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Health impact assessment of waste management facilities in three European countries

Francesco Forastiere1*, Chiara Badaloni1, Kees de Hoogh2, Martin K von Kraus3, Marco Martuzzi4, Francesco Mitis4, Lubica Palkovicova5, Daniela Porta1, Philipp Preiss6, Andrea Ranzi7, Carlo A Perucci1 and David Briggs2

Author Affiliations

1 Department of Epidemiology, Regional Health Service, Lazio, Via Santa Costanza 53, 00198, Rome, Italy

2 Department of Epidemiology and Biostatistics, Imperial College, London, UK

3 World Health Organization, Regional Office for Europe, Copenhagen, Denmark

4 World Health Organization, Regional Office for Europe, Rome, Italy

5 Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovakia

6 Institute of Energy Economics and the Rational Use of Energy, University of Stuttgart, Germany

7 Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia Romagna, Modena, Italy

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Environmental Health 2011, 10:53  doi:10.1186/1476-069X-10-53

Published: 2 June 2011



Policies on waste disposal in Europe are heterogeneous and rapidly changing, with potential health implications that are largely unknown. We conducted a health impact assessment of landfilling and incineration in three European countries: Italy, Slovakia and England.


A total of 49 (Italy), 2 (Slovakia), and 11 (England) incinerators were operating in 2001 while for landfills the figures were 619, 121 and 232, respectively. The study population consisted of residents living within 3 km of an incinerator and 2 km of a landfill. Excess risk estimates from epidemiological studies were used, combined with air pollution dispersion modelling for particulate matter (PM10) and nitrogen dioxide (NO2). For incinerators, we estimated attributable cancer incidence and years of life lost (YoLL), while for landfills we estimated attributable cases of congenital anomalies and low birth weight infants.


About 1,000,000, 16,000, and 1,200,000 subjects lived close to incinerators in Italy, Slovakia and England, respectively. The additional contribution to NO2 levels within a 3 km radius was 0.23, 0.15, and 0.14 μg/m3, respectively. Lower values were found for PM10. Assuming that the incinerators continue to operate until 2020, we are moderately confident that the annual number of cancer cases due to exposure in 2001-2020 will reach 11, 0, and 7 in 2020 and then decline to 0 in the three countries in 2050. We are moderately confident that by 2050, the attributable impact on the 2001 cohort of residents will be 3,621 (Italy), 37 (Slovakia) and 3,966 (England) YoLL. The total exposed population to landfills was 1,350,000, 329,000, and 1,425,000 subjects, respectively. We are moderately confident that the annual additional cases of congenital anomalies up to 2030 will be approximately 2, 2, and 3 whereas there will be 42, 13, and 59 additional low-birth weight newborns, respectively.


The current health impacts of landfilling and incineration can be characterized as moderate when compared to other sources of environmental pollution, e.g. traffic or industrial emissions, that have an impact on public health. There are several uncertainties and critical assumptions in the assessment model, but it provides insight into the relative health impact attributable to waste management.