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Back to Interest Areas Home Page solidw.doc International OCCUPATIONAL AND ENVIRONMENTAL MEDICINE

JESSICA A. HERZSTEIN, MD, MPH President, Environmental Health Resources Lexington, Massachusetts; Corporate Medical Director, Air Products and Chemicals, Inc. Allentown, Pennsylvania

WILLIAM B. BUNN III, MD, JD, MPH Corporate Medical Director Director, Health Management and Safety Navistar International Corporation Chicago, Illinois

LORA E. FLEMING, MD, PhD, MPH, MSc Associate Professor, Department of Epidemiology and Public Health University of Miami School of Medicine Miami, Florida

J. MALCOLM HARRINGTON, MBBS, MSc The Institute of Occupational Health, University of Birmingham Birmingham, United Kingdom

JERRY JEYARATNAM, MBBS, MSc, PhD Senior Fellow and Director World Health Organization Collaborating Center for Occupational Health Department of Community, Occupational, and Family Medicine National University of Singapore Republic of Singapore

IAN ROBERT GARDNER, MBBS, MPH Program Director, Department of Health Safety and Environmental Management IBM Asia Pacific Sydney, New South Wales, Australia St. Louis Baltimore Boston Carlsbad Chicago Minneapolis New York Philadelphia Portland London Milan Sydney Tokyo Toronto M Mosby Solid Waste

SANDRA COINTREAU-LEVINE Associate Contributors: James Listorti and Christine P. Furedy

CHAPTER OUTLINE high-income countries began requiring open dumps to Background be covered daily with soil to curtail vector access, thus Solid waste generation converting the dumps to controlled landfills. Since the Solid waste composition early 1970s, when it became apparent that even Waste collection systems controlled landfills were causing significant water Waste disposal systems pollution, sanitary landfill technology has been devel- Solid waste management costs oped and refined to provide barriers to pollutant Health and injury issues Availability of migration, as well as for leachate and gas management health and injury data Air pollution systems. disease links In the past 2 decades, occupational health and safety Bioaerosols protection for solid waste facilities has become increas- Particulates ingly regulated to minimize work-related risks. For Volatile organics Lead Direct contact disease example, most waste collection in developed countries links involves vehicles with low loading heights and easy- HIV and hepatitis infection to-lift plastic containers or bags. Waste sorting at Parasitic infections Water materials recovery facilities involves dust suppression, contamination disease links Vector conveyance enclosure, and ventilation-controlled work disease links environments, and workers are required to wear per- Dengue fever sonal respiratory protection if working spaces do not Leptospirosis, plague, and Hantavirus meet air standards set for occupational safety and health. Enteric bacteria Animal However, in developing countries the health-related feeding disease links underpinnings of solid waste management still need to Trichinella spiral is be addressed. Even the minimal regulatory framework Taeniasis Injuries that exists in most of these countries for environmental Collection injuries protection and occupational health and safety is not Disposal injuries enforced. Solid waste workers and waste pickers are Dump site slides and subsidence directly exposed to health risk factors of fecal matter, Lifting-induced injuries blood, volatile organics, air particulates, bioaerosols, Vibration-induced injuries and hazardous chemicals. For waste pickers, living Noise-induced injuries Summary and adjacent to the dump site in poor housing conditions and recommendations with minimal basic infrastructure for clean water and sanitation often exacerbates these health risks.

Current standards and norms for handling municipal BACKGROUND solid wastes in industrialized countries have substan- Solid Waste Generation tially reduced the occupational health and environmen- Municipal solid waste is produced as a result of tal effects from these wastes. About 3 decades ago, economic productivity and consumption and includes nonhazardous wastes from households, commercial 620 Solid Waste 621

establishments, institutions, markets, and industries. Construction and demolition debris and yard wastes typically are not included in the estimated waste generation rate per capita of municipal solid waste, as they are highly variable and skew quantity assessments. Countries with higher incomes produce more waste per capita and per employee, and their wastes have higher proportions of packaging materials and recyclable wastes. In low-income countries, less commercial and industrial activity, as well as less institutional activity, results in lower waste generation rates. In countries where personal incomes are low, there is, of necessity, extensive recycling at the source. Table 38-1 shows how waste generation rates vary by country average income level and city size.

Middle class area with sewage-laden streets in Alexandria, Solid Waste Composition Egypt, during 1980s. Courtesy Daniel A. Okun. Table 38-2 demonstrates how waste composition varies by income levels. Because the solid waste of high-

Global Perspective on Solid Waste Quantities Low-income country Middle-income country High-income country

Mixed urban waste: large city (kg/capita/day) 0.50 to 0.75 0.55 to 0.95 0.75 to 1.8 Mixed urban waste: medium city (kg/capita/day) 0.35 to 0.65 0.45 to 0.75 0.65 to 1.5 Residential waste (kg/capita/day) 0.25 to 0.45 0.35 to 0.65 0.55 to 1.0

Notes: World Bank country categorization by income is based on 1992 gross national product data. For purposes of this table, a medium city is 100,000-500,000 residents; a large city is >500,000 residents; waste weight based on "wet received" (i.e., not dried).

