AbstractBackground: Policies on waste disposal in Europe are heterogeneous and rapidly changing, with potential healthimplications that are largely unknown. We conducted a health impact assessment of landfilling and incineration inthree European countries: Italy, Slovakia and England.Methods: A total of 49 (Italy), 2 (Slovakia), and 11 (England) incinerators were operating in 2001 while for landfillsthe figures were 619, 121 and 232, respectively. The study population consisted of residents living within 3 km ofan incinerator and 2 km of a landfill. Excess risk estimates from epidemiological studies were used, combined withair pollution dispersion modelling for particulate matter (PM10) and nitrogen dioxide (NO2). For incinerators, weestimated attributable cancer incidence and years of life lost (YoLL), while for landfills we estimated attributablecases of congenital anomalies and low birth weight infants.Results: About 1,000,000, 16,000, and 1,200,000 subjects lived close to incinerators in Italy, Slovakia and England,respectively. The additional contribution to NO2 levels within a 3 km radius was 0.23, 0.15, and 0.14 μg/m3,respectively. Lower values were found for PM10. Assuming that the incinerators continue to operate until 2020, weare moderately confident that the annual number of cancer cases due to exposure in 2001-2020 will reach 11, 0,and 7 in 2020 and then decline to 0 in the three countries in 2050. We are moderately confident that by 2050, theattributable impact on the 2001 cohort of residents will be 3,621 (Italy), 37 (Slovakia) and 3,966 (England) YoLL. Thetotal exposed population to landfills was 1,350,000, 329,000, and 1,425,000 subjects, respectively. We are moderatelyconfident that the annual additional cases of congenital anomalies up to 2030 will be approximately 2, 2, and 3whereas there will be 42, 13, and 59 additional low-birth weight newborns, respectively.Conclusions: The current health impacts of landfilling and incineration can be characterized as moderate whencompared to other sources of environmental pollution, e.g. traffic or industrial emissions, that have an impact onpublic health. There are several uncertainties and critical assumptions in the assessment model, but it providesinsight into the relative health impact attributable to waste management.
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