research about solid waste management

What a Waste: An Updated Look into the Future of Solid Waste Management

The Kiteezi landfill near Kampala was expanded as part of the Kampala Institutional Infrastructure Development Project, allowing for the storage and treatment of waste collected in the city. © Sarah Farhat/World Bank

“Waste not, want not.” This old saying rings so true today, as global leaders and local communities alike increasingly call for a fix for the so-called “throwaway culture.” But beyond individuals and households, waste also represents a broader challenge that affects human health and livelihoods, the environment, and prosperity.

And with over 90% of waste openly dumped or burned in low-income countries, it is the poor and most vulnerable who are disproportionately affected.

In recent years, landslides of waste dumps have buried homes and people under piles of waste. And it is the poorest who often live near waste dumps and power their city’s recycling system through waste picking, leaving them susceptible to serious health repercussions.

“Poorly managed waste is contaminating the world’s oceans, clogging drains and causing flooding, transmitting diseases, increasing respiratory problems from burning, harming animals that consume waste unknowingly, and affecting economic development, such as through tourism,” said Sameh Wahba, World Bank Director for Urban and Territorial Development, Disaster Risk Management and Resilience.

Greenhouse gasses from waste are also a key contributor to climate change.

“Solid waste management is everyone’s business. Ensuring effective and proper solid waste management is critical to the achievement of the Sustainable Development Goals,” said Ede Ijjasz-Vasquez, Senior Director of the World Bank’s Social, Urban, Rural and Resilience Global Practice.

What a Waste 2.0

While this is a topic that people are aware of, waste generation is increasing at an alarming rate. Countries are rapidly developing without adequate systems in place to manage the changing waste composition of citizens.

According to the World Bank’s What a Waste 2.0 report,

An update to a previous edition, the 2018 report projects that

How much trash is that?

Take plastic waste, which is choking our oceans and making up 90% of marine debris. The water volume of these bottles could fill up 2,400 Olympic stadiums, 4.8 million Olympic-size swimming pools, or 40 billion bathtubs. This is also the weight of 3.4 million adult blue whales or 1,376 Empire State Buildings combined.

And that’s just 12% of the total waste generated each year.

In addition to global trends, What a Waste 2.0 maps out the state of solid waste management in each region. For example, the  And although they only account for 16% of the world’s population,

Because waste generation is expected to rise with economic development and population growth, lower middle-income countries are likely to experience the greatest growth in waste production. The fastest growing regions are Sub-Saharan Africa and South Asia, where total waste generation is expected to triple than double by 2050, respectively, making up 35% of the world’s waste. The Middle East and North Africa region is also expected to double waste generation by 2050.

Upper-middle and high-income countries provide nearly universal waste collection, and more than one-third of waste in high-income countries is recovered through recycling and composting. Low-income countries collect about 48% of waste in cities, but only 26% in rural areas, and only 4% is recycled. Overall, 13.5% of global waste is recycled and 5.5% is composted.

To view the full infographic, click  here . 

Toward sustainable solid waste management

“Environmentally sound waste management touches so many critical aspects of development,” said Silpa Kaza, World Bank Urban Development Specialist and lead author of the What a Waste 2.0 report. “Yet, solid waste management is often an overlooked issue when it comes to planning sustainable, healthy, and inclusive cities and communities. Governments must take urgent action to address waste management for their people and the planet.”

Moving toward sustainable waste management requires lasting efforts and a significant cost.

Is it worth the cost?

Yes. Research suggests that it does make economic sense to invest in sustainable waste management. Uncollected waste and poorly disposed waste have significant health and environmental impacts. The cost of addressing these impacts is many times higher than the cost of developing and operating simple, adequate waste management systems.

To help meet the demand for financing, the World Bank is working with countries, cities, and partners worldwide to create and finance effective solutions that can lead to gains in environmental, social, and human capital.

, such as the following initiatives and areas of engagement.

Scavengers burning trash at the Tondo Garbage Dump in Manila, Philippines. © Adam Cohn/Flickr Creative Commons

In   Pakistan , a $5.5 million dollar project supported a composting facility in Lahore in market development and the sale of emission reduction credits under the Kyoto Protocol of the United Nations Framework Convention on Climate Change (UNFCCC). Activities resulted in reductions of 150,000 tonnes of CO 2 -equivalent and expansion of daily compost production volume from 300 to 1,000 tonnes per day.

In Vietnam , investments in solid waste management are helping the city of Can Tho prevent clogging of drains, which could result in flooding. Similarly, in the Philippines , investments are helping Metro Manila reduce flood risk by minimizing solid waste ending up in waterways. By focusing on improved collection systems, community-based approaches, and providing incentives, the waste management investments are contributing to reducing marine litter, particularly in Manila Bay.

Leaving no one behind

But the reality for more than 15 million informal waste pickers in the world – typically women, children, the elderly, the unemployed, or migrants – remains one with unhealthy conditions, a lack of social security or health insurance, and persisting social stigma.

