Vulnerability Scoping Study: Air Pollution Exposure amongst Waste Pickers in Dandora Dumpsite
About this report:
The ASAP-East Africa vulnerability scoping studies explore the experiences of those particularly vulnerable populations, occupations and locations in the East African cities of Addis Ababa, Kampala and Nairobi, exposed to high levels of both indoor and outdoor air pollutants. By undertaking vulnerability scoping studies, the research team seeks to generate a more textured understanding of specific characteristics and factors associated with vulnerability to air pollution. This will allow the exploration of these vulnerabilities across cities and facilitate the development of targeted recommendations that respond to the needs of specific populations, occupations or locations. Author and contributions:
This report was written by William Avis (Research Fellow, University of Birmingham United Kingdom), Michael Gatari (University of Nairobi) and David Ng'ang'a (University of Nairobi). The authors would like to thank Nairobi Media House staff who facilitated the air pollution study and provided invaluable input into its preparation as well as survey respondents who participated in the study. Without their willing participation this study would not have been possible. The author also appreciates the contributions of Francis Pope (University of Birmingham) and Winnie Khaemba (African Centre for Technology Studies) who made valuable comments on earlier versions of the Report. About the A Systems Approach to Air Pollution – East Africa (ASAP-East Africa) project
ASAP-East Africa brings together leading UK and East African researchers in air pollution, urban planning, economic geography, public health, social sciences and development studies to provide a framework for improved air quality management in three East African cities: Addis Ababa (Ethiopia), Kampala (Uganda) and Nairobi (Kenya). This timely and responsive programme of activity will enhance local decision-making abilities to improve urban air quality, reduce the effects of air pollution upon human health, and allow for sustainable development to proceed without further deterioration in air quality. Central to the project’s aims are strengthening research capabilities and technological expertise in East Africa, with local stakeholders and experts involved in the conception, implementation, and uptake of the programme and its outcomes. Suggested citation:
Avis, W. (2018). Air Pollution Exposure amongst Waste Pickers in Dandora Dumpsite. ASAP-East Africa Vulnerability Scoping Study no. 2. Birmingham, UK: University of Birmingham.
Disclaimer Statement
This material has been funded by UK aid from the UK government; however the views expressed do not necessarily reflect the UK government’s official policies.
asap-eastafrica.com 2
Title of Research Programme A Systems Approach to Air Pollution – East Africa
Reference Number 17-0600
Name of Lead Organisation University of Birmingham
Project Management Team Dr Pope, Dr Andres, Dr Avis and Ms Blake
Key/Core Partners Addis Ababa Institute of Technology/ Ethiopian Roads Authority
African Centre for Technology Studies
Cardiff University
Ethiopian Public Health Institute
Kampala Capital City Authority
Ndejje University
Strathmore University
Uganda National Roads Authority
University of Nairobi
Countries to be Covered by Research Ethiopia (Addis Ababa), Kenya (Nairobi), Uganda (Kampala)
Project Start Date/End Date 01/09/17-30/06/2020
asap-eastafrica.com 3
Table of Contents Acronyms ...... 5
Executive Summary ...... 6
Introduction ...... 6 Vulnerability scoping studies ...... 7 Occupational exposure and air pollution ...... 8 Methodology ...... 11 Study site ...... 12 Environmental management and dumpsites ...... 13 Vulnerability and air pollution ...... 14
Vulnerability Dimensions...... 15 Exposure ...... 17 Air pollution exposure of waste pickers ...... 18 Outdoor air pollution (Dandora dumpsite) ...... 22 Susceptibility ...... 23 Impacts on public health ...... 24 Respiratory Disorders ...... 25 Adverse Birth Outcomes...... 26 Cancer (Malignant Tumours) ...... 26 Social risks ...... 26 Perceptions of susceptibility to air pollution (Dandora dumpsite) ...... 27 Adaptive capacity...... 27 Facilitating adaptation...... 32
Conclusions and recommendations ...... 35 Individual (waste pickers) ...... 35 Organisational (dumpsite operators, employers and representative organisations and others) . 37 Governmental ...... 38
References ...... 41
asap-eastafrica.com 4
Acronyms
AQ: Air Quality ARI: Acute Respiratory Infection ASAP-East Africa: A Systems Approach to Air Pollution – East Africa CBD: Central Business District COPD: Chronic Obstructive Pulmonary Disease CSO: Civil Society Organisations DFID: Department for International Development EARH: East African Research Hub IHME: Institute for Health Metrics and Evaluation IPCC: Intergovernmental Panel on Climate Change ISWA: International Solid Waste Association LAC: Local Adaptive Capacity LMIC: Low and Middle-Income Countries MSW: Municipal Solid Waste NGO: Non-Governmental Organisation OPC: Optical Particle Counter PM: Particulate Matter RoK: Republic of Kenya UNEP: UN Environment Programme US EPA: United States Environmental Protection Agency UoB: University of Birmingham UoN: University of Nairobi VSD: Vulnerability Scoping Diagram WHO: World Health Organisation WP: Work Package
asap-eastafrica.com 5
Executive Summary Air pollution is a global environmental health threat, contributing to an estimated 3-7 million deaths per year globally. Whilst there are different types of air pollution, particulate matter (PM) air pollution contributes the most to the global burden of disease. The effects of air pollution on human health are well documented in a range of epidemiological studies; exposure increases the risk of lung cancer, heart disease, bronchitis and other cardiorespiratory conditions. Whilst air pollution is considered to impact on all groups, particularly when exposed over prolonged periods of time, some groups are considered to be more susceptible than others. Those that work in occupations where exposure frequency, duration and intensity or concentration of pollutants are particularly susceptible due to the nature of their working environments. The second of the ASAP-East Africa vulnerability scoping studies explores the vulnerability of waste pickers who work in the Dandora dumpsite (Nairobi, Kenya). Vulnerability scoping studies were conducted with the aim of gaining a deeper understanding of specific characteristics and factors associated with vulnerability to air pollution. They provide readers with a synthesis of existing evidence and theoretical approaches to the study of air pollution exposure. This synthesis in turn contextualises the empirical data gathered during the study and allows the reader to relate findings to existing literature.
This study has explored the exposure of waste pickers to air pollution in Dandora dumpsite via the deployment of a low cost PM sensor located in an outdoor setting. The study also probed perceptions of waste pickers regarding air pollution. Findings underscore the vulnerability of waste pickers to air pollution and suggest that those from low socioeconomic backgrounds are likely to face a dual burden of exposure both at home and in work environments. Data gathered during this study indicates that air pollution levels in Dandora exceed World Health Organisation
3 (WHO) guidelines. PM concentrations, in the PM2.5 range, were measured to be on average 47.4 ± 9.5 µg/m and peak concentration was 94.5 ± 32.6 µg/m3 during the monitoring period1. Further to this, air pollution levels demonstrated a high degree of variability, though consistently reaching unhealthy levels on weekdays (Monday- Friday). Whilst air pollution levels recorded during weekends were lower, they suggested that air pollution is consistently at levels considered unhealthy for sensitive groups.
Survey findings suggest that waste pickers, whilst relatively cognisant of their exposure to air pollutants, recorded a relatively low perception of vulnerability to air pollution. On a scale of 1-5, the average score of respondents was 2.24/5 (with five indicating extreme levels of vulnerability). This may in part be explained by survey participant’s views of their inability to access alternative livelihoods, resources to minimise exposure or support. This study underscores that broader efforts to address solid waste management (SWM) and support alternative or improved livelihoods will concomitantly improve air quality. Given the inherent vulnerability of waste pickers to air pollution
1 PM2.5 particles (sometimes termed fine particles) are those with a diameter less than 2.5 µm in diameter. asap-eastafrica.com 6
exposure, coupled with the overlap of work and home environments, it is clear that there is a need to develop and implement policies that simultaneously address broader SWM issues and air pollution in such settings. Introduction Air pollution is a global environmental health threat contributing to an estimated three million deaths per year worldwide (Lelieveld et al., 2015). The Global Burden of Disease project (World Bank & IHME, 2016) estimates a figure for premature deaths closer to 5.5 million (one in every ten and the fourth highest factor for causing early death). The most extreme estimates are presented by the WHO, reporting that in 2012 seven million people died - one in eight of total global deaths - as a result of air pollution exposure (WHO, 2014).
The effects of air pollution on human health are well documented in a range of epidemiological studies; exposure increases the risk of lung cancer, heart disease, bronchitis and other cardiorespiratory conditions (Kelly & Fussell, 2015). The economic cost of this health loss is also significant, the World Bank estimates that globally in 2013 air pollution led to an estimated $5.11 trillion in welfare losses, and $225 billion in lost labour income (World Bank & IHME, 2016). The World Bank concludes that air pollution “is not just a health risk but also a drag on development… By causing illness and premature death, air pollution reduces the quality of life. By causing a loss of productive labour, it also reduces incomes” (IBID: 2).
Whilst these headline figures are alarming, they tend to gloss over the disproportionate impact of poor air quality on certain populations, locations and occupations. Common approaches to assessing the impact of air pollution have tended to assume an equal vulnerability, sensitivity or susceptibility to air pollution (Stilianakis, 2015). This assumption masks differences in exposure and risk across populations, locations and occupations with air quality in cities varying both spatially and temporally (Kathuria & Khan, 2007). Although average changes in risk associated with exposure to air pollution are considered small, some individuals or groups can be considered more vulnerable or susceptible than others (Avis & Khaemba, 2018).
Vulnerability scoping studies
The ASAP-East Africa vulnerability scoping studies explore the experiences of those particularly vulnerable populations, occupations and locations in the East African cities of Addis Ababa (Ethiopia), Kampala (Uganda) and Nairobi (Kenya), exposed to high levels of both indoor and outdoor air pollutants. By undertaking vulnerability scoping studies, the research team seeks to generate a more textured understanding of specific characteristics and factors associated with vulnerability to air pollution. This will allow the exploration of these vulnerabilities across cities and facilitate the development of targeted recommendations that respond to the needs of specific populations, occupations or locations.
Whilst air pollution is considered to impact on all groups, particularly when exposed over prolonged periods of time, some groups are considered to be more susceptible than others. The WHO considers as vulnerable groups; young children, the elderly, persons with certain underlying diseases, foetuses, groups exposed to other toxicants
asap-eastafrica.com 7
that interact with air pollutants and those with low socioeconomic status (WHO, 2004). The second of the ASAP- East Africa vulnerability scoping studies explores the vulnerability of waste pickers at Dandora dumpsite in Nairobi, Kenya.
Vulnerability scoping studies provide readers with a synthesis of existing evidence and theoretical approaches to the study of air pollution. This synthesis in turn contextualises the empirical data gathered during the study and allows the reader to relate findings to existing literature.
Occupational exposure and air pollution
It is estimated that in 2017, 2.78 million work related deaths occurred globally. Of this figure those attributed to work-related diseases far exceeded that of work accidents and fatalities. Work-related diseases accounted for 2.4 million (86.3%) of the total death estimate. Of this figure, respiratory diseases (17%), malignant neoplasms/cancers (26%) and cardiovascular diseases (31%) were the leading causes of death (all of which have been linked with exposure to air pollutants) (Hämäläinen et al., 2017: 4; Pope et al., 2011).
Despite a growing body of evidence regarding the health impacts of air pollution, relatively little attention has focussed on the effects of occupational exposure (Fang et al., 2010). Findings from systematic reviews suggest that occupational exposure may differ from general ambient exposures in both particle type (i.e.. composition), as well as exposure frequency (i.e. environmental exposures are relatively constant while occupational exposures are more variable), duration (i.e. a work-shift and working lifetime versus an entire day and lifetime), and intensity or concentration (i.e. occupational exposures may be higher than ambient levels) (Fang et al., 2010: 1774). These differences in exposure composition, duration, frequency and population exposed may have implications for how occupational exposure impacts on individual and group health. Certain types of work (e.g. in transport or construction) may lead to higher exposure (Rotko et al., 2000).
It is broadly accepted that certain occupational activities will increase exposure of individuals to physical hazards, pathogens, and environmental pollutants. Studies in Kenya highlight differences across occupational groups. Ngo et al. (2015) undertook a study of occupational exposure to roadside emissions of four occupations in Mathare, Nairobi (bus drivers, female workers, mechanics and street vendors). Findings suggested that bus drivers had the greatest exposure to PM2.5 and were the only occupation that experienced statistically different exposure levels from the other three groups, exposure levels of PM2.5 for street vendors, mechanics and women were not statistically different from each other.
Further examples of hazardous work can include those who live on or near waste dumps and make a living from sorting and selling waste products which is the focus of this vulnerability scoping study. In such contexts, vulnerability to air pollution will intersect and exacerbate other issues stemming from unsafe or precarious jobs, low income and poor quality housing.
asap-eastafrica.com 8
Dumpsites and waste pickers
In many cities, poor solid waste management has a direct impact upon health, length of life and the environment. According to the World Bank2, in 2016, the worlds’ cities generated an estimated 2.01 billion tonnes of solid waste, with annual waste generation expected to increase by 70% to 3.40 billion tonnes by 2050, its management is a central concern of government departments, pollution control agencies, regulatory bodies and the public (Scheinberg, 2012). The public sector in many countries struggles to deliver waste collection services effectively, Table 1: The world’s five largest dumpsites (ISWA, 2014) government regulations pertaining to SWM are often lacking, poorly implemented or not enforced and is further Location of Dumpsite Waste in Place (Tonnes) exacerbated by the widespread absence of appropriate Bantar Gebang (Jakarta, 28,280,000-40,400,000 Indonesia) disposal facilities. According to the International Solid Waste Association (ISWA, 2015), disposal through open Estrutural (Brasilia, Brazil) 21,000,000-30,000,000 dumping continues to be a dominant method of waste Dandora (Nairobi, Kenya) 19,500,000-27,750,000 disposal in many low and middle-income countries with Olushosun (Lagos, Nigeria) 17,150,000-24,500,000 dumping usually taking place close to the urban centres La Duquesa (Santo Domingo, 14,700,000-21,000,000 where waste is generated (Schübeler, 1995). The rapid Dominican Republic) accumulation of solid waste in many growing cities is considered a direct by-product of urbanisation, population growth and low budgetary allocation to SWM (Ndunda & Muia, 2018). Conversely, high waste collection coverage has been closely related to good governance, demonstrating the commitment of authorities to keep cities clean and healthy.
