efforts~111,000

lives touched in our India social
responsibility efforts

2,000+ZSers engaged in volunteeringand pro bono consulting

The project will have a tangible impact on the
lives of BVHP youth: with every additional $3,500
3rd Street Youth Center & Clinic is able to raise,
we would expect the organization to be able toprovide one additional person with life and careernavigation, housing, and mental health, physicalhealth and crisis support resources.

ZSers in Atlanta

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Improving healthcare
accessibility in India
At our Pune and New Delhi offices in India, ZSers
volunteered with the Seva Arogya Foundation
and Jeevan Stambh Foundation, organizations
dedicated to improving healthcare accessibility
and quality for underserved communities. Our
teams assisted medical professionals in healthcheck-up camps for:- Women by providing regular screenings,
gynecological care, testing and medication
to promote overall well-being- Children by targeting nutritional health,immunization and detection of deficiencies- Senior citizens by offering services such aseye check-ups to screen for cataracts, testing,diagnosis, treatment of general health ailments
and medical support
Between these health camps and other
health-awareness sessions, we served nearly
31,000 citizens.
Read more about our impact in our India Corporate
Social Responsibility Report

ZSers volunteering in India

Health equity

Appendix60

BpeaceZS supports Bpeace—a nonprofit whereentrepreneurs and small businesses in crisisaffected regions can access expert growthadvice from international industry and businessvolunteers such as ZS.
In 2023, 28 ZS volunteers supported 12
Salvadoran chemical-pharmaceutical businesses,
all part of the Association of Pharmaceutical
Laboratories of El Salvador (ALFA). These smalland medium-sized businesses have high potential
for expansion, creating local jobs and positively
impacting thousands of families.
ZSers delivered 117 hours of support, including
consulting and workshops on pharma trends,
setting objectives and key results, pitch
preparation and e-commerce. In May 2023,
five participating businesses conducted a trade
mission to the U.S. to deepen their knowledge ofthe pharmaceutical sector, concluding with a ZShosted networking reception in New York.
The support from ZSers came at a critical time, asbusinesses in El Salvador negotiated the uncertain
and complex business and sociopoliticalenvironment of the post-COVID-19 market.

ESG Report 2023

A year of action

Appendix
In this section
Data collection and methodology

62

Strategic partnerships

64

GRI Index

66

SASB

74

ZSers in Kingston

Ethical operations

Equitable opportunities

Health equity

Appendix61

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Appendix

Health equity

62

Data collection and methodology
Annual emissions and YoY changes from 2019 to 2023
(air travel emissions excluding radiative forcing/non-CO2 effects)

Annual emissions and YoY changes from 2019 to 2023 per FTE(air travel emissions excluding radiative forcing/non-CO2 effects)

2019

2020

2021

2022

2023

Scope 1

324

324

283

391

716

Fleet Vehicles

30

35

24

26

Natural Gas

174

129

129

Generator–

42

Refrigerants

120

Scope 2 (market-based)
Electricity (market-based)
Cooling
Steam

2019

2020

2021

2022

2023

Scope 1

0.05

0.04

0.02

0.03

0.05

37

Fleet Vehicles

0.00

0.00

0.00

0.00

0.00

115

123

Natural Gas

0.02

0.02

0.01

0.01

0.01

9

89

234

Generator

-

0.00

0.00

0.01

0.02

118

121

160

322

Refrigerants

0.02

0.01

0.01

0.01

0.02

3,814

3,111

2,980

2,564

816

Scope 2 (market-based)

0.54

0.37

0.26

0.18

0.06

3,588

2,858

2,723

2,145

534

Electricity (market-based)