In the  West Bank , for example, World Bank loans have supported the construction of three landfill sites that serve over two million residents, enabled dump closure, developed sustainable livelihood programs for waste pickers, and linked payments to better service delivery through results-based financing.

A focus on data, planning, and integrated waste management

Understanding how much and where waste is generated – as well as the types of waste being generated – allows local governments to realistically allocate budget and land, assess relevant technologies, and consider strategic partners for service provision, such as the private sector or non-governmental organizations.

Solutions include:

• Providing financing to countries most in need, especially the fastest growing countries, to develop state-of-the-art waste management systems. 
• Supporting major waste producing countries to reduce consumption of plastics and marine litter through comprehensive waste reduction and recycling programs. 
• Reducing food waste through consumer education, organics management, and coordinated food waste management programs.

No time to waste

If no action is taken, the world will be on a dangerous path to more waste and overwhelming pollution. Lives, livelihoods, and the environment would pay an even higher price than they are today.

Many solutions already exist to reverse that trend. What is needed is urgent action at all levels of society.

The time for action is now.

Click here to access the full dataset and download the report What a Waste 2.0: A Global Snapshot of Solid Waste Management to 2050 .

What a Waste 2.0 was funded by the government of Japan through the World Bank’s Tokyo Development Learning Center (TDLC).

• The Bigger Picture: In-depth stories on ending poverty
• Press release: Global Waste to Grow by 70 Percent by 2050 Unless Urgent Action is Taken: World Bank Report
• Infographic: What a Waste 2.0
• Video blog: Here’s what everyone should know about waste
• Brief: Solid Waste Management
• Slideshow: Five ways cities can curb plastic waste

Introduction to Solid Waste Management

• First Online: 01 January 2022

Cite this chapter

• Hamidi Abdul Aziz 6 , 7 ,
• Salem S. Abu Amr 8 ,
• P. Aarne Vesilind 9 ,
• Lawrence K. Wang 10 &
• Yung-Tse Hung 11  

Part of the book series: Handbook of Environmental Engineering ((HEE,volume 23))

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An increase in population growth, industrial development, and urbanization has led to increasing solid waste generation. Complications associated with solid waste can be dated back to ancient history. The waste produced and collected in an urban area is called municipal solid waste (MSW), mainly associated with the wastes produced from domestic, industrial, commercial, and institutional areas. The amount and composition of waste vary by country. New and effective strategies are generally needed to design urbanization models, and policies are required for effective solid waste management. All aspects of waste storage, collection, transportation, sorting, disposal, and related management are included in solid waste management. It does not stop after collection only, but what needs to be done with the wastes is part of the important aspects of the whole management protocol. Basic waste data are included in this chapter. These include their types, sources, quantity, and compositions. Next, the functional elements of the waste management system are discussed, which among others, includes the aspects of storage, collection, transportation, recovery and processing, composting, thermal treatment, and the final disposal. The legislation related to waste is also discussed, followed by the descriptions of the integrated solid waste management.

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Strategies for Municipal Solid Waste: Functional Elements, Integrated Management, and Legislative Aspects

A Review of the Long-Term Viability of Municipal Solid Waste and the Impact It Has on People

Waste Management: Challenges and Opportunities

Abbreviations.

Air Pollution Control Residues

American Society of Mechanical Engineers

Commercial and industrial

Construction and demolition

Cost-Benefit Analysis

Brominated flame retardants

Chlorofluorocarbons

Hydrochlorofluorocarbons,

Environmental Impact Assessment

Environmental Protection Act

European Union

Humic and fulvic acids

Integrated solid waste management

Life Cycle Assessment

Municipal solid waste

Material Flow Analysis

Pneumatic waste conveyance system

Resource Conservation and Recovery Act

Risk Assessment

Rubber Modified Asphalt

Strategic Environmental Assessment

Socio-economic Assessment

Sustainable Assessment

Solidification/stabilization

Tyre-Derived Aggregate

United Nations Environment Programme

United States

US Environmental Protection Agency

United Kingdom

Volatile fatty acids

American dollar

head/person or individual

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School of Civil Engineering, Engineering campus, Universiti Sains Malaysia, Nibong Tebal, Pulau Pinang, Malaysia

Hamidi Abdul Aziz

Solid Waste Management Cluster, Science & Engineering Research Centre (SERC) Engineering Campus, Universiti Sains Malaysia, Nibong Tebal, Pulau Pinang, Malaysia

Faculty of Engineering, Department of Environmental Engineering, Karabuk University, Karabuk, Turkey

Salem S. Abu Amr

Department of Civil Engineering, Duke University, Durham, NC, USA

P. Aarne Vesilind

Lenox Institute of Water Technology, Latham, NY, USA

Lawrence K. Wang

Department of Civil and Environmental Engineering, Cleveland State University, Cleveland, OH, USA