UNEP (2015) comment that improper management of solid waste is one of the main causes of environmental pollution and degradation. Common issues associated with dumpsites include surface water, groundwater and soil contamination (from toxic elements such as heavy metals and metalloids3); air pollution from burning of materials, underground fires fuelled by landfill gas, and gas leakage; and biodiversity problems. As such, dumpsites are sources of fine and coarse particulates, the make-up of which will depend on activities undertaken onsite and the types of waste handled (ISWA, 2015).
Women in Informal Employment (WIEGO: 2013: 1) estimate that 24 million people worldwide are engaged in various stages of SWM (recycling: collecting, recovering, sorting, grading, cleaning, baling, or compacting waste, as well as processing waste into new products). The majority of these jobs, circa 80%, are in the informal sector. More specifically, ISWA (2014) conservatively estimate that over 52,500 waste pickers work in the fifty largest dumpsites. Waste picking provides an income for low income groups and is also considered to benefit municipal authorities, reducing the amounts of material requiring disposal, diminishing the carbon (CO2) footprint of the solid
2 http://www.worldbank.org/en/topic/urbandevelopment/brief/solid-waste-management 3 See here for details of toxic elements found globally https://www.pollution.org/ asap-eastafrica.com 9
waste system, and improving performance of disposal facilities (Scheinberg, 2012). Whilst work situations differ greatly across countries, a number of basic categories of waste pickers have been identified45.
Dumpsite/landfill waste pickers reclaim and sell recyclables and gather organic matter.
Street waste pickers reclaim recyclables from mixed waste disposed in garbage bags and bins on streets or in dumpsters; some have arrangements with commercial and/or office buildings.
Doorstep waste pickers collect recyclables as part of door-to-door selective waste collection schemes run by municipalities in partnership with membership-based organisations.
On route/truck waste pickers refers to formal collection crews who segregate recyclables from household waste to supplement their salaries.
Itinerant buyers collect recyclables from households/businesses in exchange for payment or barter. They generally work on fixed routes and use pushcarts or other collection vehicles.
Sorters select and sort recyclables by type from conveyor belts or other devices.
Handlers/processors of organic waste work in compost or biogas plants.
In the context of this report, the focus is on dumpsite waste pickers. As this group often live near to or on dumpsites they are exposed to pollution both at work and home. Of those surveyed during this research, 24 of the 25 lived under two kilometres from the dumpsite (see figure 1). Groups working as waste pickers often share low social status, poor living and working conditions, and receive little support from local governments. Muniafu and Otiato (2010) estimate that those engaged as waste pickers in dumpsites such as Dandora earn as little as USD$1 per day. Lubaale & Nyang’oro (2013: 38) estimate a figure between USD$ 1.4-2.4 per day for waste pickers working in Nakuru (Kenya) dumpsite. Other reports suggest that earnings, in a number of contexts exceed legal minimum wage levels (e.g. Pune, Lima and Cluj), this has often been associated with the formation of waste picker representative organisations (GIZ, 2011).
Whilst limited, available studies, drawn from a range of geographic settings, suggest that air quality in and around dumpsites is often poor (see table 7) and that various air pollutants are found in dumpsites and households built in close proximity. Findings also indicate that those who live or work near to dumpsites suffer from a variety of health conditions, particularly respiratory issues. In such environments a number of factors affect air quality, including emissions from open burning of waste, dust and vehicular emissions associated with the delivery and movement of waste. Studies exploring this issue in East Africa are, however, limited. The present study seeks to address this paucity of evidence and was initiated to fulfil four objectives:
4 http://www.wiego.org/informal-economy/basic-categories-waste-pickers 5 The term “waste picker” was adopted at the First World Conference of Waste Pickers (Bogota, Colombia 2008) to facilitate global networking and to supplant derogatory terms like “scavenger”. asap-eastafrica.com 10
1) to measure the levels of PM2.5 in a city dumpsite and assess waste pickers exposure to air pollution;
2) to study outdoor (dumpsite) PM2.5 concentrations;
3) to investigate perceptions or air pollution amongst waste pickers;
4) to develop recommendations to improve air quality and reduce exposure to air pollution of waste pickers.
Methodology
Based on initial findings from urban profiling and stakeholder mapping alongside data collected in Work Packages 1-5 (WP), six case studies (two per city) are being undertaken that explore the spatial and demographic impact of air pollution, focusing on areas exposed to high levels of air pollution, or particularly vulnerable populations. Case studies focus on the following subset of vulnerability issues: vulnerable locations (e.g. informal settlements or areas close to sources of pollution such as roads or factories); vulnerable populations (e.g. the urban poor, women, children or the elderly who may be more susceptible to air pollution) and vulnerable occupations (e.g. street vendors, motorcycle taxi drivers that may be exposed to higher levels of PM over sustained periods of time). A mixed methods approach is used, combining quantitative and qualitative data collection and drawing on other WPs. This approach includes:
A desk review to identify and incorporate existing and available information, including previously conducted research, surveys and assessments. Our desk review was undertaken using a Boolean methodology searching a range of databases and including both academic and grey literature.
Participatory risk mapping and vulnerability scoping utilised to produce Participatory Risk Maps involving city research partners and a selection of survey respondents and city stakeholders (circa 5). The vulnerability scoping studies deploy an assessment tool known as the Vulnerability Scoping Diagram (VSD). The VSD defines the system being studied, divides vulnerability into its three dimensions (exposure, sensitivity/susceptibility, and adaptive capacity), defines components of these dimensions, and assigns measures to these. Participatory vulnerability scoping facilitates better understandings of place and group-based vulnerability and enables comparison across cities and studies.
Table 2: Steps in the participatory risk mapping and vulnerability scoping diagram process (Wood et al., 2013)
Phase 1: Issue definition Phase 2: Risk Identification and Ranking Phase 3: Visualising Results
1. Recruit Participants from 2. Individuals list and 5. Group compiles 8. Display rankings in system stakeholders define risks consensus risk list vulnerability scoping diagram 3. Individual ranking of 6. Group ranking of severities and risk severities and probabilities probabilities 4. Individuals assign 7. Group assigns vulnerability vulnerability dimensions to risks dimensions to risks
asap-eastafrica.com 11
Standardised surveys will be conducted in vulnerable areas and amongst vulnerable groups. Surveys will be co- designed with research partners and tailored in relation to findings from WP1-5, urban profiles and stakeholder mapping. A total of 20-30 surveys will be conducted per case study Survey modules will be tailored for specific occupations, locations and populations6.
Semi-structured key informant interviews will be undertaken with a minimum of 5 stakeholders including relevant representatives of; Local Government, Private Sector, Civil Society Organisations and Informal Community based organisations.
Synthesis of data collection and analysis (WP1-5), information gathered from other WPs will also inform the development of vulnerability scoping studies.
Study site
The ASAP-East Africa team partnered with Nairobi Community Media House to undertake this study of air pollution exposure of waste pickers working in Dandora. Dandora is Nairobi’s principle dumpsite, located in east Nairobi approximately eight kilometres from the city centre and comprises an area of 53 ha2. Over 2,000 tonnes of waste generated and collected from various locations is deposited on a daily basis (UNEP, 2007a). Dandora is Image 1: Location of Dandora dumpsite (orange marker) and areas from which survey participants commute (one estimated to receive around 730,000 tonnes3 of waste respondent commutes from Kamulu not included on the map) annually (domestic, industrial, agricultural and hospital) with 19,500,000-27,750,000 tonnes of waste thought to have been disposed on site since it was established in 1975 with financing from the World Bank (ISWA, 2014: 21). The site was deemed full in 2001 yet continues to operate (Onyari, 2017). Nearby residential areas and informal settlements have a population of one million, while circa 3.5 million people living within a ten kilometre radius of the site (ISWA, 2014: 21). The site is bordered by the Kariobangi and Korogocho informal settlements and the residential areas of Dandora and Babadogo.
Movement into and out of the site is unrestricted and illicit dumping is common place. Waste pickers operate across the area, mostly searching for food products and valuables (such as metals, rubber, glass, plastic and electronics). Estimates of the number of waste pickers active at Dandora are difficult to ascertain and vary considerably. ISWA (2014) suggest a figure of 3,000 waste pickers active on site on a daily basis. Other studies place this figure between 6,000-10,000 (Odero, 2012)..
6 This scoping study includes 25 completed surveys. asap-eastafrica.com 12
To explore exposure to air pollution of waste pickers working at Dandora dumpsite, the research team implemented a short pollution monitoring campaign between 26th and 5th October 2018. Air pollution was monitored via the deployment of an air pollution monitor installed within the dumpsite. Measurements were collected using calibrated Alphasense optical particle counters (OPC-N2) which recorded PM2.5 and PM10 at ten second intervals, aggregated to one-hour time steps. The calibration approach, and the use of the OPC-N2, is discussed by Crilley et al. (2017) and Pope et al. (2018).
The OPC-N2 sensor was placed on the rooftop of a building (approximately 20 meters above the ground level) in Dandora’s Phase 2 estate. The site is located in the North-Eastern part of Nairobi and is off Komarock road, which connects with the busy Outer Ring road in Nairobi. The sampling site is located approximately 300 meters from Dandora dumpsite. Given the location of the monitor, readings provide an overview of background dumpsites Table 3: Sources of solid waste (UNEP, 2007: 10) pollution levels. To gain an accurate reading of individual Domestic waste originates from homes and air pollution exposure one would need to deploy sensors includes foods, household chemicals, packaging at locations across the site as well as providing personal materials, electrical goods and utensils. sensors. Industrial waste includes falloff or unused A survey was also undertaken with twenty five Dandora chemicals/raw materials used in manufacturing waste pickers recruited by Nairobi Community Media processes, expired products and substandard House, to explore perceptions of air pollution. Exploring goods. perceptions of air pollution provides an opportunity to Agricultural waste includes chemicals used as investigate societal attitudes towards this issue and to pesticides (herbicides and fungicides) and draw associations between perceived and actual unwanted agricultural products. exposure. A number of studies have identified correlations Hospital waste includes packaging, containers, between perceptions of air quality and monitoring data used syringes and sharps, biological waste, and (Hunter et al., 2004), other studies challenge this pharmaceuticals. association (Semenza et al., 2008). Given the small number of participants involved, the survey is primarily used for illustrative purposes, to identify broad trends and differences across participant responses and areas for future research. Surveys were conducted in English and Kiswahili and were facilitated by Nairobi Community Media House.
Environmental management and dumpsites in Kenya
Environmental problems associated with dumpsites often stem from a lack of planning and sound management. An adequate SWM system consists of collection, transportation, resource recovery and disposal, all of which entail significant costs. Many countries experience challenges associated with waste management associated with weak economies, low technical capacities, limited physical infrastructure, an inability to enforce legislation, financial mismanagement and poor administrative capacity (Muniafu & Otiato, 2010: 343).
asap-eastafrica.com 13
The National Government has historically been responsible for establishing the institutional and legal framework for municipal SWM and ensuring that local governments have the necessary authority and capacity to deliver this service (UN HABITAT, 2008). In a devolved system of government effected by the 2010 Constitution, county governments are generally responsible for the provision of solid waste collection and disposal services. Article 42 of the Kenyan Constitution states that every person has a right to a clean and healthy environment and article 69 encourages public participation in environmental management, protection and conservation (Republic of Kenya, 2010). Similarly, the social pillar of Kenya Vision 2030 (Kenya’s long-term development plan), indicated the need to have a just and cohesive society that enjoys equitable social development in a clean and secure environment (Republic of Kenya, 2007).
Nairobi’s solid waste situation is, however, characterised by low coverage and collection, pollution from uncontrolled dumping, inefficient waste managment, an unregulated and uncoordinated private sector operations in this sector and lack of key SWM infrastructure. City authorities (now county governments) have responsibility for waste collection with studies (UN HABITAT, 2008; Zamberia, 2007) estimating that around 50% of residents lack waste collection services with only 1,560 tonnes (48-52%) of solid waste collected per day of the total waste generated (UNEP, 2007). Total waste reuse and recycling is estimated at about 100-150 tonnes per day or approximately 5% of total waste generated (Kasozi & Blottnitz, 2010).
Muindi et al. (2016) indicates that the failure of municipal authorities to adequately provide SWM services, coupled with the ‘informalisation’ of the Kenyan economy in the 1990s has meant that the private sector has become the main providers of waste management services. Despite the presence of security officers, Dandora dumpsite has become a locus of criminal activity. Organised criminal groups exert a significant influence and control materials recovered and onward sale to recyclers. It is reported that criminal elements, levy a security fee (about USD$5) to all vehicles delivering waste at the dumpsite.