0.51

0.34

0.24

0.15

0.04

226

253

257

419

202

Cooling

0.03

0.03

0.02

0.03

0.01

not measured not measured not measured not measured

80

Steam

not measured not measured not measured not measured

0.01

Scope 356,177

26,64027,71255,78947,051

Scope 3

7.98

3.16

2.41

3.89

3.43

Purchased Goods and Services

28,84521,75823,68337,88722,938Purchased Goods and Services

4.10

2.58

2.06

2.64

1.67

552

220

281

290

129

Capital Goods

0.08

0.03

0.02

0.02

0.01

1,404

926

902

1,242

1,568

Fuel- and Energy-Related Activities

0.20

0.11

0.08

0.09

0.11

Upstream Transportation andDistribution

212

189

309

319

145

Upstream Transportation andDistribution

0.03

0.02

0.03

0.02

0.01

Waste Generated in Operations

861

157

14

371

735

Waste Generated in Operations

0.12

0.02

0.00

0.03

0.05

Business Travel

13,344

1,260

2,130

10,783

16,578Business Travel

1.90

0.15

0.18

0.75

1.21

Employee Commuting

10,372

1,821

173

4,584

4,473

Employee Commuting

1.47

0.22

0.02

0.32

0.33

Upstream Leased Assets

587

309

220

166

130

Upstream Leased Assets

0.08

0.04

0.02

0.01

0.01

–

–

–

149

355

Investments

–

–

–

0.01

0.03

Capital Goods
Fuel- and Energy-Related Activities

Investments

ESG Report 2023

A year of action

Ethical operations

Share of renewable energy
2019(baseline)

2023

Renewable energy(procured at source)

16%

43%

Renewable energy credits

0%

49%

Nonrenewable energy

84%

7%

7,945 MWh

10,441 MWh

Total electricity consumption

Waste related to office operations
Although not a significant material issue, ZS is committed to avoiding, reducing and properly
disposing of waste related to office operations. Please refer to the below table for estimated 2023
waste consumption and emissions related to waste disposal.
Read more about initiatives underway on pages 18 and 19.
Estimated
Amount (mt)

Estimated
Waste Disposal
Emissions(tCO2e)Recycled waste

103.33

10.25

Composted waste

169.9028.09

All other waste

905.31

692.18Equitable opportunities

Health equity

Appendix63

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix64

Strategic partnerships
Stakeholder engagement
At ZS, we deeply integrate stakeholder engagement into our ESG strategy to uphold responsible, sustainable, ethical and equitable practices. We collaborate with a diverse
array of stakeholder groups, fostering dialogue and partnerships to drive systemic change. By actively listening to and understanding the needs and perspectives of ourpeople, clients, partners and communities, we continuously evolve our operations as needed to align with their best interests. This commitment not only enhances ourorganizational resilience but also ensures our contributions to a more inclusive and sustainable future.

Stakeholder

Who they areWays we engage

ZS leadership

We engage with various leadership bodies—including our Shareholders’ Council, Operating
Leadership Team, Enterprise Risk Management
team, DEI Council and other groups of ZS principals—
to set strategic direction, sustainability priorities,
and risk management and compliance bestpractices for our firm.

•M onthly or quarterly
leadership calls

Key ESG topics raised in 2023
• Monthly email updates• General ESG risk management• Business performance• I nternal employee social
networking platform• Climate-related risk
• Corporate governance• Annual Global Principals Meeting•C limate reduction targets andnet-zero goal

• Diversity, equity and inclusionpriorities and progress• Ethical business practices andoperations• Data security and privacy assurance• Sustainable procurement
ZSers

We engage with ZSers constantly and draw on theirinsights to inform and sustain a culture of impact,
collaboration, growth, empathy, equity
and empowerment.