Yung-Tse Hung

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Aziz, H.A., Abu Amr, S.S., Vesilind, P.A., Wang, L.K., Hung, YT. (2021). Introduction to Solid Waste Management. In: Wang, L.K., Wang, MH.S., Hung, YT. (eds) Solid Waste Engineering and Management. Handbook of Environmental Engineering, vol 23. Springer, Cham. https://doi.org/10.1007/978-3-030-84180-5_1

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Achieving sustainable development goals from the perspective of solid waste management plans

• K. M. Elsheekh   ORCID: orcid.org/0000-0001-7257-3201 1 , 2 ,
• R. R. Kamel 2 ,
• D. M. Elsherif 1 &
• A. M. Shalaby 2  

Journal of Engineering and Applied Science volume  68 , Article number:  9 ( 2021 ) Cite this article

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Achieving the Sustainable Development Goals (SDGs) by 2030 ad is one of the challenges and among the cross-cutting issues that countries around the world strive to achieve, despite it is not mandatory, to take control of the various negative environmental, economic, social, and urban impacts that threatened cities, in addition to benefits that are realized from achieving it. The research aims to promote the achievement of Sustainable Development Goals from the perspective of solid waste management (SWM) plans and programs, through analyzing and finding the interrelationship between SWM plans and programs and the related specific targets for each goal, in addition to using experts’ questionnaires to conclude the varying degrees of impact of SWM plans and programs at the level of 17 SDGs, which have been classified into groups, according to the most and the least affected by the SWM plans and programs. Where the goals of “sustainable cities and communities” and “good health and well-being” came in the lead of the goals; however, the goals of “quality education” and “peace, justice, and institutions” came in the tail of the goals that are affected by SWM plans and programs, according to the experts’ opinion.

Introduction

Rapid growth and urbanization processes in developing countries over the past decades have negatively affected cities, such as high rates of poverty and unemployment; problems related to providing infrastructure and social services, in addition to environmental problems and depletion of local resources; and other negative economic, social, and environmental impact be annexed on cities. Therefore, the need for achieving the Sustainable Development Goals appeared in all countries.

SDGs address not only the measurable changes in the well-being of people, economic development of countries, and better environment on the planet but also the means of how these changes shall be induced, in addition to enabling an environment of peace and security and rule of law and conditions for inclusion and participation [ 1 ]. All sectors of development can contribute to achieving SDGs, and every contribution, small or big, will make an impact on our world. Integrated solid waste management (ISWM) is one of the systems that can contribute to achieving 17 SDGs; it can act as a strong driver for achieving a wide range of specific target of goals, whether directly or indirectly.

The research focuses on the role of ISWM in achieving SDGs; it aims to observe the impact of solid waste management plans and programs on achieving the seventeen sustainable development goals and identifying the sustainable development goals that are the most/the least affected by solid waste plans and programs. The methodology of the research is based on two parts, the first part discussing “the concept of integrated solid waste management and “the role of SWM sector in achieving the SDGs” by analyzing the seventeen sustainable development goals from the perspective of solid waste management plans and programs. The second part is arranging the goals from the most affected by solid waste management to the least, depending on structured interviews and experts’ questionnaires for a diverse sample of 30 experts in this field from academics, researchers, and employees in local administrations.

The experts’ questionnaires were designed by 27 questions distributed into three sections; the first section included 8 questions at the level of “policies and general principles of the system,” the second section dealt with 10 questions at the level of “the solid waste management parties,” and the third section dealt with 9 questions at the level of “the technical stages solid waste management.” All the sections included the seventeen sustainable development goals. By transcribing the experts’ answers through 27 questions and by aggregating the number of times each goal was selected during each of the 27 questions and collecting them, it was possible to calculate the number of points collected for each goal through the use of Microsoft Excel. Accordingly, it was possible to arrange the goals from the most affected by solid waste management to the least.

The concept of integrated solid waste management

ISWM is used to refer to the management of the chain of processes, which starts with discharge/storage and extends through the collection, intermediate, treatment, and final disposal of all waste materials [ 2 ]. The core concept of ISWM has been developed out of the experience to address certain common problems with municipal waste management. The international agencies realized that improvements in waste management could not be achieved through a piecemeal approach. An integrated approach was required to reduce the increasing amount of waste that requires the proper collection, treatment, and disposal [ 3 ]. This integrated approach tries to take into account all the dimensions that may affect the solid waste management processes, in addition to taking into account all the actors and influencers on the solid waste management processes.

The role of SWM sector in achieving the SDGs

Considering SDGs, which encompass multiple sectors of urban governance. It can be seen that the interconnectedness and the basic interdependence between it and the solid waste management sector, where environmentally sound and integrated solid waste management programs and plans affect the achievement and improvement of many indicators of SDGs, whether that effect is directly or indirectly. “The environmentally sound management of waste touches on many vital aspects of development,” says Silpa Caza [ 4 ]. The next part deals with how the solid waste management sector affects the achievement of the SDGs, at the level of 17 goals.