Vulnerability and air pollution
Understanding vulnerability to air pollution presents a unique challenge for researchers. Authors commonly refer to vulnerability as the level of exposure of human life, property and resources to the impact from hazards (in this case air pollution) (Fussel, 2007; O’Brien et al., 2009). Factors, such as sex, age, education, and occupational exposure can modify the relationship between hazards and mortality (Kan et al., 2008). Further to this, the effects of air pollution exposure on health are considered greater in people from lower socioeconomic backgrounds (O’Neil, 2003). According to Stilianakis (2015: 10-11) exposure to air pollution may have different effects on individuals and population groups due to differences in innate and acquired characteristics. Innate characteristics are mainly biological and physiological and reflect the capacity of the human body to respond to exposure. Acquired factors, such as socioeconomic status, are those that affect social coping or adaptive capacity and do not allow the individual or the population group to minimise exposure. Vulnerability is thus considered to involve two components:
External risks, shocks and stresses to which an individual or household is subject. asap-eastafrica.com 14
Internal abilities which offer a means for coping without causing damage or loss (i.e. adaptive capacity).
The ASAP-East Africa programme adopts the WHO’s (2004) definition of vulnerability i.e. “the likelihood of being unusually severely affected by air pollutants either as a result of susceptibility to the effects of these substances or as a result of a greater than average exposure”. Three dimensions of vulnerability are commonly identified in the literature and are explored in the ASAP-East Africa Vulnerability Scoping Studies (Howe et al., 2013):
Exposure i.e. the degree to which the subjects or areas could be affected by air pollution.
Susceptibility i.e. the likelihood of being harmed by air pollution.
Adaptive capacity i.e. the ability to take actions to either reduce or avoid risk.
Vulnerability may thus be compounded by factors including location; adaptive capacity (i.e. the ability to protect oneself from harm including access to materials, technology, knowledge, information and social protection), the extent of assistance and support, including services, resources and technical expertise, that society can provide. For an overview of relationships between population, location and occupation characteristics and associated factors that contribute to vulnerability see Avis and Khaemba (2018: 20). Table 4: Survey respondents ranking of issues of concern (1 = most pressing concern, 10 = least pressing concern) An individual’s vulnerability to air pollution is thus complex, the product of interactions between environmental Concerns stressors, innate and acquired susceptibility, differential 1: Lack of employment 6: Crime exposure and adaptation mechanisms (US EPA, 2003). opportunities Further to this, vulnerability to air pollution consists of a 2: Food shortages 7: Government corruption number of compounding factors inherent in the individual 3: Poor health care 8: Lack of access to clean and influenced by broader social or environmental toilets contexts e.g. smoking and co-exposures. It is also 4: Lack of clean drinking 9: Air pollution water important to note that concerns regarding air pollution compete for space alongside a number of other issues 5: Poor quality schools 10: Energy shortages (see table 4). Vulnerability Dimensions In the context of ASAP-East Africa research, exposure to high levels of particulate matter (PM) is a focus. PM or atmospheric aerosols is the term used to indicate any solid or liquid particles suspended in the atmosphere. Atmospheric particles vary widely in their physical parameters such as size and chemical composition. PM is generated from a variety of natural and anthropogenic processes. Natural sources of PM include dust storms, ocean/sea spray (sea salt), dust erosion due to wind, forest fires, volcanic eruptions, and the release of biogenic PM (e.g. pollen and spores). Man-made sources include traffic, non-combustion and industrial combustion processes, power plants, construction activities, agricultural activities (including agricultural waste burning) (Haq &
asap-eastafrica.com 15
Schwela, 2008: 6). A key contributor to heightened levels of PM in urban areas is the combustion of solid and liquid fuels for power generation, domestic heating, cooking or lighting and in vehicle engines. PM of small size fractions are considered to be particularly detrimental to public health as they can enter the respiratory system and lead to respiratory disease, asthma, strokes, cancer and heart disease (Thurston et al., 2016). Other health- effects of exposure to air pollution include dermal absorption and ocular exposure which may result in eye or skin irritation. The smaller the size of PM, the more impact they are considered to have on health. PM2.5 and PM10 are particulate matter with aerodynamic diameters less than 2.5 and 10 µm, respectively (Seinfeld & Pandis, 2016).
The PM2.5 size fraction is the focus of this study since it has greater association with determinental health outcomes.
To guide discussions of vulnerability to air pollution, the ASAP-East Africa research team have adapted the US Environmental Protection Agencies (US EPA) Air Quality Index Scale to illustrate how different levels of air pollution contribute to different health impacts amongst different groups. An air quality index identifies limits on the amount of a given pollutant in the air. The standards are designed to protect people’s health and have been calculated to allow a margin for people most at risk e.g. the young and old and people with pre-existing health conditions. The ambient air quality standards most often utilised include those developed by the European Union, the United States and the WHO. The WHO air quality standards (25 μg/m3 24 hour mean) are not legally binding, rather they represent a guideline for countries and are significantly tougher than those suggested by others. Table
5 provides a guide to different levels of exposure to PM2.5 over a 24 hour period, health implications associated with that level of exposure and provides a cautionary statement identifying those groups likely to be affected.
Table 5: Air Quality Index scale as defined by the US EPA (2016)
3 PM2.5 μg/m (24 hour Air Pollution Level Health Implications Cautionary Statement for PM2.5 average)
0.0-12.0 Good Air quality is considered satisfactory, None and air pollution poses little or no risk.
12.1-35.4 Moderate Air quality is acceptable; however, for Active children and adults, and people some pollutants there may be a with respiratory disease such as moderate health concern for a very asthma should limit prolonged outdoor small number of people who are exertion unusually sensitive to air pollution.
35.5-55.4 Unhealthy for Members of sensitive groups may Active children and adults, and people Sensitive Groups experience health effects. The general with respiratory disease such as public is not likely to be affected. asthma should limit prolonged outdoor exertion
55.5-150.4 Unhealthy Everyone may begin to experience Active children and adults, and people health effects; members of sensitive with respiratory disease such as groups may begin to feel more serious asthma should limit prolonged outdoor health effects. exertion; everyone else, especially children, should limit prolonged outdoor exertion.
150.5-250.4 Very Unhealthy Health warnings of emergency Active children and adults, and people conditions. The entire population is with respiratory disease such as more likely to be affected. asthma should limit prolonged outdoor exertion; everyone else, especially asap-eastafrica.com 16
children, should limit prolonged outdoor exertion.
250.4-500.4 Hazardous Health alert; everyone may experience Everyone should limit outdoor exertion. more serious health issues.
Exposure
Exposure denotes the degree to which subjects or areas could be affected by air pollution. The level of exposure is generally defined by several components and measures, including: the frequency and intensity of exposure and the location relative to sources of air pollution. Exposure to air pollution is thus largely determined by the concentration of air pollutants in the environments where people spend time, and the duration spent within them. To understand exposure of vulnerable populations to air pollution it is therefore important to identify the micro- environments in which they spend significant amounts of time. However, current data regarding occupational exposure is limited. As noted by Brauer (2010), while ambient monitoring network data provides useful information on air pollutions temporal pattern, it typically lacks precision regarding the spatial variability in concentrations within urban areas. This is an important shortcoming with regard to studies of air pollution, where it is possible that an individual's home or workplace location might confer exposures to air pollution that differs from others in the same urban area.
Globally a range of occupations are exposed to a variety of substances (e.g. chemicals, fumes, dusts, fibres) which may, under certain circumstances, have a detrimental effect on health if exposure to such substance is not properly controlled. Overall occupational and environmental exposures to PM are considered to account for a significant percentage of annual global mortality (Dimakakou et al., 2018).
To gauge waste picker perceptions pertaining to air Figure 1: Survey respondent’s perceptions of pollution, they were asked, “do you feel that the air in your vulnerability by age group home is polluted?” and “do you consider the air in your place of work to be polluted?” Of the sample 40% indicated that they felt they were exposed to air pollution in their home and 80% at their place of work.
The waste pickers were also asked “how would you rate your vulnerability to air pollution on a scale of 1-5 (one being not vulnerable at all, five being extremely vulnerable)?” Survey responses were grouped according to the age of respondents. The survey sample included waste pickers aged 0-24 (six respondents), 25-44 (ten respondents), 45-64 (eight respondents) and 65 plus (one respondent). The average score of those surveyed was 2.24/5, suggesting a relatively low perception of vulnerability. There was, however, some variance between age groups, those aged 0-24 (3/5) and 65+ (3/5) reporting the highest perceptions of vulnerability followed by the 25- 44 age group (2.3/5). Those aged 45-64 (1.5/5) reported the lowest perceptions of vulnerability (figure 1). asap-eastafrica.com 17
The following comments provide an insight into the sentiments of respondents and may explain why perceptions of vulnerability are relatively low; ‘we have been working here for so long we are used to the stale air’, ‘there is no motivation to take action’, ‘we lack resources, we are also here temporary, the government can reclaim the place any time’. This also testifies to the failure to recognise waste pickers as a central element of SWM.
Findings suggest that waste pickers of younger age groups perceive air quality to be worse than those of older age groups (except the oldest respondent). To explore this issue further, waste pickers were asked to provide an assessment of air pollution levels at different locations
Figure 2: Survey respondents perceptions of air pollution (indoors at home, indoors at other locations, outdoors levels (1 being not polluted at all, 5 being extremely at home, outdoors at other locations, and in transit). polluted) Those from younger age groups consistently identified
5 higher levels of air pollution in the majority of settings, closely followed by the oldest respondent. Those aged 4 45-65 consistently recorded the lowest perceptions of 3 air pollution. This corroborates limited evidence that 2 suggests that younger age cohorts tend to be more 1
Air Pollution Air Level concerned or knowledgeable about the environment 0 than older age groups (Qian et al., 2016; Fischer et al., 0-24 25-44 45-64 65+ Age Group 1991). Studies also suggest the concerns of older age Indoors at home Indoors at other locations groups tend to focus around health and safety issues Outdoors at home Outdoors at other locations In transit (Fischer et al., 1991).
Air pollution exposure of waste pickers
Hazardous working conditions and poor quality employment are considered to result in a substantial burden of ill- health and injuries, thereby contributing to high costs to health systems and national economies as well as perpetuating poverty. Quantifying the contribution of occupational exposure alongside observed health symptoms, however, poses a number of challenges. In addition to ascertaining the impact of non-occupational exposures, the air pollutant exposure is influenced by variable daily patterns of physical and traffic activity during and outside work hours making comparisons difficult (WHO, 2000). Table 6 provides an overview of studies that have explored PM exposure in a number of dumpsites.
Table 6: List of air pollutant concentration values in dumpsites reported in different studies
Average + Std Dev (if applicable) Reference Location Data Characteristics concentrations
Seven (7) Municipal Solid Waste dumpsites were Mopol Base (31.22 / 20.9 µg/m3) investigated. The study was carried out dry Angaye et al. Yenagoa, (November, January and March) and wet (May, Etegwe (30.63 / 21.73 µg/m3) (2018) Nigeria July and September) seasons in a post-monthly Opolo (24.53 / 22.15 µg/m3) manner, from November 2016 through September 2017.(Dry season / wet season) Kpansia (23.11 / 20.41 µg/m3)
asap-eastafrica.com 18
Central Dumpsite (1) (28.13 / 29.43 µg/m3) Central Dumpsite (2) (44.37 / 32.07 µg/m3) Control Station (20.11 / 18.80 µg/m3) PM10 measurements were performed at several Chalvatzaki et Crete, locations at the Akrotiri landfill from October 2007 Akrotiri (42 to 601 µg/m3) al. (2010). Greece to April 2009
Studies were carried out at two dumpsites in Chennai (Kodungaiyur and Perungudi). Two sets of air samples were collected from Kodungaiyur Karthikeyan et Chennai, Kodungaiyur (149.77 µg/m3) respectively during summer (April) and monsoon al. (2011) India (July) periods. Whereas, the samples were Perungudi (87.6 µg/m3) collected only during summer (March) at Perungudi for 24 hours. According to a number of studies (Cointreau, 2006; UN Habitat, 2010) people living and working in the vicinity of solid waste processing and disposal facilities are a group particularly exposed to environmental health and accident risks with injury rates and occupational issues higher than those recorded in industrial work. These risks relate, in part, to the emissions from solid waste, the pollution control measures used to manage these emissions, and the overall safety standards of the facility. Such risks are largely unmanaged in many countries in the global south. Pollution control has significant costs and adherence to design standards requires a commitment to construction and operation supervision. Cointreau (2006) comments that all activities in SWM involve risk, either to the worker directly, or to nearby residents. Health risks from waste are associated with a number of factors (Cointreau, 2006: 1):
The composition of waste (e.g. toxic, allergenic and infectious substances), and its components (e.g., gases, dusts, leachates, sharps etc.);
The nature of waste as it decomposes (e.g. gases, dusts, leachates, PM) and their change in ability to cause a toxic, allergenic or infectious health response;
The handling of waste (e.g. working in traffic, shovelling, lifting, equipment vibrations, accidents);
The processing of waste (e.g. noise, vibration, accidents, air and water emissions, residuals, explosions, fires);
While standards and norms for handling solid wastes in industrialised countries has significantly reduced occupational and environmental impact, the risk levels are still high in many countries because of lack of financial resources and inadequate understanding of the scale or complexity of the issue. Studies of Dandora have confirmed the presence of toxic substances such as lead, mercury and cadmium which pose hazards to those working and living near the site (UNEP, 2007; 2007a). A number of sources of PM that originate in dumpsites can also impact at the neighbourhood, city and regional level.
asap-eastafrica.com 19
Interest in waste picker’s exposure to environmental factors and air pollutants at dumpsites has grown in recent years though there are a limited number of studies focused on PM2.5 in terms of mass and source contribution (Angaye et al., 2018; Chalvatzaki et al., 2010; Karthikeyan et al., 2011). The dumpsite environment is a complex setting in which to undertake an assessment of air quality. In what follows, I provide an overview of sources of air pollution that impact on waste pickers.