Global Perspective on Urban Solid Waste Characteristics Composition of raw waste (by wet weight, %) Low-income country Middle-income country High-income country

Vegetable/putrescible 40 to 85 20 to 65 20 to 50 Paper and carton 1 to 10 15 to 40 15 to 40 Plastic 1 to 5 2 to 6 2 to 10 Metal 1 to 5 1 to 5 3 to 13 Glass 1 to 10 1 to 10 4 to 10 Rubber, miscellaneous 1 to 5 1 to 5 2 to 10 Fines (sand, ash, broken glass) 15 to 50 15 to 40 5 to 20 Other characteristics: 40 to 80 40 to 60 20 to 30 Moisture Density in trucks (kg/cm) 250 to 500 170 to 330 100 to 1 70 Lower heating (kcal/kg) 800 to 1100 1000 to 1300 1500 to 2700

Notes: World Bank country categorization by income is based on 1992 gross national product data. Compaction trucks achieve load densities of 400 to 500 kg/cm. For self-sustained incineration, a year-round minimum greater than 1300 kcal/kg lower calorific value is needed; for waste-to-energy plants, 2200 kcal/kg is the minimum calorific value desired; waste weight based on "wet received" (i.e., not dried). 622 Environmental Hazards and Populations income countries contains a lower percentage of food especially invite defecation; and, where buckets or bed material, yard wastes, and other putrescible organics, pans are used, the human waste is often placed in a the resulting moisture content of the waste is lower and plastic bag before discarding it with the solid waste. the resulting calorific value higher. The waste of Even where there are latrines and toilets, it is common developing countries does not have sufficient calorific practice to throw the used toilet tissue in the solid waste value to self-sustain incineration; that is, it will not burn dustbin. And finally, pumped seepage from septic tanks without the addition of fuel. and cesspits is commonly discharged at open dumps In high-income countries, hazardous wastes are because treatment facilities are seldom available for this strictly regulated to be source segregated and separately material. managed in secured transport, processing, and disposal facilities. Despite the lower level of commercial, Waste Collection Systems industrial, and institutional activity in developing coun- In all but the most rural areas of high-income countries, tries, their solid waste is not necessarily devoid of virtually all municipal solid wastes are collected. hazardous wastes (defined as toxic, inflammatory, Because of the relatively high cost of labor, loading reactive, explosive, or infectious, including such wastes commonly is made as easy and as mechanized as as the heavy metals in batteries, electroplating sludges, possible, thus minimizing occupational health and paint solvents, pesticides, and infectious medical injury risk. All waste is required to be fully contained, wastes) because the regulatory framework and enforce- either in a covered metal or plastic bin or within a plastic ment system to control such wastes are usually nonex- bag. Occupational health and safety regulation limits the istent or dysfunctional. Bloodied bandages, cotton size and weight of each container or bag. swabs, and syringes from hospitals are commonly found Most low-income countries experience low levels of within the mixed municipal solid waste collected in collection service. Typically only 30% to 60% of the developing countries. Hazardous solvents, adhesives, municipal solid wastes are collected. Service levels in plating materials, and pesticides from industries, as well middle-income countries are slightly higher; typically as hazardous asbestos products from construction and 50% to 80% of the wastes are collected. Because demolition activity, are common. uncollected wastes accumulate near homes and work In 1993, hazardous waste surveys conducted in areas, city dwellers (and their domestic animals) in 21 Latin American countries showed, as expected, that low-income countries have much more direct contact the per person waste generation rate for industrial with wastes than city dwellers in high-income countries. hazardous waste sludges and solids is a function of the Municipal solid waste in developing countries com- country's level of industrialization, with the highest monly is collected through labor-intensive systems, rates (over 0.3 tons/person/year) in countries like sometimes using handdrawn or animal-drawn carts. The Mexico and Brazil, and the lowest rates (under 0.1 waste discharged for collection seldom is stored in a tons/person/year) in countries like Bolivia and Ecuador. plastic or metal container and covered with a lid, unless In most of these countries, more than 30% of the unsuitably large oil drums are available. More typically, hazardous industrial wastes are inappropriately dis- the waste is placed on the ground directly, requiring that charged to open dumps and controlled landfills. Simi- it be shoveled by hand, or it is left in an open carton or larly, most of the hazardous medical wastes are being basket to be picked up by hand. In either case, the waste co-disposed with general municipal solid waste in open awaiting collection is readily available to insect and dumps and controlled landfills, seldom in sanitary rodent vectors and to scavenging animals. Collection 15 landfills with adequate protective measures. workers in developing countries therefore have signifi- Human waste (i.e., fecal matter) is common in solid cantly more direct contact with solid waste than their waste, especially in developing countries (see Chapter counterparts in high-income countries, who predomi- 36). In high-income countries, most human waste is nantly handle sealed plastic bags and covered dustbins. handled in separate sewage and septic tank systems. Nevertheless, a limited amount of human waste arrives Waste Disposal Systems largely through disposable diapers. However, in devel- In high-income countries, essentially all collected oping countries, human waste is common in municipal wastes go to safe sanitary landfill, composting, materials solid waste because of inadequate sanitation. In the recovery, or incineration facilities that are designed and poorest of countries, people defecate along roadways operated to meet environmental protection standards. and on open lots, and the resulting street sweepings Sanitary landfill is a disposal technology wherein solid contain feces. Open piles of uncollected solid waste wastes are placed on impermeable soils that protect Solid Waste 623