Waste pickers and improve poverty rates

While it is known, millions of people in developing countries earn their living from recycling or reusing waste. Reliable statistical data are difficult, as waste pickers are mobile and their population may fluctuate by seasons. For example, Brazil’s official statistical system found over 229,000 people did this work in 2008 [ 5 ]. Many developing countries aim to determine the factors for successful informal sector integration in SWM systems to design measures for the integration of the informal workers in formal waste management strategies, which will have an impact on reducing poverty rates within this sector.

Organic waste and food security

Recycling of organic waste is a real opportunity to provide a large number of organic fertilizers that may improve the quality of crops and raise the rates of agricultural productivity in countries, thus supporting the provision of more safe and nutritious food throughout the year and reducing the proportion of the world population suffering from hunger. Only 13.5% of the world’s waste is recycled, and 5.5% turns into organic fertilizer [ 6 ]. This requires a greater effort to raise those rates and make greater use of them at the level of that goal.

SWM processes and ensuring a healthy life

The medical waste disposal system in developing countries is often subject to defects and faults. Under the pressure of crowded hospitals, workers make mistakes and get infected in return. Adopting the proper management of medical waste inside the health facilities, by incineration or sterilizing and shredding, can greatly reduce the transmission of infection and the transmission of pathogens.

In addition, garbage collectors are still exposed on a daily and continuous basis to the dangers of disease and infection as a result of improper practices of sorting and recycling this hazardous waste, especially many are pregnant and postpartum women within the garbage collectors communities, and to the dangers of premature death as a result of their abuse of sorting processes in the informal system and dealing with waste directly without taking precautionary measures to prevent the transmission of infection and disease.

Therefore, hepatitis C virus (HCV) is one of the most common diseases among litter collectors, which leads to their lives at early ages. Figure 1 shows a comparison between the population in Manshiyat Nasser (one of the largest garbage collectors communities in Egypt) and Greater Cairo by age groups. The available data indicate that the age group over 50 years old in Manshiyat Nasser is much lower compared to Greater Cairo, where the percentage in the Nasser facility is 8.4%, while the Cairo governorate is 14.3%, according to the Central Agency for Public Mobilization and Statistics [ 7 ], which reflects the low average age in the region. This confirms that the proper management of solid waste collection and sorting processes has a great impact on reducing disease rates.

The population in Manshiyat Nasser and Greater Cairo by age groups [the author]

Ensuring quality education for garbage collector communities

Looking at the garbage collectors’ communities in most developing countries, it can be seen the use of children significantly throughout the work system, which increases the cases of illiteracy, and children drop out of education in exchange for the temptations of financial return. As in Manshiyat Nasser, which represents one of the largest garbage collectors’ communities in Egypt, statistics indicate that the level of education in it is much lower if compared to Cairo, where the illiteracy rate in Manshiyat Nasser is 52%, while in Cairo it is 24.2%, according to the Central Agency for Public Mobilization and Statistics [ 7 ]. The illiteracy rate among females in Manshiyat Nasser is 59.6%, while in Cairo, it reaches 30.6% for males; the illiteracy rate in Manshiyat Nasser stands at 45.1%, while in Cairo governorate, it reaches 18.2% [ 7 ]. Figure 2 illustrates an approach between the ratios of the education in Manshiyat Nasser and Greater Cairo.

Educational levels ratios in Greater Cairo and Manshiyat Nasser [the author]

The previous data can be interpreted as an indication of the increasing rates of dropout from education with the advancement of age in one of the largest garbage collector communities in Egypt as a result of work requirements and the rise of child labor within the profession. The reduction of child labor and the provision of technical and vocational education for them, especially in developing countries, supports enrollment opportunities. In schools and learning for garbage collectors’ communities and family members of those in charge of this profession.

Achieve gender equality and empower all women and girls in SWM

Women and girls are considered one of the main actors in informal SWM as they play a major role in the waste sorting stage, which is one of the most influential stages on health, as most of the sorting processes take place in the informal system inside residential spaces and residential streets [ 8 ], as shown in Fig. 3 that affects women’s health as women spend most of their time inside the home practicing this process, which makes them more vulnerable to serious diseases [ 9 ], in addition to the use of young girls in this process as well, which leads to an increase in the educational dropout rate among girls. This confirms the importance of the efforts made by civil organizations in Egypt such as the association for the Protection of the Environment (APE) and Youth Spirit Association (YSA) to spread awareness of the importance of adopting proper practices for sorting solid waste, as well as providing proper job opportunities based on solid waste recycling directed at women and girls and providing medical assistance to women who got infected, in addition to the inclusion of young girls in recycling schools that allow them to practice recycling for a paid fee while ensuring their continuation in the educational system.

Women and young girls sorting garbage in Manshiyat Nasser [ 8 ]

Dumping solid waste and provide clean water

Freshwater sources are exposed to pollution from a wide range of sectors, which threatens human health, as well as wildlife as a whole, and water pollutants include plastic garbage as well as invisible chemicals, in addition to direct discharges of factory waste. It ends up in lakes, rivers, streams, and underground water.