• Belonging Network events• Engagement surveys• Quarterly town hall meetings• Weekly employee newsletter•S peaking Up email inbox for
employee concerns

Clients

We help our clients solve complex problems
by understanding their industries, customers,
challenges and evolving demands. Through thesedeep partnerships, we evolve our services andofferings to best suit their needs and deliver
high-quality, expertise-driven outcomes.

 ormal engagement through•F
request for proposals, request
for information, etc.
• Client relationship management• Internal employee social
networking platform• Diversity, equity and inclusionpriorities and progress• Recognition• Belonging Networks(employee resource groups)• ZS’s impact on the environment• Career and talent development• ZS’s stance on social issues• DEI Council• Philanthropy• Compensation and benefits• Health, well-being and safety• People and Culture Team•Z
 S-led Impact Summits andconferences•R eporting disclosures, including
EcoVadis and CDP• Client-specific emissions accounting• Climate impact and reduction targets• Data security and privacy assurance•R esponsible business practices andsustainable supply chain•D iversity, equity and inclusionpriorities and progress

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

Stakeholder

Who they areWays we engage

Future ZSers

We seek a powerful collective of thinkers and idea
makers driving toward life-changing solutions
and technology innovations that affect patients,
caregivers and consumers globally. We evolve ourrecruiting strategies to create seamless, equitable
experiences for all candidates and set them up for
success on their ZS journey• Recruiting conferences

We partner with industry experts and global
initiatives, such as the World Economic Forum (WEF),
to address the most complex health challenges
disrupting our world today. We share knowledge andalign on new practices and solutions together.

• Industry forums

We engage with our suppliers to bring cutting-edge
technology, innovative programs and best-in-classservices and products to our clients and people. We
work to systematically engage with our suppliers tointegrate ESG metrics and sustainable procurement
across the entire value chain.

• Third-party risk management
engagement process• Supplier onboarding• Supplier diversity• Standardized contract requirements• Ethical supplier relationships• Formal annual assessments• Completion of required andapplicable training• Environmental sustainability

We partner with nonprofit organizations to make apositive impact on our local communities.

• Pro bono consulting• ZS Cares Day• Access to healthcare services• Food security• Volunteering• Economic stability• ZS Donation Match Program• Transportation access• Environmental healthand stewardship

Civil society

Suppliers

Local
communities

65

Key ESG topics raised in 2023
• Diversity, equity and inclusioncommitments and actions• Recognition• Job fairs• Digital marketing• Climate impact and reduction targets• Career and talent development• Compensation and benefits• Hybrid working model expectations• Referrals and “Boomerang” program• Industry association memberships• Patient centricity• Roundtable discussions• Consumer centricity• Co-authored thought leadership• Ethical and sustainable business• Compliance with Supplier
Code of Conduct• Health, well-being and safety• Education

A year of action

ESG Report 2023

Ethical operations

Equitable opportunities

Health equity

Appendix

GRI Index
ZS is reporting in reference to the GRI Standards for the reporting period January 1–December 31, 2023.
GRI Standard

Disclosure No.

Disclosure

Location / Response

2-1

Organizational details

a. ZS

General Disclosures
GRI 2: General Disclosures 2021

b. Private company
c. Evanston, IL
d. Argentina, Brazil, Canada, China, Denmark, France, Germany, India, Italy, Jamaica, Japan, Singapore, Spain, Switzerland,
Trinidad and Tobago, United Kingdom, United States of America
2-2Entities included in the organization’ssustainability reporting

ZS is the only entity included in the sustainability reporting. As a private firm, we do not report financial statements or information.

2-3

Reporting period, frequency
and contact point

a. January 1–December 31, 2023 (unless otherwise noted)
b. As a private firm, we do not report financial informationc. May 13, 2023
d. ESG@ZS.com

2-4

Restatements of information

No significant restatements for historical data and information in previous reporting periods have been identified.

2-5

External assurance

About this report, p2

2-6

Activities, value chain and otherbusiness relationships

a. Industries
b. About ZS, p4
ZS by the numbers, p5
Managing a responsible supply chain, pp26–27
c. Healthcare partnerships in action, p58
d. No significant changes.

66

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

GRI Standard

Disclosure No.