Global Perspective on Solid Waste Management Costs vs. Income Low-income country Middle-income country High-income country

Average waste generation (mt/cap/yr) 0.2 mt 0.3 mt 0.6 mt Average income based on GNP ($/cap/yr) $370 $2,400 $22,000 Collection cost ($/mt) $10-30 $30-70 $70-120 Transfer cost ($/mt) $3-8 $5-15 $15-20 Sanitary landfill cost ($/mt) $3-10 $8-15 $20-50 Total cost without transfer ($/mt) $13-40 $38-85 $90-170 Total cost with transfer ($/mt) $16-48 $43-100 $105-190 Cost as % of income 0.7-2.6% 0.5-1.3% 0.2-0.5%

Notes: World Bank country categorization based on 1992 gross national product data. $/mt = US dollars per metric ton; $/cap/yr = US dollars per capita per year. groundwater, underlaid with impermeable plastic mem- solid waste management are not proportionately low. branes and drainage systems to collect contaminated Equipment capital costs and fuel costs in low-income seepage (leachate) for treatment, and ventilated with gas countries are comparable to those in high-income management systems. Within a sanitary landfill for countries, and sometimes are higher because of impor- mixed municipal solid waste, each day's solid waste is tation. The result, as seen in Table 38-3, is that solid formed into a cell and covered with soil to minimize waste management cost is higher in low-income water infiltration, mitigate odors, and limit vector countries when viewed as a percentage of personal breeding. income. Given the proportionately high cost of full Composting is a solid waste disposal technology service in developing countries and competing urban where the organic fraction of the waste is aerobically infrastructure needs, the prevailing low levels of solid decomposed by the natural microorganisms within the waste service are likely to continue for at least another waste. It involves enhancing the conditions necessary decade. for decomposition (e.g., nutrient, oxygen, and moisture levels). Materials recovery facilities provide conveyance, sorting, and processing facilities that enable the HEALTH AND INJURY ISSUES recovery of secondary materials such as paper, carton, Population growth and economic development have metal, and glass from solid waste. brought increasing amounts of solid waste to urban In middle-income countries, probably less than 5% of areas. In most developing countries, the ever-increasing collected waste is deposited in sanitary landfills. quantities have overwhelmed local governments' capa- Roughly another 10% of collected waste is deposited in bilities to cope efficiently. Infectious medical wastes and controlled landfills. A controlled landfill offers less toxic industrial wastes in the solid waste mixture expose environmental protection than a sanitary landfill. It has waste handlers to a wide array of risks. In many of these only daily soil cover and perimeter drainage to minimize countries, waste pickers commonly find their livelihood leachate generation, but not the impermeable underlin- through sorting and recycling of secondary materials. A ing and underdrainage, leachate treatment, and gas majority of waste pickers usually are children and collection systems required of sanitary landfills. Most women of childbearing age. Exhaust fumes of waste collected waste in middle-income countries is dis- collection trucks traveling to and from disposal sites, charged to open dumps, which have no soil cover, burn dust from disposal operations, and open burning of openly during dry seasons, and sometimes have steep waste all contribute to occupational health problems unstable side slopes. (Box 38-1). More removed environmental impacts, such as downwind air pollution and downgradient water Solid Waste Management Costs pollution from solid waste disposal facilities, can affect Table 38-3 shows how solid waste collection, transport, the surrounding population as well as the families of and sanitary landfill costs vary as a function of income. waste pickers (Box 38-2). In developing countries, while the per capita quantities A global relationship appears to exist between solid of wastes and labor costs are low, the costs of providing waste handling and increasing health risk. The risk is 624 Environmental Hazards and Populations

BOX 38-1 BOX 38-2 OCCUPATIONAL HEALTH AND INJURY ISSUES ENVIRONMENTAL HEALTH AND INJURY ISSUES Commonly reported occupational health and injury issues in solid waste management include the fol- Commonly reported environmental health and in- lowing: jury issues in solid waste management include the • Back and joint injuries from lifting heavy following: waste-filled containers and driving heavy • Contaminated leachate and surface runoff landfill and loading equipment from land disposal facilities affecting down- • Respiratory illness from ingesting particulates, gradient ground and surface water quality bioaerosols, and volatile organics during • Methane and carbon dioxide air emissions waste collection and from working in smoky from land disposal facilities adding to global and dusty conditions at open dumps warming, thus increasing subsequent vector- • Infections from direct contact with contami borne disease abundance and pathogen nated material, dog and rodent bites, or eating survival of waste-fed animals • Volatile organic compounds and dioxins in air • Puncture wounds leading to tetanus, hepatitis, emissions increasing cancer incidence and and HIV infection psychological stress for those living near in • Injuries at dumps due to surface subsidence, cinerators or land disposal facilities underground fires, and slides • Animal feeding with solid waste, providing a • Headaches and nausea from anoxic condi food chain path for transmitting disease tions where disposal sites have high methane, • Uncollected wastes that collect and hold wa carbon dioxide, and carbon monoxide con ter and clog drains, thus leading to stagnant centrations waters that encourage mosquito vector • Lead poisoning from burning of materials abundance with lead-containing batteries, paints, and • Uncollected wastes providing food and breed solders ing sites for insect and rodent disease vectors