One-third of plastic waste ends up in the soil or freshwater. Plastic never degrades, but rather into tiny particles less than 2.5 mm in size known as nano-plastics, which break down further into nanoparticles (less than 0.1 μm in size) and that becomes part of the food chain. Fresh drinking water becomes contaminated with plastic particles, causing various diseases of cancer origin and hormonal disorder s[ 10 ]. For sure, reducing pollution caused by dumping hazardous wastes in or near waterways increases the chances of obtaining higher quality water.

Energy recover from solid waste

The scientific and technical development in dealing with solid waste has led to a review of the tons of waste that the city produces daily, and to look at it as alternative sources of energy. The concept of generating energy from waste is based on chemically treating solid waste to produce energy; waste is currently the third growing renewable energy source worldwide, after solar and wind. It also contributes, with biomass energy, to more than half of the renewable energy used globally [ 11 ]. This is what made many countries of the world strive in research and development and devising plans on a large scale to separate garbage and recycle it to convert it into energy.

Now, due to the tremendous development in the science of solid waste management and a large number of specialists in it, more than half of the garbage is incinerated and converted into liquid or gaseous fuels [ 10 ].

The informal sector in SWM and decent work for all

Informal employment remains a major challenge to the goal of providing decent work for all. In the SWM system, the percentage of informal employment is increasing in developing countries, which operates according to a framework that does not guarantee social insurance or safety standards, which requires improving the working conditions of the informal sector in the SWM system by integrating it within the formal framework of the system.

The utilization of the human resources of the informal sector in the SWM system and its accumulated experience in this field according to a framework that guarantees to improve the work environment and provide opportunities for decent work. It can support the promotion of economic growth by increasing the productivity rates of the several SWM sectors, by investing in solid waste recycling technology and maximizing the economic return by saving in the use of raw materials used in industries and replacing them with solid waste materials in different industries. These activities, industries, and small enterprises that are based on recycling operations of solid waste produce great decent job opportunities for the informal sector.

Recycling projects to stimulate industrialization and foster innovation

Small industries constitute the backbone of industrial development in developing countries [ 12 ], with a relatively small amount of investment and a domestic resource base. Small industries generate a great deal of employment and self-employment to which the SWM sector can contribute. Recycling materials is one of the processes that create opportunities for unlimited industries and small projects that stimulate innovation processes in various fields of industry, which depends on the output of sorting solid waste from plastic, glass, paper, or cloth and other recyclable materials, in addition to making use of organic waste to create opportunities for small projects that depend on the production of compost from well-separated organic waste. All of that can support growth and innovation processes in manufacturing.

Promoting social and economic inclusion for informal SWM communities

SWM sector could contribute to achieving economic and social integration within developing countries and reducing inequalities. As it is divided in many developing countries into two main systems, namely the formal and informal systems, each of them affects the economic growth processes to varying degrees. Therefore, the merger between the formal and informal SWM sectors will support the reduction of social and economic inequalities for all.

Many developing countries are making great efforts and multiple attempts and putting forward new policies to support the merging processes between the two systems because of the great economic and social benefits that this merging will bring. Some governments are trying to allay the concerns of the informal sector about bearing new tax and insurance burdens, as they try to add benefits to enjoy health care in addition to implementing appropriate systems of insurances and pensions in exchange for monthly installments. This enhances the ability to reduce social and economic inequalities within communities.

Sustainable SWM enhancing the quality of life

By looking at the services of SWM, there are two billion people without access to waste collection services globally, and 3 billion people lack controlled waste disposal facilities according to data collected between 2010 and 2018 ad [ 13 ]. This leads to a lack of indicators of quality of life for cities and the sustainability of local communities. Therefore, good practices for SWM through waste reduction, reuse, recycling, and exploitation in generating energy or safe disposal of it are an essential element in sustainable city management and improving the quality of life. “It is impossible to create a sustainable, livable city without rational solid waste management. It is no longer about technical solutions only. There are impacts on climate, health, and safety as well as important social considerations,” Vasquez stresses [ 14 ]. Therefore, there is an urgent need to invest in waste management infrastructure, including the opportunities to convert full landfills into green parks.

SWM and “sustainable consumption and production patterns”

ISWM contains many concepts related to reducing production and controlling consumption patterns such as moving towards the circular economy model which is based on recycling of materials and converting useful waste into resources. That supports the use of fewer natural resources in manufacturing processes. It can also be said that adopting the concept of extended producer responsibility which requires companies to collect and recycle the waste generated from their products is one of the applications of the green circular economy concepts.

In addition to many practices that are being developed to maximize the benefit from the generated solid waste, such as the MSWM Hierarchy (5Rs), which is considered a widely accepted guideline method on what is better for the environment, as it gives top priority to preventing waste generation in the first place then for reuse, recycling, energy recovery, and finally for final disposal. The importance of using the concept of hierarchy for managing solid waste (5Rs) is due to avoiding wasting an important economic value, which is recyclable waste and reducing the rates of environmental pollution.

