Solid Waste Incinerators: Health Impacts: Abbreviations

Solid Waste Incinerators: Health Impacts
MF Reis, Institute of Preventive Medicine, University of Lisbon, Lisbon, Portugal

& 2011 Elsevier B.V. All rights reserved.
Abbreviations TCDD 2, 3, 7, 8-tetrachlorodibenzodioxin

ATSDR Agency for Toxic Substances and TDI tolerable daily intake
Disease Registry UK EA UK Environment Agency
CRF concentration–response function UNEP United Nations Environment
DRF dose–response function Programme
EC European Commission US EPA United States Environmental
EIS environmental impact studies Protection Agency
ERF exposure–response function VOC volatile organic compound
ESBIO Expert Team to Support WHO World Health Organization
BIOmonitoring (EU-funded research
project) Glossary
EU European Union
Abatement reducing the degree or intensity of, or
EUROSTAT European Office for Statistics
eliminating, pollution
HBM human biomonitoring
Absorbed dose in exposure assessment, the amount
HHRAP Human Health Risk Assessment
of a substance that penetrates an exposed organism’s
Protocol
absorption barriers (e.g., skin, lung tissue, and
IPA impact pathway analysis
gastrointestinal tract) through physical or biological
LOAEL lowest-observed-adverse-effect level
processes. The term is synonymous with internal dose
MSW municipal solid waste
Absorption the uptake of water, other fluids, or
MSWI municipal solid waste incinerators
dissolved chemicals by a cell or an organism (as tree
MSWM municipal solid waste management
roots absorb dissolved nutrients in soil)
NEHAP National Environment and Health
The process of taking in. For a person or an animal,
Action Plan
absorption is the process of a substance getting into the
NOAEL no-observed-adverse-effect level
body through the eyes, skin, stomach, intestines, or lungs
OECD Organization for Economic
Acid gas a gas produced in the combustion process. It
Co-operation and Development
contains acid components such as sulfides and
PAH polycyclic aromatic hydrocarbon
chlorides
PCB polychlorinated biphenyl
Acute occurring over a short time (compare with
PCDD polychlorinated dibenzo-para-dioxins
chronic)
PCDF polychlorinated dibenzofuran
Acute exposure contact with a substance that occurs
PFC perfluorinated compound
once or for only a short time (up to 14 days) (compare
PM particulate matter
with intermediate duration exposure and chronic
PM10 particulate matter (nominally 10 mm
exposure)
and less)
Acute toxicity toxic effects that can cause rapid
PM15 particulate matter (nominally 15 mm
(acute) deleterious effects on biological (human, animal,
and less)
and plant) systems
PM2.5 particulate matter smaller than
Adverse health effect a change in body function or
2.5 mm in diameter
cell structure that might lead to disease or health
POP persistent organic pollutant
problems
ProVEpAs Portuguese Environmental Health
Analyte a substance measured in the laboratory. A
Surveillance Programs in relation to
chemical for which a sample (such as water, air, or
incinerators
blood) is tested in a laboratory. For example, if the
REACH Registration, Evaluation,
analyte is mercury, the laboratory test will determine the
Authorization, and Restriction of
amount of mercury in the sample
Chemical substances
Analytical epidemiologic study a study that
SWI solid waste incinerator
evaluates the association between exposure to
SWOT analysis of Strengths, Weaknesses,
hazardous substances and disease by testing scientific
analysis Opportunities, and Threats
hypotheses
162
Solid Waste Incinerators: Health Impacts 163
Antagonistic effect a biological response to exposure Carbon dioxide (CO2) a colorless, odorless,
to multiple substances that is less than would be nonpoisonous, heavier than air, gas; one of the major
expected if the known effects of the individual constituents of landfill gas. It is a by-product of aerobic
substances were added together (compare with additive and anaerobic decomposition. It decreases the pH of
effect and synergistic effect) water and is the most important greenhouse gas
Ash inorganic, particulate residue of combustion. Ash Carcinogen a substance that causes cancer
is usually polluted by small quantities of organic material Case study a medical or epidemiological evaluation of
resulting from incomplete combustion one person or a small group of people to gather
Background level an average or expected amount of information about specific health conditions and past
a substance or radioactive material in a specific exposures
environment, or typical amounts of substances that Case–control study a study that compares exposures
occur naturally in an environment of people who have a disease or condition (cases) with
Best practice the planning and operational practice people who do not have the disease or condition
that is the most technically and politically feasible, (controls). Exposures that are more common among the
cost-effective, sustainable, environmentally beneficial, cases may be considered as possible risk factors for the
and socially sensitive, to a particular locality disease
Bioaccumulation the retaining and accumulation over Central nervous system the part of the nervous
time of certain chemical compounds in organic matter system that consists of the brain and the spinal cord
such as the tissues of plants and animals used as food Chronic occurring over a long time (compare with
sources acute)
Biologic indicators of exposure study a study that Chronic exposure contact with a substance that
uses (1) biomedical testing or (2) the measurement of a occurs over a long time (more than 1 year) (compare
substance (an analyte), its metabolite, or another marker with acute exposure and intermediate duration
of exposure in human body fluids or tissues to confirm exposure)
human exposure to a hazardous substance (also see Combustion refers to controlled burning of municipal
exposure investigation) solid waste, in which heat chemically alters organic
Biologic monitoring measuring hazardous compounds, converting them into stable inorganics such
substances in biological materials (such as blood, hair, as carbon dioxide and water
urine, or breath) to determine whether exposure has Commercial waste all municipal solid waste
occurred. A blood test for lead is an example of emanating from business establishments such as
biological monitoring stores, markets, office buildings, restaurants, shopping
Biologic uptake the transfer of substances from the centers, and entertainment centers
environment to plants, animals, and humans Waste materials originating in wholesale, retail,
Biomedical testing testing of persons to find out institutional, or service establishments, such as office
whether a change in a body function might have occurred buildings, stores, markets, theaters, hotels, and
because of exposure to a hazardous substance warehouses
Body burden the total amount of a substance in the Rubbish from buildings, which are used mainly for
body. Some substances build up in the body because trade, business, sport, recreation, or entertainment, for
they are stored in fat or bone or because they leave the example, a school, a leisure center, a supermarket, or
body very slowly an office building
Bottom ash (1) the nonairborne combustion residue Concentration the amount of a substance present in
from burning solid fuel including MSW in boiler or a certain amount of soil, water, air, food, blood, hair,
incinerator; (2) the material that falls to the bottom of the urine, breath, or any other media
boiler and is removed mechanically; (3) a concentration Disposal (1) the final placement of MSW that is not
of the noncombustible materials, which may include salvaged or recycled; (2) the process of finally disposing
toxic substances MSW in a landfill; (3) MSW disposal is an ultimate action
Bottom ash the remaining noncombustible material by which MSW is disposed on land in acceptable
collected on grates or in other locations during the engineering manner with or without previous treatment/
combustion process processing and recycling
Cancer any one of a group of diseases that occurs Domestic waste see Household Waste
when cells in the body become abnormal and grow or Dose (for chemicals that are not radioactive) the
multiply out of control amount of a substance to which a person is exposed
Cancer risk a theoretical risk for getting cancer if over some time period. Dose is a measurement of
exposed to a substance every day for 70 years (a exposure. It is often expressed as milligram (amount)
lifetime exposure). The true risk might be lower per kilogram (a measure of body weight) per day
164 Solid Waste Incinerators: Health Impacts
(a measure of time) when people eat or drink how often and for how long they are in contact with the
contaminated water, food, or soil. In general, the greater substance, and how much of the substance they are in
the dose, the greater the likelihood of an effect. An contact with
exposure dose is how much of a substance is Exposure investigation the collection and analysis of
encountered in the environment. An ‘absorbed dose’ is site-specific information and biological tests (when
the amount of a substance that actually got into the body appropriate) to determine whether people have been
through the eyes, skin, stomach, intestines, or lungs exposed to hazardous substances
Dose–response relationship the relationship Exposure pathway the route a substance takes from
between the amount of exposure (dose) to a substance its source (where it began) to its end point (where it
and the resulting changes in body function or health ends), and how people can come into contact with (or
(response) get exposed to) it. An exposure pathway has five parts: a
Emission a material that is expelled or released to the source of contamination (such as an abandoned
environment. Usually applied to gaseous or odorous business), an environmental media and transport
releases to atmosphere mechanism (such as movement through groundwater),
Energy from waste this is the production of energy a point of exposure (such as a private well), a route of
from waste. This can be in the form of burning solid exposure (eating, drinking, breathing, or touching), and
waste in an incinerator or collecting gases such as a receptor population (people potentially or actually
methane from landfill sites. The heat produced is used to exposed). When all five parts are present, the exposure
make electricity pathway is termed a completed exposure pathway
Energy recovery conversion of waste to energy, Exposure registry a system of ongoing follow-up of
generally through the combustion of processed or raw people who have had documented environmental
refuse to produce steam (see municipal waste exposures
combustion, and incineration) Exposure–dose reconstruction a method of
Environment the sum of all external conditions estimating the amount of people’s past exposure to
affecting the life, development, and survival of an hazardous substances. Computer and approximation
organism methods are used when past information is limited, not
Environmental impact assessment (EIA) an available, or missing
environmental analysis prepared to determine whether Feasibility study a study to determine the best way to
an action (such as a proposed development project) clean up environmental contamination. A number of
would significantly affect the environment and the factors are considered, including health risk, costs, and
mitigation measures to reduce the impacts to acceptable what methods will work well
level (1) Analysis of the practicability of a proposal. The
Environmental media soil, water, air, biota (plants feasibility study usually recommends selection of a cost-
and animals), or any other parts of the environment that effective alternative. (2) A small-scale investigation of a
can contain contaminants problem to ascertain whether a proposed research
Environmental monitoring (of landfills) A continuous approach is likely to provide useful data
or regular periodic check to determine the environmental Ferrous metals a term used to describe iron and its
impact of landfill operations to ensure compliance with alloys, for example, steels. It is also used to describe the
disposal license conditions and other statutory general class of metallic materials containing iron,
environmental safety requirements cobalt, and nickel as major components
EPA United States Environmental Protection Agency Fly ash noncombustible residual particles of MSW
Epidemiologic surveillance (see Public health expelled by flue gas
surveillance) Small, solid particles of ash and soot generated when
Epidemiology the study of the distribution and coal, oil, or waste materials are burned. Fly ash is
determinants of disease or health status in a population; suspended in the flue gas after combustion and is
the study of the occurrence and causes of health effects removed by pollution control equipment
in humans Garbage an American term for municipal solid waste
Evaluation systematic assessment and comparison of components that include the putrescible fraction of MSW
available options/alternatives such as animal and vegetable waste resulting from the
Exposure contact with a substance by swallowing, handling, storage, sale, preparation, cooking, and
breathing, or touching the skin or eyes. Exposure may serving of foods
be short term (acute exposure), of intermediate duration, Half-life (t1/2) the time it takes for half the original
or long term (chronic exposure) amount of a substance to disappear. In the environment,
Exposure assessment the process of finding out how the half-life is the time it takes for half the original
people come into contact with a hazardous substance, amount of a substance to disappear when it is changed
to another chemical by bacteria, fungi, sunlight, or other can be disposed of safely on land; (2) the thermal
chemical processes. In the human body, the half-life is process aimed in MSW destruction. It is applied in
the time it takes for half the original amount of the countries where high content of combustible fraction
substance to disappear, either by being changed to (paper and plastics/synthetics) is present in the MSW
another substance or by leaving the body. In the case of and where land for disposal is very limited and scarce.
radioactive material, the half-life is the amount of time The main objective of this process is in reducing volume
necessary for one-half the initial number of radioactive of MSW so that landfill life span could be extended. It
atoms to change or transform into another atom (that is requires high technological level in the country that is
normally not radioactive). After two half-lives, 25% of the supported by adequate equipment, infrastructure facility,
original number of radioactive atoms remain and trained personnel
Hazard a source of potential harm from past, current, Incinerator a facility in which solid waste is combusted
or future exposures Industrial waste a heterogeneous mixture of different
A source of potential negative effects on the materials generated during an industrial operation. It
environment and of subsequent risks to human health or may be gaseous, liquid, sludge, or solid. The
quality of life, direct or indirectly associated with past, composition is site specific and depends on the natural
current, or future exposure to plant emissions resources, raw materials, and markets that provide the
Hazardous Substance Release and Health Effects base for a given city’s industrial activity
Database (HazDat) the scientific and administrative Infectious waste hazardous waste with infectious
database system developed by ATSDR to manage data characteristics, including contaminated animal waste,
collection, retrieval, and analysis of site-specific human blood and blood products, isolation waste,
information on hazardous substances, community pathological waste, and discarded sharps (needles,
health concerns, and public health activities scalpels, or broken medical instruments)
Hazardous waste potentially harmful substances that Inhalation the act of breathing. A hazardous
have been released or discarded into the environment substance can enter the body this way (see route of
Waste generated during production or other activities exposure)
by society that can pose a substantial or potential hazard Inorganic waste waste composed of matter other
to human health or the environment when improperly than plant or animal (i.e., contains no carbon)
managed. Possesses at least one of the following four Institutional waste waste originating in schools,
characteristics: ignitability, corrosivity, reactivity, and hospitals, prisons, research organizations, and other
toxicity public buildings. Where the institution involves residents,
Heavy metals metallic elements with high atomic the waste composition is similar to those from
weights, for example, mercury, chromium, cadmium, households
arsenic, and lead. They can damage living things at low Integrated waste management (1) a frame of
concentrations and tend to accumulate in the food chain reference for designing and implementing new waste
through build-up of concentrations in plant and animal management systems and for analyzing and optimizing
tissue existing systems. Based on the concept that all the
Hierarchy see Waste Management Hierarchy strategic aspects of the MSWM system should be
Household waste (domestic waste) MSW analyzed together since they are interrelated and
composed of garbage and rubbish, which is generated development in one component frequently affects other
as the consequence of household activities. In areas of the system. (2) A practice using several
developing countries, up to two-thirds of this category alternative waste management techniques to manage
consists of putrescible fraction of MSW. In poor and dispose of specific components of the municipal
neighborhoods traditional cooking can also produce ash solid waste stream. Waste management alternatives
and where sanitation facilities are limited, the waste include source reduction, recycling, composting, energy
might also include fecal matter. Domestic waste may recovery, and landfilling
contain a significant amount of hazardous waste Key stakeholders those persons, groups, or
This includes rubbish thrown in bins at home and institutions who can significantly influence, or are
collected by the local council. Also, litter collection and important to, the success of a project/program
street sweepings, garden rubbish, rubbish from civic Leachate wastewater that collects contaminants as it
amenity sites, and rubbish collected for recycling or trickles through MSW disposed in a landfill. Leaching
composting from domestic properties may result in hazardous substances entering surface
Incineration (1) a treatment technology involving water, groundwater, or soil
destruction of MSW by controlled burning at high License see Permit
temperatures, for example, burning sludge to reduce the Lowest-observed-adverse-effect level (LOAEL) the
remaining residues to a safe, noncombustible ash that lowest tested dose of a substance that has been
reported to cause harmful (adverse) health effects in flaring to reduce or eliminate odorous gases emanating
people or animals from decomposing wastes
Medical waste any municipal solid waste generated Operation the process of waste handling and
in the diagnosis, treatment, or immunization of human associated management activities
beings or animals Organic (1) referring to or derived from living
Metabolism the conversion or breakdown of a organisms; (2) in chemistry, any compound containing
substance from one form to another by a living organism carbon
Metabolite any product of metabolism Organic material (organic waste) materials
Methane an odorless, colorless, flammable, explosive containing carbon. The organic fraction of MSW includes
gas produced by municipal solid waste undergoing paper, wood, food scraps, plastics, and yard trimmings
anaerobic decomposition. Methane is emitted from Particulate matter (PM) tiny pieces of matter
municipal solid waste landfills resulting from the combustion process. PM can have
Minimization a comprehensive program to minimize harmful health effects when breathed. Pollution control
or eliminate wastes, usually applied to wastes at their at combustion facilities is designed to limit particulate
point of generation (see waste minimization) emissions
Morbidity state of being ill or diseased. Morbidity is Pathogenic capable of causing disease
the occurrence of a disease or condition that alters Pathogens microorganisms that can cause disease in
health and quality of life other organisms or in humans, animals, and plants (e.g.,
Mortality death. Usually the cause (a specific disease, bacteria, viruses, or parasites) found in municipal solid
a condition, or an injury) is stated waste, sewage, runoff from farms or rural areas
MSW composition MSW is as a heterogeneous populated with domestic and wild animals, and water
mixture of different types of discarded materials. The used for swimming
composition of MSW depends on the conditions of the Permit an authorization, license, or equivalent control
city in question. In general, MSW is composed of the document issued by governmental body or an approved
following fractions: paper, rubber, plastic, fabric, leather, state agency to implement the requirements of an
vegetable/putrescible, wood, etc. (combustibles), and environmental regulation, for example, a permit to
coal ash, glass, metal, etc. (noncombustibles) operate a landfill site or to operate a facility that may
MSW management (MSWM) supervised municipal generate harmful emissions
solid waste management from its source of generation Pest an insect, rodent, nematode, fungus, weed, or
through collection or street sweeping, recovery, and other form of terrestrial or aquatic plant or animal life that
treatment/processes to disposal is injurious to health or the environment
Municipal solid waste (MSW) includes Physiologically based pharmacokinetic model
nonhazardous waste generated in households, (PBPK model) a computer model that describes what
commercial and business establishments, institutions, happens to a chemical in the body. This model describes
and nonhazardous industrial process wastes, how the chemical gets into the body, where it goes in the
agricultural wastes, and sewage sludge. In practice, body, how it is changed by the body, and how it leaves
specific definitions vary across jurisdictions the body
MSW means household waste, commercial solid Pica a craving to eat nonfood items, such as dirt, paint
waste, nonhazardous sludge, conditionally exempt chips, and clay. Some children exhibit pica-related
small quantity of hazardous waste, and industrial solid behavior
waste Plume a volume of a substance that moves from its
Municipal wastewater (sewage) the spent or used source to places farther away from the source. Plumes
water from a home, community, institution, farm, or can be described by the volume of air or water they
industry that contains dissolved or suspended matter occupy and the direction they move. For example, a
(see wastewater) plume can be a column of smoke from a chimney or a
NIMBY acronym for ‘not in my back yard.’ An substance moving with groundwater
expression frequently used by residents whose A three-dimensional envelope that contains all the
opposition to siting a waste management facility is material (solid, liquid, or gas) released by a source into
based on the facility’s proposed location its surroundings
No-observed-adverse-effect level (NOAEL) the Point of exposure the place where someone can
highest tested dose of a substance that has been come into contact with a substance present in the
reported to have no harmful (adverse) health effects on environment (see exposure pathway)
people or animals Point source a stationary location or fixed facility from
Odor control the use of equipment such as activated which pollutants are discharged; any single identifiable
carbon filters, odor-attenuating cover materials, and gas source of pollution
Policy a series of broad statements setting out the is a summary written in words that are easy to
overall policy framework for either environmental understand. The public health statement explains how
management or MSWM at the national or regional level. people might be exposed to a specific substance and
For MSWM, policy is often termed a ‘national sector describes the known health effects of that substance
strategy’ Public health surveillance the ongoing, systematic
Pollution generally, the presence of matter or energy collection, analysis, and interpretation of health data.
whose nature, location, or quantity generates undesired This activity also involves timely dissemination of the
environmental effects data and use for public health programs
Pollution prevention the active process of identifying Quality assurance/quality control a system of
areas, processes, and activities that generate excessive procedures, checks, audits, and corrective actions to
waste for the purpose of substitution, alteration, or ensure that all research design and performance,
elimination of the process to prevent waste generation in environmental monitoring and sampling, and other
the first place technical and reporting activities are of the highest
Population a group or number of people living within a achievable quality
specified area or sharing similar characteristics (such as Radioisotope an unstable or radioactive isotope
occupation or age) (form) of an element that can change into another
Pretreatment process used to reduce, eliminate, or element by giving off radiation
alter the nature of wastewater pollutants from Radionuclide any radioactive isotope (form) of any
nondomestic sources before they are discharged into element
wastewater treatment facility Receptor population people who could come into
Prevalence the number of existing disease cases in a contact with hazardous substances (see exposure
defined population during a specific time period (contrast pathway)
with incidence) Recovery (1) chemical/biological processes such as
Prevalence survey the measure of the current level of biogas (methane) generation carrying out at the landfill
disease(s) or symptoms and exposures through a to recover gas (energy/heat). Municipal wastewater
questionnaire that collects self-reported information from sludge generated at the municipal wastewater treatment
a defined population facility is usually added to enhance process of gas
Prevention actions that reduce exposure or other generation. Putrescible fraction of the MSW is also
risks, keep people from getting sick, or keep disease used to produce compost or methane by fermentation
from getting worse (anaerobic digestion). (2) The process by which
Public health action a list of steps to protect public MSW otherwise destined for disposal are collected,
health re-processed or remanufactured, and reused
Public health assessment (PHA) a document that Recycling separation physical/mechanical process by
examines hazardous substances, health outcomes, and which secondary raw materials (paper, metals, glass,
community concerns at a hazardous waste site to and plastics/synthetics) are obtained from MSW. The
determine whether people could be harmed from coming process could be accomplished manually, by simple or
into contact with those substances. The PHA also lists sophisticated mechanical equipment
actions that need to be taken to protect public health The process by which materials otherwise destined for
(compare with health consultation) disposal are collected, reprocessed, or remanufactured,
Public health hazard a category used in public health and are reused
assessments for sites that pose a public health hazard Reduction this involves using less materials so that
because of long-term exposures (greater than 1 year) to less rubbish is created. For example, many glass bottle
sufficiently high levels of hazardous substances or makers now use less glass to make a bottle than they
radionuclides that could result in harmful health effects did 10 years ago. This means that less glass rubbish is
Public health hazard categories public health created when the bottles are thrown away
hazard categories are statements about whether people Refuse another term for municipal solid waste
could be harmed by conditions present at the site in the Registry a systematic collection of information on
past, present, or future. One or more hazard categories persons exposed to a specific substance or having
might be appropriate for each site. The five public health specific diseases (see exposure registry and disease
hazard categories are no public health hazard, no registry)
apparent public health hazard, indeterminate public Regulation generally used for secondary national
health hazard, public health hazard, and urgent public legislation, that is, detailed regulations to implement a
health hazard more general law
Public health statement the first chapter of an Regulator function refers to the responsibility for
ATSDR toxicological profile. The public health statement ensuring that MSWM happens in a manner that is in
conformance with legal requirements. In practical terms, Sensitivity analysis analysis of how errors in one or
this largely relates to the prevention of illegal waste more estimates would affect the conclusion drawn from
disposal (dumping) activities, and inspecting and the estimates
monitoring the operation of landfill sites and other waste Solid waste MSW composed of solid matter from
management facilities to ensure the conditions of the household, commercial, institutional, and industrial
site license or permit sources (see MSW)
Residual amount of a pollutant remaining in the Any garbage, or refuse, sludge from a wastewater
environment after a natural or technological process has treatment plant, water supply treatment plant, or air
taken place, for example, the sludge remaining after pollution control facility and other discarded material,
initial wastewater treatment, or particulates remaining in including solid, liquid, semisolid, or contained gaseous
air after it passes through a scrubbing or other process material resulting from industrial, commercial, mining,
Residuals unintended outputs of production and agricultural operations, and from community
processes. These include municipal solid waste and activities, but does not include solid or dissolved
wastewater materials in domestic sewage, or solid or dissolved
Residue the materials remaining after processing, materials in irrigation return flows or industrial
incineration, composting, or recycling of MSW. Residues discharges that are point sources subject to permit
are usually disposed of in landfills Source of contamination the place where a
Resource recovery the process of obtaining matter or hazardous substance comes from, such as a landfill,
energy from MSW waste pond, incinerator, storage tank, or drum. A source
A term describing the extraction and use of materials of contamination is the first part of an exposure pathway
and energy from the waste stream. The term is Special populations people who might be more
sometimes used synonymously with energy recovery sensitive or susceptible to exposure to hazardous
Reuse the act of using an item more than once. For substances because of factors such as age, occupation,
example, many supermarkets now have carrier bags sex, or behaviors (e.g., cigarette smoking). Children,
that you can use over and over again, and some pregnant women, and older people are often considered
businesses deliver goods in reusable plastic crates special populations
Reuse using a component of MSW in its original form Special waste refers to items that require special or
more than once, for example, refilling a glass bottle that separate handling, such as household hazardous
has been returned or using a coffee can to hold nuts and wastes, bulky wastes, tires, and used oil
bolts Stakeholder a person, group, or community who has
Risk the probability that something will cause injury or an interest in activities at a hazardous waste site
harm Stakeholders persons, groups, or institutions with
Risk communication the exchange of information to interests (often financial) in a project or program
increase understanding of health risks Standards governmental norms that impose limits on
Risk reduction actions that can decrease the the amount of pollutants or emissions generated
likelihood that individuals, groups, or communities will Stationary source a fixed-site generator of pollution,
experience disease or other health conditions mainly power plants and other facilities using industrial
Route of exposure the way people come into contact combustion processes
with a hazardous substance. Three routes of exposure Statistics a branch of mathematics that deals with
are breathing (inhalation), eating or drinking (ingestion), collecting, reviewing, summarizing, and interpreting data
and contact with the skin (dermal contact) or information. Statistics are used to determine whether
Rubbish the US EPA defines rubbish as municipal differences between study groups are meaningful
solid waste, excluding food waste and ashes, from Strategy develops MSWM at the metropolitan level
homes, institutions, and workplaces within the overall policy, taking account of all the
Sample a portion or piece of a whole. A selected strategic aspects as identified within the overall
subset of a population or subset of whatever is being conceptual framework. The three principal strategic
studied. For example, in a study of people the sample is dimensions at the core of MSWM are: (1) What is the
a number of people chosen from a larger population (see scope of MSWM activities that need to be addressed?
population). An environmental sample (e.g., a small (2) Who are the actors and stakeholders who will
amount of soil or water) might be collected to measure implement various activities? (3) How should the
contamination in the environment at a specific location strategic objectives and issues be addressed? The
Sample size the number of units chosen from a strategic component within the strategic plan also takes
population or an environment the ‘how’ question to the next level of detail. For
Sampling collecting a portion of a large amount as example, for all the technical levels of providing facilities
representative of the whole for the recycling, treatment, and disposal of MSW, the
strategy will focus on establishing a broad framework exposure can occur. The environmental media and
indicating, in outline terms, the types of facilities, where transport mechanism are the second part of an exposure
and when those facilities are to be built, their capacity, pathway
and the organizational/institutional arrangements for Treatment any method, technique, or process
their provision, funding, and management designed to remove solids and pollutants from MSW
Substance a chemical streams, effluents, and air emissions
Surveillance (see public health surveillance) Treatment plant a structure built to treat municipal
Surveillance system a series of monitoring devices wastewater before discharging it into a receiving water
designed to check on environmental conditions body
Survey a systematic collection of information or data. Tumor an abnormal mass of tissue that results from
A survey can be conducted to collect information from a excessive cell division that is uncontrolled and
group of people or from the environment. Surveys of a progressive. Tumors perform no useful body function.
group of people can be conducted by telephone, by mail, They can be either benign (not cancer) or malignant
or in person. Some surveys are done by interviewing a (cancer)
group of people (see prevalence survey) Uncertainty factor mathematical adjustments for
Sustainable waste management using material reasons of safety when knowledge is incomplete. For
resources efficiently to cut down on the amount of waste example, factors used in the calculation of doses that
produced. And, where waste is generated, dealing with it are not harmful (adverse) to people. These factors are
in a way that actively contributes to the economic, social, applied to the LOAEL or the NOAEL to derive a minimal
and environmental goals of sustainable development risk level (MRL). Uncertainty factors are used to account
Synergistic effect a biological response to multiple for variations in people’s sensitivity, for differences
substances where one substance worsens the effect of between animals and humans, and for differences
another substance. The combined effect of the between a LOAEL and a NOAEL. Scientists use
substances acting together is greater than the sum of uncertainty factors when they have some, but not all, the
the effects of the substances acting by themselves (see information from animal or human studies to decide
additive effect and antagonistic effect) whether an exposure will cause harm to people (also
Targets referring to or relating to result(s) aimed at by sometimes called a safety factor)
carrying out an action(s). An objective is usually Volatile organic compounds (VOCs) organic
qualitative, whereas a target is more specific or compounds that evaporate readily into the air. VOCs
quantitative include substances such as benzene, toluene,
Thermal treatment use of elevated temperatures to methylene chloride, and methyl chloroform
treat MSW (see incineration) Volatile organics organic compounds that vaporize at
Toxic harmful to living organisms relatively low temperatures or are readily converted into
Toxic agent chemical or physical (e.g., radiation, heat, a gaseous by-product
cold, and microwaves) agents that, under certain Volatilization a process in which gases are produced
circumstances of exposure, can cause harmful effects to and escape into the atmosphere. In landfills, methane
living organisms volatilization is of concern
Toxic pollutants materials that cause death, disease, Volume reduction processing MSW to decrease the
or birth defects in organisms that ingest or absorb them. amount of space they occupy, usually by compacting,
The quantities and exposures necessary to cause these shredding, or incineration
effects can vary widely Waste (1) unwanted materials left over from any
Toxic waste a waste that can produce injury if inhaled, human activity. (2) Refuse from places of human or
swallowed, or absorbed through the skin (see hazardous animal habitation. Waste may be generically defined as
waste) heterogeneous mixture of material that is discarded as
Toxicological profile an ATSDR document that superfluous and has no further use or value to its owner.
examines, summarizes, and interprets information about The EC Framework Directive on Waste defines waste as
a hazardous substance to determine harmful levels of ‘‘any substance or object which the holder discards or
exposure and associated health effects. A toxicological intends or is required to discard.’’ In waste planning
profile also identifies significant gaps in knowledge on there are various categorizations of waste (e.g.,
the substance and describes areas where further municipal solid waste, controlled waste, hazardous
research is needed waste, etc.), and the terms relevant to this guide have
Toxicology the study of the harmful effects of been defined elsewhere in this glossary
substances on humans or animals Waste collected (WC) the quantity of MSW in a given
Transport mechanism transport mechanisms move time period that is collected from municipal and domestic
contaminants from the source to points where human properties and other collection points
Waste combustion the combustion of MSW in an Wastewater the spent or used water from a home,
incinerator to produce electrical or thermal energy. The community, institution, farm, or industry that contains
MSW may be sorted or nonsorted, and may also be dissolved or suspended matter (see municipal
processed before incineration wastewater)
Waste disposed (WD) the quantity of MSW going to Water that is generated usually as a by-product of a
final disposal at the landfill or dump process, which cannot be released into the environment
Waste feed the continuous or intermittent flow of without some type of treatment
MSW into an incinerator Wastewater treatment plant a facility containing a
Waste generated the total amount of MSW arising series of tanks, screens, filters, and other processes by
from a generator. Includes both waste presented for which pollutants are removed from municipal
waste collection and waste sold or presented for wastewater
recycling
Waste management hierarchy the waste
management hierarchy is a symbol for the strategic
options available for dealing with MSW and their Introduction
desirability. An adapted version of the hierarchy
presents the more ‘desirable’ waste management Solid waste incinerators (SWIs) are industrial facilities,
practices at the top of the hierarchy (avoid, minimize, based on sustained high-temperature combustion
and recover material) and the least ‘desirable’ practices processes and intended to treat hazardous, clinical, or
at the bottom (treatment or disposal in landfill), with municipal waste, so as to reduce its volume and haz-
dumping ‘floating’ around the bottom, not even ardousness, capture, concentrate, and destroy potentially
recognized by the MSWM concepts as an option in harmful substances, and, as of more recently, recover
industrialized countries of the West energy from the combustion of the waste for disposal.
Waste minimization measures or techniques that The first SWI was built in Manchester (in 1876), for
reduce the amount of wastes generated during industrial purposes of hygiene and waste volume/weight reduction.
production processes; the term is also applied to Some years later (1893), a steam-generating incinerator
recycling and other efforts to reduce the amount of was in operation in Hamburg and two plants for local
waste going into the waste management system (also heating and cogeneration were built, between 1903 and
waste reduction) 1905, in the United States. But it was only toward the
The process of reducing the amount of waste that is end of the 1960s that SWIs for municipal solid waste
disposed of whether by businesses or households (MSW) started to be more frequently equipped with
Waste reduction waste reduction is a broad term energy recovery systems.
encompassing all waste management methods – source The quantities of MSW collected, landfilled, and
reduction, recycling, and composting – that result in incinerated (and respective percentage) in European and
reduction of waste going to a combustion facility or other technologically comparable countries for which
landfill information relative to the most recent years was
Waste stream a term describing the total flow of solid obtained are shown in Annexes 1 and 2. For selected
waste from homes, businesses, institutions, and years, Figures 1 and 2 present the same kind of data.
manufacturing plants that must be recycled, burned, or From these figures it is evident that the quantities of
disposed of in landfills, or any segment thereof, such as MSW incinerated vary greatly among countries, landfills
the ‘residential waste stream’ or the ‘recyclable waste are still widely used for the disposal of solid waste, and
stream’ many countries do not employ incineration at all, al-
Waste-to-energy plant combustion of MSW to though at the European level the percentage is slowly
generate electrical energy or heat rising. However, incineration is already an important
Waste treatment and disposal facility (WTDF) an option for the treatment and disposal of MSW in most
MSW facility comprising of MSW treatment (i.e., countries, accounting for a mean proportion of nearly
composting and incineration) and landfill for final 20% among Organization for Economic Co-operation
disposal of residues and Development (OECD) member countries and for the
Waste treatment stream the continuous movement latest available years.
of MSW from generator to treater and disposer Across Europe, in the late 1990s, MSW incinerators
Waste types in general, MSW include the following were either closed or upgraded to meet legislative
main groups of different waste types: household waste, requirements. Nowadays, new-generation SWIs are
commercial waste, institutional waste, street sweepings, becoming an increasingly common part of an ever more
construction debris, sanitation residues, and industrial complex MSW management system that, in spite of
waste (see also MSW Composition) being tightly regulated in most developed countries and
EU (27 countries)
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
1995
Hungary
Iceland
Ireland
Italy
Latvia
Lithuania
Luxembourg
Macedonia* 2000
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain 2005
Sweden
Switzerland
United Kingdom
Turkey
Canada (1)
Canada (2)
USA (1)
USA (2)
Japan (1)
Japan (2)
0 500 1000 1500 2000