greatest in developing countries, where the contact risk for solid waste workers and waste pickers in between the solid waste worker and waste is greatest and developing countries is undoubtedly much higher. the level of protection is least. From the information Most of the developing country data discussed in this available, most occupational health and injury problems chapter has not been published. The data are from direct could be minimized by simple safety procedures that in-country observations and surveys, largely by local cost little, and most adverse environmental effects could physicians, health workers, and sociologists and docu- be minimized by closing open dumps and implementing mented in modest reports to their respective local sanitary landfills. governments and health institutions. None appears to qualify as true epidemiological studies and rarely do they relate the incidence of injury or disease observed AVAILABILITY OF HEALTH AND INJURY DATA to global country norms or control group observations. Relatively few data are available on the health and For most of the information presented, this is a first safety conditions of solid waste workers in the higher- reporting in a comparative format and is indicative of income countries. One of the few good studies pub- the hidden nature of the health risks suffered by solid lished from high-income countries was conducted by waste workers and the shadow life of the informal sector the Danish National Institute of Occupational Health, waste pickers. As an example, data from Ghana provide which provided a review of occupational health prob- some indication of the differences in worker health and lems associated with collection of solid waste (domestic safety between solid waste workers versus a group of only). The study found that in 1995 the relative risk (1.5) workers in construction45 (Box 38-3). among Denmark's solid waste collection workers for A number of health studies have been conducted in occupational disease and injury was elevated when India and Nepal16'21'26 (Table 38-4). Tuberculosis, compared to Denmark's total work force.48 The relative bronchitis, asthma, pneumonia, dysentery, parasites, Solid Waste 625

BOX 38-3 Table 38-4 ACCRA (GHANA) OCCUPATIONAL DATA Katmandu, Nepal, Waste Pickers: Before and After Health data from 1994 for the Accra Municipal Solid Waste Work Diseases21 Waste Department were reviewed and compared Disease/reported symptoms % Before % After with a local construction company. The solid waste workers had a higher incidence of sick days, work- Diarrhea 20 32 related accidents, and mortality. The percentage of Dysentery 11 27 people reporting sick during the year was 47.6% of Parasitic diseases 18 45 the total solid waste staff, versus only 33% of the total Colds 48 86 construction staff. Sick days consumed 0.7% of the Eye problems 6 18 total days among the solid waste staff, but only 0.5% Headache 3 23 among the construction staff. Death occurred for 3.6% of the solid waste staff, but for only 0.6% of the construction staff. One death among the solid waste staff was directly work related. Lower incomes and showed that 30% had skin diseases (including rashes, higher ages among solid waste staff may explain hypopigmentation, fungal infection, or boils) at the time some of these differences, but not all.45 of examination. They also reported multiple respiratory symptoms including chronic cough (23%), chronic phlegm production (18%), wheezing (25%), and short- and malnutrition are the most common diseases among ness of breath (19%). Based on chest x-rays conducted waste pickers based on health studies of waste pickers following the survey, in only 3% were these symptoms conducted in Bangalore,Manohar, and New Delhi.26 Of attributable to residual or minimally active pulmonary 1 56 the 180 waste pickers surveyed at Calcutta's open tuberculosis. ' dumps in 1995, 40% had chronic cough, and 37% jaundice; the average quarterly prevalence of diarrhea AIR POLLUTION DISEASE LINKS was 85%; fever, 72%; cough and cold, 63%; eye soreness or redness, 15%; and skin ulcers, 29%.16 In developing countries, one of the major effects of A study comparing waste pickers working at Calcut- occupational and environmental exposure to solid waste ta's Dhapa dump in the 1980s with nearby farmers who occurs in the respiratory system as a result of a wide use organic solid waste as fertilizer showed that pickers range of potentially toxic respiratory exposures (Box reported a higher prevalence of respiratory diseases 38-4) (see also Chapter 30). (71% vs. 34%), diarrhea (55% vs. 28%), and proto- Bioaerosols zoal and helminthic infestation (32% vs. 12%).46 At Bombay's open dump sites, 80% of solid waste workers The elevated incidence of pulmonary diseases reported reported eye problems, 73% respiratory ailments, 51% among waste pickers is probably related to exposure to gastrointestinal ailments, 40% skin problems, and 22% biologically active agents (e.g., microorganisms and orthopedic ailments. Based on clinical examination, their metabolites and toxins), volatile compounds, and 90% had decreased visual acuity, and 27% had skin mold spores. Waste collection involves a physically lesions, of which 30% were determined to be directly strenuous effort resulting in significantly higher pulmo- related to work.36 nary ventilation and a greater tendency to breathe Women and children often make up a majority of through the mouth instead of the nose. Over a study waste pickers at dump sites in developing countries (see period of 1984 to 1992, Danish solid waste collection Chapter 32). Besides the implications for reproductive workers were reported to have a relative risk of 2.6 for toxicity described below, morbidity data from dump site work-related allergic pulmonary diseases and 1.4 for waste pickers in India suggest that waste picking work-related nonallergic pulmonary diseases, as com- children have 2.5 times more risk of morbidity than pared with the entire work force. Waste collectors in non-waste picking children from the same housing Geneva had a 2.5 relative risk of acquiring chronic areas. In 1991, 974 children below 16 years of age bronchitis, according to studies during the mid-1970s.48 A were working at the largest dump site of Metro Manila study in Geneva found collection workers had a high in the Philippines. Clinical examination of 194 children exposure to bioaerosols, mostly molds. Micro- organism counts were between 104 and 105cfu/m3 626 Environmental Hazards and Populations