Image 2: Factors and linkages that impact on dumpsite air quality - primary factors highlighted in the grey area
Open burning of waste
Open burning of waste is a common practice in many dumpsites, a process through which unwanted products, by products and materials are incinerated, typically at low temperatures and in an uncontrolled manner. An estimated 41% of global waste is burned openly and in low income countries that figure is believed to be higher (Wiedinmyer et al., 2013). Open burning is a practice used to reduce the quantity of waste or to recover certain materials resulting in harmful public health and environmental effects. Research has demonstrated that burning of waste at dumpsites produces air toxins (Cogut, 2016). These may increase the concentration of pollutants such as nitrogen oxides (NOx), sulfur oxides (SOx), heavy metals (mercury, lead, chromium, cadmium, etc.), dioxins and furans and PM (Cogut, 2016). The burning of waste also produces ash (bottom and fly ash). Fly ash consists of light particles which may contain toxic metals, dioxins/furans and other products of incomplete combustion which can travel significant distances before being deposited. These substances may enter the food chain if absorbed by animals or crops destined for human consumption (Cogut, 2016). Estimates suggest that uncontrolled mixed garbage burning is a larger source of dioxins than coal combustion, ferrous metal smelting or hazardous waste incineration. Table 7 provides an overview of some of the harmful by-products of open burning of waste.
Table 7: Harmful by-products of open burning of waste (New Hampshire Department of Environmental Services, 2013: 1)
Dioxin is a known carcinogen and is associated with birth defects. Dioxin can be inhaled directly or deposited on soil, water and crops.
asap-eastafrica.com 20
Hexchlorobenzene is a toxin that degrades slowly in the air. It bio-accumulates in fish, marine animals, birds, lichens and animals that feed on the above. It can damage a developing foetus, lead to kidney and liver damage, and cause fatigue and skin irritation.
Formaldehyde is released when pressed wood products, paints, coatings, siding, urea-formaldehyde foam, and fiberglass insulation are burned. Exposure to formaldehyde can result in watery eyes, a burning sensation in the eyes and throat, nausea, difficulty in breathing and skin rashes. Prolonged exposure to formaldehyde may cause cancer.
Hydrogen chloride gas/hydrochloric acid is a product of burning of plastics, or polyvinyl chloride. Exposure can cause fluid build-up in the lungs and possible ulceration of the respiratory tract.
Black Carbon is a common output of open burning practices, it is the second-greatest contributor to global warming after carbon dioxide. It poses risks to human health, including cardiovascular disease, respiratory disease and premature death.
Carbon monoxide is generated from the incomplete combustion of waste. It is dangerous when inhaled by young children, the elderly, and people with chronic heart conditions or lung diseases.
Dust
Dust produced from activities in dumpsites will also include particles, which fall into both the PM10 and PM2.5 categories. Sources of dust will include those created by traffic (i.e. the delivery and moving of waste) as well as smoke produced by open burning and underground fires. The resuspension of dust from the sifting of waste is also a significant source (ISWA, 2014).
Diesel exhaust emissions
In a number of countries, waste pickers are also exposed to higher levels of diesel exhaust fumes than their counterparts in high-income countries. Some studies suggest a relationship between diesel exhaust exposure, asthma, and decreasing lung function (Cointreau, 2006). Diesel exhaust may amplify the effect of normal allergens in susceptible individuals.
E-Waste recycling
In recent years, E-waste recycling has become an important source of livelihood for the urban poor, notably in West Africa (Perkins et al., 2014) though the practice is also evident in East Africa (Otieno & Omwenga, 2016). E- waste is an umbrella term for a variety of discarded electronic and electrical appliances exported from Europe and North America for disposal. E-waste recyclers are exposed to high levels of dust and fumes containing heavy metals and organic pollutants generated through the process of manual dismantling of appliances and burning of circuit boards and cables to recover metals and other valuable constituents (Kaya, 2016).
asap-eastafrica.com 21
Outdoor air pollution (Dandora dumpsite)
Findings from the Dandora dumpsite air pollution 3 Table 8: Average outdoor PM2.5 (µg/m ) daily monitoring campaign highlight that air quality levels (PM2.5) concentrations at outdoor locations exceed WHO guidelines at all times.
At the monitoring site, the average PM2.5 daily Average PM2.5 Average PM2.5 Average PM2.5 3 3 3 3 (µg/m ) daily (µg/m ) daily (µg/m ) daily concentration was 47.4 ± 9.5 µg/m and peak concentration concentration concentration concentration was 94.5 ± 32.6 µg/m3. Peak concentration (Mon - Sat) (Sunday) (Combined) is the hourly peak over daily cycle (see figure 3 for hourly 48.9 ± 9.2 37.5 ± 3.3 47.4 ± 9.5 time series data). Over the seven days air quality was monitored, pollution levels exceeded WHO guidelines for PM2.5 on all days monitored and for 100% of the time during these days. Concentrations of air pollutants were found to exceed WHO guidelines by at least double, approximately 31.8% of the time. During the study period, outdoor air quality at Dandora dumpsite is thus considered to be at a level considered unhealthy for sensitive groups. To contextualise these readings, figure 4 maps outdoor air pollution on the US EPA air quality index.
Figure 3: Hourly time series data showing PM2.5 and PM10 mass concentrations at Dandora dumpsite.
Whilst the focus of this study is PM2.5, it is important to note that recorded levels of PM10 (known as coarse particulate matter) exceed WHO guidelines set at 50 μg/m3 24-hour mean. At the monitoring site, the average
3 3 PM10 daily concentration was 79.4 ± 15.1 µg/m and peak concentration was 135.3 ± 31.2 µg/m , peak being hourly peak over daily cycle (see figure 3). Over the days air quality was monitored, pollution levels exceeded
WHO guidelines for PM10 on all days monitored and 100% of the time during these days. Concentrations of air pollutants were found to exceed WHO guidelines by at least double, approximately 9.1% of the time.
asap-eastafrica.com 22
To contextualise data, figure 4 maps outdoor air pollution on the US EPA air quality index during an average week day (Monday-Friday) and weekend (Saturday and Sunday). Findings indicate that dumpsite activities are relatively consistent throughout Monday-Saturday with Sunday recording the lowest air pollution levels, suggesting lower levels of activity.
Figure 4: Average weekday and weekend concentration of PM2.5 at Dandora dumpsite
120
100
80
60
PM2.5 PM2.5 (µg/m3) 40
20
0 00:00 02:00 04:00 06:00 08:00 10:00 12:00 14:00 16:00 18:00 20:00 22:00 Unhealthy Time (hour) Unhealthy for Sensitive Groups Moderate Good Weekday Weekend WHO AQ Standard
Susceptibility
Susceptibility to air pollution is more difficult to assess than exposure and one needs to consider both the components and measures of susceptibility. Demographic factors such as age, gender, and socioeconomic status play an important role in assessing susceptibility to air pollution. However, these factors are highly context- specific, and can also interact with one another.
Certain occupational groups are considered to be particularly susceptible to air pollution exposure due to a number of factors (WHO, 2006; Schwartz 2004). This will include those who work in environments where the composition or air pollutants is particularly toxic, those whose work shifts entail prolonged exposure to air pollutants, and those who work in occupations where exposure levels are significant. Occupational exposure is further exacerbated or mitigated by income status. As dumpsites and those who work the sites are often located in low income settings, it can be difficult to distinguish between occupational and environmental exposures. Dangers for the informal sector are often greater because living and working environments may overlap.
asap-eastafrica.com 23
Impact on public health
Several studies have shown that waste pickers are at risk of a number of occupation related illnesses. Risk of infections and parasites is considered to be three to six times higher and acute diarrhoea occurs ten times more often for solid waste workers than for other populations (Cointreau, 2006). In terms of the impact of air pollution on waste pickers, pulmonary problems have an incidence of 1.4 to 2.6 times higher (Cointreau, 2006). Although waste pickers are usually exposed to a range of occupational health risks (Cointreau, 2006), age plays a crucial role in determining the exposure impact and vulnerability to health and environmental hazards (Hunt, 1996; Longe et al., 2009). Young waste-pickers are considered especially susceptible because specific risks are added to the general vulnerability of children (Hunt, 1996; Longe et al., 2009 see also Avis et al, 2018 for an overview of air pollution exposure and impacts in Nairobi schools). In the context of waste pickers, this vulnerability may relate to lower level of awareness of risk and limited experience and knowledge in waste handling. Consequently, children may expose themselves unwittingly to dangerous material that adults are likely to avoid (Longe et al., 2009).
Studies of health issues afflicting informal recyclers in Nicaragua, Costa Rica and Colombia identified a range of health problems including kidney problems, blood pressure and diabetes, these were considered to be related to low income status rather than occupational type (GIZ, 2011). However, GIZ (2011) asserted that dizziness, asthma, coughing, skin diseases, arthritis, urinary tract and kidney infections were linked to the conditions in which work is undertaken, i.e. where there is smoke from the burning of waste, limited sanitary facilities and low water consumption. Studies have also suggested that length of tenure as a waste picker is associated with certain impacts. Aweng and Fatt (2014: 36) concluded that those “with higher years of experiences have higher chances of getting skin disease and respiratory disease such as shortness of breath. The results also showed that the risk of injury by sharp objects decreased with the increase in education level of garbage collectors”.
More specifically, studies of those living and working in, or near, Dandora have reported significant health issues. A UNEP (2007: 13) study that reviewed medical records from the Catholic Church dispensary at Kariobangi, (2003-2006) found that circa 9,121 people annually were treated for respiratory tract issues. Importantly, whilst this study examined soil and water samples collected from Dandora and surrounding areas, no active air quality monitoring was undertaken. Findings from other studies support the above (see Nduta, 2014).
UNEP (2007a) data also identified that a high number of children and adolescents living near Dandora were found to have upper respiratory tract infections, chronic bronchitis, asthma, fungal infections, allergic and unspecified dermatitis/pruritis – inflammation and itchiness of the skin (see table 9). Significantly 46.9% of children examined where identified as suffering from respiratory issues. In contexts such as Dandora, the impact of co-exposures i.e. home versus dumpsite requires further exploration.
Table 9: Impact on public health and systems - results of 328 children aged 2-18 years (UNEP, 2007a: np)
System affected No. of children affected with disorders
Dermatological (skin disorders) 48 14.5%
asap-eastafrica.com 24
Respiratory 154 46.9%
Gastroenteritis (GE) (abdominal and 59 17.9% intestinal problems)
Dental disorders 31 9.5%
Oto (affecting the hearing system) 15 4.6%
Skeletal /muscular systems 8 2.4%
Central nervous system 7 2.13%
Eye infections 32 9.8%
Blood (anaemia) 1 0.3%
Others* 21 6.4%
Normal 26 7.9%
Others*: malaria, chicken pox, septic wounds, congenital abnormalities, cardiovascular diseases and lung cancer
The economic impact of occupational health conditions is also significant. The OECD (2011) reviewed the empirical literature relating to the human health impact of exposure to PM and ozone, hazardous chemicals and unsafe water and sanitation. Table 10 identifies medical costs associated with certain conditions. By identifying the economic consequences of exposure to PM, one can demonstrate the necessity of policy interventions to address air pollution and dumpsite emissions. In what follows I highlight specific health issues associated with waste picking.
Table 10: Range of costs for selected diseases associated with dumpsites emissions (OECD, 2011: 9-11)
Exposure to Health Impact Range of Costs (USD 2010,ppp)
PM & Ozone Chronic bronchitis 170,000-500,000
Respiratory hospital admissions 2,000-24,000
Cardiac hospital admissions 200-29,000
Cancer (lung) 481,000
Hazardous Chemicals Skin cancer 9,300
Leukaemia 2,658
Neuro-development. Disorders 10,000
Unsafe Sanitation Gastrointestinal illness 40-170 Respiratory Disorders
People working on dumpsites are at risk of developing respiratory diseases as a result of the practice of burning waste to recover materials. In a study conducted in Nigeria, waste pickers were reported to have developed
asap-eastafrica.com 25
pneumonia whilst working on dumpsites (Oyelola, 2009). Sankoh et al., (2013) reported that workers in Freetown, Sierra Leone presented symptoms of bacterial upper respiratory tract infections, chronic bronchitis and asthma. As noted, similar findings were found among children living in close proximity to Dandora, (UNEP, 2007). Another study conducted in Delhi, India found a prevalence of inflammation of the airways and decreased lung function among dumpsite workers (Ray et al., 2005).
Adverse Birth Outcomes
A study in Alaska, United States identified an association between low birth weight and pre-term delivery in women who lived in the vicinity of dumpsites (Gilbreath & Kass, 2006). The same study also found an association between intra uterine growth retardation disorders and proximity to dumpsites. Low birth weight, pre-term delivery and congenital malformations were also reported in live births among women who lived in the vicinity of the Love Canal dumpsite in New York, United States (Berry & Bove, 1997).
Cancer (Malignant Tumours)
Comba, et al. (2006) conducted a study in the Naples and Caserta Provinces in Italy. The area has several dumping sites in which toxic waste was disposed. There was an elevated prevalence of cancers (oesophagus, pleura, stomach, kidney, liver, trachea, bronchus, lung and bladder) compared with other regions in Italy. Cancer related deaths were also higher in these two provinces.
Social risks
Cointreau (2006), observed that waste pickers in open dumps in developing countries consist of a significant proportion of pregnant women and children. This corroborates findings from a study in India which revealed that most waste pickers were women and children from lower castes (Hunt, 1996). Beyond health impacts, a number of social risks are associated with SWM, especially for young children. Children who are involved in waste picking may miss out on educational opportunities (Longe et al., 2009). This may impact negatively on transitions to adulthood, such as ability to earn a decent income which may in turn affect how they are able to provide for future offspring. These intergenerational effects of poor SWM are visible across cities in resource constrained settings.