−1 −1
MSW generated (kg person year )
Figure 1 Municipal solid waste generated per capita, selected countries, and years (1995, 2000, and 2005). (For source, see
Annexes 1 and 2 respective notes.)
including schemes for reduction of production, differ- large US cohort studies suggest that long-term exposure
entiated collection, and recycling of waste, as well as for to low concentrations of airborne pollutants is associated
recovery of energy and materials and for final disposal, with chronic health effects. A consensus has then been
has not proven sufficient to counter the problem of emerging among public health experts that airborne
growing waste production. pollutants, even at the lower current ambient levels,
Although recognized as effective means of reducing aggravate morbidity, especially respiratory and cardio-
and disposing of waste materials, modern, well-managed vascular diseases, and lead to premature mortality.
incinerators still raise public and scientific concerns Therefore, in view of the growing evidence of the pos-
related to the by-products of the incineration processes, sible direct effects of a wide variety of long-term low-
in particular the atmospheric emissions of hazardous or level exposures to pollutants that are also emitted during
toxic inorganic and organic substances resulting from the processes involved in waste incineration, the large
combustion and from incomplete combustion, which add proportion of the population potentially exposed to the
to background pollution levels. Reasons for concern are currently on-the-increase practice of waste incineration,
the inhalation of airborne pollutants, the consumption of and its indirect implications on human health through
polluted food and water, or contact with polluted soil and a nonnegligible contribution to greenhouse gases and
consequent potential adverse health effects. However, persistent pollutants on a global scale, the potential
since SWI technology has evolved over time, in general health impacts of SWIs cannot be disregarded.
leading to a reduction of emissions, it is unlikely that
modern incinerators, when built with the best available
technologies, properly run and maintained, and pro- Hazards Associated with Solid Waste
cessing adequate waste, make a significant contribution to Incinerators
the overall background pollution level in the vicinity of
the incinerators. The level of public exposure due to such In the context of waste incineration, a hazard can be
facilities is substantially lower than that from the older defined as a source of potential negative effects on the
generation of incinerators and the occurrence of meas- environment and of subsequent risks to human health or
urable health effects on nearby communities is becoming quality of life, directly or indirectly associated with past,
less probable (Tables 1–3). Nevertheless, results from current, or future exposure to plant emissions.
% MSW incinerated % MSW landfilled

0 10 20 30 40 50 60 10 20 30 40 50 60 70 80 90 100
EU (27 countries)
Austria
Belgium
Bulgaria
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
Switzerland
United Kingdom
Turkey
USA (1)
USA (2)
1995 2000 2005
Figure 2 Comparative analysis of percentage of municipal solid waste generated disposed of by incineration and landfilling (selected
countries and years – 1995, 2000, and 2005). (For source, see Annexes 1 and 2 respective notes.)
Major emissions from waste incinerators consist of in aggressive environments and that potentially harmful
gaseous combustion products, two main forms of solid constituents are stabilized by the cement, reuse of bottom
products, namely air pollution control residues and fur- ash does not represent a significant health or environ-
nace bottom ash, and cooling water discharges. Air pol- mental risk. Waste incineration releases to sewer or surface
lution control residues are usually disposed of to landfill as water practically only occur through cooling water,
special waste, being more or less likely to determine since nowadays most incinerators have dry or semi-dry gas
a wide variety of human exposures to a multiplicity of cleaning systems, eliminating discharges to the aquatic
hazardous agents depending on site factors and manage- environment of pollutants associated with wastewater
ment practices. On the contrary, bottom ash is disposed of resulting from the cleaning of exhaust gases. Emissions
to landfill as nonspecial waste, although very commonly it to air, in particular stack releases, have a large number
is reused in, for example, road construction or building of different hazardous substances that, although mostly
materials. Because these materials are not normally used produced at extremely low levels, have potentially
Table 1 Summary of epidemiological reviews to assess the health effects from waste incinerator emissions in the populations living
close to the facilities
Studies Findings/conclusions
Studies on cancer and Excesses were reported for specific cancer causes (cancer of the digestive system, the liver,
noncancer effects kidneys, pancreas, and non-Hodgkin’s lymphomas)
reviewed by Rushton in a Little evidence has been found for an association between modern incinerators and reproductive or
study in 2003a developmental effects
Little evidence has also been found for increased prevalence of respiratory illness using either self-
reported symptoms or physiological measures
Most of the studies have assessed exposure using some measure of distance from the site or an
estimate of areas at most risk from emissions. Exposure data were found to be inadequate for
drawing reliable conclusions
Studies included in the Conclusion is that despite reports of cancer clusters around the older generation of incinerators, there
review carried out by is no convincing evidence of association between incinerators and cancer: ‘‘y any potential risk of
Enviros Consulting Ltd. in cancer due to residency (for periods in excess of ten years) near to municipal solid waste
a study in 2004b incinerators was exceedingly low and probably not measurable by the most modern techniques’’
There is also little evidence to suggest that waste incinerators are associated with increased
prevalence of respiratory symptoms in the surrounding population. Rather it seems unlikely that
incinerators make respiratory problems worse as in most cases the modern incinerators contribute
only a small proportion of the local level of air pollutants
The epidemiological studies on the incidence of reproductive outcomes of communities living in the
vicinity of incinerators have also failed to establish any convincing links with incinerator emissions
It is stressed that in most cases the incinerator emissions make a small contribution to local levels of
air pollution
Studies published between The studies included in this review are from both first-generation and more modern incinerators.
1987 and 2003 and Therefore, the results of all the studies cannot be easily compared, and consistency across studies is
reviewed by Franchini not expected
et al. in a study in 2004c Significant positive results were found for two-thirds of those studies focusing on some specific
cancers (non-Hodgkin’s lymphomas (NHL), soft tissue sarcomas (STS), lung cancer, and childhood
cancer)
Results on noncancer end points, such as chronic or acute respiratory effects in children or adults,
were inconclusive
Biomonitoring studies did not provide conclusive evidence, although in some studies exposure to
PCB and heavy metals was associated with reduction of thyroid hormones
In most of the studies exposure was poorly characterized
Studies published between Most of the studies assessed the individual exposure using biomarkers. Only a small number of
2003 and 2006 and ‘traditional’ epidemiological studies, based on surrogate exposure metrics, were considered
reviewed by Bianchi and Some associations for NHL and STS were reported but the number of studies was limited and
Minichilli in a study in exposure was poorly characterized
2006d
European studies reviewed Two French studies dealing with the relation between dioxin levels in blood of population and cancer
by Linzalone and Bianchi incidence did not give consistent results
in a study in 2007e,f An Italian meta-analysis found an excess of male mortality for NHL in the population of 25 small
municipalities with municipal solid waste incinerator
A significant association between modeled dioxin exposure and sarcoma risk was detected in the
Province of Venice
a
Rushton L (2003) Health hazards and waste management. British Medical Bulletin 68: 183–197.
b
Enviros Consulting Ltd., University of Birmingham, Risk and Policy Analysts Ltd., Open University, Thurgood M (2004) Review of Environmental and
Health Effects of Waste Management: Municipal Solid Waste and Similar Wastes. London: Department for Environment, Food and Rural Affairs.
Available online as PDF file (420pp.). http://www.health.gov.au/internet/main/publishing.nsf/Content/03D879161615A79ACA2571E0000C8CF1/
$File/EHRA%202004.pdf (accessed May 2010).
c
Franchini M, Rial M, Buiatti E, and Bianchi F (2004) Health effects of exposure to waste incinerator emissions: A review of epidemiological studies.
Annali dell’Istituto Superiore di Sanità 40(1): 101–115.
d
Bianchi F and Minichilli F (2006) Mortalità per linfomi non Hodgkin nel periodo 1981–2001 in 25 comuni italiani con inceneritori di rifiuti solidi urbani
[Mortality for non-Hodgkin lymphoma in the period 1981–2000 in 25 Italian municipalities with urban solid waste incinerators]. Epidemiologia e
Prevenzione 30(2): 80–81 (in Italian).
e
Linzalone N and Bianchi F (2007) Inceneritori: Non solo diossine e metalli pesanti, anche polveri fini e ultrafini [Incinerators: Not only dioxins and
heavy metals, also fine and ultrafine particles]. Epidemiologia e Prevenzione 31(1): 62–66 (in Italian).
f
World Health Organization (2007) Population Health and Waste Management: Scientific Data and Available Options. Report of a WHO Workshop –
Rome, Italy, 29–30 March 2007. Copenhagen, Denmark: WHO Regional Office for Europe. Available online as PDF file (90pp.). http://www.euro.
who.int/document/E91021.pdf (accessed May 2010).
Table 2 Summary of a large surveillance program carried out on the population living near two Portuguese waste incinerators, one in
Lisbon (since 1999) and one in Madeira Island (since 2002)
Methodological approaches of the studiesa Findings/conclusions
Studies addressed to exposure