BOX 38-4 their counterparts in high-income countries. Diesel OPEN DUMPS AND DECREASED LUNG exhaust may play a potentiating role where waste FUNCTION collection is conducted in high traffic density, especially in developing countries where vehicle emissions are not At open dumps in Bombay the majority of waste controlled. Some studies suggest a relationship between workers (73%) complained of aggravated symptoms of cough and breathlessness during working hours. diesel exhaust exposure, asthma, and decreasing lung 48 Abnormal pulmonary function tests (PFTs) were pre- function. sented in 23% of the dump site workers, and 26% In Denmark in 1986, high particulate levels, includ- had restrictive patterns. Chest x-rays showed 17.5% ing airborne bacteria, endotoxins, and fungi, led to 8 had nonspecific shadows consistent with posttuber- cases of bronchial asthma and 1 of chronic bronchitis culosis fibrosis, and about 11% presented reticulo- among 15 materials recovery plant workers at a new nodular shadows.36 PFTs were conducted on dump plant.42 In Finland in 1989, dust concentrations at the site waste pickers and residents surrounding the sorting stations of the materials recovery plants were as dump in Bangkok; 40% were below the normal high as 38 mg/m3 compared to an occupational health range. Individual and environmental tobacco expo- standard of 10 mg/m3 for 15 minutes of exposure, while sure information did not explain the data.37 dust levels within the incinerator were lower than the PFTs on 53% of children working at the largest 49 dump site at Metro Manila, Philippines, revealed occupational health standard. In the United States in decreased pulmonary function compared to country 1992, dust levels measured at six newly built materials norms, especially the forced expiratory volume and recovery facilities were found to be at least one order of forced vital capacity.56 magnitude lower than worker protection standards.52 Dusts at open dumps and landfills, including hazardous dusts such as asbestos and crystalline silica particles, may be injurious to the respiratory system of solid waste 3 (cfu/m refers to the bioaerosol count in 1 cubic meter workers.61 Solid waste workers and waste pickers at of air) in immediate proximity to the waste collection open dumps in developing countries suffer from smoke 3 3 truck's loading hopper, and less than 10 cfu/m at a generated by open burning and underground fires. distance of only 2 to 3 m away.48 A similar study in Denmark found bioaerosols were as high as 106 and 107 Volatile Organics 3 cfu/m at the loading hopper and that waste collectors Because of their high vapor pressures and low solubili- carrying containers to the curb were exposed to only ties, volatile organic compounds are present in solid 25% of the bioaerosol count confronting collectors waste decomposition gases. One study identified 92 emptying containers into the truck. When the trucks different volatile organic compounds in the headspace were equipped with a cover over the loading hopper and loading area of solid waste collection trucks, including an exhaust to pull air under the cover, exposure levels alcohols, aldehydes, ketones, carboxylic acids, and dropped substantially to fewer than 2 x 104 cfu/m3.48 esters. Total volatile organic concentration varied from Measurements at six materials recovery facilities in the 0.9 to 8.1 mg/m3 in the loading area headspace. United States showed that airborne bacteria and fungi Furthermore, sudden peaks in exposure are likely to concentrations measured inside the facilities were occur when the lids of waste containers are opened.48 roughly one order of magnitude higher than the levels Landfill decomposition gases have a number of trace found outside the facility, with a wide variety of volatile organic compounds, some of which are poten- pathogenic and nonpathogenic organisms identified.52 tially toxic (dichloromethane) and carcinogenic (ben- At two materials recovery facilities in Finland, airborne zene and vinyl chloride), as well as potentially affecting bacteria and fungi concentrations were from 2 to 10 the incidence of kidney disease (toluene) and leukemia times higher than background concentrations.49 Similar (benzene)13'51 (see Chapter 39). The U.S. government results were found at landfills in Liguria and Genoa estimated its municipal solid waste landfills released (Italy).30'31 approximately 200,000 tons/year of volatile organic compounds, aside from methane.51 These trace con- Particulates stituents are normally at nontoxic concentrations, unless Waste collectors in developing countries are exposed to significant quantities of hazardous wastes (solvents, significantly higher levels of diesel exhaust fumes than paints, pesticides, adhesives) are present.61 Elevated levels of volatile organics were measured at the Solid Waste 627