Solid waste disposal and climate change measures

Greenhouse gasses such as methane emitted from solid waste are a major factor in air pollution and climate change. Many municipal solid waste (MSW) disposal facilities in developing countries are open dumpsites that contribute to air, water, and soil pollution, as well as greenhouse gas emissions. In 2016, 5% of global emissions were generated from solid waste [ 15 ]. This calls for the need to improve solid waste disposal in most parts of the world, as the safe disposal and the reduction of open burning of garbage are one of the most important climate change-related measures.

According to the statistics issued by the World Bank, the world generates 2.01 billion tons of MSW annually, and at least 33% of it is not managed in an environmentally safe manner. Without improvements in the SWM sector, emissions related to solid waste are probably to increase to 2.6 billion tons of carbon dioxide equivalent by 2050 ad [ 16 ]. Environmentally sound management of solid waste will help reduce the spread of carbon dioxide and other greenhouse gasses in the atmosphere.

SWM and “conserve the oceans, seas, and marine resources”

The oceans constitute the largest ecosystem on the planet, and they produce about half of the oxygen we breathe and act as a climate regulator, they also absorb heat from the atmosphere and more than a quarter of the carbon dioxide that man makes, and carbon emissions lead to the accumulation of heat in the oceans and to changes in their chemical composition, which increases acidification. Reducing open burning can limit the diffusion of carbon dioxide. On the other hand, plastic waste is one of the biggest threats to the oceans. Global production of plastic reached more than 300 million tons in 2014. Much of this plastic has ended up in the oceans, where plastic waste accounts for 90% of marine debris, damaging wildlife and harming marine ecosystems [ 17 ]. The environmentally sound management of solid waste and its safe disposal, especially plastics, can reduce damage to the oceans.

SWM impact on land ecosystems

As a result of the rapid urbanization processes and the increase in the population, the solid waste sector is one of the important sectors with a significant impact on the health of ecosystems with their growth rates of waste. One of the aspects of preserving the ecosystems on the earth’s surface is the safe disposal of solid waste. and Adopting an integrated and sustainable SWM system, which takes care of reducing the amount of waste from the source according to a set of concepts related to such as the (3Rs), and (5Rs), in addition to the circular economy model, which are all widely accepted approaches and principles for waste management operations. The importance of using these concepts is due to the reduction of waste production, which supports the reduction of the need for land utilized for the sanitary burying of waste and using a lower amount of land sustainably and the reduction of the impact on the pollution of soil, water, and air.

Integrated SWM and institutional building strengthening

Given the ISWM, the institutional framework depends on delegating and distributing responsibilities and functions between central governments and local administrations, in addition to the partnership with the private sector, civil society organizations, and all actors in the system. This ensures that decisions are made in a manner that is responsive, inclusive, participatory, and representative at all levels. Many developing countries have turned to the institutional framework based on the principle of decentralization because of its potential benefits as a result of its application in the processes of integrated solid waste management, such as improving economic efficiency, protecting local interests, enhancing citizen participation, and ensuring the availability of tools and methods to activate transparency and accountability to ensure that the costs of programs and projects are evaluated and then monitor the service delivery process.

Partnerships between different parties and sectors

The participation of multiple parties in the SWM system is one of the most important points that the system aspires to, as the transformation from the traditional government sector to the government as a partner by adopting multi-lateral partnerships such as the private sector, non-governmental organizations, and the local community has become inevitable and necessary for the success of the SWM system, also establishes partnerships with other sectors such as industry and trade. All of that is a result of the government sector in developing countries’ realization of its limited ability alone to meet the increasing demand for SWM services. And its need to benefit from the local and foreign experiences of the private sector, ensure the utilization of the human capital and the accumulated experiences of the informal sector, and the inclusion of the local community in identifying the actual needs and evaluating the services provided to it, all of that to support the improvement of the SWM system’s performance. Partnerships with donors also provide opportunities to support the system technically and financially. This supports the achievement of goal 17 by making use of the experiences gained from partnerships and their resource mobilization strategies.

Results and discussion

In view of the Egyptian case and its similarity with developing countries with regard to the solid waste management systems, the research committed to monitoring the impact of SWM plans and programs in developing countries on achieving SDGs through their specific related targets, as the research limitations.

Through the previous section, it became possible to analyze the possibility of achieving the SDGs from the perspective of SWM plans and programs, as it supports the achievement of a wide range of specific targets set within the 17 SDGs, whether directly or indirectly, starting with the development of the natural and urban environment by improving the quality of life for cities, maintaining the sustainability of local communities, reducing the individual negative environmental impacts of cities, and preserving the ecosystems on earth, and its ability to contribute to economic and social development by providing job opportunities. In addition to its support for building transparent institutional frameworks that guarantee partnerships with different sectors and various stakeholders as well. Table 1 deduced the contribution of SWM plans and programs to each of the 17 SDGs.