Disclosure

Location / Response

GRI 2: General Disclosures 2021
continued

2-7

Employees

a. 12,577 total employees (as of Dec. 31, 2023).
4,329 female, 8,093 male, 8 non-binary, 26 do not wish to disclose.
8,450 employees in India, 3,420 employees in the Americas, 467 employees in Europe, 240 employees in East Asia.

67

b. 12,538 permanent employees (8,430 in India, 3,411 in the Americas, 466 in Europe, 231 in East Asia).
12,455 full-time employees (8,444 in India, 3,342 in the Americas, 438 in Europe, 231 in East Asia).
122 part-time employees (6 in India, 78 in the Americas, 29 in Europe, 9 in East Asia).
c. The above reflects 2023 year-end Work-life data of ZS employees. It does not include contractors.
d. Not applicable.
e. No significant changes.
2-8Workers who are not employees

ZS had 891 contractors in 2023. Several factors contributed to the drop in contractors between 2022 and 2023. This includes projects
coming to an end and contractor resources no longer needed, some contractors being converted to permanent employees and some
contractors leaving on their own for other opportunities or personal reasons.

2-9

Governance structure andcomposition

Our approach to ESG governance, p7

2-10Nomination and selection of thehighest governance body

Our approach to ESG governance, p7

2-11

Chair of the highest governance body

Our approach to ESG governance, p7

2-12

Role of the highest governancebody in overseeing the managementof impacts

Our approach to ESG governance, p7

Increasing representation in leadership, p44

The ESG Steering Committee develops and manages initiatives that support ESG goals, oversee reporting and disclosure requirements,
assess our progress, and design data-driven and strategic paths forward.
The Chief Risk Officer (CRO) team maintains an enterprisewide risk inventory, which is reviewed annually by senior leaders. A riskcollection and prioritization exercise is performed every other year and a risk re-prioritization exercise on the “off” years.
In 2023, ESG was identified as an emerging risk and voted on—ESG has a “risk card” and is being monitored by the CRO team. The
CRO team provides quarterly updates to the Risk, Compliance and Professionalism (RCP) Committee, which is a Shareholders’ Council
subcommittee. The Shareholders’ Council receives at least annual updates from the CRO team.

2-13

Delegation of responsibility for
managing impacts

The Shareholders’ Council delegates responsibility for managing an enterprisewide risk inventory to the Chief Risk Officer (CRO) team,which encompasses the chief risk officer, lawyers and risk managers. They partner with the Enterprise Risk Management team, Quality
Risk Management team, Delivery Excellence Office and IT Governance, Risk and Compliance team to monitor and manage the impactsof these risks. The CRO team then reports back and provides updates to the Shareholders’ Council annually, which votes on the risks.

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

GRI Standard

Disclosure No.

Disclosure

Location / Response

GRI 2: General Disclosures 2021
continued

2-14

Role of the highest governancebody in sustainability reporting

Our approach to ESG governance, p7

2-15

Conflicts of interest

Preventing fraud in our firm, p27

Health equity

Appendix

68

100% of ZSers, including those in our Shareholders’ Council, must comply with our Conflicts of Interest Policy.
2-16

Communication of critical concerns

Speaking up at ZS, p27
At least annually, the Employee Relation teams reports into the Risk, Compliance and Professionalism Committee, a subcommittee of
the Shareholders’ Council that reports to the council as needed and at least annually.

2-17

Collective knowledge of the highest
governance body

The Shareholders’ Council receives quarterly ESG updates and discusses key items roughly twice per year. These updates include ESG
emerging risks, recommended operational changes, compliance matters, client demands, progress or lack thereof across material
issues and more.

2-18

Evaluation of the performance ofthe highest governance body

The Shareholders’ Council periodically evaluates its own performance across several dimensions typical to board effectiveness.
Additionally, each Shareholders’ Council member is subject to re-election by their peers at the end of their three-year term.

2-19

Remuneration policies

This information is currently unavailable. Please refer to “Compensation and pay” (p41) for information on our progress in auditing
pay practices globally in 2023.

