Refuse management and health
A briefing from the Board of Science and Education
July 2004
Introduction
The following motion was passed at the BMA’s 2003 Annual Representative Meeting (ARM): “That the Board of Science and Education investigate and make recommendations with regard to improving refuse management in the UK”.
This was discussed by members of the Board of Science and Education on 10 September 2004. There is a large volume of evidence published on this topic, including the recent, comprehensive, 'Review of Environmental and Health Effects of Waste Management: Municipal Solid Waste and Similar Wastes' Go to note 1 by the Department for Environment Food and Rural Affairs. Therefore, the Board resolved to produce a briefing detailing existing research from a variety of interested organisations.
Publications of interest
British Medical Association
The BMA has not examined this issue in detail since 1994. The four most significant BMA contributions are:
- 'Environmental and occupational risks of health care' (1994) Go to note 2
This work includes a chapter on clinical waste, reviewing the options for disposal.
- 'The BMA guide to pesticides, chemicals and health' (1992) Go to note 3
This text examines health and safety issues related to pesticides and various other chemicals through out the product life cycle. It pays particular attention to contamination pathways as well as individual and community health impacts. There is also information on regulatory schemes.
- 'Hazardous waste and human health (1991) Go to note 4
This report provides a comprehensive guide to all aspects of hazardous waste. It sets out clearly the nature of hazardous waste, existing methods of treatment and disposal, and the evidence linking exposure to toxic waste with ill health.
- 'A code of practice for the safe use and disposal of sharps' (1990) Go to note 5
Department for Environment Food and Rural Affairs (Defra)
Go to the website here
'Review of Environmental and Health Effects of Waste Management' Go to note 1 is the most up-to-date and authoritative guide to the impact of municipal solid waste on community health. While municipal solid waste accounts for only seven per cent of UK waste each year, it is the portion of waste people are most familiar with and one whose health effects are least studied. This report concludes that the health effects of the various waste management options for municipal solid waste were minimal when compared to the risks associated with everyday living. This assessment is extended to incineration and landfilling of waste, though the report emphasises the primacy of minimisation and recycling as these have even lower health risk profiles than incineration or landfilling.
Section six of the report, 'Context for quantified health and environmental risks, and review of public perception issues' Go to note 1, contains the information most pertinent to health professionals, both in terms of supplying information on the risks of waste management and communicating these risks to a concerned patient population. Subsection two compares the health effects of various waste management techniques and is useful for health service managers seeking to understand the environmental and health impacts of their planning decisions. In communicating the risks of waste management to patients, though, there is little utility in comparing the risk arising from proximity to a landfill to the risk arising from proximity to a recycling plant: patients are unfamiliar with the risks of either solution. It is much more useful to compare the risks of various waste management techniques to risks that arise in everyday life. Subsection three addresses this by showing that emissions from waste management practices are generally minor compared to a number of activities generally considered ‘safe’ such as driving, farming or generating power. Notable exceptions to this trend are methane and cadmium emissions, both of which are produced at significant levels during landfilling and incineration.
Environment Agency
Go to the website here
The Environment Agency produces a quarterly magazine 'your environment'. The Spring 2004 issue serves as an up to the minute accounting of the state of hazardous waste disposal in the UK. Go to note 6 It calls particular attention to the Waste Electrical and Electronic Equipment (WEEE) Directive. This directive covers an enormous amount of waste from power sources and gadgets to computers and sporting goods with electrical components. The major initiative of the directive is a requirement for industry to offer consumers the opportunity to recycle (at no cost) unwanted electronic equipment.
Prime Minister’s Strategy Unit
Go to the website here
The Strategy Unit maintains an archive of reports and working papers related to waste management, including some that reference the health impact of such measures, though generally with reference to England as health and waste management are devolved matters. The Strategy Unit last considered the health effects of waste management in September 2002. Go to note 7 Many of its findings are based on the same research which underpins the Defra report, but the presentation of data by the Strategy Unit is more accessible for clinicians wishing to explain these risks to patients.
The Strategy Unit is also responsible for Waste not, want not (2002). Go to note 8 This document supports Waste Strategy 2000 Go to note 9 and, as such, is more focused on environmental effects as opposed to health effects. However, when read in conjunction with the other highlighted documents, one can see how planning decisions as basic as how waste is collected and where it is delivered can have significant impacts on community health.
National Health Service/Department of Health
Go to the NHS website here,
Go to the Departmet of Health website here
The NHS and Department of Health have worked together to give guidance to doctors and healthcare professionals and managers on the best practice for limiting the impact of medical waste. Healthcare Waste Minimisation (2000) Go to note 10 provides case studies of best practice throughout the NHS in improving the management of healthcare waste. Improvements cover procurement, which is heavily influenced by physician behaviour, on site disposal and the removal of healthcare waste to hazardous waste sites. The case studies can serve as guidance for health service managers wishing to reduce the health impact of their services.
