Beyond Recycling: Uncovering the Sustainability–Safety Paradox in Circular Healthcare Systems

Raphael Cobra; Victor  Magno; Maiara  Rosa Cencic; Vinicius  Picanço Rodrigues; Kate Roll; Janaina Mascarenhas

doi:10.55845/joce-2026-4116

Authors

Raphael Cobra University of Sao Paulo Author https://orcid.org/0000-0003-2011-7321
Victor Magno University of Sao Paulo Translator
Maiara Rosa Cencic Fraunhofer Institute for Production Systems and Design Technology IPK Author https://orcid.org/0000-0002-6435-8285
Vinicius Picanço Rodrigues Insper Institute of Education and Research & University of Strathclyde Author https://orcid.org/0000-0002-6647-9291
Kate Roll Institute for Innovation and Public Purpose (IIPP), University College London Author https://orcid.org/0000-0001-9610-2367
Janaina Mascarenhas University of Sao Paulo Author https://orcid.org/0000-0001-9653-6499

DOI:

https://doi.org/10.55845/joce-2026-4116

Keywords:

Sustainable Healthcare, Healthcare Resilience, System Dynamics Modeling, Healthcare Policy Management

Abstract

Health crises expose the fragility of healthcare systems and the environmental burden of disposable medical waste. This study couples Circular Economy (CE) principles with System Dynamics (SD) modeling to evaluate reuse, sterilization, and recycling of N95 masks in the Brazilian healthcare system. Simulations reveal an unexpected sustainability–safety paradox: while reuse and sterilization deliver the largest reductions in waste, emissions, and costs, recycling alone yields only marginal environmental benefits despite its economic appeal. More circular configurations not only lower resource dependency but also enhance resilience, mitigating personal protective equipment (PPE) scarcity during crises. By integrating real health system data (DATASUS) into a dynamic model using the Vensim® software, we identify systemic leverage points for designing durable PPE and shaping policies that balance safety and sustainability. Our analysis spans all three pillars of sustainability (environmental, social, and economic) providing a holistic assessment of PPE circular strategies. This work demonstrates how SD–CE integration can inform evidence-based strategies to build more sustainable and resilient healthcare systems capable of facing future public health emergencies. Even though the analysis was focused on the case of N95 masks, the framework employed in this work can be generalized for many other cases in the healthcare system.

Author Biographies

Raphael Cobra, University of Sao Paulo

Raphael Cobra is a sustainability consultant and researcher specializing in circular economy strategies for healthcare systems. He holds a Ph.D. in Production Engineering from the University of São Paulo (USP), with part of his research developed at Politecnico di Milano, focusing on the reuse, repair, and recycling of medical equipment. His work integrates system dynamics, product life cycle assessment, and circular business models to advance sustainable innovation in healthcare supply chains. Raphael has contributed to international initiatives on circularity and safety, including keynote sessions at NSF EU Green Week and collaborations with ASTM International on standards for circular healthcare products.
Janaina Mascarenhas, University of Sao Paulo

Janaina Mascarenhas is an Associate Professor at the University of São Paulo (USP), where she coordinates the Circular Ecosystem Lab (CeLAB). She holds a Ph.D. in Production Engineering from USP and was a Research Associate at the Massachusetts Institute of Technology (MIT). Her research focuses on circular economy transitions, with emphasis on circular cities, waste recovery ecosystems, and the interface between digital transformation and sustainability. She has led several projects developing indicators to assess the resilience and systemic impacts of circular ecosystems, with applications in public policy and multi-stakeholder governance.

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