More broadly, social stigmatisation is seen to compound the difficulties faced by waste pickers. Findings from studies in Bogota, Colombia and Durban, South Africa reported that 97% of waste pickers felt that social exclusion was a problem in their work (WIEGO, 2014: 3). Similarly, 76% of waste pickers in Nakuru, Kenya reported experiencing social exclusion (WIEGO, 2014: 3). Waste pickers are often treated as a nuisance by authorities and the public alike. Despite their significant contribution to SWM and recycling in many settings, they are often ignored within public policy processes (Dias, 2011). This has significant impact on the ability of waste pickers to adapt to air pollution and minimise their vulnerability. As will be discussed below, waste picker organisations can play a significant role in empowering this group and help counteract social and legal exclusion (WIEGO, 2014; Dias, 2016).
asap-eastafrica.com 26
Perceptions of susceptibility to air pollution (Dandora dumpsite)
To explore perceptions of susceptibility to air pollution, survey respondents were asked to identify how they thought air pollution adversely affected them personally or their city (findings are presented in figure 5). Whilst survey respondents acknowledged that air pollution was an issue and had an impact on daily life, responses suggest that there is dissonance between understandings of air pollution and long-term health impacts. This may in part stem from a lack of knowledge and sensitisation around the consequences of air pollution exposure.
Figure 5: Survey respondent’s perceptions of air pollutions adverse Figure 6: Survey respondent’s identification of causes of impacts on individuals and Nairobi absences from work (last 12 months)
25% 20% 15% 10% 5%
0%
suffered from the following conditions following from the suffered % of respondents reporting that they had had they that reporting respondents of % Conditions
To explore the health impact of exposure, survey respondents were asked to indicate whether they had been absent from work during the past twelve months, and to specify which illness mostly caused this absence. Figure 6 provides an overview of the survey respondents who recorded being absent and the conditions identified as the cause. Whilst ten respondents recorded no absence from work in the last year, fifteen recorded missing work (eleven 1-10 days; two, 11-20 days and one 21-30 days). Though these findings remain inclusive, they suggest a possible correlation between work absence and exposure to air pollution with respiratory ailments common.
Adaptive capacity
The concept of adaptive capacity remains contested, but can broadly be defined as the ability of individuals, communities, organisations, nations or other actors to take actions to either reduce or avoid risk. While greater exposure and higher susceptibility to air pollution increase vulnerability, adaptive capacity refers to the means by which people can reduce their vulnerability. The concept of adaptive capacity is important because while exposure and susceptibility, characterise vulnerability in a negative way, adaptive capacity recognises the ability of actors to learn and change behaviour.
asap-eastafrica.com 27
Whilst many studies focus on efforts to reduce air pollution levels and improve air quality (i.e. mitigation), some recent literature has explored how various actors can protect themselves against the impacts of pollution by means of adaptation. This focus on adaptation stems from an awareness that due to a lack of air quality regulations, enforcement institutions or effective agreements on air quality management, improvements may be difficult to achieve (Ebert & Welsch, 2011; Lankao & Tribbia, 2009). Indeed, mitigation requires consensus and cooperation across a number of stakeholder groups (public and private sector and civil society) and levels (local, regional, national and global). In contrast to mitigation, adaptation requires less consensus and some actions may be taken at an individual, organisational or city level.
Finding reliable ways to measure adaptive capacity is challenging and remains a priority for researchers and policymakers. Numerous indicators have been developed, including ‘education, income, and health’ as well as access to financial, technological and institutional resources. More broadly, recent literature has attempted to identify determinants of adaptive capacity and specify the processes through which those determinants interact. Eakin et al. (2014), for example, explore the relationship between socioeconomic development and in the context of their research climate risk reduction, as an interaction between ‘generic’ and ‘specific’ capacities and explore how those capacities might complement or undermine each other. In a similar vein, the Local Adaptive Capacity (LAC) framework, seeks to understand how different determinants of adaptive capacity influence each other at household and community levels.
Common across both approaches is an agreement that knowledge represents an important determinant of adaptive capacity (Williams et al., 2015). The LAC framework identifies knowledge as both a dimension of adaptive capacity, but also an element within other dimensions. Similarly, the Intergovernmental Panel on Climate Change (IPCC) considers a ‘lack of knowledge’ to be a possible constraint on adaptation.
Whilst some studies have suggested that Kenyan’s possess a high level of awareness regarding air pollution Figure 7: Survey’s perceptions of ability to take actions to improve air pollution or minimise and its impact (Omanga et al., 2014), others report low exposure awareness. A study conducted in the informal settlement of Mathare (Nairobi) found that most residents lacked extensive awareness about air pollution and its effects on health, with some citing smoking and poor sanitation as the main pollutants (Ngo et al., 2017). Similarly, a study by Egondi et al. (2016) in Nairobi’s Viwandani and Korogocho informal settlements identified residents as having low perceptions of air pollution levels and related health risks despite high levels of exposure. As with the first scoping study (Avis et al, 2018), the ASAP-East Africa study found that whilst survey respondents perceived air pollution as a risk and identified themselves as vulnerable, knowledge regarding sources and impact were mixed (see figure 7 and figure 8).
asap-eastafrica.com 28
Participants in the survey where asked to assess “how they rated their ability (as an individual) to take actions to improve air pollution or minimise exposure (1 being no ability at all, 5 being very able)?” Those aged 25-44 and 65+ considered themselves most able, recording an average score of 2.4/5 and 4/5. Those aged 0-24 and 45-64 were less confident of their ability to improve air pollution or minimise exposure both reporting scores of 2.3/5 and 1.5/5. Given the nature of waste picking, a number of survey respondent’s highlighted limited options for alternative incomes making this question somewhat academic. Waste pickers often lack the resources or social capital to address their vulnerability with little option but to continue working on and living in dumpsites.
Survey respondents were also asked to rank what they Figure 8: Survey respondent’s perceptions of sources of air considered the primary, secondary and tertiary sources of pollution (Primary, Secondary and Tertiary) air pollution at Dandora. Whilst most respondents identified waste disposal/burning of waste as the primary source of pollution, other sources identified included dust Tertiary and industrial sources/manufacturing facilities. Secondary To explore this issue further, survey respondents were asked to specify sources of air pollution and to rank their Primary relative contribution (major, moderate, minor or whether 0% 50% 100% they did not contribute at all in their place of work). Motor Vehicles Respondents identified a broad range of sources (see Waste disposal/burning of waste Cigarette Smoking figure 9). Findings can be contrasted with EU research Industrial Sources/manufacturing facilities Pollution from other countries that identified population-weighted averages for relative Dust Household Cooking, Lighting and Heating source contributions to total PM2.5 in urban sites in Africa. Construction Diesel generators These included domestic fuel burning (34%), natural sources including soil dust and sea salt (22%), traffic (17%), unspecified sources of human origin (17%) and industry (10%) (Karagulian et al., 2015).
asap-eastafrica.com 29
There is also a correlation Figure 9: Survey respondent’s identification of sources of air pollution and relative between socioeconomic contribution status and adaptive
Waste disposal/Burning of waste capacity. According to the Industrial sources/manufacturing facilities IPCC, socioeconomic Dust factors that determine Cigarette smoking adaptive capacity include Motor vehicles access to technology and Construction Household cooking, lighting and heating infrastructure, information, Diesel Generators knowledge and skills, Power plants institutions, equity, social Pollution from other countries capital, and economic Use of air conditioning development (IPCC, 2014). 0 5 10 15 20 25 Access to financial Major Moderate Minor Do not contribute at all resources or materials may
confer an increased or decreased ability to either avoid or reduce exposure. In the context of waste pickers, both are limited. It is commonly reported that waste pickers do not use protective equipment and frequently use their bare hands and feet for scavenging, this exacerbates their exposure experiences. A study undertaken by WIEGO (2014) indicated that more than half (56%) of the waste pickers reported never wearing gloves during their work. This confirms findings from UN Habitat (2010) who report that informal-sector workers operate independently and normally lack the minimum protective equipment.
Income has a significant impact on the ability to avoid or mitigate harm (Benzeval et al., 2014). As noted above, Table 11: Mean Turnover and Working Hours by Gender average daily incomes of dumpsite workers is considered of Waste Pickers in Nakuru) (Lubaale & Nyang’oro, 2013: low and highly variable (based on the quantity of 38) recyclables recovered). Whilst data on the income of Earnings Men Women waste pickers operations in Dandora is limited, that Mean Monthly KSH 5748.07 KSH 3680.20 gleaned from over locations is useful. The average turnover (KSHs/US$) US$ 68.98 US$ 44.16 turnover of waste pickers in Nakuru is estimated at circa 5,000 Kshs. per month (approximately US $2/day). Mean hours per week 22.85 22.24 Lubaale & Nyang’oro (2013) conclude that the earnings of Mean months per year 11.11 10.04 waste pickers in Nakuru are so low that they cannot easily meet even their basic needs and thus disposable income that can be utilised to purchase protective clothing is limited or absent. The vulnerability of the waste pickers is thus two-fold: their sources of livelihood are insecure, and secondly, they have a diminished capacity to access equipment that may limit or reduce exposure. Lubaale &
asap-eastafrica.com 30
Nyang’oro (2013) conclude that that if these waste Figure 10: Survey respondent’s identification of home pickers are to continue working in the sector, the city construction materials and perceptions of vulnerability and and national government need to ensure their social adaptive capacity protection. 5 There is a dearth of evidence about the impact of socioeconomic status of workers and the location of 4 work on air pollution exposure and adaptive capacity. 3 Some studies have found that work location and exposure to pollution sources is higher for those from 2 poorer backgrounds (Hajat et al., 2016; Dimakakou, 1 2018). There is also some evidence of differences in location and associated exposure between different 0 Vulnerability Adaptive capacity types of occupation (Hajat et al., 2016). The Stone or Brick Corruggated iron/Metal sheets Mud association between socioeconomic level and exposure is, however, stronger in home environments than in the work place for those from lower-income families (Hajat et al., 2016). There is also a dearth of evidence that explores the capacity of different occupations to minimise exposure to air pollution, particularly across different socioeconomic groups. Whilst the survey sample (both in size and composition) limits the ability to make any firm assertions regarding this issue, some interesting findings do emerge. Survey respondents were asked to identify the materials their homes where constructed from, in some instances this has been used as a proxy for poverty. Of the sample, those who reported living in homes built of mud (walls) considered themselves the most vulnerable to air pollution (2.57/5), correspondingly those who reported the use of stone/brick or corrugated iron/metal sheets in their home construction identified themselves as least vulnerable (2.12 and 2.11 respectively). This finding partially held for adaptive capacity with those living in homes built of stone and brick reporting higher scores than other groups (2.25, 1.88 and 2).
Given the challenges faced by waste pickers, it is important to explore those initiatives undertaken by individuals, civil society or government to reduce or minimise exposure to air pollution. Survey respondents were asked to identify steps taken in their place of work to address air pollution (both dumpsite and external sources). Of the 25 waste pickers surveyed, eighteen indicated that they could not think of any actions taken. The remaining seven respondents could be broadly divided into two groups. The first (four respondents) consisted of those who identified actions taken that either did not reduce air pollution or exposure levels, or were targeted at minimising impact on Nairobi more broadly. Actions identified included; ‘cleaning of sewage’, ‘bringing fire brigades to put out the fire to reduce smoke’, ‘use tractor to push disposal away’ and the practice of ‘burning of waste’. The second group (three respondents) identified initiatives that were potentially of some benefit to waste pickers. These included; ‘bringing doctors to counsel us’, ‘recycling the waste to create materials like plastic wall/fence… making organic fertiliser from the waste’, and ‘planting trees’.
asap-eastafrica.com 31
Facilitating adaptation
Whilst understanding the adaptive capacity of waste pickers is challenging, it is clear that the most effective pathways for adaptation are likely to arise out of an informed evolution of existing institutions and the participation of civil society groups, public and private sector actors. A number of studies emphasise the importance of the support and political will of local public officials in developing successful solutions to environmental issues such as air pollution (Slovic et al., 2016) as well as those associated with SWM (Nwosu et al., 2015). Others emphasise the need for communities to build from, and integrate modern techniques into air quality and SWM practices and for local networks to effectively collect and disseminate data needed for assessing impacts. This may provide a means to facilitate public participation processes in formulating policy.
A European study assessing the public health impacts of urban air pollution in 25 cities showed that the monetary gain of complying with the WHO guidance for particulate matter concentration would be 31 billion Euros (Pascal et al., 2013). The long term health benefits are also clear. Gauderman et al., (2015) identified gains in respiratory outcomes in 11–15 year old children in California as a result of improvements to air quality over a 4 year period.
Few countries in East Africa have occupation specific environmental health protection policies and there are also limited examples of waste picker centred air quality campaigns. Further to this, occupational locations are often locked in, the product of historic factors and often sited in areas where sources of air pollution may be prevalent – discussions of dumpsite closure reveal the challenges of addressing SWM. Despite these challenges, the case for taking action is increasingly compelling.