Several human biomonitoring (HBM) studies were set out to investigate Results for body levels of dioxins and heavy metals showed no
the local levels of exposure to air pollutants, based on analysis of statistically significant differences between exposed and not exposed
substances in the blood of the general population (for dioxin and 10 populations (defined according to the distance from the plants)
heavy metals), in the umbilical cord blood and maternal blood and pubic suggesting the presence of effective source control measures and
hair of mother–child pairs, as well as in the blood of children under 6 abatement technology in both plants
years of age (for lead and mercury), and in the milk of breastfeeding Results from exposure determination showed a significant declining trend
women (for dioxins) for almost all the pollutants (dioxins and metals) under study
The biomonitoring campaigns were conducted through a series of cross- No consistent or convincing evidence of a link between the health
sectional studies, repeated every 2 years, which also included the outcomes under study and incineration has been found
administration of questionnaires addressed to anthropometric and The studies concluded that releases from these incinerators appeared to
sociodemographic factors, lifestyle, and behavioral variables, in order to have no detectable adverse health effects in the populations living in the
control the confounding surroundings, which is consistent not only with the available data from
Analyses and surveys of possible adverse health effects were conducted risk assessments and from emissions and ambient air monitoring in the
on asthma prevalence, cancer mortality and incidence, mental health vicinity of these incinerators, but also with findings from a number of
status, self-perception of health status, and frequency of reproductive published studies on other plants that indicate that modern, well-
disorders such as low birth weight, preterm delivery, spontaneous managed waste incinerators will only make a very small contribution to
abortion, fetal malformations, and infant and perinatal mortality background levels of air pollution
Studies addressed to potential health effects

These studies were carried out through periodic analyses of health The main limitation of these studies is the estimation of the effects for
registries (cancer mortality, infant and perinatal mortality, and low-birth- relatively small areas, which will generate the casuistic of small numbers
weight and fetal malformations data) and self-administered that may lead to put too much weight in small differences between
questionnaires dealing with asthma and tobacco consumption, mental already small numbers
health, and self-perception of health status
The studies attempted to assess exposure using two surrogate
measures: living in an incinerator community and distance from the
incinerator
The studies examined differences in the health outcomes under
investigation between individuals or registries from each of the study
communities and their respective control community
a
Related publications include:
Reis MF, Miguel JP, Sampaio C, Melim JM, and Aguiar P (2004) First results from dioxins and dioxin-like compounds in the population from
Madeira Island, Portugal. Part 1 – Biomonitoring in blood of the general population living near to a solid waste incinerator. Organohalogen
Compounds 66: 2736–2742.
Reis MF, Sampaio C, Melim JM, and Miguel JP (2004) First results from dioxins and dioxin-like compounds in the population from Madeira
Island, Portugal. Part 2 – Biomonitoring in breast milk of women living near to a solid waste incinerator. Organohalogen Compounds 66:
2743–2749.
Sampaio C, Murk A, Reis MF, and Miguel JP (2004) Possible additional exposure to dioxin and dioxin-like compounds from waste incineration.
Biomonitoring using human milk and animal samples. Organohalogen Compounds 66: 2773–2778.
Sampaio C, Reis MF, Miguel JP, and Aguiar P (2004) Levels and trends in human blood and milk of residents in the vicinity of a modern
municipal solid waste incinerator near to Lisbon. Organohalogen Compounds 66: 2779–2783.
Reis MF, Miguel JP, Sampaio C, et al. (2007) Determinants of dioxins and furans in blood of non-occupationally exposed populations living near
Portuguese solid waste incinerators. Chemosphere 67(9): S224–S230.
Reis MF, Sampaio C, Aguiar P, et al. (2007) Biomonitoring of PCDD/Fs in populations living near Portuguese solid waste incinerators: Levels in
human milk. Chemosphere 67(9): S231–S237.
Reis MF, Sampaio C, Brantes A, et al. (2007) Human exposure to heavy metals in the vicinity of Portuguese solid waste incinerators – Part 1:
Biomonitoring of Pb, Cd and Hg in blood of the general population. International Journal of Hygiene & Environmental Health 210(3–4): 439–446.
Biomonitoring of lead in maternal and umbilical cord blood. International Journal of Hygiene & Environmental Health 210(3–4): 447–454.
Biomonitoring of Pb in blood of children under the age of 6 years. International Journal of Hygiene & Environmental Health 210(3–4): 455–459.
Reis MF, Melim JM, Aguiar P, et al. (2008) Public health impact of waste incineration in Lisbon and Madeira (Portugal) during the past eight
years. European Journal of Public Health 18(supplement 1): 52–53.
Reis MF, Melim JM, Gomes P, et al. (2008). Prevalence of asthma in adolescents living near solid waste incinerators in Lisbon and Madeira.
European Journal of Public Health 18(supplement 1): 52.
disproportionate (in relation to amount emitted) great opportunities for exposure over time, subsequent bio-
impact on the environment and on human health, due to accumulation and bioamplification, and inherent toxicity.
their characteristics of environmental persistence, or long The substances associated with atmospheric emissions
half-lives in the environment or biota, which increase the from waste incineration plants are usually grouped as
Table 3 Summary of two quantitative estimates of the public health impact of emissions from waste incinerators
Study description Findings/conclusions
(A) Studya based on an impact pathway approach (IPA)

Main steps: The following summarizes the conclusions of the various
issues examined in this study:
Specification of the emissions from municipal solid waste (a) Although MSW is a dirty fuel, emissions will be lower than
incinerators (MSWI) (with emissions equal to the regulations those from most conventional combustion technologies with
proposed by the EC in 1994, for typical per capita MSW much cleaner fuels
production) (b) The incremental concentration of pollutants from MSWI with
Calculation of increased pollutant concentrations in all affected emissions equal to the EC 1994 regulations is far below the
regions (using atmospheric dispersion models) ambient air quality guidelines of the EPA or WHO
Calculation of health damages (using dose–response functions) (c) The cancer impacts of micropollutants (particularly of dioxins)
Monetary valuation of this damage is small compared to the mortality due to ordinary particulate
matter (PM) from MSWI
On the basis of assembled data and calculations, the risks of (d) The mortality due to PM from MSWI is insignificant compared
exposure to air pollution from MSWI have been put in to the contribution of other sources of PM or compared to other
perspective through the following comparisons: risks of everyday life
(e) Even if all MSW is incinerated in accordance with the EC 1994
Incremental emission versus other emissions regulations, the total health damage costs are relatively minor
Incremental concentration versus background concentration (f) On the whole, it can be concluded that by any of the
Incremental concentration (or dose) versus health guidelines comparisons made the health impacts of exposure to air
Health risks of different pollutants compared to each other pollution from MSWI appear insignificant, provided that the
Incremental years of life lost versus other risks of everyday life emissions respect the EC 1994 regulations
(B) Studyb based on a quantitative risk assessment approach The most relevant conclusions of this study are as follows:
This study was restricted to the following airborne pollutants: (a) The more significant effects are associated with emissions of
Carcinogenic metals (nickel, chromium – chromium(VI) oxidation the ‘classical’ pollutants. ‘‘The dioxin emission contribution to
state – and arsenic) exposure of local populations is entirely negligible’’ since
Polycyclic aromatic hydrocarbons (PAH) dioxin emissions from MSWI make up less than 1% of the total
Dioxins, furans, and PCBs UK dioxin emissions. On the other hand, the PAH emissions
Particulate matter (PM10) from incineration are unlikely to be significant given that overall
Sulfur dioxide emissions from MSW treatment are rather less than 3% of
Nitrogen dioxide total UK emissions to air. Moreover, metal emissions from
MSW incineration represent a very small percentage of the
The criterion for the selection was the possibility that the total national UK emissions
emissions to air might cause incremental pollutant (b) For the amount of waste currently managed in the United
concentration that, by some way, amounted to a significant
Kingdom and on a national scale, emissions to air are
proportion of a concentration considered likely to present risks estimated to cause around five additional hospital admissions
to human health for respiratory disease each year, less than one death brought
forward per 100 years, and about one additional cancer case
The basic methodological stages of the study included:
at a similar level
Estimation of typical pollutant mass emissions and related
(c) Comparing the health effects from MSW management with
relevant physical parameters
other causes, it was concluded that other influences are much
Application of an atmospheric dispersion model using typical UK
more important, even for people residing in the vicinity of MSW
meteorological data
management facilities
Adoption of two uniform population densities (rural/suburban
(d) Overall conclusion from this study is that it is essential that
and suburban/urban areas) to represent the distribution of
every opportunity be taken to carry out research where there is
population around the source of emissions
lack of good-quality data and to make independent and
Estimation of the numbers of people exposed to specific
balanced reviews of the available information on health
pollutant ground-level concentrations
impacts of MSW treatment, placing it in perspective in relation
Estimation of the following health effects on an assumed
to other influences on health
exposed population:
– Deaths brought forward (deaths occurring sooner than would
otherwise have happened)
– Additional respiratory hospital admissions
– Additional cases of cancer
a
Rabl A, Spadaro JV, and McGavran PD (1998) Health risks of air pollution from incinerators: A perspective. Waste Management & Research 16:
365–388.
b
Enviros Consulting Ltd., University of Birmingham, Risk and Policy Analysts Ltd., Open University, Thurgood M (2004) Review of Environmental and
Health Effects of Waste Management: Municipal Solid Waste and Similar Wastes. London: Department for Environment, Food and Rural Affairs. q.v.
Environment Agency (2003). Available online as PDF file (420pp.). http://www.health.gov.au/internet/main/publishing.nsf/Content/
03D879161615A79ACA2571E0000C8CF1/$File/EHRA%202004.pdf (accessed May 2010).
Environment Agency (2003) Review of Incineration and Other Combustion Techniques. Prepared by the University of Birmingham, Sheffield
University, Leeds University, Leicester University (Draft report).
Table 4 Waste incineration air emission limit values

Pollutanta Limitsb (mg Nm3 s1) Pollutanta Limits (mg Nm3 s1)
Total dust 10–30 Cd þ Tl 0.05

TOC 10–20 Hg 0.05
HCl 10–60 Sb þ As þ Pb þ 0.5
HF 1–4 þ Cr þ Co þ Cu þ
SO2 50–200 þ Mn þ Ni þ V
NOxc 200–400 Dioxins and furans 0.1 ng Nm3 d
CO 50–100 PAH –
a
From the health perspective, the most relevant of the air pollutants are:
• those classed as heavy metals, including lead (Pb), mercury (Hg), cadmium (Cd), chromium (Cr), and arsenic (As);
• the organic compounds, such as dioxins – that include two families of chemicals, polychlorinated dibenzo-para-dioxins (PCDDs) and
polychlorinated dibenzofurans (PCDFs) – the polychlorinated biphenyls (PCBs), and the polycyclic aromatic hydrocarbons (PAHs);
• the particles, particulate matter covering the full range of sizes from PM10, PM5, and PM2.5 to ultrafine, which have an aerodynamic diameter
smaller than 10, 5, 2.5, and under micrometers, respectively (particle size is a relevant factor due to the fact that it has implications on the
fraction that reaches the various parts of the airways and that chemical composition may vary with size, e.g., lead occurs mainly in ultrafine
particles, generally with a diameter of under 1 mm);
• other so-called macropollutants such as carbon monoxide (CO) and carbon dioxide (CO2), sulfur dioxide (SO2), and nitrogen oxides (NOx).
b
The double limit values are daily average and maximum (hourly or 30-min average), respectively.
c
NO and NO2 expressed as NO2.
d
Emission limit values calculated using the concept of toxic equivalence factors referred to 2,3,7,8-tetrachlorodibenzodioxin (TCDD).
Source: European Directive 2000/76/EC of the European Parliament and of the Council on the incineration of waste (28 December 2000) (OJ L332,
P91 – 111).
particles, acidic gases and aerosols, metals, and organic waste. Therefore, the discussion in this article will be
compounds. Emission limits set out by European Dir- focused on this type of incinerator.
ective 2000/76/EC are presented in Table 4. Owing to factors such as population density and
Reflecting the greatest concerns raised by emissions socioeconomic level, use of minimization initiatives,
from the stack, most available published data do not seasonality, and, with regard to commercial waste, the
include emissions to air created by the storage and pro- nature of commerce, composition of MSW can vary
cessing of waste before incineration, nor potential re- considerably with place and over time. Figure 3 sets out
leases of ash to air. As far as is known by the author of this the principal components’ relative mean contributions to
article, the only exceptions concerning biohazards in the MSW collected in OECD member countries.
air within and immediately outside incineration facilities It is apparent from the figure that although the order
are studies carried out in the United Kingdom whose of category contributions does not vary greatly over
results have shown low levels though higher within the time when considering each country individually, waste
plant, which reduced to background levels a few meters composition varies to an important degree between
from the facility. With respect to pollutants from the countries. This means that incineration emissions cor-
waste handling and storage operations such as dust and respond to a wide range of waste materials and, as such,
volatile organic compounds, some studies show higher are susceptible of reaching very different levels, if not
levels within waste incineration facilities but all studies controlled to comply with imposed limits.
suggest releases are not likely to be significant. Another source of potential variability in incinerator
Table 5 summarizes pollutants identified in the stack releases is that related with plant operating conditions.
gas analyses from a number of existing incinerator Incinerators operating out of compliance with operating
facilities. It is evident from this table that the emissions licenses and permits still exist, although decreasing
from waste incinerators may vary widely, depending in number. On the other hand, as any industrial facility,
above all on the type of incinerator and of waste, SWIs can experience incidents, if occasionally operated
to say nothing about used air pollution control device. under nonstandard conditions such as technically un-
However, the legislation in place created operating avoidable stoppages, disturbances or failures of the
conditions for incineration units in such a way as to en- purification or measurement devices, or changes in
sure that, independent of the type of waste, the quantities the composition of materials fed in, which might lead to
of pollutants emitted are always below the established emissions outside regulatory requirement levels. This
limits in order that, in terms of the current state of situation is always of concern and one whose recurrence
knowledge, no significant impacts on health occur. On it is important to prevent. Nevertheless, according
the other hand, MSW is the most generalized type of to the UK Environment Agency (UK EA) records, the
Table 5 Pollutants identified in stack emissions from US waste incineration facilities

Pollutant Incinerator typea
Municipal Hospital Biomass (4) Manure (1) Tire (1) Landfill gas Sewage
waste (5) waste (7) (20) sludge and
digester gas
(5)
Nitrogen oxides Y Y Y Y Y Y Y
Sulfur oxides Y Y ND Y Y Y Y
Particulate matter Y Y Y Y Y Y Y
Carbon monoxide Y Y Y Y Y Y Y
Total hydrocarbons Y Y Y Y Y Y Y
Hydrogen chloride Y Y NA NA Y NA NA
Hydrogen fluoride Y NA NA NA NA NA NA
Ammonia NA NA Y NA Y NA NA
Carbon dioxide Y Y Y Y Y NA Y
Arsenic Y Y Y NA Y Y Y
Beryllium Y NA NA NA Y Yb Y
Cadmium Y Y Y NA ND Yb Y
Chromium (total) Y Y Y NA Y Y Y
Chromium(VI) ND Y NA NA Y NA NA
Copper Y NA NA NA NA Y NA
Mercury Y Y NA NA ND Y Y
Iron NA NA Y NA NA NA NA
Manganese NA NA Y NA NA NA NA
Nickel Y Y Y NA ND Y Y
Lead Y Y Y NA ND Y Y
Zinc NA NA NA NA NA Y NA
Polyaromatic Y NA Y NA Y NA NA
hydrocarbonsb
Polychlorinated Y ND Y NA Y NA NA
biphenylsb
Benzene Y Y Y NA NA NA NA
Polychlorinated Y Y Y NA Y NA NA
dibenzo(p)dioxinsb
Polychlorinated Y Y Y NA Y NA NA
dibenzofuransb
2,3,7,8-Tetrachloro Y Y Y NA Y NA Y
dibenzo(p)dioxin
equivalentsb
a
Number in parentheses indicates the number of facilities for which data were tabulated.
b
Isomers and homologues that were not detected were added to total values at one-half the detection limit; pollutant may not have actually been
detected.
Y, detected in at least one emission test; ND, not detected in any emission test; NA, no analysis.
Source: Adapted from US EPA (2005) Human Health Risk Assessment Protocol (HHRAP) for Hazardous Waste Combustion Facilities, Final, EPA520-
R-05-006: Appendices and Chemical-Specific Data. Washington, DC: U.S. Environmental Protection Agency (EPA) Region 6 and the US EPA Office
of Solid Waste and Emergency Response. http://www.epa.gov/osw/hazard/tsd/td/combust/risk.htm#hhrad (accessed May 2010).
frequency of violations of MSW incinerator license nuisance, are those inherent to the nature of the waste
conditions is low and there is no consistent evidence (odors, wind-blown waste, dust, spores, flies, and other
for health impacts on the communities surrounding pest species attracted to the waste material), to transport-
the plants, suggesting that these short-term abnormal related emissions (road traffic pollution, noise, and dust),
occurrences are likely to become practically irrelevant. and to a wide variety of hazards from the operation of the
Hence, and despite the wide variety in geographic and facilities, in particular noise and sleep-disturbing light.
temporal composition of the waste materials as well as in Last but not least, when addressing hazards associated
the proportions of incinerated MSW, emission levels of with SWIs, the risk perception of the population living
current incineration plants are quite similar, mainly due near the plants also has to be considered, since it con-
to legislative requirements. stitutes a relevant though indirect source of harm linked
Less easily quantifiable hazards, which however can to waste incineration, due to the fact that it can have
also have direct impacts particularly on local workers’ effects on the psychological well-being and mental health
and nearby residents’ health due to their constituting a of the surrounding communities.
Canada Mexico USA

Percentage of total 100
80
60
40
20
Japan Korea Australia

100
Percentage of total
80
60
40
20
New Zealand Austria Belgium

100
Percentage of total
80
60
40
20
Czech Republic Denmark Finland

100
Percentage of total
80
60
40
20
France Germany Greece

100
Percentage of total
80
60
40
20
0
80 85 90 95 00 05 80 85 90 95 00 05 80 85 90 95 00 05
Year Year Year
Paper and paperboard Organic material Plastics

Glass Metals Textiles and other
Figure 3 Composition of municipal waste,a OECD member countries, 1980–2005. Source: Based on table 2B, OECD Environmental Data
Compendium 2006/2007, & OECD, 2007. http://www.oecd.org/document/49/0,3343,en_2649_37465_39011377_1_1_1_37465,00.html
(accessed May 2010).
Hungary Iceland Ireland

100
Percentage of total
80
60
40
20
Italy Luxembourg Netherlands

100
Percentage of total
80
60
40
20
Norway Poland Portugal

100
Percentage of total
80
60
40
20
Slovak Republic Spain Sweden

100
Percentage of total
80
60
40
20
Switzerland Turkey UK
100
Percentage of total
80
60
40
20
0
80 85 90 95 00 05 80 85 90 95 00 05 80 85 90 95 00 05
Year Year Year
Paper and paperboard Organic material Plastics

