Decarbonization pathways in medical waste management through circular economy strategies to advance UN-SDGs – Nature

Executive Summary

This report analyzes the critical challenge of medical waste management within the framework of decarbonization and the circular economy, with a significant focus on advancing the United Nations Sustainable Development Goals (SDGs). While global health resources have expanded, many developing nations lack the infrastructure to manage the resulting medical waste, posing a threat to environmental sustainability and public health. This study utilizes a novel hybrid DEMATEL-ANP multi-criteria decision-making (MCDM) model to identify and prioritize key factors for sustainable medical waste management. The findings reveal a strong correlation between effective waste management practices and the achievement of several SDGs, notably SDG 3 (Good Health and Well-being), SDG 12 (Responsible Consumption and Production), and SDG 13 (Climate Action). The analysis identifies ‘Sustainable Development’ (C1) and ‘Advanced Technology Adoption’ (C2) as the most influential drivers for establishing a decarbonized, circular healthcare economy. This report provides evidence-based insights for policymakers and healthcare administrators to reduce environmental impact, enhance resource efficiency, and build resilient healthcare systems aligned with global sustainability targets.

Introduction: The Climate and Sustainability Challenge of Medical Waste

The global healthcare sector, while essential for human well-being, contributes significantly to the climate crisis, accounting for 4.4% of global net emissions. Improper management of medical waste is a major contributor, releasing methane from landfills and hazardous chemicals from incineration. This transforms medical waste from a mere sanitation issue into a pressing climate and sustainability challenge. Addressing this requires a systemic shift from traditional disposal methods to integrated strategies that support global decarbonization efforts and the 2030 Agenda for Sustainable Development.

Aligning Waste Management with Sustainable Development Goals (SDGs)

The transition to a circular economy (CE) in healthcare offers a powerful framework for aligning medical waste management with key SDGs. By optimizing resource use, reusing materials, and minimizing waste, CE practices directly contribute to:

• SDG 3 (Good Health and Well-being): Reducing pollution from medical waste protects community health from hazardous materials.
• SDG 12 (Responsible Consumption and Production): Implementing sustainable procurement, waste reduction, and recycling in healthcare promotes responsible consumption patterns.
• SDG 13 (Climate Action): Adopting low-carbon waste treatment technologies and reducing the carbon footprint of healthcare operations are crucial for climate mitigation.

Integrating circularity into national health policies is essential for triggering the systemic change needed to advance these interconnected goals.

Research Objectives and Contributions

This study aims to provide a strategic framework for decarbonizing medical waste management in alignment with the SDGs. The primary objectives are:

1. To identify and map key circular economy initiatives applicable to healthcare waste systems.
2. To analyze the causal relationships between these initiatives using the DEMATEL method.
3. To prioritize CE strategies based on their effectiveness in advancing decarbonization and achieving SDGs, using the ANP method.

This research reframes medical waste as a climate issue and provides a novel methodological framework to support evidence-based policymaking, particularly in developing countries facing resource constraints.

Analytical Framework: Circular Economy and Decarbonization

A comprehensive literature review reveals that a multi-faceted approach is necessary for a successful transition to a circular economy in healthcare. This involves integrating sustainable development principles, advanced technology, education, and effective management.

Sustainable Development in Healthcare

Sustainable development strategies are foundational to aligning medical waste management with the SDGs. Key initiatives include:

• Sustainable Procurement: Sourcing reusable, recyclable, or low-impact medical products to reduce waste at its source, directly supporting SDG 12.
• Investment in Green Infrastructure: Developing local, energy-efficient waste treatment facilities to reduce reliance on centralized, carbon-intensive systems, contributing to SDG 9 (Industry, Innovation and Infrastructure) and SDG 13.
• Circular Design: Designing medical devices for reusability, upgradability, and recyclability to minimize landfill burden and enhance resource efficiency.