2-20

Process to determine remuneration

This information is currently unavailable. Please refer to “Compensation and pay” (p41) for information on our progress in auditing
pay practices globally in 2023.

2-21

Annual total compensation ratio

This data is unavailable due to confidentiality restraints.

2-22

Statement on sustainable
development strategy

A letter to our stakeholders, p3

2-23

Policy commitments

Acting with professional integrity, p26

2-24

Embedding policy commitments

ZS Supplier Code of Conduct
ZS Privacy Policy
Equal Opportunity Policy
Keeping ZS secure by design, p23
Acting with professional integrity, p26
Risk management, p28

2-25

Processes to remediate
negative impacts

The Chief Risk Officer (CRO) team maintains an enterprisewide risk inventory, which is reviewed annually by senior leaders. In 2023,
ESG was identified as an emerging risk, because the firm realized that not monitoring ESG may inhibit ZS’s ability to meet stakeholder
expectations and client agreements, impact our services, successfully manage environmental footprint and achieve diversity, equity
and inclusion objectives. Thus far, we have not identified negative ESG-related impacts.

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

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Appendix

69

GRI Standard

Disclosure No.

Disclosure

Location / Response

GRI 2: General Disclosures 2021
continued

2-26

Mechanisms for seeking advice andraising concerns

Speaking up at ZS, p27

2-27Compliance with laws and regulations

In calendar year 2023, there were no noncompliances that materially affected our employee population, the quality of our services or
our ability to serve our clients.

2-28

Membership associations

Connecting with talent, p42
Healthcare partnerships in action, p58
Key partners include the Healthcare Leadership Council, Fairygodboss, Forté Foundation, Healthcare Businesswomen’s Association,
Thurgood Marshall College Fund (TMCF), Reaching Out MBA, Sticks & Stones, Black Young Professionals (BYP) Network (EU) and MBA
Veterans Network.

2-29

Approach to stakeholder engagement

Defining the issues that matter, p8
Stakeholder engagement, p65

2-30Collective bargaining agreements

ZS acknowledges and respects employees’ rights to associate freely, engage in collective bargaining and voice their concerns.
Information regarding collective bargaining is unavailable since collective bargaining is not fully applicable to ZS.

Material Topics
GRI 3: Material Topics 2021

3-1

Process to determine material topics

Defining the issues that matter, p8

3-2

List of material topics

Defining the issues that matter, p8

3-3Management of material topics

Our approach to ESG governance, p7
Defining the issues that matter, p8
Our journey in numbers, p10

Economic Impacts
GRI 203: Indirect Economic
Impacts 2016

203-1
203-2

Infrastructure investments andservices supported

ZS Cares, p46

Significant indirect economic impacts

ZS Cares, p46

2023: Our mission in action, p50
2023: Our mission in action, p50
Healthcare partnerships in action, p58
Making our communities healthier places to live, p59

ESG Report 2023

GRI Standard

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

Disclosure No.

Disclosure

Location / Response

204-1

Proportion of spending on
local suppliers

In the fiscal year 2023, ZS allocated over 14% of our total addressable spend to certified diverse, disadvantaged and small
business entities.

205-1

Operations assessed for risks
related to corruption

100% of operations are assessed for risks related to corruption at an enterprise level. ZS identifies regions that are at higher risk of
fraud (for example, China) and implements specific interventions to prevent corruption.

205-2

Communication and training aboutanti-corruption policies
and procedures

Living the ZS values, p26

205-3

Confirmed incidents of corruption
and actions taken

Speaking up at ZS, p27

302-1

Energy consumption within
the organization

Examining our operational impact: Scope 1 and 2, p17

302-2

Energy consumption outsideof the organization

This data is unavailable.

302-3

Energy intensity

This data is unavailable.