Glass Metals Textiles and other
Figure 3 (Continued)
Notes:
a Average composition of municipal waste, expressed as the percentage contributions of various materials to the total weight.
When interpreting these data, it should be borne in mind that the definition of municipal waste and the surveying methods used
vary from country to country.
CAN: 1990, 1995, and 2005 data refer to 1988, 1998, and 2004. 1998–2004: nonhazardous solid waste (7 million tons in 2004)
generated from residential, industrial, commercial, and institutional sources prepared for recycling at an off-site facility,
excluding construction and demolition waste.
MEX: % of municipal waste generated; 1990: 1991 data; other: fines, rubber, nappies, etc. Latest year: 2006 data.
USA: Food: includes food waste and yard trimmings; other: includes rubber, leather, wood, and miscellaneous inorganic waste.
JPN: 1980: average of four cities; other: rubber, ceramics; 1985, 1990: Tokyo metropolitan area only; 2000: % of wet weight, Ministry
of Environment Survey.
KOR: Break in time series between 1990 and 1995. 2005: 2004 data.
AUS: 1995: composite results from state surveys (SA, NSW, Tasmania, ACT, Vic., WA, Qld); data refer to various years of the early
1990s. 2005: 2002–03 data; other: including concrete (3%) and timber (1%).
NZL: 1995: data for household waste landfilled only.
AUT: 1995, 2000, and 2005: 1993, 1999, and 2004 data; household waste only; foof: includes all organic waste. Textiles and other
1999, 2004: includes bulky waste.
BEL: 1995 onward: NSI estimates; 2005 data refer to 2003; textiles and other: includes bulky waste; 1980 and 1990: data refer to
household waste only.
CZE: 1985 and 1995: 1987 and 1996 data that are incomplete estimates from the pilot phase of waste survey; other: mineral, bulky
waste, street rubbish.
DNK: 1980 (1979 data), 1985: household waste only; 1995, 2000, and 2005 (2003 data): separate collection (52% of municipal waste
in 2003).
FIN: 1990 and 1995 data refer to 1992 and 1994.
FRA: Household waste (excluding bulky waste); 1995 onward: municipal waste; 1990, 2005: 1989, 2002 data.
DEU: Separate collection only; 1995: 1993 data; breaks in 2000 and 2005 (2002 data).
GRC: 2000: 1997 data; other: inert waste and other waste not mentioned.
HUN: Data based on volumetric information for Budapest; other: inorganic waste; from 2000: includes also hazardous waste.
ISL: Household waste. 2005: 2003 data; other: nappies, waste from electrical and electronic equipment, minerals, candlewax, other
undefined.
IRL: 1980: 1979 data; 1995 onward: data refer to the total municipal waste landfilled and recovered; other: wood, waste electrical
and electronic equipment, street cleansing waste.
ITA: 1985 and 1995 data refer to 1986 and 1996; 1995 onward: separate collection and bulky waste only (26% of municipal waste in
2005).
LUX: 1985: household waste only; other: composite matter, baby nappies, hazardous waste; 1995 onward: separate collection only
(42% of municipal waste in 2003); 2005: 2003 data; plastics and metals: incomplete figures from 1997 onwards.
NLD: 2005: 2004 data. Household waste only; data based on the content of waste bags (excluding separate collection).
NOR: Metals 1985: include glass; 1995: 1996 data; 2005: 2001 data for household only.
PRT: 1990, 1995, and 2005 data refer to 1989, 1994, and 2001. 2000: traditional collection only; other: wood, fine waste, and other
waste.
SVK: 1985, 2005: 1987 and 2002 data; other: includes ashes and other inert material.
ESP: Household and similar waste; 2005: 2002 data; other: batteries, rubber, and wood.
SWE: 1980: estimates for the period 1975–1980; paper: includes fraction separated at source; includes paper laminated with
plastics; food: putrescent waste; textiles and other: includes leather and rubber. 2000, 2005: separate collection (34% of
municipal waste in 2005) excluding organic waste.
CHE: Excludes separately collected waste; 1995, 2005: 1994, 2002 data; other: composite packaging and items, minerals and
fraction smaller than 8 mm.
TUR: 1995: 1993 data; refer to household waste composition in 58 urban municipalities with a population >20 000; other: includes
ash, slag, etc.
UKD: 1990: household waste only; composition based on a limited sample exercise; not compatible with previous data; other: fines
and miscellaneous. 1995: 1997 data. 2000: organic materials include compostable kitchen waste, garden waste, and soil.
Figure 3 (Continued)
Human Exposure to MSW Incineration water and food are controlled and regulated to reduce
Airborne Pollutants likelihood of adverse impacts from these pathways. On
the contrary, emissions to air once released are no longer
Human exposure to pollution resulting from either dis- subject to control, making it mandatory that incineration
posal of the solid bulk residue or discharge of con- facilities are designed, operated, and monitored in such a
taminated cooling waters can be very low, or even way as to ensure acceptable levels for airborne pollutants
negligible, if proper operating procedures are followed as well as reduced associated environmental and health
in the facilities and normal controls are maintained on risks. Therefore, although exposure to pollutants from
sludge disposal and drinking water quality. In fact, fol- other waste incineration emissions may also affect the
lowing treatment and discharge, levels of pollutants in health of local communities, airborne exposure is likely
Table 6 Historical context for incinerator emissions

Substance Estimated emissions to air (g T1 except where stated otherwise)
1980 1990 2000
Nitrogen oxides 1878 1580 1600

Total particulates 313 264 38
Sulfur dioxide 1421 1196 42
Hydrogen chloride 3791 20 58
a a
Hydrogen fluoride 1
Volatile organic compounds 25 20 8
Cadmium 2.6 16 0.005
Nickel 2.8 28 0.05
Arsenic 0.40 0.33 0.005
Mercury 1.8 2.2 0.05
Dioxins and furans a
0.00018 g TEQ T1 4 107 g TEQ T1
Dioxin-like polychlorinated biphenyls a
0.0035 g TEQ T1 0.0001 g TEQ T1
a
No data.
Source: Adapted with permission from Enviros Consulting Ltd., University of Birmingham with Risk and Policy Analysts Ltd., Open University, and
Thurgood M (2004) Review of Environmental and Health Effects of Waste Management: Municipal Solid Waste and Similar Wastes. London:
Department for Environment Food and Rural Affairs. Available online as PDF file (420pp.). http://www.health.gov.au/internet/main/publishing.nsf/
Content/03D879161615A79ACA2571E0000C8CF1/$File/EHRA%202004.pdf (accessed May 2010).
to be the pathway of greatest concern with regards to impacts of waste management in the United Kingdom
waste incineration and hence the only one considered in and of regular characterizations that are conducted near
the scope of the present work. modern incinerators in the author’s country. Populations
As shown in Table 6, atmospheric emissions have living near SWIs are therefore potentially exposed to
changed considerably over the last few decades in most a wide variety of hazards directly associated with waste
technologically more advanced countries, in response to incineration emissions to air, especially organic and
increasingly stringent limits on emissions set in legis- inorganic compounds, via inhalation of polluted air,
lative requirements. In the late 1990s, MSW incinerators ingestion of polluted food and water, or dermal contact
in Europe were either shut down or upgraded to meet with polluted soil.
the emissions limits set out in the 1989 European Dir- Residents in the vicinity of waste incinerators are also
ectives. The 2000 European Directive on the Incineration exposed to the psychological hazard determined by the
of Waste imposes even stricter emission limits, requiring close proximity of the plant and the resulting perceived
that new and existing plants comply with these limits by risk. Risk perception is defined as people’s judgments and
the end of 2002 and 2007, respectively. Nowadays, for the assessment of hazards that might pose immediate or
majority of hazardous substances, MSW incinerator long-term threats to their health and well-being. Psy-
processes throughout the European Union (EU) already chometric studies show that risks are considered to be
comply with the Waste Incineration Directive, as a greater for hazards seen as involuntary, uncontrollable,
result of the Europe-wide transposition of EU legislative potentially catastrophic, and created by technology, a
controls into national regulations. Countries outside group of characteristics defining a general factor usually
Europe, namely the USA and Canada, with a similar designated as a dread risk. Under this perspective, and
level of technological advancement, also ensure com- depending on the information made available to the
parable levels of incineration emissions due to similar surrounding communities and the way that information
legislative requirements. has been communicated, waste incinerators fit the re-
However, in spite of chemical releases from modern or quired attributes to maximize risk perception. In fact, for
updated waste incinerators being more limited than those the residents and local workers, the plants can involve a
from old plants, the fact is that hazardous substances still decrease of environmental quality, in terms of noise, dust,
continue to be released into the environment, contrib- and especially emission of pollutants, over which indi-
uting to the background levels of the surrounding areas. viduals in the communities have little control and which
Therefore, information on pollutants emitted having they are often afraid will adversely affect their health.
potential impact on environment and health is necessary. SWI’s workers can be exposed to the same potential
Usually, routine information that allows a useful en- hazards as the general population or, more specifically, as
vironmental characterization is not available. The author the surrounding communities, although the amount of
is aware of a summary of estimates for substances exposure and risk may differ.
released by MSW incineration, determined within the Although the presence of the hazards in the vicinity of
scope of a review of the health and environmental the plants can be known, it cannot easily be translated
into useful information on the corresponding human Although detailed discussion of exposure assessment
exposure. The conceptual basis for exposure assessment approaches is beyond the scope of this article, it is
is defined by following up the fate of a chemical that important to show how they can contribute to more
exerts an effect after being absorbed into the body. accurately approximate true human exposure to the main
Therefore, exposure assessment involves the determin- incineration pollutants. That contribution is shown in the
ation of the magnitude, frequency, duration, and char- following sections of this article.
acter of current, past, and future exposure, as well as the In the context of environmental management pro-
identification of potential exposure pathways and ex- grams, the most common indirect method is that referred
posed populations and particularly sensitive populations. to as environmental monitoring, meaning the systematic
In fact, as has been shown by several authors, there are collection of environmental samples for analysis of
subpopulations that show increased sensitivity to some pollutant concentrations and the use of these analytical
chemicals, in particular, air pollutants: asthmatics and results together with predictive models to obtain a
patients with chronic lung disease are sensitive to NO2 quantitative index of exposure (the external exposure or
and CO; people with angina and coronary heart disease, potential dose), determined at particular points on the
to CO; and severe asthmatics, to SO2. exposure pathways. This potential dose is estimated as
The approaches to assessing exposure can be focused the amount of the pollutant likely to enter the human
on the type of measurements being made, that is, on body from various pathways, under a range of scenarios
how data are obtained for arriving at a quantitative (including worst-case situations) in relation to frequency
estimate of exposure, or on how the data are used to and duration of exposure, for a reference person of a
develop the dose estimate. The first type of approaches potentially exposed target population.
are described in terms of direct/indirect methods Particularly for environmental impact studies (EIS),
(Figure 4), depending on both the fact that selected when the objective is to assess exposure to airborne
sampling system involves/does not involve personal pollutants from a specific incineration plant, a scenario
measurements (on or within a person) and the variable evaluation is normally used, estimating exposure by
they measure (the levels of exposure itself or factors separately evaluating the exposure concentration and
that affect exposure). The other approaches – termed the time of contact, combining then this information.
point-of-contact measurement, reconstruction of internal As shown in Figure 6, the procedure typically starts with
dose, and scenario evaluation (Figure 5) – are three an inventory of historical stack emissions, followed by the
different and independent ways to quantify exposure identification, from the full range of the existing sub-
(or dose). Since each of these approaches is based on stances, of the pollutants of potential concern, based on
different data and has strengths and limitations, it is their known potential to pose increased risk via direct
advisable (whenever possible) using the three in com- or indirect exposure pathways. In the second step, the
bination to reinforce the reliability of an exposure geographic distribution of the increased pollutant con-
assessment. centrations (i.e., the incremental media concentrations as
Direct methods Indirect methods
Bio Personal Environmental

Models Questionnaires Diaries
monitoring monitoring monitoring
Pharmacokinetic Exposure models

and pharmacodynamic models
Exposure
estimate
Figure 4 Exposure assessment strategies and methods. Adapted with permission from National Academy of Sciences (1991) Human
Exposure Assessment for Airborne Pollutants, Washington: National Academy Press.
Approaches for
quantitative estimate of exposure
Point-of-contact Reconstruction Scenario

measurement of internal dose evaluation
Exposure a Time b of Environmental Time e of

concentration contact Biomarkers concentration d contact
measurements measurements measurements measurements
Integration of Internal Exposure

measurements indicators c scenario f
Quantitative
exposure
estimate
Notes:
(a) The exposure can be measured while it is taking place, at an outer boundary of the body (the
interface between the person and the environment, the so-called point of contact), measuring
both exposure concentration and time of contact.
(b) Period of time over which the measurements are taken. For different periods (e.g., lifetime ex-
posure), some assumptions are required.
(c) Based on biomarkers to reconstruct or back-calculate dose after the exposure and uptake have
taken place. The data on biomarkers cannot be used directly unless a relationship can be es-
tablished between the biomarker’s indications and internal dose.
(d) To characterize the chemical concentrations in relevant media or locations. This is typically
indirectly accomplished by measuring, modeling, or using existing data on concentrations in the
bulk media.
(e) The time that individuals or populations contact the chemical. Usually this is indirectly estimated
by behavior observation or assumptions about behavior, activity models, demographic data, and
survey statistics, among others.
(f) The set of assumptions about how the exposure (or contact) takes place.
Figure 5 Approaches to quantification of human exposure. Source: US EPA (1992). Guidelines for Exposure Assessment. EPA/600/
Z-92/001, Federal Register 57(104): 22888–22938. Washington, DC: Risk Assessment Forum, US Environmental Protection Agency
(EPA). http://www.epa.gov/NCEA/raf/pdfs/exposure.pdf (accessed May 2010).
a consequence of the emissions) is calculated using being considered, this calculation involves some or all of
suitable air dispersion models and equations, according the following factors: (1) the estimated pollutant media
to exposure pathway (Table 7). Available databases concentrations; (2) consumption rates of the medium;
(e.g., from US EPA) provide compound-specific par- (3) information on human physical characteristics,
ameters the equations need to estimate the media namely receptor body weight; and (4) information on
concentrations, which can then be used to assess the human behavior, that is, the characteristics of exposure,
human exposure considering identified exposure scen- in terms of frequency and duration of the contact. In the
arios (Table 8 and Figure 7). Figure 8 illustrates a absence of data, default values are used and an upper end
‘how-to’ example, showing a schematic representation value may be chosen for reasons of conservatism and to
and equations for the calculation of a pollutant air con- provide a ‘worse case’ scenario.
centration for direct inhalation. Calculating pollutant To estimate the exposure to a generic pollutant via
concentrations in soil or in other media for indirect ex- inhalation (Figure 9), factors such as vapor and par-
posure can be a much more complex process that is ticulate air pollutant concentrations, particle size, and
beyond the ambit of this example. length of exposure have to be taken into consideration.
The human exposure to a chemical pollutant, received Exposure concentration is then calculated as an average
under each of the identified exposure scenarios, is exposure per unit of time (respiratory rates are not re-
quantified calculating chemical-specific exposure rates quired since they are inherent to inhalation toxicity
for each exposure pathways. Depending on the medium factors). For the exposure to a chemical via ingestion
Source
Source
(1) Inventoryofofemissions
1) Inventory emissionsand pollutantsa a
andpollutants Emissions
Emissions
(2) Atmospheric transport and

deposition modeling b Air
Air
Deposition (wet
deposition & dry)
(wet & dry)
Soil
Salt water Freshwater
Fresh water
Agricultural
Agricultural
vegetation
Fresh
Freshwater
water
Seafood
Seafood Milk Meat Eggs
fish
fish
Legend:
- Arrow: the course a pollutant takes from its source to a transport or retention medium or an exposed person
- Oval box: mechanism of transport and retention of the pollutant
- Rectangle: a transport or retention medium, or a point of potential human contact with the pollutant
Notes:
(a) Generally available regulatory measurements are usual sources for historical stack emissions. An
inventory of stack emissions is possible only for existing facilities (i.e., those already built and
operational). For every new facility, emissions are estimated within the development of the en-
vironmental impact study (EIS) that is required before the plant can be approved. Since the
purpose of an EIS is to ensure that nobody will be exposed to an unacceptable risk or burden,
estimation of the potential emissions has to be based on all the operating scenarios that may
occur while the unit is, and is not, operated as intended, except for accidental releases. Good
practice dictates a check of, and comparison with, data from similar existing units.
(b) The US EPA Report (2005) provides guidance on criteria to consider when selecting an air model
for the study-specific objectives or assessment area characteristics. The reference of this report is
as follows: US EPA (2005)Human Health Risk Assessment Protocol (HHRAP) for Hazardous
Waste Combustion Facilities, Final, EPA520-R-05-006. Washington, DC: US Environmental
Protection Agency (EPA) Region 6 and the US EPA Office of Solid Waste, and Emergency
Response. http://www.epa.gov/osw/hazard/tsd/td/combust/risk.htm#hhrad (accessed on May
2010).
Figure 6 Graphic representation of the first steps of human exposure assessment for airborne pollutants: identification of emissions/
pollutants and calculation of pollutant-specific air concentration and dispersion rates. Adapted from: Bickel P, Friedrich R (eds.) (2005).
EUR 21951 EN – ExternE – Externalities of Energy – Methodology 2005 Update. Institute of Energy Economics and the Rational Use of
Energy (IER), University of Stuttgart, Stuttgart. A Report produced for the EC Directorate-General for Research. Luxembourg: Office for
Official Publications of the European Communities. http://ec.europa.eu/research/energy/pdf/kina_en.pdf (accessed May 2010).
(termed chemical intake), a generic equation is that high-, medium-, and low-exposure groups). However,
shown in the upper part of Figure 10, which will be unfortunately they are unable to readily relate equivalent
adequately modified to calculate pathway- and receptor- groups from different studies or credibly compare or
specific exposures. An equation to calculate the daily combine the results from multiple studies.
intake of the chemical of interest via all indirect exposure When the ultimate objective of exposure assessment is
pathways is shown in the lower part of the same figure. the investigation of exposure–health effects relationships,
Usually due to practical and budgetary constraints, approaches such as scenario evaluation or some of the
studies of toxicant exposures use alternative indirect so-called indirect methods have many drawbacks in
methods (questionnaires, diaries, or software models), procuring true and representative exposure data for
almost always of some value, especially in stratify- populations of interest. Two alternative methods,
ing study groups into exposure levels (generally specifically those included in the direct exposure
Table 7 An overview of dispersion air modeling

Concept
Air dispersion models are mathematical constructs, coded into computer programs to facilitate the computational process, that attempt
to describe, on dispersion rates of emissions from the source and ultimately pollutant-specific air concentration and dispersion rates,
the effects of physical processes that occur for atmospheric transport and deposition in environmental media
The dispersion models cover well-characterized ‘study areas’ and operate on predefined grids. Although the uncertainties of these
models can be very large, they provide approximate values of pollutant concentrations in the air above, and deposition rates onto,
specific locations (physical places around the study area), that will contribute to the calculation of the media incremental concentration
for the pollutants of concern, available to be directly or indirectly ‘taken’ by the human beings
Types of models – Models will vary according to:
(a) Source (point versus diffuse)
(b) Type of pollutant (e.g., gases versus particles)
(c) Scenario (e.g., whole airshed versus properties neighboring a facility)
Input data needs (or to be considered) for use in a specific model
(a) Site-specific characteristics (surrounding terrain and land use, i.e., definition of surrounding areas in terms of rural/urban site
classification, surface roughness heights and surface cover – water, vegetation, and soil type – coordinates, and placement of the
receptor grid node array)
(b) Facility building characteristics (in particular, location, stack height, and relation with nearby structures or buildings, stack diameter,
emission rate, and temperature)
(c) Meteorological data (e.g., amount and frequency of precipitation, wind speed and direction, and ambient air temperature, usually
available from national weather services)
Relevant pollutant properties in transport-fate calculations
(a) Chemical properties
Oxidation, hydrolysis, and photolysis
Microbial and other modes of decompositiona
(b) Physical properties
Molecular weight and density
Vapor pressure (or boiling point)
Water/lipid solubility
(c) Particle properties
Size and surface area
Chemical composition
Solubility
a
The fate of the pollutants depends on their residence times. Persistent substances, or those with long half-lives in the environment or biota, will
increase the opportunities for exposure over time. They can be transported up to several hundreds to thousands of kilometers. Atmospheric
dispersion can then be significant over very long distances for most air pollutants from incinerators and both local (usually up to 50 km) and regional
effects are important. Therefore, local and regional dispersion models or a combination of them are used, if the objective is to account for all
significant effects.
Sources:
• Bickel P and Friedrich R (eds.) (2005) EUR 21951 EN – ExternE – Externalities of Energy – Methodology 2005 Update. Institute of Energy
Economics and the Rational Use of Energy (IER), University of Stuttgart, Stuttgart. A Report produced for the EC Directorate-General for
Research. Luxembourg: Office for Official Publications of the European Communities. Available online as PDF file (287pp.). http://ec.europa.
eu/research/energy/pdf/kina_en.pdf (accessed May 2010).
• enHealth (2004) Environmental Health Risk Assessment. Guidelines for Assessing Human Health Risks from Environmental Hazards.
Canberra: Department of Health and Ageing and enHealth Council, Commonwealth of Australia. Available online as PDF file (258pp.).
http://www.health.gov.au/internet/main/publishing.nsf/Content/03D879161615A79ACA2571E0000C8CF1/$File/EHRA%202004.pdf
assessment strategy, are available for approximating the To sum up, in a hierarchy of exposure assessment,
true exposure more adequately: personal monitoring or direct approaches, in particular HBM, are at the highest
the equivalent point-of-contact approach and biological level for approximating the actual levels of exposure to
monitoring or human biomonitoring (HBM; Table 9), the pollutants of interest. However, in most cases, they
the measurement procedure that uses biomarkers and is a fail in relating individual results to sources and routes of
core part of the approach named reconstruction of exposure and thus in distinguishing between pollutant
internal dose (Table 10 summarizes the existing Agency emissions from incinerators and other very likely
for Toxic Substances and Disease Registry (ATSDR) industrial sources in the area of influence of the in-
toxicological profiles information on the use of available cinerators, making crucial the availability of data from
biomarkers of exposure for the most relevant airborne environmental monitoring. In fact, using this method and
pollutants). HBM is not a question of competition in that they do not
Table 8 Relevant terms and exposure scenarios for the purpose of assessment of exposure to airborne pollutants from SWI
relevant termsa
– Human receptor: a human being potentially exposed to airborne pollutants from SWI
– Exposure route: the particular means of entry of the pollutants into the body. Within the present context, they are either direct (via
inhalation) or indirect (via pollutant deposition and subsequent ingestion of water, soil, vegetation, and animals included in the food
chain)b
– Exposure pathway: the course a pollutant takes from its source to the exposed person, including four main components:
1. A source and mechanism of pollutant release
2. A retention medium (air, water, and land), or a transport mechanism and subsequent retention medium in cases involving media
transfer of pollutants
3. A point of potential human contact with the retention medium
4. An exposure route
– Exposure scenario: a combination of exposure pathways to which a receptor is or may be subjected at a particular location
– Exposure setting: a combination of characteristics of the study area in terms of dimension (taking into account that ‘most significant
deposition occurs within a 10 km radius from the facility being assessed’), waterbodies and their associated watersheds, and human
receptors – in particular segments of the population that may be at higher risk due to increased sensitivity and increased exposure –
their current and potential activities and land uses
Generic exposure scenarios to consider for the purposes of risk assessmentc
Exposure scenario Exposure pathwaysd