An expert questionnaire (30 experts) was designed to put the 17 SDGs in the order of the impact of SWM plans and programs on achieving it. The questionnaire included 27 questions distributed into three sections: policies and general principles of the system, the system parties, and the technical stages of the system. Figure 4 shows SDGs and the number of times each goal is chosen as a result of being affected by plans and programs for solid waste management. It is based on analyzing expert answers through 27 questions in the experts’ questionnaire.

SDGs and the lead of goals that are affected by SWM programs [the author]

By transcribing the experts’ answers through 27 questions, it is possible to note the following:

Goal 11: Sustainable cities and communities and goal 3: Good health and well-being goal are in the lead goals that are affected by SWM plans and programs.

Then, comes the second stage goal 9: Industry and innovation, goal 8: decent work and economic growth, and goal 12: Responsible consumption and production.

Then, the third stage goal 17: Partnerships for the goals, goal 15: Life on land, and goal 13: Climate action. Then comes the rest of the SDGs.

Goal 4: Quality education and goal 16: Peace, justice and institutions are representing the least affected goals by the SWM plans and programs, according to the experts’ opinion.

Conclusions

It was clear that there was an impact of solid waste plans and programs on achieving SDGs, in various degrees at the level of 17 SDGs, and the greatest impact appeared in the goals related to improving the quality of life and health in cities, in addition to the goals related to providing decent work for all, supporting industrialization and innovation, and improving production and consumption patterns, as well as addressing climate change, enhancing life on earth and supporting partnerships. While some goals appeared less affected by SWM plans and programs, such as the goal related to quality and equitable education for all and the goal related to establishing institutions subject to the issue. The future direction of research should be focusing on developing a framework for achieving goals 3 and 11 (the most affected by SWM) in Egypt from the perspective of SWM plans and programs.

Availability of data and materials

The datasets generated and analyzed during the current study are available in the Google/forms repository [ https://docs.google.com/forms/d/1eDuL-tDf_xxOAKaDIUKiz8Qji6iGonwbQZHCmCgQc68/edit ].

Abbreviations

Solid waste management

• Sustainable Development Goals

Municipal solid waste

Refuse, reduce, reuse, repurpose, recycle

• Integrated solid waste management

Municipal solid waste management

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KM was a major contributor in writing the manuscript and analyzed and interpreted the experts’ questioner data regarding the impact of solid waste management plans and programs on achieving sustainable development goals. DM contributed to identifying the experts to be interviewed. RR, DM, and AM contributed to the review of the experts’ questioner and the manuscript. All authors read and approved the final manuscript.

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Elsheekh, K.M., Kamel, R.R., Elsherif, D.M. et al. Achieving sustainable development goals from the perspective of solid waste management plans. J. Eng. Appl. Sci. 68 , 9 (2021). https://doi.org/10.1186/s44147-021-00009-9

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Municipal Solid Waste Management and Adverse Health Outcomes: A Systematic Review

Giovanni vinti.

1 Department of Civil Environmental, Architectural Engineering and Mathematics, University of Brescia, 25123 Brescia, Italy; [email protected]

Valerie Bauza

2 Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; [email protected] (V.B.); [email protected] (T.C.)

Thomas Clasen

Kate medlicott.

3 Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 1211 Geneva, Switzerland; tni.ohw@kttocildem

Terry Tudor

4 SusConnect Ltd. Weedon Bec, Northamptonshire NN7 4PS, UK; [email protected]

Christian Zurbrügg

5 Department of Sanitation, Water and Solid Waste for Development (Sandec), Eawag—Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600 Dübendorf, Switzerland; [email protected]

Mentore Vaccari

Associated data.

Municipal solid waste (MSW) can pose a threat to public health if it is not safely managed. Despite prior research, uncertainties remain and refurbished evidence is needed along with new approaches. We conducted a systematic review of recently published literature to update and expand the epidemiological evidence on the association between MSW management practices and resident populations’ health risks. Studies published from January 2005 to January 2020 were searched and reviewed following PRISMA guidelines. Eligible MSW treatment or disposal sites were defined as landfills, dumpsites, incinerators, waste open burning, transfer stations, recycling sites, composting plants, and anaerobic digesters. Occupational risks were not assessed. Health effects investigated included mortality, adverse birth and neonatal outcomes, cancer, respiratory conditions, gastroenteritis, vector-borne diseases, mental health conditions, and cardiovascular diseases. Studies reporting on human biomonitoring for exposure were eligible as well. Twenty-nine studies were identified that met the inclusion criteria of our protocol, assessing health effects only associated with proximity to landfills, incinerators, and dumpsites/open burning sites. There was some evidence of an increased risk of adverse birth and neonatal outcomes for residents near each type of MSW site. There was also some evidence of an increased risk of mortality, respiratory diseases, and negative mental health effects associated with residing near landfills. Additionally, there was some evidence of increased risk of mortality associated with residing near incinerators. However, in many cases, the evidence was inadequate to establish a strong relationship between a specific exposure and outcomes, and the studies rarely assessed new generation technologies. Evidence gaps remain, and recommendations for future research are discussed.