Bangkok dump site and were found to be higher by more proximity (less than 4 km) and downwind. Analysis of than an order of magnitude compared with nearby city the landfill's gas showed at least 35 volatile organic background levels, notably for toluene (700 |LLg/m3), compounds were present in appreciable concentrations, ethylbenzene (120 (Xg/m3), m-xylene and p-xylene including suspected and known carcinogens—benzene, (330 |ig/m3), and o-xylene (110 |Hg/m3), as well as vinyl chloride, methylene chloride, chloroform, 1,2- benzene, methylene chloride, and methyl chloroform.37 dichlorethane, bromodichloromethane, tetrachloroethy- In high-income countries, where incinerators now lene, 1,4-dichlorobenzene, 1,2-dibromoethane, and car- have good pollution controls in place, air pollution bon tetrachloride.22 levels may be up to four times higher than background Also around the same Canadian landfill, the fre- within 1 to 2 km of an incinerator.18 In Japan in 1987, quency of low birthweight children born to women stack emissions were analyzed from a continuously living proximal to the site was 20% greater.22 Data from operating modern incinerator and at a discontinuous the Philippines indicate that teratogenicity may occur batch-type incinerator. Significant mutagenicity was near open dumps. At the Payatas dump site in Metro found in the stack gas, by using the Ames Salmonella/ Manila, out of 600 families living within V2 km of the microsomal mutagenicity bioassay test, and 13 poly- open dump, 3 infants were born with imperforate anuses nuclear aromatic hydrocarbon compounds were identi- and 10 children had cerebral palsy.8 fied. Similar results were reported in the United States. The results indicate that mutagenic potency is more Lead significantly affected by the completeness of combus- High blood lead levels (mean 28 |ag/dl) are reported for tion and by the effectiveness of pollution control child waste pickers in Manila. More than 70% of equipment than by the nature of the material being children working at Manila's largest dump site had burned. Results for solid waste and medical waste blood lead levels exceeding the World Health Organi- incinerators were comparable to industrial and utility zation's guideline of 20 |ig/dl. The average blood lead boilers burning coal, wood, and oil.60 Chlorinated and levels of children in a Manila slum outside the zone brominated dioxins and furans, considered among the of influence of the dump site were significantly lower most hazardous substances created during incineration, (11 |Lig/dl).56 were found in Germany to be controllable through A study of incinerator workers in New York showed controlled high temperature operating conditions and a mean blood lead level of 11.0 |Hg/dl compared to flue gas cleaning.29 7.4 |ig/dl in a heating plant control group. Significantly Lag periods of 15 to 30 years are generally assumed lower blood lead levels were found in workers who for development of solid cancers as a result of exposure reported consistent use of respiratory protection during to a cancer-inducing agent, and 5 to 15 years for cleaning of the incinerator's air pollution control hematopoietic cancers.18 Cancer incidence in more than precipitators. 14 million people living within 7.5 km of 72 solid waste 41 incinerators in Great Britain was examined from 1974 to 1984. Observed and baseline expected numbers of cases were determined for each 1 km band from each DIRECT CONTACT DISEASE LINKS incinerator. Although the relative risk differences were Solid waste workers in high-income countries routinely not high, the study determined that there was an wear gloves and boots and handle only the bags or associated risk with distance from incinerators for all containers where solid wastes are stored. On the other solid cancers combined (stomach, colorectal, liver, and hand, solid waste workers and waste pickers in devel- lung cancers), but no evidence of increased risk for oping countries touch the waste they collect or sort lymphatic and hematopoietic cancers.18 through, and they typically are wearing only sandals. In 1991, a large sanitary landfill in Quebec Province, Parasitic and enteric infections are common, and, to a Canada, was studied for cancer incidence in residents lesser extent, viral infections (see Chapter 20). Solid living near the site. In women, stomach and cervical waste collectors in Denmark had a relatively high risk cancers were in excess; in men, stomach, liver, trachea, (6.0) of occupational disease from infectious diseases.48 bronchus, lung, and prostate cancers were increased. A Comparable information is not available from develop- stronger association existed for cancer of the liver and ing countries, but the substantially greater contact intrahepatic bile ducts than for the other cancers, with between the solid waste worker and the waste in relative risk elevated by nearly 80% in the closest developing countries should create an even higher relative risk. 628 Environmental Hazards and Populations