WIEGO (2013) and Scheinberg (2012) have illustrated how municipal governments and CSO’s can collectively support waste pickers. The Belo Horizonte municipality has a formal partnership with waste picker organisations and supports waste pickers with access to waste, infrastructure, subsidies and worker education. Similarly, studies of the role of Kagad Kach Patra Kashtakari Panchayat (Trade Union of Waste-pickers) in Pune, India illustrates the role collective action can play in supporting waste pickers. According to Chikarmane and Narayan (2005), the union supports waste pickers in mobilising collectively against injustices such as police harassment; extortion by local officials; and child labour. Studies have also demonstrated that, when supported and included in SWM, waste pickers can divert a significant quantity of materials from the waste stream (UN Habitat, 2010). For example, GIZ (2011) suggest that waste pickers recover approximately 20% of all waste material in Quezon City, Pune and Lima. They report that this is associated with a concerted effort by the public sector to organise and integrate informal sector workers and recycling businesses to maximise recovery of material, with national legislation or policy as a driving force. More broadly, education and fairer wages may enable waste pickers to diversify their incomes or minimise air pollution exposure.
asap-eastafrica.com 32
Given the need for policy interventions to be publicly acceptable it is important to identify how receptive groups would be to certain interventions and what specific interventions and policy changes such groups desire. This can be accomplished through participatory consultative processes. The rationale for consultation is clear, it aides government in garnering views and preferences, understanding possible unintended consequences of a policy or getting views on implementation. Increasing the level of transparency and engagement with interested parties are also seen to improve the quality of policy making. Figure 11 below provides an overview of how strongly waste pickers agreed or disagreed with a series of statements about actions to curb air pollution. This provides an insight into areas policy makers may wish to explore when addressing air pollution in dumpsites.
Figure 11: Survey respondent’s perceptions of actions to curb air pollution
Studies of efforts to address SWM and air pollution issues around Dandora are limited but illuminating. According to Ndunda and Muia (2018: 13-15), who undertook a survey of households around the dumpsite, the majority of respondents (78.95%) are willing to pay for improved SWM. According to their estimations, the average willingness to pay was Kshs. 237 per month. Reasons presented for supporting this program included: it will reduce air pollution in the neighbourhood (20%); it will protect the surrounding ecosystem (21.11%); it will improve visibility (15.56%); it will eliminate the smell coming from the dumpsite (17.78%); and it will lower the risk of respiratory infections from poor solid waste disposal (25.56%). The respondents who were unwilling to pay for an improved SWM program commented that it is not worth supporting (8.33%); I cannot afford it (37.50%); it will only protect Dandora residents (8.33%); I worry about corruption in the program (8.33%); I plan to move (16.67%); and it is the responsibility of government (20.83%).
asap-eastafrica.com 33
Survey respondents in this study were also asked to identify how acceptable a number of potential policy interventions would be. Responses pertaining to individual actions whilst supportive, were mixed. Responses pertaining to county government supporting air quality interventions were broadly unanimously in favour.
Figure 12: Survey respondent’s perceptions of policy interventions
20 18 16 14 12 10 8 6 4 2
0
vehicles
vehicles
times
Use my own vehicle less vehicle Useown my
outside schools) outside
Use public transport more transport Usepublic
adopt clean fuel adopt sources
Keep my vehicle well maintained well vehicle my Keep
Increase enforcement of enforcement emission Increase
regulations for both diesel and gas bothdiesel and for regulations
Encourage drivers to turndrivers their to off Encourage
Promote the use of alternative fuel of the use alternative Promote
Ride a bicycle for errands and work for errands Ridebicycle a
vehicles when waiting in a line (e.g.,line a when waiting in vehicles
Establish non-motorised means of Establishnon-motorised
Improve access to and reliability of to reliability and access Improve
Support households and businesses Supportto households
Improve roads to reduce vehicle travelvehicle toreduce roads Improve
transport i.e. bicycle lanes and lanes walking i.e. transport bicycle public transport i.e. bus and rail services transport and bus rail public i.e. To help improve air quality I would be willing to: To help improve air quality, City air quality programs should:
Strongly agree Somewhat agree Somewhat disagree Strongly disagree Don’t know/ Doesn’t apply
Adaptable, affordable and acceptable initiatives to improve the quality of air should be prioritised when considering how best to address air pollution in occupational environments through both preventive and remedial actions. Relevant national, state, and local stakeholders, including municipal officials, private sector actors, waste pickers and, community organisations, need to work together to develop policies that ensure safe working environments for waste pickers. This can often be challenging given the nature of the work and competing agendas and priorities. Bodies such as the International Environmental Technology Centre (2018) have generated a series of cross cutting recommendations to improve SWM and concomitantly air pollution. These provide some insight into progressive steps that can be taken.
To achieve the goal of improving air pollution levels in dumpsites this report identifies a number of possible options targeted at the individual, organisational (waste pickers associations) and governmental (local, regional and national) levels. These are discussed below.
asap-eastafrica.com 34
Conclusions and recommendations This study has explored the exposure of waste pickers to air pollution in Dandora dumpsite via the deployment of a low cost sensor in an outdoor setting. The study also probed perceptions of waste pickers regarding air pollution. Findings underscore the vulnerability of waste pickers to air pollution and suggest that those from low socioeconomic backgrounds are likely to face a dual burden of exposure both at home and in work environments in contexts where the two overlap. Data gathered during this study indicates that air pollution levels at Dandora regularly exceed WHO guideline amounts for both PM2.5 and PM10. Outdoor air pollution exposure averaged 47.4 ± 9.5 and peaked at 94.5 ± 32.6 during the monitoring period suggesting that waste pickers are constantly exposed to harmful levels of air pollution. Air pollution levels demonstrate a high degree of variability suggestive of a number of sources including vehicular emissions, open burning of waste and the resuspension of dust. Levels recorded are consistently considered unhealthy for sensitive groups.
Survey findings suggest that whilst waste pickers are relatively cognisant of their exposure to air pollution, indifference, apathy or an inability to avoid exposure meant that waste pickers’ perceptions of vulnerability to air pollution was low. The average vulnerability score was 2.24/5 (indicating moderate to low levels of vulnerability). This may in part be explained by a degree of apathy amongst survey respondents regarding government support, alternative livelihood opportunities or means of reducing exposure.
Waste pickers demonstrated a broad understanding of the potential sources of air pollution, acknowledging that air pollution consists of a number of component elements (emissions from waste burning, dust, vehicular emissions etc.). This study underscores that good air quality in occupational environments is central to the provision of a safe, healthy, productive, and comfortable environments for workers. Given the inherent vulnerability of waste pickers to air pollution exposure, coupled with the overlap of work and home environments, it is clear that there is a need to develop proactive policies that protect waste pickers from exposure to unhealthy levels of air pollution in such settings. This is a particularly relevant consideration given the impact that occupational exposure may have on efforts to escape poverty. The results obtained in this study are evidence that waste dumping at Dandora is a significant source of environmental pollution and a risk to the health of people both working and living in or near the site and the city of Nairobi more broadly. To achieve the goal of improving air pollution levels in dumpsites, this report identifies a number of recommendations, targeted at the individuals, organisational (i.e. dumpsite operators, employers and representative organisations and others) and governmental (county and national) levels.
Individuals (waste pickers)
Effective policies to reduce emissions at their source are a clear means of addressing air pollution, in contexts where the open burning of waste is common practice, such policies are particularly needed. Evidence also supports the effectiveness of individual and collective action to reduce exposure and minimise health risks. As noted, waste pickers often have little alternative livelihood options or disposable income to purchase protective
asap-eastafrica.com 35
materials, which makes them particularly dependent on actions taken by others to minimise their exposure to air pollution (i.e. employer decisions, civil society initiatives and governmental policies).
Waste pickers should be encouraged and supported to form cooperatives that can secure rights and improve their ability to sell materials collectively in order to obtain higher prices. This will entail support from CSO’s to mediate tensions between waste pickers as well as support from government and international actors to provide a conducive environment for the emergence of such waste picker led initiatives. The Nakuru Waste Pickers’ Association provides an exemplar of attempts by waste pickers to organise. Such initiatives can be supported by bodies such as the Kenya National Association of Street Vendors and Informal Traders. By securing higher prices for goods, waste pickers may be able to purchase improved protective equipment, avoid more risky forms of waste picking or diversity away from waste picking thereby reducing exposure to air pollution.
For those who make their livelihood from collecting, sorting, or otherwise handling waste, measures to improve work conditions and avoid exposure are a central requirement. As noted by Cointreau (2006), various guidance documents exist which provide a basis for developing country-specific recommendations. Most risks can be reduced by addressing pathways of exposure and minimising the concentrations of contaminants. Measures include: wearing protective clothing and respiratory equipment; providing proper air filtration, conditioning and ventilation; controlling emissions; and practicing good hygiene. In the short term, waste workers need to be provided with adequate protective equipment such as masks, gloves, footwear and tools. Workers also require training about the risks and the importance of using tools and facilities correctly. Measures such as providing advice and guidance on steps to minimise exposure to air pollution, facilitated by local organisations would be particularly beneficial. These must be based on an acknowledgment that the purchase of protective equipment is often beyond the means of waste pickers.
Personal exposure to ambient air pollution can be reduced by avoiding activities that produce emissions. Trade-offs between the health benefits of reduced inhalation of air pollutants and the nature of activities undertaken needs to be factored into individual recommendations and choices for reducing exposure and mitigating health risks. In order to most effectively adjust behaviour, individuals must be able to anticipate when and where air pollution is likely to be elevated above levels thought to increase risk. This will involve highlighting the role burning of waste plays in releasing toxins that may impact on health.
By identifying and reporting the public health issues associated with air pollutants originating from Dandora dumpsite, both for waste pickers and residents of Nairobi, it will be possible to influence public opinion in support of addressing SWM issues. As Scheinberg (2012) notes outbreaks of disease such as cholera have historically been the first driver for better waste management. The above requires providing waste pickers with the information they need to make informed decisions. Such information would allow individuals to better understand when and where exposure is likely to be highest and whether they are more likely than the general population to be susceptible to the harmful effects of air pollutants.
asap-eastafrica.com 36
Organisations (dumpsite operators, employers and representative organisations and others)
Whilst the ability of individuals to address air pollution is limited and often dependent on financial resources, organisations that engage with waste pickers can play a pivotal role in reducing air pollution or minimising exposure. Such organisations include dumpsite operators, formal and informal businesses, CSO’s and professional bodies. There are a number of steps they can take to address sources of pollution that originate within the dumpsite or to minimise waste picker exposure.
Dumpsite operators should take steps to provide waste pickers adequate space for sorting and storing collected materials. Designated areas within the dumpsite for the salvaging and sorting of materials would increase the efficiency of material recovery, allow for the development of ‘safer’ spaces to operate and could also provide access to facilities that reduce pollution (low emission incinerators for example). Without storage, material cannot be held until prices rise; unsheltered materials will also be degraded or damaged by weather. According to the IEMS study, 59% of dumpsite workers reported that inadequate space was a problem.
Dumpsite operators should undertake an assessment of sources of air pollution that originate within the site and identify those which can be reduced or eradicated and which strategies would have most impact. This will involve the identification of infrastructure needs in each specific dumpsite and identification of technologies that can facilitate cleaner and healthier SWM. This will require input from a range of local, national and international actors. Waste services and infrastructure must be carefully chosen in terms of their sustainability and appropriateness for local conditions, and should be implemented progressively. Cities and towns should start with low-technology, low-capital, labour-intensive and culturally acceptable technologies. The establishment of adequate infrastructure that minimises environmental contamination and the adoption of modified technology that fits local circumstances offers a sustainable, though often costly, solution for many countries.
Private companies responsible for collecting, processing or disposing of waste should be mandated to support the separation of hazardous materials and prohibit the employment or exploitation of particularly vulnerable waste pickers. Governments should put in place favourable policies and appropriate incentives to promote waste reuse, recycling and recovery, including the adoption of advanced policy instruments such as economic instruments, including Extended Producer Responsibility, where appropriate. This will facilitate more effective material recovery but also lower the risks for waste workers. It may also reduce the exploitation of child labour.
Organisations at all levels should support recognition of waste-picking as a dignified and essential work. This is considered a first step in preventing harassment, violations and personal attacks, and in facilitating access to health services and a better quality of work. Studies consistently identify promoting and securing the rights and dignity of waste pickers as a prerequisite for improving conditions, CSO’s can play a significant role in this area. Examples can be drawn from a number of contexts; Belo Horizonte, Brazil (Instituto Nenuca de Desenvolvimento
asap-eastafrica.com 37
Sustentável), Bogotá, Colombia (Association of Recyclers of Bogotá), Durban, South Africa (Asiye eTafuleni), Pune, India (Kagad Kach Patra Kashtakari Panchayat and SWaCH).
CSO’s can also play a role in supporting collective negotiations on behalf of waste pickers. This would help secure a fairer price for materials recovered. According to WIEGO more than three quarters of waste pickers report that the main buyers of recyclable materials were formal businesses. The remainder was supplied to informal businesses, private individuals and the general public. However, within value chains, waste pickers are often in a disadvantaged position. Reports of difficulties in negotiating better prices from buyers is a common issue. By securing higher prices, waste pickers may be able to invest in protective clothing or to diversify income activities.
Local institutions such as medical schools and occupational health institutes should provide support to waste pickers in addressing health issues associated with air pollution exposure. This could take the form of facilitating a greater understanding of the impact on health of occupational exposures as well as sensitising workers about potential short and long term impacts. Such institutions can also play a significant role in sensitising the wider community to the causes and consequences of air pollution originating from dumpsites. Public knowledge and awareness about issues such as air pollution and SWM are often lacking.