The Role of Advanced Technology

Technology is a critical enabler for implementing CE principles and achieving decarbonization targets. This aligns with SDG 9 by fostering innovation.

• Alternative Treatment Technologies: Using methods like microwave sterilization and plasma pyrolysis instead of incineration to reduce harmful emissions.
• IoT-Based Waste Tracking: Employing smart systems for real-time monitoring of waste generation and disposal to improve compliance and data-driven decision-making.
• Blockchain for Traceability: Ensuring transparent and tamper-proof tracking of medical waste to enhance accountability.
• Decentralized Treatment Models: Utilizing small-scale, on-site sterilization units to minimize transportation-related emissions, especially in remote settings.

Education and Institutional Actions

Behavioral change and institutional culture are vital for the successful adoption of CE practices. These actions support SDG 4 (Quality Education) and SDG 12.

• Staff Training: Educating healthcare staff on proper waste segregation and management to improve compliance and reduce contamination.
• Awareness Programs: Implementing green certification programs to foster a culture of environmental stewardship within medical facilities.
• Pharmaceutical Stewardship: Adopting policies to minimize drug wastage through efficient inventory management and dispensing practices.

Management Development and Governance

Strong leadership and robust governance are necessary to institutionalize CE principles and drive long-term sustainability, contributing to SDG 16 (Peace, Justice and Strong Institutions).

• Eco-Friendly Product Policies: Mandating the use of degradable or recyclable materials in patient care.
• Asset-Sharing Platforms: Creating networks for sharing expensive medical equipment to maximize utilization and reduce unnecessary procurement.
• Waste-to-Energy Systems: Implementing technologies that convert medical waste into energy, reducing the facility’s carbon footprint.
• Regenerative Practices: Adopting practices that extend product lifecycles and recycle materials from medical devices to replenish resources.

Methodology: A Hybrid DEMATEL-ANP Approach

This study employs a hybrid MCDM model combining the Decision-Making Trial and Evaluation Laboratory (DEMATEL) and the Analytic Network Process (ANP) to analyze the complex, interdependent factors influencing sustainable medical waste management.

Study Framework

The DEMATEL-ANP method was chosen for its ability to:

1. Identify the causal relationships and influence intensity among various CE initiatives (DEMATEL).
2. Prioritize these initiatives by calculating their respective weights, accounting for interdependencies (ANP).

This structured approach facilitates strategic decision-making under uncertainty, which is characteristic of resource-constrained healthcare settings.

Data Acquisition and Processing

Data were collected through questionnaires administered to a panel of 15 experts from government, industry associations, hospitals, and universities in Pakistan. Ten experts with over a decade of experience in sustainable medical management were selected for the final analysis. The data underwent rigorous reliability and consistency checks to ensure the validity of the findings.

Key Findings and Analysis

The application of the DEMATEL-ANP model yielded critical insights into the drivers of a circular economy for medical waste management and their alignment with the SDGs.

Causal Relationships Among CE Initiatives (DEMATEL Results)

The DEMATEL analysis identified the core drivers and outcomes within the system:

• Cause Drivers: ‘Sustainable Development’ (C1) and ‘Management Development’ (C4) were identified as the most significant cause factors. This indicates that establishing a strong foundation of sustainability policies and effective governance is a prerequisite for the successful adoption of technology and other practices. Focusing on these drivers is crucial for achieving systemic change aligned with SDG 12 and SDG 13.
• Result Drivers: ‘Advanced Technology Adoption’ (C2) and ‘Education and Institutional Actions’ (C3) were identified as result factors, meaning their effectiveness is highly dependent on the foundational cause drivers. Initiatives like ‘Optimizing healthcare asset sharing’ (C42) and ‘Sustainable medical supplies’ (C14) are highly influenced by other factors.

These results suggest that investments in technology will not yield optimal returns without parallel efforts to strengthen institutional frameworks and leadership.