302-4

Reduction of energy consumption

Examining our operational impact: Scope 1 and 2, p17

302-5

Reductions in energy requirements
of products and services

Managing supplier emissions, p21

305-1

Direct (Scope 1) GHG emissions

Examining our operational impact: Scope 1 and 2, p17

305-2

Energy indirect (Scope 2)
GHG emissions

Examining our operational impact: Scope 1 and 2, p17

305-3

Other indirect (Scope 3)
GHG emissions

Zooming in on Scope 3, p20

305-4

GHG emissions intensity

Accounting for our climate impact, p16

305-5

Reduction of GHG emissions

Accounting for our climate impact, p16

Procurement		
GRI 204: Procurement
Practices 2016
Anti-corruption
GRI 205: Anti-corruption 2016

Preventing fraud in our firm, p27

EnergyGRI 302: Energy 2016

Emissions
GRI 305: Emissions 2016

70

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

GRI Standard

Disclosure No.

Disclosure

Location / Response

GRI 305: Emissions 2016
continued

305-6

Emissions of ozone-depleting
substances (ODS)

This data is unavailable.

305-7

Nitrogen oxides (NOx), sulfur
oxides (SOx), and other significant
air emissions

ZS produces near zero nitrous oxide emissions and zero sulfur oxides.

New suppliers that were screenedusing environmental criteria

Acting with professional integrity, p26

Negative environmental impacts inthe supply chain and actions taken

Managing supplier emissions, p21

New employee hires andemployee turnoverConnecting with talent, p42

Health equity

Appendix71

Supplier Environmental Assessment 		
GRI 308: Supplier Environmental
Assessment 2016

308-1
308-2

18% of ZS’s 2023 spend went to suppliers that completed a sustainability assessment.
Managing a responsible supply chain, p26

Employment			
GRI 401: Employment 2016

404-1

ZS hired 1,854 new ZSers in 2023, of which 31% (579) were female and 62% (1,152) were male. One hundred and ninety new hires werein the Americas, 1,411 were in India, 57 were in Europe and 49 were in East Asia. Finally, 1,667 were under 30 years old, 176 new hires
were 30–50 years old and 11 were over 50.
ZS had 2,417 terminations in 2023, including 817 (19%) females and 1,584 males (19%). Six hundred and twenty-six voluntary andinvoluntary turnovers took place in the Americas, 1,657 took place in India, 90 took place in Europe and 44 took place in East Asia.
Finally, 1,609 ZSers were under 30 years old, 779 were 30–50 years old and 29 were over 50 years old.

401-2

401-3

Benefits provided to full-time
employees that are not provided totemporary or part-time employees

Supporting employee well-being, p39

Parental leave

Supporting employee well-being, p39

Please find a list of comprehensive benefits per region and office by visiting ZS.com.

100% of full-time ZSers eligible for paid parental leave. In 2023, 744 employees took parental leave (279 females, 464 males and 1
person who did not want to disclose). Three hundred and 94 ZSers in India, 286 ZSers in the Americas, 54 ZSers in Europe and 10 ZSers
in East Asia took parental leave.
Occupational Health and Safety
GRI 403: Occupational Healthand Safety 2016

403-1

Occupational health and safety
management system

Occupational health and safety, p40

ESG Report 2023

A year of action

Ethical operations

Equitable opportunities

GRI Standard

Disclosure No.

Disclosure

Location / Response

GRI 403: Occupational Healthand Safety 2016 continued

403-2

Hazard identification, risk
assessment, and incident
investigation

Omitted due to confidentiality.

403-3

Occupational health services

Omitted due to confidentiality.

403-4

Worker participation, consultation,and communication on occupational
health and safety

Omitted due to confidentiality.

403-5

Worker training on occupational
health and safety

Omitted due to confidentiality.

