The healthcare sector produces 2 gigatons of CO₂. To address this impactful trend and contribute to the Sustainable Development Goals (SDGs), the adoption of circular economy (CE) practices could represent a strategic target. In this context, the present article provides a systematic and bibliometric literature review of CE practices applied in the healthcare sector by considering the collected case studies. This study aims to analyze the state of the art in CEs in the healthcare sector in order to identify CE practices in healthcare, examining how they contribute to sustainability goals and the critical issues in their implementation. A final selection of 36 articles from reputable databases, Web of Science and Scopus, was obtained and analyzed using VOSviewer. By systematically examining these papers, the study investigates the key CE practices implemented within the healthcare sector and their respective areas of application, which help the broader mission of achieving SDG 12, and also, to a lesser extent, SDG 9. Although the research criteria impose some limitations, this study offers a comprehensive review of successful circular practices adopted in the healthcare sector while shedding light on existing gaps and providing valuable insights for relevant stakeholders.

This study proposes a novel framework integrating Environmental Risk Assessment (ERA) and Material Flow Analysis (MFA) within the Deming Cycle framework to address this gap. While valuable tools, ERA and MFA offer limited perspectives on environmental impact when used alone. The framework aims to provide policymakers and decision‐makers with insights into developing sustainable waste management strategies. By combining ERA and MFA, this research offers a comprehensive approach to evaluate the environmental impacts of healthcare waste, identify potential risks, and optimize waste management practices. A case study of an Italian private healthcare clinic is conducted to demonstrate the practical application of the proposed framework. Through a SWOT analysis, the benefits and challenges of integrating ERA and MFA in healthcare waste management are revealed, providing guidance for future research and implementation efforts.

Sustainability is understood as a balanced integration of economic, ecological, and social aspects. Sustainable manufacturing can be considered one of the most important issues to address in the pursuit of sustainable development. The main purpose of the paper is to identify the most important directions of research to date and to indicate new and emerging areas of research concerned with the usage of decision-making methods in sustainability assessment in steel manufacturing companies. A systematic review was based on the publications indexed in the Web of Science and Scopus databases. In the analysis, the correspondence analysis and log-linear model were applied. To sum up, this study examines decision-making modalities and sustainable performance in terms of approaches that influence sustainability in steel manufacturing. Firstly, the study determined key decision-making aspects, such as the appropriate material identification for the manufacturing process and material labeling for the manufacturing process, which is essential for sustainable metal products. Secondly, the identification of sustainability indicators is considered vital in the hierarchical process as their integration is essential for the decision-making process and its outcome. Furthermore, system efficiency and productivity, alongside increasing attention to environmental protection, have led to significant changes in all production systems. In addition, many factors play an important role in the selection of suppliers, such as increasing the importance of the environment, increasing the recycling rate of the products, and ensuring sustainability performance. However, companies in the steel manufacturing industry rely little on the application of decision-making to assess sustainability.

Data scarcity hampers the implementation of circular economy (CE) in rural historical small towns (HSTs) where traditional agricultural practices persist outside formal monitoring systems. In this regard, this study proposes and tests an estimation framework to quantify agricultural waste flows and energy recovery potential. The methodology combines waste generation coefficients from peer-reviewed literature with administrative data to generate actionable CE assessments. Application to four Sicilian HSTs within the Local Action Group (LAG) “Terre dell’Etna e dell’Alcantara” exhibits substantial waste generation potential despite their small size. The agricultural enterprises generate an estimated 6930–7130 tons of annual agricultural waste under moderate production scenarios, comprising grape pomace (3250 tons), pruning residues (3030 tons), and mixed processing wastes (650–850 tons). The energy recovery potential ranges from 20–30 TJ through direct combustion to 4.9–8.1 TJ via anaerobic digestion. Sensitivity analysis indicates balanced contributions from all three key parameters (enterprise density, yields, and waste coefficients), each accounting for 31–35% of output variance. The framework provides resource-constrained municipalities with a cost-effective tool for preliminary CE assessment, enabling identification of priority interventions without expensive primary data collection. From a managerial perspective, local administrators can leverage this tool to transform routine administrative data into actionable CE strategies.

Industrial park (IP) expansions in Mediterranean peri-urban areas can generate conflicts between economic development and agricultural heritage preservation. This paper develops a theoretically derived circular land use symbiosis model based on Hubs for Circularity (H4C) principles, using Fosso Imperatore IP in southern Italy as an illustrative case. This model proposes a transferable three-zone gradient design that enables the transformation of industrial–agricultural boundaries when combined with appropriate governance mechanisms and stakeholder engagement. Zone A concentrates vertical industrial development with rooftop agriculture; Zone B creates mixed agro-industrial interfaces; and Zone C enhances agricultural productivity through industrial resources. The model’s components (gradient zonation, temperature–cascade matching, and bidirectional resource flows) constitute generalizable design principles. When applied to Fosso Imperatore, where farmers oppose expansion that threatens culturally significant San Marzano tomato production, the model shows how 547 tons of organic waste could generate 87,520 m³ of methane, while industrial waste heat cascades from 150–200 °C to 25–40 °C of greenhouse heating across distances of 3 km. Implementation constraints include regulatory gaps and limited empirical data. This study operationalizes H4C through spatial design, showing how benefit-sharing mechanisms can transform stakeholder conflicts into collaboration. The model provides a replicable framework for Mediterranean contexts where industrial expansion encounters agricultural heritage.