receptors
Inhalation of vapors Ingestion of
and particulate
Homegrown Homegrown beef, Fish Human milk
produce, water chicken, and
from local surface pork, and milk/
sources, and eggs from
incidental homegrown
ingestion of soil cows/chicken
Resident X X
Resident child X X
Farmer X X X
Farmer child X X X
Fisher X X X
Fisher child X X X
Acute receptor X
Nursing infant X X
a
Adapted from:
US EPA (2005) Human Health Risk Assessment Protocol for Hazardous Waste Combustion Facilities (HHRAP), Final. EPA520-R-05-006.
Washington, DC: U.S. Environmental Protection Agency (EPA) Region 6 and the US EPA Office of Solid Waste and Emergency Response.
Available at http://www.epa.gov/osw/hazard/tsd/td/combust/risk.htm#hhrad. Accessed on 15 May 2008.
enHealth (2004) Environmental Health Risk Assessment. Guidelines for Assessing Human Health Risks from Environmental Hazards. Canberra:
Department of Health and Ageing and enHealth Council, Commonwealth of Australia. Available online as PDF file (258pp.). http://
www.health.gov.au/internet/main/publishing.nsf/Content/03D879161615A79ACA2571E0000C8CF1/$File/EHRA%202004.pdf (accessed
May 2010).
b
Dermal exposure is not considered because available data cited by US EPA (2005) indicate that it is in general not significant within the present
context.
c
US EPA recommends evaluating these scenarios when they are consistent with site-specific exposure settings.
d
Each X indicates that the exposure pathway is considered in the corresponding exposure scenario (identified by the respective human receptor).
exclude each other: depending on the objective of making it very difficult to conduct exposure assessment
the study, the environmental factors under consideration, studies in such a way as to adequately provide the main
and the available expertise, either method may be scientific basis for both risk assessment and risk man-
preferred, with sometimes a combined approach being agement decisions. Its inherent complexity grants ex-
required. posure assessment the position of the most problematic
From what has been presented so far, one can con- area in the risk assessment process for air pollutants and
clude that human exposure to airborne toxicants can in the source of most of the uncertainty in the estimation of
no way be said to occur under controlled conditions, these pollutants’ risk for human health.
Source
Source
(1)
1) Inventory of emissions and pollutants Emissions
Emissions
(2)
2) Atmospheric transport and
deposition
deposition modeling
modeling Air
(3)
3) Human exposure modeling
deposition
deposition(wet
(wet&&dry)
dry)
Soil
Salt water Freshwater

Fresh water
Agricultural
Agricultural
vegetation
vegetation
Fresh
Freshwater
water
Seafood Milk Meat Eggs
fish
fish
Dermalcontact
Dermal contact Ingestiondose
Ingestion dose Inhalationdose
Inhalation dose
Legend:
− Arrow: the course a pollutant takes from its source to a transport or retention medium or an exposed person
− Oval box: mechanism of transport and retention of the pollutant
− Rectangle: a transport or retention medium, or a point of potential human contact with the pollutant
− Rounded rectangle: route of exposure
− Gray labels and arrows correspond to the first steps of the human exposure assessment
− The label for dermal contact is in gray because, within the present context, inhalation and ingestion are the most
relevant exposure routes for environmental chemicals and dermal contact is usually negligible
Figure 7 Graphic representation of the principal steps of human exposure assessment for airborne pollutants with special focus in the
exposure pathways to which a human being is or may be subjected. Adapted from: Bickel P, Friedrich R (eds.) (2005). EUR 21951
EN – ExternE – Externalities of Energy – Methodology 2005 Update. Institute of Energy Economics and the Rational Use of Energy
(IER), University of Stuttgart, Stuttgart. A Report Produced for the EC Directorate-General for Research. Luxembourg: Office for Official
Publications of the European Communities. http://ec.europa.eu/research/energy/pdf/kina_en.pdf (accessed May 2010).
Assessment of Potential Health Effects also be observed after long-term exposures (e.g.,
Associated with Airborne Pollutants convulsions following long-term exposures to lead) and
chronic after-effects following short-term exposures, as is
Environmental pollution is associated with adverse the case with nitrogen dioxide.
health effects experienced or measured in the short or Owing to differences in vulnerability, in any population
long term, that clinically may be described as either acute there will be a range of responses to exposure to a par-
or chronic. Usually acute effects follow sudden and ticular agent, with the susceptible or vulnerable persons
severe exposure and rapid absorption of the substance. occupying the extremity of the distribution corresponding
On the contrary, chronic effects may not be immediately to a lower exposure than that of the majority of the
observed and follow prolonged or repeated exposures population. Vulnerability may be based on genetically de-
over more or less relatively long periods. Examples are termined factors or physiological characteristics such as age
carbon monoxide poisoning, and lead poisoning or (children and the very elderly are usually more vulnerable),
cancer, respectively. However, clinically acute effects may pregnancy, or general health status, among others.
Source
Source
Emissions
Emissions
Vapor
Vaporphase
phase Particle
Particlephase
phase
airair concentration
concentration air concentration
air concentration
AirAir concentration
concentration
forfor direct
direct inhalation
inhalation
The equations that estimate air concentrations for evaluating direct inhalation of pollutants of
potential concern a by summing the vapor and particle phases are the following:
(1) Equation for long-term or chronic exposure b via direct inhalation:
Ca = Q [Fv C yv + (1.0 – F v )C yp]
(2) Equation for short-term or acute exposure b via direct inhalation:
Cacute = Q [F v C hv + (1.0 – Fv)C hp]
where
Ca and Cacute : Air concentration and acute air concentration, respectively
Q: Emission rate (pollutant - and site-specific)
Fv : Fraction of pollutant air concentration in vapor phase (pollutant-specific)
C yv and C yp : Yearly air concentration from vapor phase and from particle phase, respectively
Chv and C hp : Hourly air concentration from vapor phase and from particle phase, respectively
(a) – All compounds of potential concern as identified by US EPA, except mercury

(b) – To evaluate long-term or chronic exposure via direct inhalation, it is generally recommended using
unitized yearly air parameter values to calculate air concentrations. To evaluate short-term or acute
exposure via direct inhalation, the best would be using unitized hourly air parameter values to
calculate air concentrations
Figure 8 Graphic representation and equations for the calculation of a pollutant air concentration based on both the vapor phase and
the particle phase air concentrations. Adapted from: US EPA (2005). Human Health Risk Assessment Protocol (HHRAP) for Hazardous
Waste Combustion Facilities, Final, EPA520-R-05-006. Washington, DC: US Environmental Protection Agency (EPA) Region 6 and the
U.S. EPA Office of Solid Waste and Emergency Response. http://www.epa.gov/osw/hazard/tsd/td/combust/risk.htm#hhrad (accessed
May 2010).
Although specific causes for significant impacts are symptoms and illness, and reproductive health effects in
seldom evident, exposure to the environmental air pol- local communities.
lution has been reported to be associated with several There are a limited number of reviews of epidemi-
health effects (Table 11). However, even in worst-case ological studies developed to investigate the relationships
scenarios, results from the evaluations of the potential for between emissions from waste incinerators and ill-health
health effects due to short-term emissions did not indi- of either the surrounding communities, or the occu-
cate acute health effects. pationally exposed population, or both. However,
Most of the chemicals in environmental air pollution documents such as the toxicological profiles of the
are also the most relevant airborne pollutants from waste ATSDR and the World Health Organization/Inter-
incinerators emissions. It is then to be expected that most national Labour Organization/United Nations Environ-
studies on health effects in relation to living near waste ment Programme provide information on the potential
incinerators focus principally on cancer, respiratory health effects of exposure to environmental pollution
Source
Source
Emissions
Vaporphase
Vapor phase Particle
Particlephase
phase
airair concentration
concentration airair
concentration
concentration
Direct
Directinhalation
inhalation
exposure
exposure
Generic a equation for exposure via inhalation
ADI = (C air ∗ IR ∗ ET ∗ EF ∗ED ∗ 0.001) / (BW ∗ AT ∗ 356)

where
ADI : Average daily pollutant intake via inhalation mg pollutant (kg day−1)
Cair : Concentration (annual)b of pollutant in air (μg m−3)
IR : Inhalation rate (m3 h−1)
ET : Exposure time (h day−1)
EF : Exposure frequency (days year −1)
ED : Exposure duration (year)
BW : Average body weight of the receptor over the exposure period (kg)
AT : Averaging time (year)
(a) To evaluate long-term or chronic exposure via direct inhalation, it is generally recommended
using unitized yearly air parameter values to calculate air concentrations. To evaluate short-
term or acute exposure via direct inhalation, the best would be using unitized hourly air
parameter values to calculate air concentrations.
(b) This example is for the case of long-term or chronic exposure via direct inhalation; thus
unitized yearly parameter values are used.
Figure 9 Graphic representation and equations to estimate the exposure to a pollutant via direct inhalation. Adapted from US EPA
(2005). Human Health Risk Assessment Protocol (HHRAP) for Hazardous Waste Combustion Facilities, Final, EPA520-R-05-006.
Washington, DC: US Environmental Protection Agency (EPA) Region 6 and the US EPA Office of Solid Waste and Emergency
Response. http://www.epa.gov/osw/hazard/tsd/td/combust/risk.htm#hhrad (accessed on May 2010).
emitted by industrial sources including waste inciner- Each of the aspects of this strategy is liable to present
ation plants. Using some of these data, a summary has serious difficulties and nonnegligible uncertainties. First,
been prepared (Table 12) focusing on the airborne it is seldom possible to attribute a specific pollutant to an
substances that are likely to be more toxic or of higher incinerator rather than to some other source. The con-
public concern and the associated health effects of in- tribution from the waste incinerator may even be rela-
halation, oral, and dermal human exposure. tively minor to the overall exposure. On the other hand,
To establish links between waste incinerator airborne assessment of exposure is very problematic (as discussed
emissions and the ill-health of those living around the before), especially in the most likely situation of low-
facility, the usual strategy (based on the suggested en- level exposures to air pollution from modern or updated
vironmental public health continuum) involves the as- well-run waste incinerators. Alternatively surrogates of
sessment of exposure to a particular substance known to exposure are used, which can be highly unsuitable to
be released from the waste incinerators and the devel- consistently support epidemiological investigation. Dir-
opment of epidemiological studies, to identify and esti- ect measurements of exposure using HBM are increas-
mate the magnitude of adverse health outcomes, either in ingly common though still limited to a relatively small
local or worker populations, or both. number of substances for which biomarkers of exposure
Generic equation for exposure via ingestion
I = [(Cgen∗ CR ∗ EF ∗ ED) / (BW ∗ AT)]

where
I: Intake: the amount of the chemical at the exchange boundary (mg kg−1 day−1)
Cgen: Generic pollutant concentration in medium of concern (mg kg−1 for soil; mg L−1 for
surface water; etc.)
CR: Consumption rate: the amount of polluted medium consumed per event or unit of
time (kg day−1 for soil; L day−1 for water; etc.)
EF: Exposure frequency (days year−1)
ED: Exposure duration (years)
BW: Average body weight of the receptor over the exposure period (kg)
AT: Averaging time: the period over which exposure is averaged (unit dependent on the
pollutant type)
Equation for the calculation of daily intake via all indirect exposure pathways
I = I soil + I ag + I beef + I milk + I pork + I poultry + I eggs + I fish + I dw
where
I: Pollutant total daily intake (mg(kg day−1))
I soi; I ag; I beef;

I milk; I pork; Pollutant daily intake* from soil, aboveground produce, beef, milk, pork, poultry,
I poultry; I eggs; eggs, fish, and drinking water, respectively (pollutant- and site-specific; mg(kg day−1)
I fish; I dw
*It is calculated using generic equation adequately modified
Figure 10 Equations to estimate the exposure to a chemical pollutant via ingestion. Adapted from US EPA (2005). Human Health
Risk Assessment Protocol (HHRAP) for Hazardous Waste Combustion Facilities, Final, EPA520-R-05-006. Washington, DC: US
Environmental Protection Agency (EPA) Region 6 and the US EPA Office of Solid Waste and Emergency Response. Available at http://
www.epa.gov/osw/hazard/tsd/td/combust/risk.htm#hhrad (accessed on May 2010).
have already been established and to the availability of difficulties arise from the likely very small number of
appropriate and sensitive tests for the detection of the exposed people, limiting the power of the studies in
actual exposures. detecting the expected low increase of the risk. Moreover,
The characterization of the outcome poses as well a because estimates of the effect are normally made for
number of specific problems, mainly due to confounding. very small areas, it is expected that only small numbers
Furthermore, it is difficult to attribute a particular health of events are generated and thus small differences
impact to a particular pollutant since populations between already small numbers, which cannot be fully
are exposed to a mix of different pollutants that tend to considered.
be highly correlated with each other. The occurrence of Overall, analysis of published epidemiological re-
cancer latency (likely different between different can- search suggests that these studies did not succeed in es-
cers) and population migration will weaken any links tablishing any convincing links between incineration
between a pollutant source and occurrence of cancer, emissions and negative health effects on public health. In
making it difficult to identify possible causal relationships fact, specifically no impact was demonstrated on the in-
between pollutant exposures and cancer. Health impact cidence of cancer and respiratory or reproductive health
characterization is also problematic due to the expected in relation to the most relevant waste incineration air-
modest increase in the risk of the health effect of the borne pollutants. For most of the studies, health effects
exposure, which is very hard to identify in most studies. in the populations living near waste incinerators were
Usually effect estimates are quantitative, measured as the in general not evident or evidence was not consistent
difference in incidence between exposed and unexposed, or convincing. Therefore, a conclusion can be drawn on
or the ratio of the incidence of disease in the exposed the likely irrelevance of this type of epidemiological
group to that in the unexposed. Therefore, additional investigation in the surrounding populations of modern
Table 9 Overviewa of human biomonitoring (HBM)

Definition of human biomonitoring
HBM is the measurement procedure using biomarkersb that focus on environmental exposures, diseases or disorders and genetic
susceptibility, and their potential relationships. In principle, monitoring refers to a repeated or continued sampling and analysis; however,
the term HBM is also commonly used for ‘one-time activities’
Objectives of HBM
General objective: ‘to increase knowledge on the relation between human health and the environment and to use this knowledge to
improve environmental health. Distinction is made between (1) activities that aim at periodical measurements in order to produce
information on the prevalence of exposure to environmental agents and the related public health impact with a view to developing and
evaluating policies that protect health (survey projects) and (2) activities that aim at improvement of knowledge on causal links
between environmental factors and health by hypothesis generation and testing (research projects)’a
Specific objectives (among others):
– To generate data on the prevalence of exposure to environmental pollutants and on health effects across country subpopulations or
the entire population
– To provide baseline data to track spatial and temporal trends in exposure levels and to allow comparisons within and between
countries
– To explore relationships between environmental pollutants, other physical measures, and self-reported information
– To obtain data that are representative for specific areas with expected different types of environmental loads (urban areas, dense
traffic, intensive agriculture, and industry), identifying disproportionately exposed subpopulations
– To establish reference ranges/values that can be used to identify people with unusually high exposure or the percentage of the
population that has exposure above levels considered likely to present risks to human health
– To determine which specific population groups (such as minorities, people with low incomes, and children – of different ages) are at
high risk for exposure and adverse health effects
– To provide a bridge to understanding the relationships between environmental factors, exposure to these factors (including factors in
food), and health problems
– To design and evaluate precautionary, preventive, interventive, and control strategies within the framework of policy measures
related to health and environment
– To warn on emerging risks
Essentials of the use of HBM

Definition of a well-planned strategy to ensure HBM cost efficiency and effectiveness
Use uniquely in situations where it has a real additional value
Selection of the target environmental factors based on individual or cumulative relevant criteria (such as: public health concerns,
political and public interest, availability of human samples, ethical and practical feasibility of the fieldwork, and availability of suitable
analytical methods)
Existence of analytically validated biomarkers
Wide selection of available biomarkers
Use of standard (at least, consistent/comparable) operating sampling, analytical, and interpreting procedures to ensure comparability
of HBM results
Strict consideration of all ethical and privacy issues for better respecting the rights of each participant citizen (the study subjects)
Good communication and transparency at all steps of every HBM activity, to the study subjects, the general public, and policymakers
Coupling HBM as much as possible to other sources of information (e.g., health interview, examination surveys, environmental
monitoring, and analysis of registries)
Some recently finished or current HBM activitiesc

EU-funded biomonitoring-related research projects
ESBIO – development of a coherent approach to human biomonitoring in Europe
PIONEER – puberty onset – influence of nutritional, environmental, and endogenous regulators
DEVNERTOX – in vivo and in vitro studies on the neurotoxic effects of mixture of neurotoxic seafood contaminants
DIEPHY – dietary exposures to polycyclic aromatic hydrocarbons and DNA damage
NewGeneris – newborns and genotoxic exposure risks: development and application of biomarkers of dietary exposure to genotoxic
and immunotoxic chemicals and of biomarkers of early effects, using mother–child birth cohorts and biobanks
PHIME – public health impact of long-term, low-level mixed element exposure in susceptible population strata
PHOEBE – harmonizing population-based biobanks and cohort studies to strengthen the foundation of European biomedical science
in the postgenome era
NORMAN – network of reference laboratories for monitoring of emerging environmental pollutants
INTARESE – novel methods for integrated risk assessment of cumulative stressors in Europe
ATHON – assessing the toxicity and hazard of nondioxin-like PCBs present in food
CASCADE – chemicals as contaminants in the food chain: an NoE for research, risk assessment, and education
HIWATE – health impacts of long-term exposure to disinfection by-products in drinking water
ECNIS – environmental cancer risk, nutrition, and individual susceptibility
GABRIEL – a multidisciplinary study to identify the genetic and environmental causes of asthma in the European Community
GALEN – global allergy and asthma European network
EnviRisk – assessing the risks of environmental stressors: contribution to the development of integrating methodology
(Continued )
Table 9 Continued
HEIMTSA – health and environment integrated methodology and toolbox for scenario assessment
2-FUN – full-chain and uncertainty approaches for assessing health risks in future environmental scenarios
NoMIRACLE – novel methods for integrated risk assessment of cumulative stressors in Europe
National programs
US NHANES – the US National Health and Nutrition Examination Survey
The US National Children’s Study
GerES – the German Environmental Survey
CHMS – the Canadian Health Measures Survey
PT POPs – the POPs Survey in the Portuguese population
The National Survey Programme in the Czech Republic
The National Biomonitoring Programme in Slovenia
WHO, industry, and nongovernmental organizations HBM activities
The WHO/UNEP Global Survey of human milk for POPs
LRI – Long Range Initiatives (the Chemical Industry’s research program)
The NGOs (The Health and Environment Alliance and the Commonweal Biomonitoring Resource Center) raising awareness
campaigns
Examples of countries with ongoing regional or local HBM programs (as shown by the Inventory of the ESBIO projectd and presented at
the 2008 HBM Conference in Paris)
Belgium (the Flemish HBM programme); Portugal (the ProVEpAs – two Environmental Health Surveillance Programs on exposure to
heavy metals and dioxins from incinerators); France (the study on exposure to dioxins from incinerators; assessment of the impact of
prenatal exposure to pesticides); Spain (several HBM studies); Cyprus (cotinine in children); the United Kingdom (collection of infor-
mation to define reference range values); Ireland (children’s blood lead levels); Germany (HBM as a tool to explore exposure pathways);
the USA (mercury and pesticide exposures in NY City)
Chemicals addressed by the past/current HBM activities

Heavy metals and persistent organic pollutants (POPs). There is evidence of an already long experience in most of the identified HBM
activities
Phthalates, cotinine, perfluorinated compounds (PFCs), brominated flame retardants (BFRs), insecticides, and bisphenol A (BPA), all
of them increasingly addressed in different HBM programs
Strengths and limitations of human biomonitoring