South West Public Health Observatory
Go to the website here
''Waste management and public health: the state of the evidence' (2002) Go to note 11 is a review of the epidemiological research into the impact of waste management activities on health. After an exhaustive review of the academic literature, the Observatory found that it was unable to meaningfully assess the potential health impacts of waste management practices. Not least, this is due to the ubiquity of such practices. It is incredibly difficult to understand the impact of activities that may act on a population through an indeterminate number of intermediaries. The only definite link the report could find was that bathing in sewage contaminated water led to an increased risk of reporting gastrointestinal symptoms. While this review examines much of the same data as the Defra report, it strikes a much more cautious tone, arguing that while direct effects may be confidently ruled out, the existing scientific base is unable to exclude, with a high degree of certainty, effects from complex environmental and physiological interactions. In light of the current uncertainty the Observatory advocates the use of the Precautionary Principle in the assessment of waste management practices.
World Wildlife Fund
Go to the website here
'Compromising our Children: Chemical Impacts on Children’s Intelligence and Behaviour' (2004) 12 focuses on the chemicals in waste which cause the most significant health effects. The report concerns itself not with waste management, but with the effects of hazardous substances in everyday items. The key recommendation from this report is support for the new European chemicals regulation, REACH. This is supported by quantitative examination of the health effects of chemicals present in the environment and the economic cost to health services from these health effects.
Swedish Secretariat on Acid Rain
Go to the website here
'Air and the Environment' (2004) Go to note 13 includes a section on the health effects of air pollution. The rising incidence of respiratory disorders, including COPD’s, makes this an area of interest to doctors that is underserved by most literature which focuses primarily on landfills and incineration. Waste management practices contribute to air pollution not only though incineration and methane evolution at landfills, but also by poor production practices in the manufacturing sector, and through the transport of waste from kerbside to management facility.
The danger from this last point is magnified by the coming EU Directive on Hazardous Waste. Because there will be relatively few sites available to handle hazardous waste (a category that other directives will expand) more hazardous waste will be manufactured far from disposal sites. Transport of this waste will contribute to air pollution and the potential for spills (catastrophic or otherwise) indicates a danger to ground water and soil quality.
Other academic research
Vrijheid’s review of the health effects of living near landfills (2000) Go to note 14 was a key influence in the recent flurry of government reports about the health impacts of waste management practices. Like the South West Public Health Observatory, he found establishing causality to be difficult. In this case, a key stumbling block was that landfills are not uniform. As they are recipients of a variety of substances which commingle and react over time, it is difficult, if not impossible, to determine what individuals living near these sites are actually exposed to.
Vrijheid further notes the psychological reasons underpinning an interest in this area. Once a potential risk is publicly identified in news, there is an increase in self-reporting of any number of non-specific ailments which can bias the results to any perspective study of the health of the population.
Concerned organisations
Greenpeace/Friends of the Earth
Go to the Greenpeace website here,
Go to the Friends of the Earth website here
These organisations maintain extensive reporting of waste management practices and the health effects of them. They generally aim to reduce incineration and landfilling and promote waste minimisation, reuse, recycling and composting. They also maintain strong vigilance units dedicated to radiation and the health effects of proximity to nuclear sites and nuclear disposal areas.
Healthcare Without Harm
Go to the website here
This advocacy organisation promotes similar causes as the environmental activist organisations listed above, but with regard to the healthcare setting. This site serves as an excellent accompaniment to the NHS case studies in Healthcare Waste Minimisation (2000) Go to note 10 as it has advice on the actual implementation of many of the protocols deemed best practice. This organisation diverges from current government thinking by being much less in favour of incineration of medical waste than the current mainstream recommendations.
Interdepartmental Group on Health Risks from Chemicals (IGHRC)
Go to the website here
This group is not concerned with waste management specifically, but with the myriad chemical constituents of waste. In addition to offering informed and up-to-date information for clinicians on risks that their patients may face, the group has made a substantive contribution to the understanding and communication of risk to individuals.
References
1. Review of environmental and health effects of waste management: municipal solid waste and similar wastes. Defra, 2004. - read more here.
2. Environmental and occupational risks of health care. British Medical Association Board of Science, 1994.
3. The BMA guide to pesticides, chemicals and health. British Medical Association Board of Science, 1992.
4. Hazardous waste and human health. British Medical Association Board of Science, 1991.
5. A code of practice for the safe use and disposal of sharps. British Medical Association Board of Science, 1990.
6. your environment: Hazardous waste, Where is it heading? Environment Agency, Spring 2004.
7. The Context for Emissions and Health Impacts Associated with Waste Management. Enviros Aspinwall, 2002
8. Waste not, want not. Strategy Unit, 2002
9. Waste Strategy 2000 for England and Wales. Defra, 2000 - read more here
10. Healthcare Waste Minimisation. Department of Health, 2000 - read more here
11. Waste management and public health: the state of the evidence. South West Public Health Observatory, 2002.
12. Compromising our Children: Chemical Impacts on Children’s Intelligence and Behaviour. World Wildlife Fund, 2004.
13. Air and the Environment. Swedish Secretariat on Acid Rain, 2004.
14. Vrijheid M (2000) Health Effects of Residence Near Hazardous Waste Landfill Sites: A Review of Epidemiological Literature. Environmental health perspectives 108: 101-112 - read more here
For further information about this resource, editorial secretariat or Board members please contact Nicky Jayesinghe, Senior Policy Executive, Science and Education Department. (njayesinghe@bma.org.uk)