HIV and Hepatitis Infection adsorption-attenuative mechanisms.59 In the case o The United States reported 31 health-care workers who direct discharge of leachate to a surface water from \ were infected with HIV by contaminated puncture land disposal site, downgradient users can also b( wounds, but no incidence in housekeeping workers. The exposed to disease organisms in their bathing, food risk of HIV infection after puncture has been estimated irrigation, and drinking water supply, as well as through to be about 0.3%. However, the risk of HBV infection eating contaminated aquatic organisms. from a comparable injury was estimated to be at least 10 times higher, or 3% or more. Solid waste workers in the United States are currently estimated to have a risk of VECTOR DISEASE LINKS contaminated puncture that is roughly l/1000th the risk Solid waste can provide the perfect breeding ground and level of hospital nurses.65 Studies in 1990 in Genoa, continuous habitation for a number of disease vectors, Italy, showed solid waste workers had a higher preva- ranging from rodents to mosquitos (see Chapter 20). lence of HBsAg carriers (2.9%) compared to the general These vectors can then spread diseases not only to solid population (2.0%), as well as more anti-HBs and waste workers and pickers but also to the surrounding anti-HBc positive subjects (13.8%) versus the general resident populations. population (11.8%).30 Dengue Fever Parasitic Infections Dengue fever is spread by the Aedes aegypti mosquito, Studies of stool samples from solid waste workers in which favors small, clean water pools for breeding, India showed 98% were positive for parasites, espe- including containers, tires, and tin cans found in waste cially Trichuris trichium (a human whipworm) and piles.40 In towns with poor solid waste collection Ascaris lumbricoides (a human roundworm), whereas service, a high correlation exists between dengue fever only 33% of the control group were positive.6 Similarly, and households with disposable containers and tires stool specimens collected from children working at or littering open lands, as these containers hold rain water whose family members work at the dump site in and provided breeding sites.4'40'44'62 Bangkok, Thailand, showed that 65% were infected by one or more parasites. Hookworm (Ancyclostoma Leptospirosis, Plague, and Hantavirus duodenale or Necator americanus) was the most Rodents breed and feed in uncollected solid waste and prevalent (14%) of the helminthic infections, and at open dumps.40 Their numbers are related to the Giardia lamblia (a flagellate protozoon) was the most available food supply, as well as to the extent of pest prevalent (44%) protozoan infection.37 In stool samples control supported in city budgets.43 Leptospirosis is from child waste pickers at Manila's largest dump site, spread by exposure to rodent urine. Bubonic plaque is nearly 98% had T. trichiura, A. lumbricoides, or both.56 spread by rodent fleas; more than 2000 cases were reported in 1993 and 1994, the highest total since global data were first compiled in 1954 and a fourfold increase WATER CONTAMINATION DISEASE LINKS over 1990.63 In 1996 in El Bolson, a small Argentine Rainfall that runs over solid waste, or percolates through resort town, an outbreak of Hantavirus, a disease spread solid waste, extracts dissolved and suspended constitu- by contact with rodent droppings or inhaling dust ents and thus becomes a contaminated liquid called contaminated with rodent urine, killed 10 people.54 leachate. Leachate typically has high concentrations of dissolved organics, total dissolved solids, ammonia, Enteric Bacteria nitrate, phosphate, chloride, calcium, potassium, sulfate, In Tarn we, Myanmar (Burma), in 1989, houseflies were and iron, as well as heavy metals (commonly including captured in different parts of the city and during differ- lead, zinc, cadmium, and nickel).59'64 Leachate also ent seasons. Enteric bacteria were isolated more fre- contains high numbers of fecal bacteria, while viruses quently in flies from refuse dumps, latrines, and animal seldom survive because of their sensitivity to the low pH pens, with highest counts in the hot/wet season.32 values common to leachate.5 Downgradient users of leachate-contaminated groundwaters can potentially be exposed to significant dissolved contaminant levels, but ANIMAL FEEDING DISEASE LINKS seldom do pathogenic microorganisms migrate in most Domestic animals (e.g., cows, goats, pigs, chickens, soils (except sand) due to filtration, ion-exchange, and horses) are present at most open dumps in developing Solid Waste 629