Strengths Limitations
Using HBM makes it possible to identify whether exposure has HBM is only applicable for agents that are taken up by the body
occurred at all, or the amount of the exposure (e.g., it cannot be applied to sulfur and nitrogen dioxides that
HBM estimates the individual exposure after it has taken place exert their effects primarily at the point of absorption)
measuring the amount of the pollutant absorbed into the body, The data on biomarkers cannot be used directly for many
the so-called internal dose or even the biological effective dose, chemicals whose relationship of body burden levels with
if what is measured is the level of absorbed pollutant bound to or exposure is not available
available to interact with critical subcellular, cellular, or tissue HBM does not work either for every chemical due to the reactive
targets. Based on internal body indicators’ measurements after nature of the chemical or interferences, unless interfering
exposure occurrence, a total dose can be back-calculated, or reactions (e.g., metabolism of unrelated chemicals) can be
reconstructed, to estimate an average past exposure rate, if accounted for or ruled out
information about intake and uptake rates is available There is lack of reference and health-based values to take
HBM data integrate the contribution of the different routes of actions
exposure and take into consideration the differences between There is lack of harmonized procedures to sample and to analyze
individuals with regard to uptake (due to differences in hygiene, biological materials and to treat and interpret HBM data in order
breathing characteristics, etc.), giving a complete picture of the to ensure comparability of HBM results from isolated studies
body burden. When metabolites are measured, interindividual Carrying out large surveys that include HBM presents
differences in metabolism of the compounds are also implied challenging logistical problems and generally cannot be done
Assessment of exposure through HBM may provide data that without having medical staff available (at least if blood samples
approximate the relevant exposure at the target organs and that are taken)
allow detection of time trends and of exposure differences HBM has limitations related to ethics and communication issues,
among subpopulations which may include, for example, questions of inconvenience to
The establishment of periodically updated biomonitoring and the subjects, health risk, personal data protection, and right to
reporting systems to evaluate the impact of environmental
know (or not to know) with regards to results
measures on human health may be particularly relevant for Gaps in knowledge are significant within areas of mechanistic
policymakers actions, uptake, distribution, metabolism, storage, and excretion
of environmental pollutants
(Continued)
Table 9 Continued
HBM research needs
Scientific research must address the critical knowledge gaps that hamper the ability to generate, use, and interpret HBM data, for
example:
Establishment of HBM tools that provide a real added value for public health and that support operational corrective policy measures
when needed to protect the population from health effects of the exposure to environmental pollutants
Definition of harmonized procedures to sample and to analyze biological materials and to treat and interpret HBM data
Definition of adequate communication tools for better providing information to the study subjects, the general public, and policymakers
Identification of new biomarkers for emerging risks and for combined effects of ‘chemical cocktails’
Integration of HBM with environmental and health data
a
Adapted from:
• Technical Working Group on Integrated Monitoring Subgroup Biomonitoring of Children (2004a) Baseline Report on ‘‘Biomonitoring of
Children’’ in the Framework of the European Environment and Health Strategy (COM(2003)338 Final). Brussels: EC. Available online as PDF file
(399pp.). http://ec.europa.eu/environment/health/pdf/children_biomonitoring.pdf (accessed May 2010).
• Technical Working Group on Integrated Monitoring Subgroup Biomonitoring of Children (2004b) Options for Action for ‘‘Biomonitoring of
(109 pages) at http://ec.europa.eu/environment/health/c_forum_march2004/biomonitoring.pdf.
• Biot P, Bonvalot Y, Casteleine L, et al. (2009) Highlights and Conclusions of the European Conference on Human Biomonitoring: From the Use
of Biomarkers to Human Biomonitoring. Final Report (27 January 2009). Paris: French Presidency of the EU Council.
• Ludwine Casteleyn L, Biot P, and Viso AC (2009) From human biomarkers to human biomonitoring in environmental health in Europe.
Highlights of the Conference held in Paris on 4–5 November 2008. Bulletin Épidémiologique Hebdomadaire (special edn): 2–5.
b
The term biomarker comprises biomarkers of exposure, biomarkers of effect, and biomarkers of susceptibility. This term is used for the specific
determination of each interaction between a biological system and an environmental agent, and can be divided into three types:
• biomarker of exposure – a xenobiotic substance or its metabolite(s) or the product of an interaction between a xenobiotic agent and some
target molecule(s) or cell(s) that is measured within a compartment of an organism;
• biomarker of effect – measurable biochemical, physiological, behavioral, or other alterations within an organism that, depending on the
magnitude, can be recognized as associated with an established or possible health impairment or disease;
• biomarker of susceptibility – indicators of inherent or acquired abilities of an organism to respond to the challenge of exposure to a specific
xenobiotic substance.
Human biomarkers are typically a tool in research studies (to improve knowledge on causal associations between environmental factors and health
effects by hypothesis generation and testing), in survey studies (to produce information on the prevalence of exposure to environmental agents and
the related public health impact), and in raising awareness campaigns (e.g., to help consumer choices and improve product design, and to promote
preventive interventions).
c
Source: Karjalainen T (2008) Overview of EU-funded research projects relevant to human biomonitoring. Presentation at the European Conference
on Human Biomonitoring: From the use of biomarkers to human biomonitoring. Paris: French Presidency of the EU Council. http://www.invs.sante.
fr/publications/2008/biosurveillance/S4_Tuomo_Karjalainen.pdf.
d
Source: Reis MF (2006) Updated inventory of biomonitoring research and non research actions and databases in electronic form. In: ESBIO –
Expert Team to Support BIOmonitoring in Europe. A European Commission Funded Project to Support the Development of a Coordinated
Approach for Human Biomonitoring in Europe. http://www.eu-humanbiomonitoring.org/index.htm. Web-based inventory is available at
http://www.hbm-inventory.org.
or updated waste incinerators. Nevertheless, it must be mind that an essential principle of toxicology is that a
stressed that the lack of consistent evidence of increased dose–response relationship exists for most toxic effects,
risk to health from exposure to the pollution of current a more fruitful approach to establish a convincing link
waste incinerators only indicates that pollutants emitted between incinerator emissions and adverse effects on
from those well-run or punctually abnormally operated public health would be one based on available dose–
plants do not imply consistently detectable health effects response functions (DRFs). The DRF, here represented
by currently used methods. But absence of evidence is not by Y ¼ fimpact(X), relates the quantity X of a pollutant
evidence of absence and hence that does not necessarily that affects a receptor (e.g., population) to the physical
mean that the very likely low-level exposures are safe. impact or toxic effect (the response) Y on this receptor.
It is known that scientific knowledge accumulates Such a dose–response relationship is typically summar-
slowly. Therefore, gaps in understanding health effects of ized in a graph plotting dose (x-axis) against response
low-level exposure may be pending for years, which is (y-axis). In the narrow sense of the term, X should be the
incompatible with the needs of regulators to make their dose of the pollutant actually absorbed by the receptor
decisions to control, or manage, risks to human health. under consideration. However, X is more often used in
They have thus to rely on available scientific evidence, a wider sense, in terms of the pollutant concentration in
integrating and interpreting existing scientific data for the ambient air, accounting implicitly for the absorption
the practical purpose of making a decision. Bearing in of the pollutant from the air into the body; hence, the
194
Table 10 Biomarkersa usedb to identify/quantify exposure to airborne pollutants
Pollutant Measurements Tissues and body fluids Excreta
Blood Breast milk Hair Nails Saliva Bone/tooth Fat Autopsy tissues Urine Feces Sweat
Whole blood Plasma Serum
HF Pollutant level
Metabolite(s) level X X X X X U
Biological responsec
SO2 Pollutant level
Metabolite(s) level
Biological responsec X
Cd Pollutant level X # X X X X X XU# X
Metabolite(s) level
Biological responsec X X
Tl Pollutant level X X X U
Metabolite(s) level
Hg Pollutant level X # X X XU#
Metabolite(s) level X
Sb Pollutant level X X X X
Metabolite(s) level
As Pollutant level X X X X U#
Pb Pollutant level X U# X X X X X X X X X
Cr(VI) Pollutant level X U X X X X X X U X
Metabolite(s) level
Co Pollutant level X X
Metabolite(s) level
Cu Pollutant level X X X X X
Metabolite(s) level
Mn Pollutant level X X X X X
Metabolite(s) level
Biological responsec X X
Ni Pollutant level X XU X XU X
Metabolite(s) level
V Pollutant level X X
Metabolite(s) level
Dioxins and furans Pollutant level X X X U X X X
Metabolite(s) level
PAH Pollutant level X X X X X
Metabolite(s) level X X
a
The World Health Organization defines biomarkers of exposure as an exogenous substance or first metabolite or the product of an interaction between a xenobiotic agent and some target molecule or cell
that is measured in a compartment within an organism, that is, the biological response.
b
Each symbol (X, , and U) indicates that there is at least one study where the corresponding biomarker has been used. It does not necessarily imply anything about the quality of the study. The meaning of the
symbols is as follows: X – used; – most widely used; U – considered the most reliable; # – suitable for biological monitoring of general environmental exposures.
c
The biological response for the corresponding pollutant is as follows:
SO2: Plasma S-sulfonate levels
Cd: Metallothionein gene expression levels

Pb: Blood zinc protoporphyrin, urinary coproporphyrin, erythrocyte ALAD activity
Mn: Serum prolactin (PRL) levels
Ni: An increase in IgG, IgA, and IgM and a decrease in IgE
Dioxins and furans: CYP1A1 gene expression in peripheral blood lymphocytes as an exposure marker for 2,3,7,8-TCDD and related compounds
PAH: DNA adducts and adducts with other cellular macromolecules, such as hemoglobin, globin, and other large serum proteins.
Sources:
• ATSDR (2008) ATSDR’s Toxicological Profiles. Atlanta: Agency for Toxic Substances and Disease Registry (ATSDR). Available online at http://www.atsdr.cdc.gov/toxpro2.html (accessed May 2010) and
at 2008 ToxProfiles CD ROM (copy under request).
• enHealth (2004) Environmental Health Risk Assessment. Guidelines for Assessing Human Health Risks from Environmental Hazards. Canberra: Department of Health and Ageing and enHealth Council,
Commonwealth of Australia. Available online as PDF file (258pp.). http://www.health.gov.au/internet/main/publishing.nsf/Content/03D879161615A79ACA2571E0000C8CF1/$File/EHRA%202004.pdf
195
196
Table 11 Environmental air pollutants and their effects on health
Associated Air pollutants
health effectsa
Particulate Sulfur Nitrogen VOC Carbon PAH Dioxins/ PCB Arsenic Cadmium Chromium(VI) Lead Mercury Nickel Benzene Toluene
matter dioxide dioxide monoxide furans
Asthma X X
Bronchitis X X
Cancer X X X X X X X
Cardiopulmon- X X X
ary
morbidity
Effects on the X X X
central
nervous
system
Effects on the X X X X X X X X X
immune
system
Effects on the X X X X X X X
kidney
Effects on the X X
liver
Eye irritation X
Increased X X X
cardio-
respiratory
morbidity
and
mortality
Increased X
mortality
from a
variety of
causes
(particularly
in
susceptible
subgroups
of the
general
population)
Increased X
susceptibil-
ity to
respiratory
infection
Lower X X
respiratory
symptoms
Reduction in X
oxygen-
carrying
capacity of
blood
Reproductive X X X X X X X X
effects
a
Dioxins and furans as well as some heavy metals are proven or suspected carcinogens and cofactors in birth defects. In relation to the classical pollutants, long-term exposure to airborne particles is
associated not only with increased risk of respiratory and cardiovascular diseases, but also with other pathologies and health conditions usually associated with exposure to metals and dioxins, since
particulate matter carries a range of metal and toxic organic compounds. SO2 has also been directly implicated in respiratory short-term effects, especially for particularly susceptible persons. The evidence is
less convincing for direct impacts of NO2.
Sources:
Bickel P and Friedrich R (eds.) (2005) EUR 21951 EN – ExternE – Externalities of Energy – Methodology 2005 Update. Institute of Energy Economics and the Rational Use of Energy (IER), University of
Stuttgart, Stuttgart. A Report produced for the EC Directorate-General for Research. Luxembourg: Office for Official Publications of the European Communities. http://ec.europa.eu/research/energy/pdf/
kina_en.pdfas PDF file (287pp.) (accessed May 2010).
Enviros Consulting Ltd., University of Birmingham, Risk and Policy Analysts Ltd., Open University, and Thurgood M (2004) Review of Environmental and Health Effects of Waste Management: Municipal
Solid Waste and Similar Wastes. London: Department for Environment, Food and Rural Affairs. Available online as PDF file (420 pages) at http://www.health.gov.au/internet/main/publishing.nsf/Content/
03D879161615A79ACA2571E0000C8CF1/$File/EHRA%202004.pdf. Accessed on May 2008.
Staines A, Collins C, Bracken J, et al. (2003) Health and Environmental Effects of Landfilling and Incineration of Waste – A Literature Review. Dublin: Health Research Board. Available online as PDF file
(292 pages) at http://www.hrb.ie/publications/hrb-publications/publications//162/. Accessed on April 2009.

197
198
Table 12 Summary of existing dataa on health effects of inhalation, oral, and dermal exposure of humans to air pollutants from industrial sources including SWI
Airborne Route of Death Systemic effectsb Immunologic Neurological Reproductive Developmental Genotoxic Cancer Main systemic effects
pollutants exposure lymphoretic associated with human

exposure to the pollutant
Acute Intermediate Chronic
HF Inhalation X X X X X Respiratory,
cardiovascular,
gastrointestinal,
musculoskeletal,
ocular, dermal
Oral X
Dermal X X
SO2 Inhalation X X X X X X X X X X Respiratory
Oral
Dermal
Cd Inhalation X X X X X X X X X X Respiratory,
hematological,
musculoskeletal,
hepatic, renal
Oral X X X X X X X X
Dermal X X
Tl Inhalation X X Respiratory,
cardiovascular,
hepatic, renal
Oral X X X X
Dermal
Hg Inhalation X X X X X X X X X X Respiratory,
cardiovascular,
gastrointestinal, renal
Oral
Dermal X X X X
Sb Inhalation X X X X X X Respiratory,
cardiovascular,
gastrointestinal
Oral X
Dermal
As Inhalation X X X X X X X X X Cardiovascular,
gastrointestinal, dermal
Oral X X X X X X X X X X
Dermal X X X X X
Pb Inhalation X X X X X X X X X X Cardiovascular,
hematological, renal
Oral X X X X X X X X X X
Dermal
Cr(VI) Inhalation X X X X X X X X Respiratory,
gastrointestinal,
hematological
Oral X X X X X
Dermal X X X X X
Co Inhalation X X X X X X Respiratory,
cardiovascular,
hematological, dermal
Oral X X X X
Dermal X X
Cu Inhalation X X Gastrointestinal, hepatic
Oral X X X X
Dermal X X X
Mn Inhalation X X X X X X Respiratory,
cardiovascular
Oral X X X X X X
Dermal
Ni Inhalation X X X X X X X Respiratory, dermal
Oral X X X X X
Dermal X X
V Inhalation X X X X X Respiratory, ocular
Oral X X
Dermal
Dioxins and Combined O O O O O O O O O O Respiratory,
furansc routes cardiovascular,
gastrointestinal,
hepatic, dermal
Inhalation
Oral X X X X X X X X
Dermal
PAH Inhalation X X Respiratory,
cardiovascular,
gastrointestinal,
hematological,
endocrine, dermal
Oral X
Dermal X X X X
a
Each X or O indicates that there is at least one study providing information associated with the corresponding particular effect.
b
Including: respiratory, cardiovascular, gastrointestinal, hematological, musculoskeletal, hepatic, renal, endocrine, ocular, and dermal.

c
O – dioxins; X – furans.
Sources:
• ATSDR (2008) ATSDR’s Toxicological Profiles. Atlanta: Agency for Toxic Substances and Disease Registry (ATSDR). Available online at http://www.atsdr.cdc.gov/toxpro2.html. Accessed on April 2008.
ATSDR’s toxicological profiles are also available at 2008 ToxProfiles CD ROM (copy under request).
Note: ATSDR’s toxicological profiles is a constantly updated database of toxicological and epidemiological information. It contains 162 final profiles and it is the only database organized by route of exposure –
inhalation, oral, and dermal.
• WHO (2000) Hazardous Chemicals in Human and Environmental Health. Geneva: World Health Organisation/International Labour Organisation/United Nations Environment Programme. Available online
as PDF file (116 pages) at http://www.who.int/pcs/training_material/hazardous_chemicals/section_3.html. Accessed on April 2008.
• enHealth (2004) Environmental Health Risk Assessment. Guidelines for Assessing Human Health Risks from Environmental Hazards. Canberra: Department of Health and Ageing and enHealth Council,
Commonwealth of Australia. Available online as PDF file (258 pages) at http://www.health.gov.au/internet/main/publishing.nsf/Content/03D879161615A79ACA2571E0000C8CF1/$File/
EHRA%202004.pdf. Accessed on April 2008.
199
expressions exposure–response function (ERF) or con- incremental impact of the emissions due to operation, in
centration–response function (CRF) seem more appro- a specific location, of a polluting activity (such as waste
priate. For air pollutants, the DRFs are typically of that incineration), tracing the passage of each pollutant from
kind and ERF and CRF are often used. where it is emitted to the affected receptors (Table 15).
Dose–response assessment involves the investigation In conclusion, to establish links between waste in-
of the relationship between the amount of the pollutant cinerator airborne emissions (that add to background
to which the subject is exposed and the frequency and pollution levels) and possible effects on health of suscep-
severity of health effects. Not all airborne pollutants are tible people, the evidence indicates that new studies are
carcinogenic, though all carcinogenic pollutants do have needed that are able to tackle small increments in health
some noncarcinogenic toxicity. For this reason, in con- outcomes hypothetically caused by exposure to current
sidering a given pollutant, impact (or risk) assessors in- MSW incinerators. It is also evident that further insights
tegrate what is known about mechanisms (or, more are unlikely to be gained from distance-based exposure
recently, modes of action) that lead to cancer and non- estimates, given their substantial limitations in both the
cancer effects, using procedures shaped by several as- exposure assessment and the determination of the ERFs.
sumptions and limitations (Tables 13 and 14). Although most final decisions on action derived from
Despite all uncertainties and challenges of the ap- human health risk assessment are fundamentally political,
proaches based on DRFs, their interest and value they must be scientifically informed, meaning that the
are unquestionable, mainly to allow scientifically based extent of uncertainties inherent to health impact assess-
interventions, in particular to support decision-making, ment should be well known and these uncertainties have
either to evaluate the health impacts of air pollution from to be acknowledged. Another type of toxicological, ex-
existing incinerators or to communicate the risks from posure assessment, and epidemiological study must then
a proposed facility. This requires an impact pathway be developed, incorporating as much HBM data as pos-
analysis (IPA), which is an approach that quantifies the sible, to investigate individual and population health
Table 13 Overview of impact (or risk) assessment of air pollutants using DRFs: limitations and implications
Limitations Implications
For many pollutants and many impacts (particularly noncancer – For risk assessment, a reference dose (RfD) is derived
effects), the DRFs are very uncertain or even not known. The (typically from NOAEL or LOAEL) and downward adjusted,
only available information is on NOAELa or LOAELb through uncertainty factors, to account for the most sensitive
people in the population and, in some cases, for gaps in the
pollutant toxicity data
– For impact assessment, NOAEL or LOAEL is not sufficient
and DRFs have to be derived
To determine DRFs, one has to use epidemiological studies Large uncertainties arise due to:
(some of the workers exposed to high pollutant The extrapolation from relatively high doses to much lower
concentrations), or, more often, laboratory studies (mainly in real-world exposures
animal models and using high doses to obtain observable The extrapolation from animal models to humans and from
nonzero responses) high doses too
Most toxicological data are obtained from relatively high short- For impact or risk assessment, the toxic effects are typically
term exposures, bringing out the question of the relation evaluated using DRFs under the more damaging approach,
between acute and chronic effects which is as if the entire dose was taken at one time instead of
gradually over a longer period
The DRFs are typically derived for specific conditions under Large uncertainties may arise for the real situations that may be
well-designed controlled toxicological studies different from the ones on which the DRFs have been based
and where relevant variables may not have been taken into
account
a
NOAEL – no-observed-adverse-effect level.
b
LOAEL – lowest-observed-adverse-effect level.
Adapted from:
Bickel P and Friedrich R (eds.) (2005) EUR 21951 EN – ExternE – Externalities of Energy – Methodology 2005 Update. Institute of Energy
Economics and the Rational Use of Energy (IER), University of Stuttgart, Stuttgart. A Report Produced for the EC Directorate-General for
Research. Luxembourg: Office for Official Publications of the European Communities. Available online as PDF file (287 pages) at http://
ec.europa.eu/research/energy/pdf/kina_en.pdf (accessed May 2010).
Sonnemann GW, Pla Y, Schuhmacher M, and Castells F (2002) Framework for the uncertainty assessment in the impact pathway analysis with
an application on a local scale in Spain. Environment International 28: 9–18.
White RH, Cote I, Zeise L, et al. (2009) State-of-the-science workshop report: Issues and approaches in low-dose–response extrapolation for
environmental health risk assessment. Environmental Health Perspectives 117: 283–287.
Table 14 Overview of impact (or risk) assessment of air pollutants using DRFs: assumptions, rationale, and implications
Assumptions Rationale Implications
The dose–response functions are linear – Although the complex molecular and Invoking the assumption of linearity leads
cellular events underlying the actions of those charged with population health
agents that lead to cancer and protection from exposure to
noncancer outcomes are likely to be environmental pollutants (e.g.,
both linear and nonlinear, at the human government agencies) to set more
population level, biological and statistical stringent regulatory limits on emissions
attributes tend to smooth and linearize
the dose–response relationshipsa
The dose–response function is a straight – At the human population level, there is – This assumption implies that, in principle,
line through the origin, that is, there is biological plausibility of the model any dose, no matter how low, carries
absence of a no-effect threshold (absence of a no-effect threshold) since some risk of toxic effects, meaning that
real populations always contain there is no safe dose
individuals with widely differing – As there is no safe dose, both local and
sensitivities regional ranges of the impact analysis
– For real populations, there is lack of are important, if most of the impact is to
evidence for no-effect thresholds at be included
current ambient pollutant concentrations – The possibility of a no-effect threshold
cannot be ruled out for some pollutants
(e.g., particles, NOx, SO2, O3, and CO).
However, because in most industrialized
countries they have background
concentrations above the level where
effects are known to occur, both local
and regional ranges of the impact
analysis are important
Carcinogenic effect has no threshold The mechanistic model of carcinogenesis – For impact assessment of carcinogenic
as a multistage process suggests that air pollutants, only the slope matters,
any dose, however small, could produce meaning that all dose–response
an initiated cell that ultimately results in relationships can be considered only in
a cancer. For substances that promote terms of their slope
the growth of a cancer, there is lack of – Both local and regional ranges of the
specific data on a no-effect thresholdb impact analysis are important
Noncancer effects have a threshold A wide range of toxicological evidence – In principle, there could be a safe dose,
suggests that nearly all noncancer expected to have no adverse effects in
effects have threshold. The only known people
exception is the neurotoxicity of lead – Regulatory limits on emissions are
imposed according to the known
thresholds
– For pollutants with background
concentrations that are (and remain)
below their thresholds, health impact
assessment is irrelevant
a
Findings from numerous studies (e.g., those cited in the reference 1 below) are in support of linearity.
b
The US EPA takes the view that dioxins do not have a threshold for safe exposure. In contrast, the WHO and some experts in the United Kingdom
are of the opinion that there is a practical threshold for dioxin exposure, leading to the establishment of a Tolerable Daily Intake (TDI) to set allowable
levels in foods. The level at which a TDI should be set is however not consensual and there is even disagreement on the health effects caused by low
levels of dioxins and other toxic chemicals.
Adapted from: (1) Bickel P and Friedrich R (eds.) (2005) EUR 21951 EN – ExternE – Externalities of Energy – Methodology 2005 Update. Institute of
Energy Economics and the Rational Use of Energy (IER), University of Stuttgart, Stuttgart. A Report produced for the EC Directorate-General for
Research. Luxembourg: Office for Official Publications of the European Communities. Available online as PDF file (287 pages) at http://ec.europa.eu/
research/energy/pdf/kina_en.pdf. Accessed on April 2009; (2) Sonnemann GW, Pla Y, Schuhmacher M, and Castells F (2002) Framework for the
uncertainty assessment in the impact pathway analysis with an application on a local scale in Spain. Environment International 28: 9–18; (3) White
RH, Cote I, Zeise L, et al. (2009) State-of-the-science workshop report: Issues and approaches in low-dose–response extrapolation for environ-
mental health risk assessment. Environmental Health Perspectives 117: 283–287.
Table 15 An overview of the impact pathway analysis (IPA)