403-6

Promotion of worker healthActing with professional integrity, p26

Health equity

Appendix

Supporting employee well-being, p39
Occupational health and safety, p40
403-7

Prevention and mitigation ofoccupational health and safety
impacts directly linked by business
relationships

Occupational health and safety, p40

403-8

Workers covered by an occupational
Occupational health and safety, p40
health and safety management system

403-9Work-related injuries

Occupational health and safety, p40

403-10Work-related ill healthOccupational health and safety, p40

404-1

Average hours of training per year
per employee

Enabling our people to grow and thrive, p38

404-2

Programs for upgrading employee
skills and transition assistanceprograms

Enabling our people to grow and thrive, p38

404-3

Percentage of employees receiving
regular performance and careerdevelopment reviews

Enabling our people to grow and thrive, p38

Training and Education
GRI 404: Training and
Education 201632 average hours spent on learning in 2023.

100% of associate, associate consultant, consultant and manager ZSers receive regular performance reviews.

72

ESG Report 2023

GRI Standard

A year of action

Ethical operations

Equitable opportunities

Health equity

Appendix

Disclosure No.

Disclosure

Location / Response

405-1

Diversity of governance bodies
and employees

Our 2023 representative diversity, p43

405-2

Ratio of basic salary andremuneration of women to men

Compensation and pay, p41

406-1

Incidents of discrimination andcorrection actions taken

Speaking up at ZS, p27

410-1

Security personnel trained in humanrights policies or procedures

Investing in cybersecurity training, p25

Operations with local community
engagement, impact assessments,
and development programs

ZS Cares, p46

413-2

Operations with significant actualand potential negative impacts on
local communities

Omitted due to data being unavailable.

414-1

New suppliers that were screenedusing social criteria

From June 1 to Dec. 23, 2023, we ensured that 39% of executed master service agreements (MSAs) contained the Supplier Code of
Conduct. That number has increased already in 2024, with 97% of executed MSAs containing the Supplier Code of Conduct.

414-2

Negative social impacts in the supply
chain and actions taken

Omitted due to confidentiality.

418-1

Substantiated complaints concerning
breaches of customer privacy andlosses of customer data

There have been no substantiated complaints concerning breaches of customer privacy, and no identified leaks, thefts or losses ofcustomer data.

Responsible use of AI

Safeguarding AI solutions, p25

Diversity and Equal Opportunity
GRI 405: Diversity andEqual Opportunity 2016

Increasing representation in leadership, p44

Non-discrimination
GRI 406: Non-discrimination
2016
Security Practices
GRI 410: Security Practices 2016

Our strategies for ethics and compliances, p27

Local Communities
GRI 413: Local Communities
2016

413-1

Making our communities healthier places to live, p59

Supplier Social Assessment
GRI 414: Supplier Social
Assessment 2016

Customer Privacy
GRI 418: Customer Privacy 2016

ZS-specific disclosure73

A year of action

ESG Report 2023

Ethical operations

Equitable opportunities

SASB
ZS is reporting in reference to the SASB Standards for the reporting period January 1–December 31, 2023.
Standard

Disclosure No.

Disclosure

Location / Response

SV-PS-230a.1

Description of approach toidentifying and addressing data
security risks

Keeping ZS secure by design, p23

SV-PS-230.2

Description of policies and practices
relating to collection, usage andretention of customer information

Keeping ZS secure by design, p23

SV-PS-510a.1

Description of approach toensuring professional integrity

Acting with professional integrity, p26

SV-PS-330a.1

Percentage of gender and racial/ethnic group representation for
executive management and allother employees

Increasing representation in leadership, p44

SV-PS-330a.3

Employee engagement as apercentage

HealthCheck survey, p36

Data Security

Professional Integrity

Workforce Diversity & Engagement

Health equity

Appendix74About ZS
ZS is a management consulting and technology firm that partners
with companies to improve life and how we live it. We transform
ideas into impact by bringing together data, science, technology andhuman ingenuity to deliver better outcomes for all. Founded in 1983,
ZS has more than 13,000 employees in over 35 offices worldwide. To
learn more, visit www.zs.com or follow us on LinkedIn.
Learn more: zs.com/about/environmental-social-and-governance.
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