Prioritization of CE Initiatives (ANP Results)

The ANP analysis ranked the CE initiatives based on their overall importance for achieving a decarbonized healthcare system:

1. Sustainable Development (Weight: 0.3684): This emerged as the most critical dimension, underscoring the need to embed sustainability into the core of healthcare operations. The sub-initiative ‘Sustainable medical supplies’ (C14) was ranked highest within this category.
2. Advanced Technology Adoption (Weight: 0.2776): Technology is the second most important driver. ‘Blockchain for traceability’ (C23) and ‘Decentralized treatment models’ (C24) were identified as high-priority technological interventions.
3. Education and Institutional Actions (Weight: 0.2132): Building human capacity and awareness is essential. ‘Training and Education of Medical staff’ (C31) was highlighted as a key initiative.
4. Management Development (Weight: 0.1408): Effective management practices, particularly the use of ‘Eco-Friendly medical products’ (C41), are vital for implementation.

Discussion: Implications for Policy and Practice

The findings provide a clear roadmap for decarbonizing medical waste management through circular economy strategies that directly support the SDGs.

Strategic Insights for Achieving SDGs

The analysis confirms that a holistic approach is required. Policy and management reforms (C1 and C4) must guide technological and behavioral changes (C2 and C3). For developing countries, this means prioritizing investments in governance, institutional capacity building, and regulatory frameworks. Such a strategy not only addresses climate goals (SDG 13) but also creates co-benefits for public health (SDG 3) and promotes sustainable economic patterns (SDG 12). The high ranking of initiatives like blockchain traceability (C23) and decentralized treatment (C24) highlights the potential for technology to leapfrog traditional, inefficient systems, provided the foundational governance is in place.

Overcoming Barriers to Implementation

Practical barriers such as high capital costs for technology, regulatory gaps, and resistance to change persist. To overcome these challenges, this report suggests:

• Implementing economic incentives for sustainable procurement and resource efficiency.
• Developing hybrid models that combine high-tech solutions with low-cost, community-level interventions.
• Integrating CE targets into national healthcare regulations and climate action plans (Nationally Determined Contributions).
• Fostering public-private partnerships to finance green healthcare infrastructure.

Conclusion and Recommendations

This study successfully demonstrates that a strategic focus on circular economy principles in medical waste management is a powerful pathway to decarbonization and the advancement of the UN-SDGs. The research identifies ‘Sustainable Development’ and ‘Management Development’ as the foundational pillars upon which technological innovation and educational initiatives must be built.

Based on these findings, the following recommendations are proposed for policymakers and healthcare administrators:

1. Integrate CE Principles into National Health Strategy: Embed sustainable procurement, waste reduction, and circular design requirements into healthcare policies to drive progress on SDG 12.
2. Incentivize High-Impact Technologies: Promote investment in decentralized waste treatment and digital traceability systems to reduce emissions and enhance accountability, supporting SDG 9 and SDG 13.
3. Invest in Capacity Building: Launch comprehensive training and awareness programs for healthcare staff to foster a culture of sustainability and ensure the effective implementation of CE practices, contributing to SDG 4.
4. Strengthen Governance and Leadership: Empower healthcare managers with the tools and mandates to lead the transition towards a circular, low-carbon operational model, which is essential for achieving all related SDGs.

By adopting this integrated, evidence-based framework, healthcare systems can transform from being a source of pollution into a leading sector in the global transition to a sustainable and resilient future.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on decarbonization and circular economy principles for medical waste management directly and indirectly addresses several UN Sustainable Development Goals (SDGs). The analysis identifies the following key SDGs:

• SDG 3: Good Health and Well-being: The core subject is medical waste, which, if mismanaged, poses significant risks to human health through pollution and contamination. The article links the healthcare sector’s operations directly to environmental health, which is integral to overall public well-being.
• SDG 9: Industry, Innovation, and Infrastructure: The article heavily emphasizes the need for “advanced technology adoption” and “investments in innovative setups” to manage medical waste sustainably. This includes IoT-based waste tracking, blockchain for traceability, and decentralized treatment facilities, all of which fall under building resilient infrastructure and promoting sustainable industrialization.
• SDG 12: Responsible Consumption and Production: This is a central theme. The article explicitly mentions SDG 12 and focuses on circular economy (CE) principles, which aim to “optimize resource use, reuse products and materials, recycle as much as possible, and reduce waste.” It discusses sustainable procurement, circular design for medical devices, and reducing waste generation at the source.
• SDG 13: Climate Action: The article reframes medical waste management as a “climate challenge.” It states that the health system contributes 4.4% of global net emissions and that mishandling medical waste adds to this footprint. The entire study is centered on finding “decarbonization pathways” for the healthcare sector, directly aligning with the goal of combating climate change and its impacts.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues and solutions discussed, several specific SDG targets can be identified:

1. Under SDG 3 (Good Health and Well-being):

   • Target 3.9: By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. The article’s focus on the “safe disposal of medical waste” and reducing pollution from “methane released to the air at landfills” and “hazardous chemicals generated during incineration” directly contributes to this target.

2. Under SDG 9 (Industry, Innovation, and Infrastructure):

   • Target 9.4: By 2030, upgrade infrastructure and retrofit industries to make them sustainable, with increased resource-use efficiency and greater adoption of clean and environmentally sound technologies and industrial processes. The article advocates for adopting advanced technologies like “autoclave treatment, microwave sterilization and plasma pyrolysis” as alternatives to traditional incineration, investing in “decentralized waste treatment systems,” and using “IoT-based solutions” and “blockchain” for efficient management.

3. Under SDG 12 (Responsible Consumption and Production):

   • Target 12.2: By 2030, achieve the sustainable management and efficient use of natural resources. The discussion on “optimizing healthcare asset-sharing platforms,” promoting “reusable or recyclable medical products,” and implementing “regenerative practices” aligns with this target.
   • Target 12.4: By 2020, achieve the environmentally sound management of chemicals and all wastes throughout their life cycle…and significantly reduce their release to air, water and soil. The entire study is premised on finding optimal solutions for the “management and safe disposal of medical waste” to reduce environmental impact.
   • Target 12.5: By 2030, substantially reduce waste generation through prevention, reduction, recycling and reuse. The article highlights CE initiatives such as “waste sorting and recycling,” “reprocessing of SUDs (single-use devices),” and designing medical devices that are “upgradeable, reusable, recyclable rather than disposable.”

4. Under SDG 13 (Climate Action):

   • Target 13.2: Integrate climate change measures into national policies, strategies and planning. The article underscores the “importance of integrating waste management into national decarbonisation strategies” and aligning national health policies with circularity goals.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article does not cite official SDG indicator codes but mentions several quantifiable metrics and outcomes that can serve as practical indicators to measure progress:

• Indicator for Emissions Reduction: The article states that the health system is responsible for “4.4% of global net emissions.” Progress can be measured by the reduction of this percentage. It also mentions specific reduction potentials, such as a “reduction potential by 25% by 2030 through implementation of CE practices” and a potential to “reduce related emissions by 30%” with investments in waste management infrastructure.
• Indicator for Waste Reduction and Recycling: The article implies that progress can be measured by the reduction in the “huge volume of medical waste.” Specific metrics mentioned include a “15% decrease in procedural waste” through staff training and a “20% increase in recycling” through awareness programs.
• Indicator for Resource Efficiency: The efficiency of new technologies can be measured. For example, “circular design for reusable medical devices” can reduce “lifecycle emissions up to 30%,” and “decentralized medical waste treatment models” can “decrease transportation emissions by 18%.”
• Indicator for Sustainable Procurement: The impact of purchasing decisions can be measured. The article notes that replacing single-use plastics with biodegradable alternatives resulted in “40% less emissions in neonatal units.”

4. Table of SDGs, Targets, and Indicators

Source: nature.com