Context and merits of IPA
– Management decisions (of industries and governments) have traditionally ignored the costs of environmental damages due to air
emissions
– Different stakeholders have now a growing interest in considering such costs
– Several methods have been proposed, which revealed too simplistic for adoption for policy analysis
– Promotion (by the European Commission) of the development of an alternative approach (IPA) within the ExternE project, which
produces results on the incremental impact of the emissions due to the operation of a new installation in a specific location
– Monetization of such an incremental impact and introduction in the cost accounting give important support for decision-making on the
level of environmental politics and business strategies
The principal steps of an impact pathway analysis

1. Emission: specification of the site, technology, relevant pollutants, and level (local/regional)
2. Dispersion (environmental fate analysis): increased pollutant concentration calculation at receptor sites
3. Impact
– Calculation of the cumulated exposure from the increased concentration
– Calculation of impacts – or damages in physical units – from calculated exposure, using exposure–response functions
4. Cost: valuation of the impacts (in monetary terms), which are summed over all affected receptors (the entire European Continent, for
most air pollutants emitted in Europe, and the entire globe, for greenhouse gases)
Most relevant limitations of IPA

– Uncertainty due to the complexity of the process, not only that associated with measurement of parameters that appear in equations
(equipment limitations or spatial and temporal variances), but also that associated with all models (the dose–response models used in
extrapolations and computer models used to predict the fate and transport of chemicals in the environment)
– Lack of reliability in the final results due to uncertainty (parameter uncertainty and model uncertainty) and spatial and temporal
variability (inherent variations in the real world) that make it more difficult to convince decision-makers by the outcomes of the
approach
Adapted from:
• Bickel P and Friedrich R (eds.) (2005) EUR 21951 EN – ExternE – Externalities of Energy – Methodology 2005 Update. Institute of Energy
Economics and the Rational Use of Energy (IER), University of Stuttgart, Stuttgart. A Report produced for the EC Directorate-General for
Research. Luxembourg: Office for Official Publications of the European Communities. Available online as PDF file (287 pages) at http://
ec.europa.eu/research/energy/pdf/kina_en.pdf. Accessed on April 2009.
• Sonnemann GW, Pla Y, Schuhmacher M, and Castells F (2002) Framework for the uncertainty assessment in the impact pathway analysis
with an application on a local scale in Spain. Environment International 28: 9–18.
effects, mainly those caused by low-level long-term ex- the major issues that this topic raises. The first concerns
posures to environmental chemicals (Table 16). the identification of the pollutant load that is currently
From another perspective, it is relevant to also discuss emitted during the incineration processes and the prob-
the potential psychological impact of the incinerators on ability of human exposure to those pollutants, con-
local communities and workers. In fact, waste inciner- sidering, on the one hand, the reduction of emissions,
ators also represent, mainly for those residing and resulting from a tightening of regulations, and, on the
working nearby, an increase in the potential to affect other, the currently generally increasing population
people’s quality of life and health, in terms of adverse density in the vicinity of incinerators.
effects on safety, in consequence of hypothetical and The probability of human exposure to environmental
non-null risk technological accidents. As a result, and pollutants proven to be the most critical in the occur-
according to the findings of several authors, the risks rence of adverse health effects is now considerably lower
associated with this type of facilities are characterized by as the quantities emitted have been greatly reduced,
uncertainty, in particular concerning the time scale and often by several orders of magnitude. As inhalation is
severity of potential consequences, and are perceived as potentially reduced under these conditions and ingestion
unknown, dread risks, with potential negative impact on is less probable given the reduced likelihood of crop
the human health, in terms of psychological symptoms, growing and animal rearing in the surrounding areas to
such as anxiety, depression, and stress. incinerators, a significant exposure of local populations to
the most concern-raising pollutants from incineration
processes is becoming ever more unlikely.
Conclusions The lack of consistent evidence for an additional risk
of the most probable effects of exposure to these pollu-
To conclude the discussion on the impacts of waste in- tants appears to confirm the potential irrelevance of this
cinerators on human health, rather than the presentation exposure and the potentially reduced impact on the
of major conclusions, it is more appropriate to present health of the surrounding population. However, several
Table 16 A SWOT analysis of human biomonitoring (HBM) to identify and quantify health impacts of waste incineration
Strengths Weaknesses
HBM may generate data on the body burden of, or the human HBM is only applicable for agents that are taken up by the body
body response to, a number of chemicals, making it possible to (e.g., it cannot be applied to highly relevant pollutants such as
identify whether exposure has occurred at all, and to estimate sulfur and nitrogen dioxides that exert their effects primarily at
the amount of the exposure the point of absorption)
HBM estimates the individual total exposure after it has taken HBM does not work either for every chemical due to its reactive
place, measuring the amount of the chemical absorbed into the nature or interferences, unless interfering reactions (e.g.,
body (the so-called internal dose), or even the biological metabolism of unrelated chemicals) can be accounted for or
effective dose, from all pathways, irrespective of pollution ruled out
source, exposure time, and exposed population factors, such The data on biomarkers cannot be used directly for many
as age, gender, health status, socioeconomic level, and chemicals whose relationship of body burden levels with
lifestyle, including physical exercise, that can affect not only the exposure is not available
amount of the chemicals entering the human body, but also
their degree of absorption. Based on these measurements, a There is lack of standardized procedures to sample and to
total dose can be back-calculated, or reconstructed, to analyze biological materials and to treat and interpret HBM
estimate an average past exposure rate, if information about data in order to ensure comparability of HBM results from
intake and uptake rates is available isolated studies
The results of HBM can be used to estimate chemical uptake Carrying out large surveys that include HBM presents
during a specific interval if the background levels do not mask challenging logistical problems and generally cannot be done
the biomarker and the relationships between uptake and every without having medical staff available (at least if blood samples
selected biomarker are known are taken)
Biomonitoring programs have the potential to provide valuable Interpreting HBM data to improve characterization and
HBM data on the geographic and (if studies are carried out evaluation of health risks still is a major, far-reaching, and
repeatedly) temporal differences in exposure among challenging issue
populations HBM has limitations related to ethics and communication
Within properly defined research studies, the results of HBM issues that arise with respect to sampling, collecting, and using
can be used to study the cause–effect framework of specific these data, as well as in communicating results to study
chemicals and to document the level of scientific evidence of participants, policymakers, and the general public
cause–effect links Gaps in knowledge are significant in many different areas (such
HBM of exposure can assess the health risk providing a as environmental and analytical chemistry, toxicology,
measurement of exposure that, when used with available biostatistics, stakeholders’ involvement, ethics, and
epidemiological, toxicological, and pharmacokinetic data, gives communication) and still with regard to reference and health-
information on the amount of a particular substance absorbed based values and low-dose/effect relations, which impedes
into the organism and then an indication of the potential risk for making scientifically sound decisions on (perceived)
health, on a group or individual basis environmental pollution
HBM is a versatile and powerful tool for the assessment of low- There are multiple research gaps where greater understanding
level long-term exposures to critical pollutants, and hence for of environmental and health interactions may be required
the assessment of their impacts on human health
Opportunities Threats
Rapidly developing technology is greatly improving sampling and The still-limited understanding of the potential of HBM among
analytical approaches making it much easier now to achieve relevant stakeholders implies lack of funding and competition for
detection and quantification of very low levels of chemicals in funding with other surveillance tools
humans Complexity and need for intersectoral and interdisciplinary work
Many population-based biomonitoring efforts are already taking
place. Biomonitoring is rapidly developing in the USA and
Separate routes for health surveys and HBM at regional,
Europe with comparable types and numbers of analytes being national, or local levels
measured. The US experience and that of a few countries in
Europe (e.g., Germany) are of reference
The biomonitoring of chemicals especially in children appears to
have a high priority in both the United States and the European
Union. Environment and health strategies and plans are now
also developing at the level of WHO, EU, and European
Member States (through the National Environment and Health
Action Plans – NEHAPs)
The potential use of HBM information for EU policies (e.g.,
REACHa), related in particular to the more precise identification
of substances of very high concern and to the evaluation of
effects of precautionary measures on the long term
a
REACH: Registration, Evaluation, Authorization, and Restriction of Chemical substances.
Adapted from:
Technical Working Group on Integrated Monitoring Subgroup Biomonitoring of Children (2004a) Baseline Report on ‘‘Biomonitoring of Children’’
in the Framework of the European Environment and Health Strategy (COM(2003)338 Final). Brussels: EC. Available online as PDF file (399
pages) at http://ec.europa.eu/environment/health/pdf/children_biomonitoring.pdf.
(Continued)
(Table 16 footnote Continued)
Technical Working Group on Integrated Monitoring Subgroup Biomonitoring of Children (2004b) Options for Action for ‘‘Biomonitoring of
(109 pages) at http://ec.europa.eu/environment/health/c_forum_march2004/biomonitoring.pdf.
Committee on Human Biomonitoring for Environmental Toxicants, National Research Council (2006) Human Biomonitoring for Environmental
Chemicals. Washington, DC: The National Academies Press. Available online as PDF file (420 pages) at http://www.nap.edu/catalog/
11700.html. Accessed on May 2008.
Biot P, Bonvalot Y, Casteleine L, et al. (2009) Highlights and Conclusions of the European Conference on Human Biomonitoring: From the Use
of Biomarkers to Human Biomonitoring. Final Report (27 January 2009). Paris: French Presidency of the EU Council.
Ludwine Casteleyn, L, Biot P, and Viso AC (2009) From human biomarkers to human biomonitoring in environmental health in Europe.
Highlights of the conference held in Paris on 4–5 November 2008. Bulletin Épidémiologique Hebdomadaire (special edn): 2–5.
aspects must be considered before drawing this type of To identify and quantify potential health impacts
conclusion: on the one hand, the absence of evidence is of waste incinerators, it is therefore necessary to develop
not evidence of absence, meaning that one cannot con- another type of study using more powerful tools
clude that because an excess of risk has not been identified, that allow the identification of pollutants or their me-
the exposure is safe. What may be happening is that the tabolites in the organism and the effects of these
traditional epidemiological methods and the way in which pollutants at levels as close as possible to the cellular or
exposure is determined are not appropriate for the de- molecular, only possible in approaches based on
tection of the increments in effects on potentially exposed HBM. As a nascent field, HBM raises certain issues in
people. Besides this, the low population density in the area which ethics and communication are of central impo-
surrounding incinerators is a changing reality, since the rtance. Surpassing these issues is one of the current
lack of resources of disadvantaged groups, for example, challenges it faces. The positive results that are achi-
migrant populations, does not offer them much alternative eved in the interim will surely be a valuable contri-
in terms of residing in areas less subject to environmental bution to reducing the also considerable psy-
pressures. Increasing numbers of these groups will tend to chosocial impact that results from the perception of
be subject to chronic exposure that, although reduced, additional risk due to the presence of incinerators on
may have yet unidentified health impacts. local populations.
Appendix
Annex 1 Municipal solid waste generated (per capita, selected countries, 1980–1990)
Country 1980 1985 1990
MSW generated (kg per capita MSW generated (kg per capita MSW generated (kg per capita
per year) per year) per year)
EU (27 countries) : : :
Euro area (15 countries) : : :
Euro area (13 countries) : : :
Austria : : :
Belgium : : :
Bulgaria : : :
Croatia : : :
Cyprus : : :
Czech Republic : : :
Denmark : : :
Estonia : : :
Finland : : :
France : : :
Germany : : :
Greece : : :
Hungary : : :
(Continued)
Annex 1 Continued
Country 1980 1985 1990
MSW generated (kg per capita MSW generated (kg per capita MSW generated (kg per capita
per year) per year) per year)
Iceland : : :
Ireland : : :
Italy : : :
Latvia : : :
Lithuania : : :
Luxembourg : : :
Macedoniaa : : :
Malta : : :
Netherlands : : :
Norway : : :
Poland : : :
Portugal : : :
Romania : : :
Slovakia : : :
Slovenia : : :
Spain : : :
Sweden : : :
Switzerland : : :
Turkey : : :
United Kingdom : : :
Canada (1) : : :
Canada (2) : : :
USA (1) : : :
USA (2) 610 630 750
Japan (1) : : :
Japan (2) 380 360 410
a
The former Yugoslav Republic of Macedonia.
Annex 2 Municipal solid waste generated and disposed of by incineration and by landfilling (per capita, selected countries,
1995–2006)
Country MSW generated (kg MSW incinerated MSW landfilled (kg Incinerated (%) Landfilled (%)
per capita per year) (kg per capita per per capita per year)
year)
1995
EU (27 countries) 474 65 296 14 62

EU (25 countries) 476 69 293 14 62
EU (15 countries) 505 82 292 16 58
Euro area 509 83 278 16 55
(15 countries)
Euro area 509 83 278 16 55
(13 countries)
Austria 438 54 205 12 47
Belgium 453 163 198 36 44
Bulgaria 693 0 530 0 76
Croatia : : : : :
Cyprus 600 0 600 0 100
Czech Republic 302 0 302 0 100
Denmark 567 294 96 52 17
Estonia 368 0 365 0 99
Finland 414 0 268 0 65
France 476 178 214 37 45
Germany 624 97 245 16 39
Greece 302 0 311 0 103
Hungary 460 32 346 7 75
Iceland 427 82 322 19 75
(Continued )
Annex 2 Continued
year)
Ireland 514 0 398 0 77

Italy 454 24 422 5 93
Latvia 263 0 247 0 94
Lithuania 424 0 424 0 100
Luxembourg 592 312 161 53 27
Macedoniaa : : : : :
Malta 332 0 305 0 92
Netherlands 549 139 158 25 29
Norway 626 84 456 13 73
Poland 285 0 280 0 98
Portugal 385 0 200 0 52
Romania 350 0 259 0 74
Slovakia 295 28 168 9 57
Slovenia 596 0 457 0 77
Spain 510 24 308 5 60
Sweden 386 149 136 39 35
Switzerland 598 288 77 48 13
Turkey 445 0 326 0 73
United Kingdom 499 45 414 9 83
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) : : : : :
USA (2) 730 : : : 0
Japan (1) : : : : :
Japan (2) 400 : : : 0
1996
EU (27 countries) 485 66 290 14 60

EU (25 countries) 490 70 289 14 59
EU (15 countries) 520 83 285 16 55
Euro area 525 86 265 16 50
(15 countries)
Euro area 525 86 264 16 50
(13 countries)
Austria 517 54 186 10 36
Belgium 451 152 189 34 42
Bulgaria 616 0 477 0 77
Croatia : : : : :
Cyprus 642 0 593 0 92
Denmark 619 308 82 50 13
Estonia 396 0 396 0 100
Finland 410 0 275 0 67
France 486 170 225 35 46
Germany 642 106 225 17 35
Greece 337 0 322 0 96
Hungary 468 32 367 7 78
Iceland 437 82 328 19 75
Ireland 524 0 419 0 80
Italy 457 27 380 6 83
Latvia 263 0 247 0 94
Lithuania 400 0 400 0 100
Luxembourg 589 306 163 52 28
Malta 344 0 317 0 92
Netherlands 563 171 115 30 20
Norway 632 81 425 13 67
Poland 301 0 295 0 98
Portugal 399 0 231 0 58
(Continued)
Annex 2 Continued
year)
Romania 333 0 235 0 71

Slovakia 275 28 172 10 63
Slovenia 590 0 465 0 79
Spain 536 25 298 5 56
Sweden 385 147 126 38 33
Switzerland 602 282 69 47 11
Turkey 471 0 345 0 73
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) : : : : :
USA (2) : : : : :
Japan (1) : : : : :
Japan (2) : : : : :
1997
EU (27 countries) 499 70 293 14 59

EU (25 countries) 506 75 291 15 58
EU (15 countries) 537 88 285 16 53
Euro area 541 93 262 17 48
(15 countries)
Euro area 541 93 261 17 48
(13 countries)
Austria 532 56 189 11 36
Belgium 467 179 123 38 26
Bulgaria 577 0 433 0 75
Croatia : : : : :
Cyprus 650 0 597 0 92
Denmark 588 315 65 54 11
Estonia 422 0 421 0 100
Finland 448 22 281 5 63
France 497 170 228 34 46
Germany 658 111 216 17 33
Greece 363 0 329 0 91
Hungary 487 32 391 7 80
Iceland 445 82 333 18 75
Ireland 547 0 439 0 80
Italy 468 31 374 7 80
Latvia 254 0 238 0 94
Lithuania 421 0 421 0 100
Luxembourg 607 300 145 49 24
Malta 354 0 328 0 93
Netherlands 590 219 70 37 12
Norway 619 84 383 14 62
Poland 315 0 306 0 97
Portugal 405 0 269 0 66
Romania 333 0 263 0 79
Slovakia 275 30 177 11 64
Slovenia 589 0 491 0 83
Spain 561 35 319 6 57
Sweden 416 150 130 36 31
Switzerland 606 281 68 46 11
Turkey 503 0 362 0 72
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) : : : : :
(Continued )
Annex 2 Continued
year)
USA (2) : : : : :
Japan (1) : : : : :
Japan (2) : : : : :
1998
EU (27 countries) 497 71 285 14 57