countries, and animal infection is likely. The presence of injuries out of 100 sanitary landfill workers studied.31 human and animal fecal matter, as well as slaughter For the 180 waste pickers at Calcutta's main open dump, waste, raises concern about disease (such as mad cow in 1995 the quarterly cut injury prevalence was 69%, disease, which necessitated the selective slaughter of pin prick was 33%, and eye injury was 16%. Also, 49% hundreds of thousands of cattle in 1996) being spread of waste pickers reported they had received dog bites when animals eat the infected flesh of other animals.12 and 16% had received rat bites at the dump.16 In Bangkok, 88% of waste pickers reported being injured Trichinella spiralis by glass, 73% by needles, 30% by bamboo, and 25% by Trichinosis is rare unless animals that are natural hosts metal.37 Roughly 82% of the dump site waste pickers (e.g., pigs, bears, boars, badgers) to Trichinella spiralis surveyed in Katmandu, Nepal, stated they had received are fed with raw meat.11'53 Recent studies from 31 farms in wounds to the leg, and 70% had received wounds to the Oahu, Hawaii, showed that pigs testing positive for T. hand.21 spiralis were found only on farms feeding garbage to pigs.17 T. spiralis increased in Soviet-bloc countries Dump Site Slides and Subsidence including Latvia, Belorussia, and Georgia from the late Open dumps often have side slopes of waste that are 1970s through the 1980s, in part because of access of steep and unstable, and underground fires are com- animals to raw meat in domestic garbage at open mon and create underground cavities. In 1993 in dumps.5 In 1985, more than 400 rats at a pig farm in Istanbul, a large displacement of the waste mass the United States were found to be infected with T. occurred (about 1.2 million cubic meters). The slide spiralis.39 engulfed 11 homes and killed 39 people.34 Similarly, in 1994 in Oportino, Spain, a man was killed and 250 Taeniasis residents evacuated because of a solid waste slide.3 Taeniasis is an infection caused by the adult stage Landfill slides have been responsible for child deaths in of tapeworm Taenia saginata (beef tapeworm) and a couple of cities in India.7 Child deaths from landfill Taenia solium (pork or dog tapeworm). Cysticercosis equipment also have been reported in Indonesia and the is an infection caused by the larvae stage of tapeworm Philippines.35'56 T. solium from pigs. In developing countries, the prevailing practice of grazing domestic animals and living Lifting-induced Injuries with freely roaming dogs on open dumps creates an Waste collection work is characterized by heavy lifting. infection risk.20'38 Researchers determined that canine Loading weights and heights in some developing tapeworm infects 76% of dogs living on discarded raw countries are not regulated, making the potential for meat or organs.55 injury greater. Substantial risk exists for low back pain and musculoskeletal disorders of the neck, shoulders, and arms. Records from the United States reveal that INJURIES musculoskeletal restrictions due to arthritis were four Collection Injuries times as common for waste collectors as for general In 1995 the relative risk for occupation accidents among laborers. From 1984 to 1992, the relative risk for Denmark's waste collectors was about 5.6, compared to musculoskeletal problems among Danish waste collec- Denmark's total work force. The most commonly tors was 1.9.48 Relative energetic loads, expressed as reported accidents among Danish waste collectors were oxygen consumption, are typically high for waste fractures, sprains, wounds, soft tissue injuries, and collectors, and coronary-related disease events were chemical burns.48 Two decades earlier, a study in New twice as common among U.S. waste collectors as for York City showed that solid waste workers had 20 times general laborers.10 more injuries than all other laborers; the U.S. average for solid waste-related injuries was 10 times that for all Vibration-induced Injuries industry.10'27 A Brazilian study reported annual accident German studies found that the effect of vibration on levels of about 7 per 10 waste collectors.48 drivers of landfill equipment is significant. Spinal injuries experienced by landfill equipment operators Disposal Injuries develop from higher than average degeneration of the In 1994 in Liguria, Italy, a region with 11 active landfills vertebrae and intense vibration of hands and arms from for municipal solid waste, there were 10 occupation operating the equipment levels.61 A study of landfill 630 Environmental Hazards and Populations personnel in Liguria, Italy, found 18 workers had tection. Equipment in developing countries is not lumbago (low back pain).31 required to address noise safety standards and noise levels are expected to be higher. Noise-induced Injuries Noise levels from processing equipment in materials recovery facilities in the United States often have been SUMMARY AND RECOMMENDATIONS found to exceed Occupational Safety and Health This discussion of health and injury effects shows that Administration (OSHA) action levels for worker pro- it is difficult to distinguish between occupational and environmental risks in developing countries, since many people who are not solid waste personnel live and work in the immediate proximity of large piles of solid waste, whether uncollected accumulations, clandestine dumps, BOX38-5 or official land disposal sites. Improved solid waste RECOMMENDATIONS REGARDING SOLID collection in developing countries would decrease the WASTE WORKERS population exposed to risk, and measures are needed to • Provide clean drinking water and washing and improve the work environment for those who make their sanitation facilities for solid waste workers and livelihood from collecting, sorting, or otherwise han- waste pickers dling waste. • Prohibit children and domestic animals from The people involved in solid waste management in entering solid waste disposal sites developing countries would benefit significantly if a few • Provide vaccination for hepatitis A and B, teta modest steps were taken to protect their health, as nus, polio, and typhoid and provide annual medical examinations outlined in Box 38-5. In addition, every developing • Provide education on personal hygiene and on country needs to adopt a plan to upgrade open dumps to the safe care and feeding of domestic livestock controlled landfills. Emergency measures are necessary and pets to curtail underground fires by placing soil daily on • Provide protective clothing, glasses, shoes or waste to help prevent surface collapse and resulting boots, and gloves to all solid waste workers and injuries. waste pickers Every city needs to implement record keeping on the • Require respiratory protection, such as face health of its solid waste workers, including the informal masks, at waste processing facilities waste pickers and recyclers. Rather than having open • Provide conveyance belts or tables that facilitate access of waste pickers to solid waste disposal sites, all sorting • Improve the source storage of solid wastes in solid waste workers should be registered and participate bags and covered dustbins and limit the weight in a regular vaccination and health examination pro- of containers that are manually loaded gram. Local medical schools and occupational health • Provide hearing protection for workers in the institutes need to be encouraged to study the health of vicinity of heavy equipment and waste process solid waste workers in comparison with appropriate ing operations baseline control populations, since true epidemiological • Provide health and safety plans for all solid data are sorely lacking for this sector. waste processing and disposal facilities, includ ing operational procedures for waste handling and emergency procedures of first aid and REFERENCES evacuation 1. Adan BL, Cruz VP, Palapay M: Metro Manila solid waste • Implement source segregation of nonhazardous management study: scavenging study, May 1982. recyclable wastes and hazardous wastes 2. 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