Governmental
Given the multi-scalar and interdependent nature of urban air pollution it is clear that government must play a key role in supporting efforts to address this issue. This is particularly the case in terms of addressing air pollution exposure of waste pickers. At its core this will involve sustained support for improved SWM. There exists a high tendency for waste reuse in Africa, which should be encouraged and maintained; single-use products should be discouraged where appropriate and where end-use markets do not exist. Recommendations for government include:
Governments at a local, regional and national level must support the development of an integrated approach to SWM. Strong institutions and an enabling governance environment that facilitates partnerships between government, the private sector, civil society, consumers and the informal sector need to be put in place. Waste policies and legislation must be introduced where absent, strengthened where weak, and where they do exist, they need to be harmonised across the region to ensure that weaknesses in legislation in one country are not exploited. This will involve addressing the finances and governance of solid waste to make generators responsible for their waste. This issue has been discussed by Scheinberg et al., (2010) and the Waste Framework Directive and Landfill Directive of the European Union7 provides an example of such an initiative.
Government should support the integration of waste pickers into the SWM system. The integration of the informal sector in SWM activities leads to more material recovery at lower environmental cost (Scheinberg, 2013).
7 http://ec.europa.eu/environment/waste/framework/ asap-eastafrica.com 38
The integration of waste pickers in the formal waste management chain has to be accompanied by training that increases the efficiency of collection, sorting and recycling activities. Some successful examples were observed in projects outlined by GIZ (2011). The training of informal e-waste recyclers in India increased work efficiency and usage of protective equipment. The work of waste-pickers in pre-sorting activities in treatment plants in Thailand and Brazil helped to improve sorting efficiency and to minimise risky picking and separation activities in dumpsites. Examples from Pune, India and the establishment of municipally run buy-back centres have encouraged the purchase of materials at a fair price. In Bogota, Colombia and Diadema, Brazil, the municipality pay waste pickers a set fee per kilogram of recyclables collected as remuneration for the environmental service they provide. Steps to support waste picker integration may include (Lubaale & Nyang`oro, 2013: 41-42):
The amendment and development of by-laws to ensure that waste pickers have access to recyclables and are not harassed while performing their work. The municipality should engage with the national police force to ensure they do not harass waste pickers. The municipality should develop an inclusive SWM system. Waste pickers must be remunerated for this service in addition to earning an income from selling the materials they collect. Waste pickers must be consulted and involved in the development and implementation of policies and systems. The municipality should hire staff with expertise in integrated waste management. The municipality should run awareness campaigns with city residents to educate them on the role played by waste pickers and instruct them how to correctly separate materials. The municipality should develop a forum where municipal officials, waste pickers, residents and other actors in the waste management and recycling sectors can engage to develop and oversee the implementation of inclusive waste management policies.
Replacement of repressive policies with inclusive policies focused on legal backing, redistributive measures, social recognition and the strengthening of waste picker organisations is considered crucial.
Governments should develop long-term strategies for the closure of dumpsites. Whilst government officials have identified the closure of Dandora dumpsite as a priority, a number of challenges are associated with such a strategy. These include (ISWA, 2016); securing finance to support the closure; identifying new waste disposal methods; difficulty in encouraging behavioural change associated with SWM and the adoption of new technologies; provision of new waste disposal facilities that are equipped to accept waste and enable the old site to be completely closed. Crosscutting the above is a need to undertake a significant programme of informing, training and educating waste generators and site users – including waste pickers. According to ISWA (2014) there are three principle methods available for dump closure:
1. Closing by covering the waste (in-place method)
2. Closing by removing the waste from the site (evacuation/mining method)
3. Closing by upgrading the dump to a controlled dumping site or sanitary landfill (up-grading method) asap-eastafrica.com 39
According to ISWA (2014), when choosing a closure/upgrading method it should be borne in mind, that it is not always the most technically advanced solution that is the most appropriate. Improvements of operational aspects (such as eliminating open burning) can result in improved site performance and reduced environmental impacts. This entails sustained government commitment at national and local level to develop strategies for the closure of dumpsites. These efforts can draw on global best practice and lessons learnt from organisations such as ISWA (2016: 43). Steps will include: stakeholder identification, mapping and engagement (including local councils and grievance redress mechanisms); assessment, diagnostics and analysis; development and discussion of proposals; implementation of solutions. Complimentary activities (such as training); operation and maintenance; monitoring and evaluation will also be needed.
Livelihood plans must be an integral component of any dump closure process. Any dump closure must include a comprehensive and articulated approach that addresses the impact on waste pickers. WIEGO (2018) recommends that moving from open dumps into sanitary landfills should be part of an integrated and sustainable solid waste framework with an emphasis on waste minimisation, reuse and reduce strategies (“zero waste’), and on final disposal based on environmentally friendly technologies suited for local contexts and the composition of waste (WIEGO, 2018). Decisions to address SWM issues alongside air pollution must factor in the potential impact on the local economy of Dandora and the waste pickers whose precarious incomes are dependent on the site. In particular support should be provided for identifying alternative livelihood sources.
asap-eastafrica.com 40
References Amegah, A. & Jaakkola, J. (2016). Street vending and waste picking in developing countries: a long-standing hazardous occupational activity of the urban poor. Int J Occup Environ Health. 22 (3): 187–192. https://dx.doi.org/10.1080%2F10773525.2016.1209621
Amugsi, D. et al. (2016). Solid Waste Management Policies in Urban Africa: Gender and Life-course Considerations in Nairobi and Mombasa. Urban Africa Risk Knowledge. https://assets.publishing.service.gov.uk/media/5a02e083ed915d0adcdf467b/REVISED_SWM_PAPER_CLEAN__1_.pdf
Angaye, T. et al. et al. (2018). Evaluation of suspended particulate matter (SPM) around municipal solid waste dumpsites in yenagoa metropolis, Nigeria. MOJ Toxicology. Volume 4 Issue 2. https://medcraveonline.com/MOJT/MOJT-04-00090.pdf
Avis, W. & Khaemba, W. (2018). Vulnerability and air pollution. ASAP-East Africa Rapid Literature Review. Birmingham, UK: University of Birmingham. https://static1.squarespace.com/static/5a6b5aad12abd97ed4679071/t/5b0fe3cb2b6a282944ee1a22/1527768016134/ASAP+- +East+Africa+-+Vulnerability+and+air+pollution+Rapid+Lit+Review+Final.pdf
Avis, W. et al. (2018). Air Pollution Exposure in an Inner City Nairobi Primary School. ASAP-East Africa Vulnerability Scoping Study no. 1. Birmingham, UK: University of Birmingham.
Aweng, E. & Fatt, C. (2014). Survey of Potential Health Risk of Rubbish Collectors from the Garbage Dump Sites in Kelantan, Malaysia. Asian Journal of Applied Sciences. Vol 2 Issue 1. https://www.researchgate.net/publication/265024506_Solid_Waste_Management_Health_and_Safety_Risks_Epidemiology_and_Ass essment_to_Support_Risk_Reduction
Benzeval, M. et al. (2014). How Does Money Influence Health. Joseph Rowntree Foundation. https://www.jrf.org.uk/sites/default/files/jrf/migrated/files/income-health-poverty-full.pdf
Berry, M. & Bove, F. (1997). Birth Weight Reduction Associated with Residence near a Hazardous Waste Landfill. Environmental Health Perspectives. 105 (8). https://www.jstor.org/stable/3433704?seq=1#metadata_info_tab_contents
Brauer, M. (2010). How Much, How Long, What, and Where: Air Pollution Exposure Assessment for Epidemiologic Studies of Respiratory Disease. Proceedings of the American Thoracic Society. 7 (2). 111-115. https://www.atsjournals.org/doi/full/10.1513/pats.200908-093RM
Chalvatzaki, E. (2010). Measurements of particulate matter concentrations at a landfill site (Crete, Greece). Waste Management 30(11):2058- 64. http://dx.doi.org/10.1016/j.wasman.2010.05.025
Chikarmane, P. & Narayan, L. (2005). Organising the Unorganised: A Case Study of the Kagad Kach Patra Kashtakari Panchayat (Trade Union of Waste-pickers). http://www.wiego.org/sites/default/files/resources/files/Chikarmane_Narayan_case-kkpkp.pdf
Cogut, A. (2016). Open Burning of Waste: a Global Health Disaster. R20 Regions of Climate Action. https://regions20.org/wp- content/uploads/2016/08/OPEN-BURNING-OF-WASTE-A-GLOBAL-HEALTH-DISASTER_R20-Research-Paper_Final_29.05.2017.pdf
Cointreau, S. (2006). Occupational and Environmental Health Issues of Solid Waste Management Special Emphasis on Middle- and Lower- Income Countries. World Bank. http://documents.worldbank.org/curated/en/679351468143072645/pdf/337790REVISED0up1201PUBLIC1.pdf
Comba, P. (2006). Cancer Mortality in an Area of Campania (Italy) Characterized by Multiple Toxic Dumping Sites. Annals of the New York Academy of Sciences 1076(1):449-61. https://www.researchgate.net/publication/6679247_Cancer_Mortality_in_an_Area_of_Campania_Italy_Characterized_by_Multiple_To xic_Dumping_Sites
asap-eastafrica.com 41
Crilley, L. et al. (2017). Evaluation of a low-cost optical particle counter (Alphasense OPC-N2) for ambient air monitoring, Atmospheric Measuring Techniques, 11. https://www.atmos-meas-tech.net/11/709/2018/
Dias, S. (2011). Recycling in Belo Horizonte, Brazil – An Overview of Inclusive Programming. WIEGO. http://www.wiego.org/sites/wiego.org/files/publications/files/Dias_WIEGO_PB3.pdf
Dias, S. (2016). Waste pickers and cities. Environment and Urbanization. https://doi.org/10.1177%2F0956247816657302
Dimakakou, E. et al., (2018). Exposure to Environmental and Occupational Particulate Air Pollution as a Potential Contributor to Neurodegeneration and Diabetes: A Systematic Review of Epidemiological Research. International Journal of Environmental Research and Public Health. 15. https://doi.org/10.3390/ijerph15081704
Eakin, H. et al. (2014). Differentiating capacities as a means to sustainable climate change adaptation. Global Environment Change. Vol 27. https://www.sciencedirect.com/science/article/pii/S095937801400079X
Ebert, U. & Welsch, H. (2011). Adaptation and Mitigation in Global Pollution Problems: Economic Impacts of Productivity, Sensitivity, and Adaptive Capacity. Wirtschaftswissenschaftliche Diskussions papiere, Volume 5. https://www.econstor.eu/bitstream/10419/105021/1/V- 332-11.pdf
Egondi, T. et al (2016). Household Air Pollution: Sources and Exposure Levels to Fine Particulate Matter in Nairobi Slums. Toxics 4, 12: 1-13. https://doi.org/10.3390/toxics4030012
Fang, S. et al. (2010). A Systematic Review of Occupational Exposure to Particulate Matter and Cardiovascular Disease. Int. J. Environ. Res. Public Health. 7. 1773-1806. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872342/pdf/ijerph-07- 01773.pdf
Fischer, G. (1991). What Risks Are People Concerned About. Risk Analysis 11 (2). https://doi.org/10.1111/j.1539-6924.1991.tb00606.x
Fussell, H. (2007). Vulnerability: A generally applicable conceptual framework for CC research. Global Environmental Change. 17(2): 155– 167. http://www.riesgoycambioclimatico.org/biblioteca/archivos/DC1089.pdf
Gauderman, W. et al., (2015). Association of Improved Air Quality with Lung Development in Children. The New England Medical Journal. 372. https://www.nejm.org/doi/full/10.1056/NEJMoa1414123
Gilbreath, S. & Kass, P. (2006). Adverse birth outcomes associated with open dumpsites in Alaska Native Villages. Am J Epidemiol. 164 (6). 518-28. https://www.ncbi.nlm.nih.gov/pubmed/16840520
GIZ (2011). The Economics of the Informal Sector in Solid Waste Management. GIZ and CWG. https://www.giz.de/en/downloads/giz2011- cwg-booklet-economicaspects.pdf
Hajat, A. et al. (2016). Socioeconomic Disparities and Air Pollution Exposure: A Global Review. Curr Environ Health Rep. 2 (4): 440–450. https://dx.doi.org/10.1007%2Fs40572-015-0069-5
Hämäläinen, P. et al. (2017). Global Estimates of Occupational Accidents and Work-related Illnesses 2017. Workplace Safety and Health Institute. http://www.icohweb.org/site/images/news/pdf/Report%20Global%20Estimates%20of%20Occupational%20Accidents%20and%20Wor k-related%20Illnesses%202017%20rev1.pdf
Haq, G. & Schwela, D. (2008). Foundation Course on Air Quality Management in Asia. Asia Foundation. https://www.sei.org/publications/foundation-course-air-quality-management-asia/
Howe, P.D. et al. (2013). The participatory vulnerability scoping diagram: deliberative risk ranking for community water systems. Annals of the Association of American Geographers, 103(2), 343-352. https://www.tandfonline.com/doi/abs/10.1080/00045608.2013.754673
Hunt, C. (1996). Child waste pickers in India: the occupation and its health risks. Environment and Urbanization, 8(2), 111–118. https://www.ucl.ac.uk/dpu-projects/drivers_urb_change/urb_environment/pdf_hazards_pollution/IIED_hunt_indiachildren.pdf
asap-eastafrica.com 42
Hunter, P. et al. (2004). Potential sources of bias in the use of individuals recall of the frequency of exposure to air pollution for use in exposure assessment in epidemiological studies: a cross-sectional survey. Environmental Health: A Global Access Science Source 3 (3). https://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-3-3
Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease study 2013 - Results by risk factor. IHME. https://vizhub.healthdata.org/gbd-compare/
International Environmental Technology Centre (2018). Africa Waste Management Outlook. UNEP. https://wedocs.unep.org/bitstream/handle/20.500.11822/25515/Africa_WMO_Summary.pdf?sequence=1&isAllowed=y
IPCC (2014). Climate Change 2014: Synthesis Report. IPCC. http://www.ipcc.ch/report/ar5/syr/
ISWA et al. (2014). Waste Atlas: the World’s 50 Biggest Dumpsites. ISWA. http://www.atlas.d-waste.com/Documents/Waste-Atlas-report- 2014-webEdition.pdf
ISWA (2015). Wasted Health: the Tragic Case of Dumpsites. ISWA. https://www.iswa.org/fileadmin/galleries/Knowledge_Base/THE_TRAGIC_CASE_OF_DUMPSITES.pdf
ISWA (2016). A Roadmap for closing Waste Dumpsites: the World’s most Polluted Places. ISWA. https://www.iswa.org/fileadmin/galleries/About%20ISWA/ISWA_Roadmap_Report.pdf
Kan, H. et al. (2008). Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study. Environ Health Perspect 116. 1183–1188. https://www.ncbi.nlm.nih.gov/pubmed/18795161
Kathuria, V. & Khan, N.A. (2007). Vulnerability to Air Pollution: Is There Any Inequity in Exposure? Economic and Political Weekly. 3158-3165. https://www.jstor.org/stable/4419846?seq=1#page_scan_tab_contents
Karagulian, F. et al. (2015). Contributions to cities' ambient particulate matter (PM): A systematic review of local source contributions at global level. Atmospheric Environment. Volume 120. https://www.sciencedirect.com/science/article/pii/S1352231015303320
Karthikeyan, O. et al. (2011). Characterization of Particulate Matters and Volatile Organic Compounds in the Ambient Environment of Open Dump Sites.