EU (25 countries) 507 76 286 15 56
EU (15 countries) 540 89 280 16 52
Euro area 543 92 257 17 47
(15 countries)
Euro area 543 93 256 17 47
(13 countries)
Austria 532 55 186 10 35
Belgium 460 164 101 36 22
Bulgaria 495 0 382 0 77
Croatia : : : 0 :
Cyprus 664 0 601 0 91
Denmark 593 312 67 53 11
Estonia 400 0 399 0 100
Finland 466 28 294 6 63
France 508 167 230 33 45
Germany 647 112 199 17 31
Greece 378 0 344 0 91
Hungary 484 35 396 7 82
Iceland 452 70 338 15 75
Ireland 557 0 478 0 86
Italy 472 34 365 7 77
Latvia 247 0 230 0 93
Lithuania 443 0 443 0 100
Luxembourg 629 288 146 46 23
Macedoniaa : : : 0 :
Malta 378 0 338 0 89
Netherlands 593 198 54 33 9
Norway 647 85 417 13 64
Poland 306 0 300 0 98
Portugal 423 0 310 0 73
Romania 284 0 230 0 81
Slovakia 259 34 181 13 70
Slovenia 584 0 512 0 88
Spain 566 38 317 7 56
Sweden 431 165 121 38 28
Switzerland 616 280 66 45 11
Turkey 510 0 371 0 73
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) : : : : :
USA (2) : : : : :
Japan (1) : : : : :
Japan (2) : : : : :
1999
EU (27 countries) 511 76 287 15 56

EU (25 countries) 521 81 287 16 55
EU (15 countries) 555 95 280 17 50
Euro area 555 98 255 18 46
(15 countries)
(Continued)
Annex 2 Continued
year)
Euro area 555 99 254 18 46

(13 countries)
Austria 563 57 195 10 35
Belgium 465 150 91 32 20
Bulgaria 503 0 388 0 77
Croatia : : : : :
Cyprus 670 0 605 0 90
Denmark 627 315 68 50 11
Estonia 413 0 412 0 100
Finland 485 38 280 8 58
France 509 169 224 33 44
Germany 638 125 180 20 28
Greece 393 0 358 0 91
Hungary 482 34 404 7 84
Iceland 457 62 345 14 75
Ireland 581 0 517 0 89
Italy 498 37 382 7 77
Latvia 244 0 227 0 93
Lithuania 350 0 350 0 100
Luxembourg 650 311 140 48 22
Malta 467 0 432 0 93
Norway 596 92 328 15 55
Poland 319 0 312 0 98
Portugal 442 62 303 14 69
Romania 322 0 261 0 81
Slovakia 261 32 185 12 71
Slovenia 551 0 455 0 83
Spain 615 36 331 6 54
Sweden 428 163 108 38 25
Switzerland 640 299 66 47 10
Turkey 463 0 354 0 76
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) : : : : :
USA (2) : : : : :
Japan (1) : : : : :
Japan (2) : : : : :
2000
EU (27 countries) 524 79 288 15 55

EU (25 countries) 531 84 286 16 54
EU (15 countries) 569 99 280 17 49
Euro area (15 569 103 255 18 45
countries)
Euro area (13 569 103 253 18 44
countries)
Austria 581 65 196 11 34
Belgium 474 156 73 33 15
Bulgaria 516 0 399 0 77
Croatia : : : 0 :
Cyprus 680 0 613 0 90
Denmark 665 352 67 53 10
Estonia 440 0 438 0 100
Finland 503 52 306 10 61
(Continued )
Annex 2 Continued
year)
France 516 169 220 33 43

Germany 643 133 165 21 26
Greece 408 0 372 0 91
Hungary 445 34 376 8 84
Iceland 466 57 351 12 75
Ireland 603 0 554 0 92
Italy 509 41 385 8 76
Latvia 270 0 252 0 93
Lithuania 363 0 344 0 95
Luxembourg 658 284 138 43 21
Malta 535 0 483 0 90
Norway 615 90 336 15 55
Poland 316 0 310 0 98
Portugal 472 96 338 20 72
Romania 363 0 302 0 83
Slovakia 254 39 196 15 77
Slovenia 513 0 402 0 78
Spain 662 37 339 6 51
Sweden 428 164 98 38 23
Switzerland 660 321 40 49 6
Turkey 458 0 357 0 78
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) 847 120 481 14 57
USA (2) 760 : : : 0
Japan (1) : : : :
Japan (2) 410 : : : 0
2001
EU (27 countries) 522 82 279 16 53

EU (25 countries) 531 87 277 16 52
EU (15 countries) 572 102 275 18 48
Euro area 570 106 247 19 43
(15 countries)
Euro area 570 106 246 19 43
(13 countries)
Austria 578 65 192 11 33
Belgium 467 160 54 34 12
Bulgaria 491 0 392 0 80
Croatia : : : 0 :
Cyprus 703 0 634 0 90
Denmark 658 374 47 57 7
Estonia 372 1 295 0 79
Finland 466 41 284 9 61
France 528 175 215 33 41
Germany 633 135 160 21 25
Greece 417 0 380 0 91
Hungary 451 35 375 8 83
Iceland 469 53 353 11 75
Ireland 705 0 540 0 77
Italy 516 45 346 9 67
Latvia 302 4 285 1 94
Lithuania 377 0 335 0 89
Luxembourg 650 275 131 42 20
(Continued)
Annex 2 Continued
year)
Malta 542 0 494 0 91

Norway 635 99 274 16 43
Poland 290 0 278 0 96
Portugal 472 104 355 22 75
Romania 345 0 272 0 79
Slovakia 239 25 209 10 87
Slovenia 479 0 358 0 75
Spain 658 37 364 6 55
Sweden 442 169 99 38 22
Turkey 457 0 360 0 79
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) : : : : :
USA (2) : : : : :
Japan (1) : : : : :
Japan (2) : : : : :
2002
EU (27 countries) 527 85 270 16 51

EU (25 countries) 534 90 266 17 50
EU (15 countries) 576 106 264 18 46
Euro area 573 109 236 19 41
(15 countries)
Euro area 572 110 234 19 41
(13 countries)
Austria 609 66 187 11 31
Belgium 471 157 50 33 11
Bulgaria 500 0 404 0 81
Croatia : : : 0 :
Cyprus 709 0 638 0 90
Denmark 665 374 41 56 6
Estonia 406 0 308 0 76
Finland 455 42 286 9 63
France 532 182 212 34 40
Germany 640 143 137 22 21
Greece 423 0 386 0 91
Hungary 457 28 384 6 84
Iceland 478 49 359 10 75
Ireland 698 0 504 0 72
Italy 524 48 331 9 63
Latvia 338 5 280 1 83
Lithuania 401 0 322 0 80
Luxembourg 656 275 129 42 20
Malta 541 0 516 0 95
Norway 677 109 274 16 40
Poland 275 1 265 0 96
Portugal 439 91 319 21 73
Romania 383 0 307 0 80
Slovakia 283 29 222 10 78
Slovenia 407 2 357 0 88
Spain 645 38 359 6 56
Sweden 468 188 93 40 20
(Continued )
Annex 2 Continued
year)
Turkey 450 0 357 0 79

Canada (1) : : : : :
Canada (2) 301 : : : 0
USA (1) 831 116 470 14 57
USA (2) : : : : :
Japan (1) : : : : :
Japan (2) : : : : :
2003
EU (27 countries) 519 85 256 16 49

EU (25 countries) 527 91 253 17 48
EU (15 countries) 568 106 249 19 44
Euro area 564 109 223 19 40
(15 countries)
Euro area 564 110 222 20 39
(13 countries)
Austria 609 73 183 12 30
Belgium 451 151 44 33 10
Bulgaria 499 0 407 0 82
Croatia : : : 0 :
Cyprus 724 0 653 0 90
Denmark 672 363 34 54 5
Estonia 418 0 274 0 66
Finland 460 49 278 11 60
France 535 182 204 34 38
Germany 601 137 115 23 19
Greece 428 0 393 0 92
Hungary 463 24 390 5 84
Iceland 485 45 364 9 75
Ireland 736 0 480 0 65
Italy 524 53 314 10 60
Latvia 298 5 248 2 83
Lithuania 383 0 328 0 86
Luxembourg 684 266 129 39 19
Malta 581 0 543 0 93
Norway 696 120 253 17 36
Poland 260 1 251 0 97
Portugal 447 96 293 21 66
Romania 350 0 277 0 79
Slovakia 297 30 233 10 78
Slovenia 418 3 348 1 83
Spain 655 42 364 6 56
Sweden 471 212 64 45 14
Turkey 445 0 363 0 82
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) : : : : :
USA (2) : : : : :
Japan (1) 427 : : 74 0
Japan (2) : : : : :
(Continued)
Annex 2 Continued
year)
2004
EU (27 countries) 516 89 243 17 47

EU (25 countries) 525 95 239 18 46
EU (15 countries) 567 111 233 20 41
Euro area 560 114 209 20 37
(15 countries)
Euro area 560 115 207 21 37
(13 countries)
Austria 620 136 126 22 20
Belgium 474 153 40 32 8
Bulgaria 471 0 396 0 84
Croatia : : : 0 :
Cyprus 739 0 659 0 89
Denmark 696 379 31 54 4
Estonia 449 0 283 0 63
Finland 465 55 273 12 59
France 543 183 203 34 37
Germany 587 144 104 25 18
Greece 433 0 389 0 90
Hungary 454 15 381 3 84
Iceland 506 45 365 9 72
Ireland 745 0 451 0 61
Italy 538 61 306 11 57
Latvia 311 6 259 2 83
Lithuania 366 0 334 0 91
Luxembourg 688 271 133 39 19
Malta 642 0 588 0 92
Norway 724 118 243 16 34
Poland 256 1 241 0 94
Portugal 436 95 291 22 67
Romania 345 0 273 0 79
Slovakia 274 34 222 12 81
Slovenia 417 8 313 2 75
Spain 608 41 309 7 51
Sweden 464 217 42 47 9
Turkey 421 0 345 0 82
Canada (1) 423 : 73 : 0
Canada (2) 307 : : : 0
USA (1) 849 117 466 14 55
USA (2) : : : : :
Japan (1) : : : : :
Japan (2) : : : : :
2005
EU (27 countries) 512 94 223 18 44

EU (25 countries) 519 100 217 19 42
EU (15 countries) 560 117 209 21 37
Euro area (15 554 121 187 22 34
countries)
Euro area (13 554 121 186 22 34
countries)
Austria 619 169 80 27 13
Belgium 476 160 37 34 8
Bulgaria 475 0 405 0 85
(Continued )
Annex 2 Continued
year)
Croatia : : : 0 :
Cyprus 739 0 653 0 88
Denmark 737 397 38 54 5
Estonia 436 0 274 0 63
Finland 474 43 282 9 59
France 542 183 195 34 36
Germany 564 160 48 28 9
Greece 438 0 387 0 88
Hungary 460 30 382 7 83
Iceland 521 37 368 7 71
Ireland 742 0 444 0 60
Italy 542 65 295 12 54
Latvia 310 3 243 1 78
Lithuania 376 0 343 0 91
Luxembourg 705 272 134 39 19
Malta 615 0 546 0 89
Norway 759 133 233 18 31
Poland 245 1 226 0 92
Portugal 446 98 278 22 62
Romania 377 0 296 0 79
Slovakia 289 34 228 12 79
Slovenia 423 1 330 0 78
Spain 597 44 292 7 49
Sweden 482 242 23 50 5
Turkey 438 0 362 0 83
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) 837 113 458 13 55
USA (2) 750 102 407 14 54
Japan (1) : : : : :
Japan (2) 400 : : : 0
2006
EU (27 countries) 517 98 213 19 41

EU (25 countries) 525 104 206 20 39
EU (15 countries) 563 122 193 22 34
Euro area 557 125 173 22 31
(15 countries)
Euro area 556 126 171 23 31
(13 countries)
Austria 617 181 59 29 10
Belgium 475 155 24 33 5
Bulgaria 446 0 356 0 80
Croatia : : : 0 :
Cyprus 745 0 652 0 88
Denmark 737 405 37 55 5
Estonia 466 1 278 0 60
Finland 488 42 286 9 59
France 553 183 192 33 35
Germany 566 179 4 32 1
Greece 443 0 386 0 87
(Continued)
Annex 2 Continued
year)
Hungary 468 39 376 8 80

Iceland 534 47 370 9 69
Ireland 804 0 471 0 59
Italy 548 65 284 12 52
Latvia 411 2 292 0 71
Lithuania 390 0 356 0 91
Luxembourg 702 266 131 38 19
Malta 652 0 562 0 86
Norway 793 132 245 17 31
Poland 259 1 236 0 91
Portugal 435 95 274 22 63
Romania 385 0 326 0 85
Slovakia 301 36 234 12 78
Slovenia 432 3 362 1 84
Spain 583 41 289 7 50
Sweden 497 233 25 47 5
Turkey 434 0 364 0 84
Canada (1) : : : : :
Canada (2) : : : : :
USA (1) 839 105 461 12 55
USA (2) : : : : :
Japan (1) : : : : :
Japan (2) : : : : :
a
The former Yugoslav Republic of Macedonia.
Source: See the following notes:
European MSW generation data
Source of data: EUROSTAT. Last update – 9 January 2008. Date of extraction – 3 April 2008, 09:59:39 GMT. Hyperlink to the table:
http://epp.eurostat.ec.europa.eu/tgm/table.do?tab ¼ table&init ¼ 1&plugin ¼ 0&language ¼ en&pcode ¼ en051
Short description: This indicator presents the amount of municipal waste generated. It consists of waste collected by or on behalf of
municipal authorities and disposed of through the waste management system. The bulk of this waste stream is from households, though
similar wastes from sources such as commerce, offices, and public institutions are included. For areas not covered by a municipal waste
scheme, estimation has been made of the amount of waste generated. The quantity of waste generated is expressed in kilogram per
person per year
European MSW incineration data

Short description: This indicator presents the amount of municipal waste disposed of through incineration. The bulk of this waste stream
is from households, though similar wastes from sources such as commerce, offices, and public institutions are included. Incineration
means thermal treatment of waste in an incineration plant as defined in Article 3(4) or a co-incineration plant as defined in Article 3(5) of
the Directive on the incineration of waste (Directive 2000/76/EC of 4 December 2000). The quantity of waste incinerated is expressed in
kilogram per person per year
European MSW landfill data

Short description: This indicator presents the amount of municipal waste disposed of through landfill. The bulk of this waste stream is
from households, though similar wastes from sources such as commerce, offices, and public institutions are included. Landfill is defined
as the depositing of waste into or onto land, including specially engineered landfill, and temporary storage of over 1 year on permanent
sites. The definition covers landfill both in internal sites (i.e., where a generator of waste is carrying out its own waste disposal at the place
of generation) and in external sites. The quantity of waste landfilled is expressed in kilogram per person per year
(Continued)
General disclaimer of the EC: http://europa.eu/geninfo/legal_notices_en.htm

Canada (1)
Source of data: UN. http://unstats.un.org/unsd/ENVIRONMENT/qindicators.htm. Municipal waste collected per capita served (kilogram
per person served per year). Household waste generated only. MSW landfilled refers to percent household waste landfilled
Canada (2)
Source of data: Values calculated from data from the Waste Management Business Survey, 2004. Refers to disposal of waste from
residential sources
Residential nonhazardous wastes disposed include: Solid waste produced by all residences, waste that is picked up by the municipality
(either using its own staff or through contracting firms), and waste from residential sources that is self-hauled to depots, transfer stations,
and disposal facilities. It does not include nonresidential nonhazardous solid wastes – those wastes generated by all sources excluding
the residential waste stream. These include: industrial materials, which are generated by manufacturing, and primary and secondary
industries, and are managed off-site from the manufacturing operation; commercial materials, which are generated by commercial
operations such as shopping centers, restaurants, offices, etc.; and institutional materials, which are generated by institutional facilities
such as schools, hospitals, government facilities, seniors’ homes, universities, etc. These wastes also include construction, renovation,
and demolition nonhazardous waste, also referred to as demolition, land clearing, and construction waste (DLC)
USA (1)
Source of data: Values calculated from data from the EPA (USA MSW Data Characterization Tables, 2006). MSW generation before
materials recovery or combustion. Does not include construction and demolition debris, industrial process wastes, or certain other wastes
Note: MSW incinerated refers to combustion with energy recovery (includes combustion of MSW in mass burn or refuse-derived fuel form,
and combustion with energy recovery of source-separated materials in MSW (e.g., wood pallets and tire-derived fuel)). MSW landfilled
refers to discards to landfill and other disposal, and equals discards after recovery for recycling and recovery for composting minus
combustion with energy recovery. Includes combustion without energy recovery
USA (2)
Source of data: OECD. http://www.oecd.org/dataoecd/60/59/38106368.pdf. Municipal waste (kilogram per capita per kilogram per
habitant)
Japan (1)
Source of data: UN. http://unstats.un.org/unsd/ENVIRONMENT/qindicators.htm. Municipal waste collected per capita served (kilogram
per person served per year). Data refer to waste treated by municipalities and separate collection for recycling by the private sector
Japan (2)
Source of data: OECD. http://www.oecd.org/dataoecd/60/59/38106368.pdf (OECD Environmental Data/Données OCDE sur l’envir-
onnement COMPENDIUM, 2006/2007). Municipal waste (kilogram per capita). Municipal waste: data cover municipal waste collection,
waste directly delivered, and in-house treatment. It excludes separate collection for recycling by the private sector (2.8 million ton). Total
incineration as a percentage of total amounts (waste treated by municipalities and separate collection for recycling by the private sector)
See also: Air Pollution Episodes, Assessment of Human Area Reputation, Occupational Cancer: Modern History,
Exposure to Air Pollution, Biological Pathways Between PM2.5 Sources and Their Effects on Human Health in
the Social Environment and Health, Biomarkers in China: Case Report, Political and Social Violence: Health
Environmental Carcinogenesis, Cancer Risk Assessment Effects, Polymorphism and Gene–Environment
and Communication, Disabling Environments, Economic Interactions in Environmental Cancer, Respiratory and
Inequality and Health in the Age of Globalization, Cardiovascular Effects of NO2 in Epidemiological Studies,
Endocrine Disrupting Chemicals and Human Sense of Coherence and Social Structure, Short-Term
Cancer, Environmental Carcinogens and Regulation, Effects of Air Pollution on Health, Social Capital and its
Environmental Lung Cancer Epidemiology, Links to Health, Social Support and Social Networks,
Environmental Tobacco Smoke and Cancer, Exposure Sulfur Oxides: Sources, Exposures and Health Effects.
Science: Pharmacokinetic Modeling, Fate and Transport:
Geostatistics and Environmental Contaminants, Global
Development and Population Health, Hazardous Further Reading
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Solid Waste Incinerators: Health Impacts: Abbreviations

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Solid Waste Incinerators: Health Impacts: Abbreviations

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Solid Waste Incinerators: Health Impacts

MF Reis, Institute of Preventive Medicine, University of Lisbon, Lisbon, Portugal

Abbreviations TCDD 2, 3, 7, 8-tetrachlorodibenzodioxin

0 500 1000 1500 2000

% MSW incinerated % MSW landfilled

1995 2000 2005

Studies addressed to exposure

Studies addressed to potential health effects

(A) Studya based on an impact pathway approach (IPA)

Table 4 Waste incineration air emission limit values

Total dust 10–30 Cd þ Tl 0.05

Table 5 Pollutants identified in stack emissions from US waste incineration facilities

Canada Mexico USA

Japan Korea Australia

New Zealand Austria Belgium

Czech Republic Denmark Finland

France Germany Greece

Paper and paperboard Organic material Plastics

Hungary Iceland Ireland

Italy Luxembourg Netherlands

Norway Poland Portugal

Slovak Republic Spain Sweden

Paper and paperboard Organic material Plastics

Table 6 Historical context for incinerator emissions

1980 1990 2000

Nitrogen oxides 1878 1580 1600

Direct methods Indirect methods

Bio Personal Environmental

Pharmacokinetic Exposure models

Point-of-contact Reconstruction Scenario

Exposure a Time b of Environmental Time e of

Integration of Internal Exposure

(2) Atmospheric transport and

Table 7 An overview of dispersion air modeling

Generic exposure scenarios to consider for the purposes of risk assessmentc

Exposure scenario Exposure pathwaysd

Salt water Freshwater

(1) Equation for long-term or chronic exposure b via direct inhalation:

Ca = Q [Fv C yv + (1.0 – F v )C yp]

(2) Equation for short-term or acute exposure b via direct inhalation:

Cacute = Q [F v C hv + (1.0 – Fv)C hp]

(a) – All compounds of potential concern as identified by US EPA, except mercury

Generic a equation for exposure via inhalation

ADI = (C air ∗ IR ∗ ET ∗ EF ∗ED ∗ 0.001) / (BW ∗ AT ∗ 356)

Generic equation for exposure via ingestion

I = [(Cgen∗ CR ∗ EF ∗ ED) / (BW ∗ AT)]

I = I soil + I ag + I beef + I milk + I pork + I poultry + I eggs + I fish + I dw

I soi; I ag; I beef;

*It is calculated using generic equation adequately modified

Table 9 Overviewa of human biomonitoring (HBM)

Essentials of the use of HBM

Some recently finished or current HBM activitiesc

Chemicals addressed by the past/current HBM activities

Strengths and limitations of human biomonitoring

Whole blood Plasma Serum