Current methods of waste management emit numerous substances, which can sometimes be toxic for humans in direct exposure. Most of the waste in the UK is currently sent to landfills, which has brought up some concerns regarding the potential health effects of landfill on human health.

The European Union (EU) Landfill Directive (1999) requires considerable volumes of waste to be diverted away from landfill, which leads to different waste management routes for the future such as incineration, which is a considerable danger for humans and the environment.

Managing waste sites in a way that minimizes toxic impacts on the current and future generations is obviously a crucial part of sustainable development, although it is very difficult to keep a health conscious waste management without putting the environment at risk.

The Integrated Pollution Prevention and Control regime, which requires the input of public health professionals on the regulation of such sites, provided that all waste management installations should now be operating in a way that minimizes any risks to human health.

However, public health professionals are not currently taking responsibility when it comes to the impacts of waste disposal on climate change, resource use and health inequalities.

Furthermore, there is currently no requirement for public health professionals to become involved in future waste management planning issues, which may lead to decisions that might be very harmful for the future generations.

The fact that public health professionals are not involved in this decision-making process makes the potential impacts upon health ignored, and reduces the sustainability of waste management.

Today, the impact of waste management upon human health is an important factor to consider, along with the direct toxicological impacts of potential new waste disposal installations. If these two factors remain completely ignored, these impacts may increase which would make sustainability a bigger challenge to overcome.

In order to achieve a sustainable development through a responsible waste management plan it is important to set the improvement of the quality of life of current and future generations as a main goal, ensuring that waste management sites have a minimum risk to the health of the public.

This concern about the negative impact of waste installations on human health has resulted in various epidemiological studies, which have, although giving slightly different conclusions, highlighted the possibility of a link between landfill and adverse health effects.

Many studies on the potential adverse health effects of different waste management options such as incineration and hazardous waste disposal can be found. However, there is a considerable lack of information provided regarding potential problems resulting from environmental exposures.

It is important to consider every type of waste exposure in order to improve waste management operations, including health problems of the workforce involved in waste management as well as the exposure of people living near waste disposal site.

Today, most studies conducted regarding the toxicity of the dangerous substances found in waste relates to exposure due to the work environment or waste disposal related accidents, and therefore usually to higher levels of exposure than those expected from waste disposal methods.

Many of the substances generally found in waste management sites, such as arsenic, chromium or nickel are considered to be carcinogenic based on animal or human exposure. In addition to this danger, these substances have been proven to have toxic effects on different human organs such as liver, kidneys, heart or lungs.

However, the main concern associated with exposure to large amounts of waste is the impact on reproduction and congenital malformations. A geographical study of adverse birth outcomes [1] associated with living within 2 km of a landfill site between 1982 and 1997 in Great Britain found an increasing risk of congenital malformations and low birth weight for people directly exposed to landfill sites, as 80% of the population in Great Britain lives within 2 km of an operating or closed landfill site.

A similar study on the Welsh landfill site of Nant-y-Gwyddon [2] has found that risks of congenital malformations and spontaneous abortions were considerably higher for the population surrounding landfill sites and therefore exposed to hazardous waste. In both of these studies, residential proximity was directly looked at the main reason for such incidents.

Five exposed wards surrounding Nant-y-Gywddon landfill site 
Rate of births with congenital malformation per 1000 total births in exposed wards

Another research conducted by EUROHAZCON on the risk of congenital anomalies near hazardous-waste landfill sites in Europe [3] has found high risks of such anomalies for women who lived within 3 km of these sites in around 21 hazardous waste landfill sites in Europe, which shows not only the impact of hazardous waste disposal on humans but also on future generations, which, once again, puts potential sustainability at risk.

However, very little importance is currently given to the impact of waste management solutions such as incineration and landfill disposal on public health, as the outcomes of exposures such as cancers or early spontaneous abortions would not be expected to occur until several years after exposure. It is therefore important for healthcare professionals to be involved in decisions regarding waste management operations, whose role is today very limited in this process.

Currently, public health professionals are only fully involved in the regulation of waste management issues is in the Integrated Pollution Prevention and Control (IPPC) process, where they are able to make decisions to minimize the toxicity of waste management.

However, they are limited by a lack of knowledge regarding the health effects of low doses of chemical mixtures over the time, as most risk assessments only focus on the risks from inhaling atmospheric pollutants, as other exposure pathways such as soil, water and food are not clearly understood.

Such limitations could also mean that the relationship between landfill site operation and adverse health outcomes is not yet clear. Despite the fact that there is even less evidence of adverse health impacts with other types of waste disposal (e.g. incineration and composting), these still appear to be a concern.

In cases where a health risk in acknowledged, it could be more efficient to undertake a health risk assessment of each installation, based on exposure and toxicology data. Another option is to carry out a health impact assessment detailing all the potential impacts that the waste management site could have upon the health of the local community, and then consider alternative waste management plans.

However, we cannot ignore the fact that the regulation of waste management sites has significantly improved in recent years. By 2006, IPPC permits became a legal requirement for all landfill sites and incinerators. The IPCC is the Intergovernmental Panel on Climate Change (IPCC), which is a United Nations body for assessing the science related to climate change.

This type of permit was enforced by the Environment Agency in England and Wales, the Scottish Environmental Protection Agency in Scotland, and the Environment and Heritage Service in Northern Ireland, who grants permits based on emissions to all landfill sites, who need to show the use of the best-available techniques to reduce their environmental impact.

The IPPC has given the opportunity for health professionals to be active consultees to the process, which makes it the first time that medical practitioners are involved in waste management regulations. However, they have a very limited role, as no specific references to human health can be found in IPCC applications, which means that health care professionals' decisions are based on emissions' data rather than health factors.

The IPCC is an important tool for the protection of human health despite the limitations regarding health professionals as it is ensuring a safe way for the operation of waste management installations in order to protect both public health and the environment, by ensuring that sites are carefully monitored, respecting environmental regulations, as well as ensuring the use of appropriate environmental techniques.

This provides health professionals with a significant contribution at regional level, where local authorities are required to produce waste management plans for several years.

Despite the limitations they are facing, health professionals are today essential in waste management operations as improper disposal of wastes can lead to serious effects on the health and comfort of individuals. Poor waste handling and disposal can also lead to environmental pollution, which has been known to be harmful to humans for decades now.

Participation of healthcare practitioners in waste management planning should be encouraged by European organizations in order to maintain healthy and safe waste disposal and improve sustainability for future generations.

[1] Risk of adverse birth outcomes in populations living near landfill sites- US National library of medicine.

[2] Assessment of impact on health of residents living near the Nant-y-Gwyddon landfill site: retrospective analysis- US National library of medicine.

[3] Sustainable waste management in the UK: the public health role

[4] Risk of congenital anomalies near hazardous-waste landfill sites in Europe: the EUROHAZCON study.