Kasozi, A. & von Blottnitz, H. (2010). Solid Waste Management in Nairobi: A Situation Analysis Technical Document accompanying the Integrated Solid Waste Management Plan. UNEP. http://www.ecopost.co.ke/assets/pdf/nairobi_solid_waste.pdf
Kaya, M. (2016). Recovery of metals and nonmetals from electronic waste by physical and chemical recycling processes. Waste Management. 57. 64-90. https://doi.org/10.1016/j.wasman.2016.08.004
Kelly, F.J. and Fussell, J.C. (2015). Air pollution and public health: emerging hazards and improved understanding of risk. Environmental geochemistry and health, 37(4). 631-649. https://link.springer.com/content/pdf/10.1007%2Fs10653-015-9720-1.pdf
Lankao, P. & Tribbia, J. (2009). Assessing patterns of vulnerability, adaptive capacity and resilience across urban centers. Fifth Urban Research Symposium. http://siteresources.worldbank.org/INTURBANDEVELOPMENT/Resources/336387-1256566800920/6505269- 1268260567624/Romero.pdf
Lelieveld, J. et al. (2015). The contribution of outdoor air pollution sources to premature mortality on a global scale. Nature, 525 (7569). 367- 371. https://www.nature.com/articles/nature15371
Longe, E. et al. (2009). People’s Perception on Household Solid Waste Management in Ojo Local Government Area in Nigeria. Iran. J. Environ. Health. Sci. Eng. Vol. 6, No. 3. 201-208. http://www.bioline.org.br/pdf?se09031
Muindi, K. et al. (2016). Conflict and Crime in municipal solid waste management: evidence from Mombasa and Nairobi, Kenya. Urban Africa Risk Knowledge.
asap-eastafrica.com 43
https://assets.publishing.service.gov.uk/media/5a02de12ed915d0adcdf467a/Conflict_and_Crime_in_municipal_solid_waste_manage ment_Final_1_.pdf
Nduta, M. (2014). Sharing the Burden of Solid Waste on Society: an Assessment of Environmental Equity at Dandora Dumpsite, Nairobi, Kenya. University of Nairobi (Masters Thesis). Uhttp://erepository.uonbi.ac.ke/bitstream/handle/11295/74266/Nduta_Sharing%20The%20Burden%20Of%20Solid%20Waste%20On% 20Society_%20An%20Assessment%20Of%20Environmental%20Equity%20At%20Dandora%20Dumpsite,%20Nairobi,%20Kenya.pdf? sequence=2
Ndunda, E. & Muia, V. (2018). Estimating the Willingness to Pay for Improved Municipal Solid Waste Management in Nairobi, Kenya. International Journal of Environmental Science. http://www.iaras.org/iaras/filedownloads/ijes/2018/008-0002(2018).pdf
New Hampshire Department of Environmental Services (2013). Open Burning of Residential Trash Environmental Impacts and Safer Alternatives. New Hampshire Department of Environmental Services. https://www.des.nh.gov/organization/commissioner/pip/factsheets/ard/documents/ard-33.pdf
Ngo, N. et al. (2017). Why participation matters for air quality studies: risk perceptions, understandings of air pollution and mobilization in a poor neighbourhood in Nairobi, Kenya. Public Health. Volume 142, 177–185. http://www.publichealthjrnl.com/article/S0033- 3506(15)00274-7/pdf
Nwosu, B. et al. (2015). Waste and well-being: a political economy of informal waste management and public policy in urban West Africa. Review of African Political Economy. https://www.researchgate.net/publication/281746457_Waste_and_well- being_a_political_economy_of_informal_waste_management_and_public_policy_in_urban_West_Africa
Nyonyintono, G. & Nyang’oro. O. Waste Pickers in Nakuru, Kenya. WIEGO. http://www.wiego.org/sites/wiego.org/files/publications/files/IEMS-Nakuru-Waste-Pickers-City-Report.pdf
O'Brien, K. et al. (2009). Vulnerability interventions in the context of multiple stressors: lessons from the Southern Africa Vulnerability Initiative (SAVI). Environmental Science and Policy. 12. https://doi.org/10.1016/j.envsci.2008.10.008
OECD (2011). Policy Interventions to Address Health Impacts Associated with Air Pollution, Unsafe Water Supply and Sanitation, and Hazardous Chemicals. OECD. http://www.oecd.org/greengrowth/tools-evaluation/49453368.pdf
O'Neill, M. et al. (2003). Workshop on Air Pollution and Socioeconomic Condition Health, wealth, and air pollution: advancing theory and methods. Environ Health Perspect 111. 1861–70. https://pdfs.semanticscholar.org/a180/e2bb97e6671eef84994fccd91c86e3bc0a37.pdf
Onyari, J. (2017). Special Report for #closedumpsites: Kenya's Dandora Dumpsite - a Health and Environmental Tragedy. International Solid Waste Association. https://www.iswa.org/home/news/news-detail/article/special-report-for-closedumpsites-kenyas-dandora- dumpsite-a-health-and-environmental-tragedy/109/
Otieno, I & Omwenga, E. (2016). E-Waste Management in Kenya: Challenges and Opportunities. Journal of Emerging Trends in Computing and Information Sciences. Vol 6 No 12. https://www.researchgate.net/publication/290947613_E- Waste_Management_in_Kenya_Challenges_and_Opportunities
Oyelola, O. et al. (2009). Health implications of solid waste disposal: Case study of Olusosun Dumpsite, Lagos, Nigeria. International Journal of Pure and Applied Science. 3(2): 1- 8. https://www.academia.edu/13279888/Impacts_of_Waste_Dumps_on_the_Health_of_Neighbours_A_case_study_of_Olusosun_Waste _Dump_Ojota_Lagos_State_Nigeria
Pascal, M. et al. (2013). Assessing the public health impacts of urban air pollution in 25 European cities: Results of the Aphekom project. Science of the Total Environment. Volume 449. https://doi.org/10.1016/j.scitotenv.2013.01.077
Perkins, D. et al. (2014). E-Waste: A Global Hazard. Annals of Global Health. Vol 80, Issue 4. https://doi.org/10.1016/j.aogh.2014.10.001
asap-eastafrica.com 44
Pope III, C.A., et al. (2011). Lung cancer and cardiovascular disease mortality associated with ambient air pollution and cigarette smoke: shape of the exposure–response relationships. Environmental health perspectives, 119(11), p.1616.
Pope, F. et al. (2018). Airborne particulate matter monitoring in Kenya using calibrated low cost sensors. Atmospheric Chemistry and Physics. https://www.atmos-chem-phys-discuss.net/acp-2018-327/
Qian, X. (2016). Knowledge and perceptions of air pollution in Ningbo, China. BMC Public Health. https://doi.org/10.1186/s12889-016-3788- 0
Ray, M. et al. (2005). Respiratory and general health impairments of workers employed in a municipal solid waste disposal at an open landfill site in Delhi. Int J Hyg Environ Health. 208 (4):255-62. https://www.ncbi.nlm.nih.gov/pubmed/16078639
Sankoh, F. et al. (2013). Environmental and Health Impact of Solid Waste Disposal in Developing Cities: A Case Study of Granville Brook Dumpsite, Freetown, Sierra Leone. Journal of Environmental Protection. 4, 665-670. https://file.scirp.org/pdf/JEP_2013071509411898.pdf
Scheinberg, A. et al. (2010). Comparing Solid Waste Management in the World’s Cities. ISWA. https://www.iswa.org/uploads/tx_iswaknowledgebase/Rodic.pdf
Scheinberg, A. (2012). Informal Sector Integration and High Performance Recycling: Evidence from 20 Cities. WIEGO. http://www.wiego.org/sites/wiego.org/files/publications/files/Scheinberg_WIEGO_WP23.pdf
Schwartz, J. (2004). Air pollution and children’s health. Paediatrics. 113. 1037– 1043. http://pediatrics.aappublications.org/content/pediatrics/113/Supplement_3/1037.full.pdf
Seinfeld, J. & Pandis, S. (2016). Atmospheric Chemistry and Physics: From Air Pollution to Climate Change, 3rd Edition. Wiley
Semenza, J. et al. (2008). Public perception of climate change voluntary mitigation and barriers to behavior change. Am J Prev Med. 35 (5). https://doi.org/10.1016/j.amepre.2008.08.020
Slovic, A. et al. (2016). How Can Urban Policies Improve Air Quality and Help Mitigate Global Climate Change: a Systematic Mapping Review. J Urban Health. 93 (1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794467/pdf/11524_2015_Article_7.pdf
Stilianakis, N. (2015). Susceptibility and vulnerability to health effects of air pollution: The case of nitrogen dioxide. EU. http://publications.jrc.ec.europa.eu/repository/bitstream/JRC98587/lb-na-27634-en-n%20.pdf
Thurston, G. et al., (2016). Ambient Particulate Matter Air Pollution Exposure and Mortality in the NIH-AARP Diet and Health Cohort. Environ Health Perspect. 124. 484-490. https://ehp.niehs.nih.gov/wp-content/uploads/124/4/ehp.1509676.alt.pdf
UNEP (2007). Environmental Pollution and Impact to Public Health; Implication of the Dandora Municipal Dumping Site in Nairobi, Kenya. UNEP. https://por.habitants.org/content/download/63622/744639/version/1/file/Report+UNEP+Dandora+Environmental+Pollution+and+Impa ct+to+Public+Health+%282007%29.pdf
UNEP (2007a). Environmental Pollution and Impacts on Public Health: Implications of the Dandora Municipal Dumping Site in Nairobi, Kenya. UNEP. https://file.ejatlas.org/docs/dandora-landfill-nairobi-kenya/dandorawastedump-reportsummary.pdf
US EPA (2003). Environmental Protection Agencies Report on the Environment. US EPA. https://cfpub.epa.gov/ncea/risk/recordisplay.cfm?deid=56830
US EPA (2016). Technical Assistance Document for the Reporting of Daily Air Quality – the Air Quality Index (AQI). US EPA. https://www3.epa.gov/airnow/aqi-technical-assistance-document-may2016.pdf
UN Habitat (2010). Solid Waste Management in the World’s Cities. UN Habitat. https://thecitywasteproject.files.wordpress.com/2013/03/solid_waste_management_in_the_worlds-cities.pdf
WHO (2000). Quantification of the Health Effects of Exposure to Air Pollution. WHO. http://www.euro.who.int/__data/assets/pdf_file/0011/112160/E74256.pdf asap-eastafrica.com 45
WHO (2004). Health Aspects of Air Pollution. WHO. http://www.euro.who.int/__data/assets/pdf_file/0003/74730/E83080.pdf?ua=1
WHO (2006). Air Quality Air Quality Guidelines Global Update 2005. World Health Organisation. http://www.euro.who.int/__data/assets/pdf_file/0005/78638/E90038.pdf?ua=1%201/23/17
WHO (2014). Burden of disease from Household Air Pollution for 2012. WHO. http://www.who.int/phe/health_topics/outdoorair/databases/FINAL_HAP_AAP_BoD_24March2014.pdf?ua=1
WIEGO (2018). WIEGO’s Position on Dump Closures. WIEGO. http://www.wiego.org/sites/default/files/resources/files/WIEGO%20POLICY%20STANCE%201_DUMP%20CLOSURES.pdf
Wood, N. et al. (2013). The Participatory Vulnerability Scoping Diagram: Deliberative Risk Ranking for Community Water Systems. Annals of the Association of American Geographers. 103 (2). https://www.researchgate.net/publication/259802405_The_Participatory_Vulnerability_Scoping_Diagram_Deliberative_Risk_Ranking _for_Community_Water_Systems
World Bank and Institute for Health Metrics and Evaluation (2016). The Cost of Air Pollution Strengthening the Economic Case for Action. Washington DC: World Bank. https://openknowledge.worldbank.org/bitstream/handle/10986/25013/108141.pdf?sequence=4&isAllowed=y
Williams, C. Fenton, A. and Huq, S. (2015). Knowledge and adaptive capacity. Nature Climate Change. Volume 5. http://www.icccad.net/wp- content/uploads/2015/12/Knowledge-and-adaptive-capacity.pdf
asap-eastafrica.com 46