1. Introduction

Municipal solid waste (MSW) poses a threat to public health and the environment if it is not safely managed from separation, collection, transfer, treatment, and disposal or recycling and reuse. The World Health Organization (WHO) has highlighted the risks associated with the inadequate disposal of solid waste with respect to soil, water, and air pollution and the associated health effects for populations surrounding the involved areas [ 1 ].

Globally, MSW generation is expected to increase to 3.40 billion tonnes by 2050 [ 2 ]. In general, waste management practices tend to improve going from low-income to high-income countries [ 3 , 4 ]. As a consequence, the related health risks tend to be greater in low-income countries, where the most dangerous practices, such as open dumping and uncontrolled burning of solid waste, are still common [ 5 ]. Using published data, Vaccari et al. [ 6 ] compared characteristics of leachate from more than 100 landfills and dumpsites in Asia, Africa, and Latin America, and found statistically significant concentrations of pollutants in dumpsites.

Waste treatment and disposal includes recycling, composting, anaerobic digestion, incineration, landfilling, open dumping, and dumping in marine areas [ 2 ]. The impact of solid waste on health may vary depending on numerous factors such as the nature of waste management practices, characteristics, and habits of the exposed population, duration of exposure, prevention, and mitigation interventions (if any) [ 5 , 7 , 8 ]).

An investigation of the relationship between solid waste and human health begins with hazard identification and exposure assessment [ 1 ]. Figure 1 schematically represents the linkages between waste management practices, the respective hazards associated with these practices, the possible environmental pathways of transmission by which the most vulnerable or exposed population segments can absorb contaminants, and possible adverse health outcomes. Different waste management practices result in the release of different specific substances, including different environmental matrices that can be involved in transport and exposure. For example, air is the first environmental transport pathway for burning waste. By-products such as dioxins can be generated, and the ingestion of contaminated dairy products can represent an indirect source of exposure [ 9 ]. Other practices, such as waste disposal in landfills or dumpsites, can also affect groundwater through the leaking of leachate [ 10 ]; the consequent exposure would be represented by the ingestion of water contaminated with toxic or carcinogenic compounds [ 11 ].

Schematic representation of the linkages between solid waste management practices and possible adverse health outcomes.

Various reviews have explored the health effects related to solid waste management. Cointreau [ 12 ] published a detailed report on solid waste and health risks for population and workers, noting that the situation in low-income countries is usually worse. Cointreau’s work is probably the most exhaustive of the last 15 years. Porta et al. [ 13 ] examined epidemiological studies on health effects associated with management of solid waste, except for dumpsites and open burning areas. Mattiello et al. [ 14 ] analyzed the health effects focusing on people living nearby landfills and incinerators. Ashworth et al. [ 15 ] gathered data focusing on waste incineration and adverse birth outcomes. Ncube et al. [ 16 ] considered epidemiological studies related to municipal solid waste management, assembling the results based on the health risk (e.g., cancer, birth weight, congenital malformations, respiratory diseases), but this made difficult a comparison among MSW practices. None of these reviews analyzed studies published later than 2014. A further systematic review, recently published [ 17 ], focused on waste incinerators’ health impact, considering studies until 2017. In many cases, the authors suggested that MSW management practices can pose some adverse health effects for the population residing nearby, although the current evidence often lacked statistical power, highlighting the need for further investigations. At the same time, with a moderate level of confidence, some authors derived effects from old landfills and incinerators, such as an increased risk of congenital malformation within 2 km for landfills and cancer within 3 km for incinerators [ 13 ]; other authors [ 14 ] found an increased risk of congenital anomalies mainly nearby special waste landfills, and regarding incinerators some authors found some limited risks of cancer and birth defects, highlighting changes in technology are producing more reassuring results [ 14 ]. Still, the previous reviews rarely analyzed the changing operational standards associated with the evolving legislation. Although their approach can represent a prudent strategy, it limited the interpretation of some data. Only Mattiello et al. [ 14 ] conducted this type of analysis.

Focusing on composting facilities, two systematic reviews analyzed health outcomes, but only considered bioaerosols exposure [ 18 , 19 ]. In both studies, the authors concluded that there is insufficient evidence to provide a quantitative comment on the risk to nearby residents, although there is sufficient evidence to support a precautionary approach, and further research is needed.

In most of the reviews mentioned above, vector-borne diseases (such as malaria) were not included. Only Ncube et al. [ 16 ] cited one study about malaria [ 20 ] and Cointreau [ 12 ] mentioned a couple of old studies related to vector-borne diseases. Although one recent review [ 21 ] focused on the link between solid waste and vector-borne diseases, the methodology and results did not follow a systematic procedure, and appeared excessively approximate.

Additionally, the PRISMA methodology, characterizing a recently recommended systematic review approach [ 22 , 23 ], was rarely implemented. Only in the works of Pearson et al. [ 18 ], [ 19 ] and Tait et al. [ 17 ] was it applied, i.e., in studies that only involved a specific solid waste management practice.

Therefore, despite such prior reviews, uncertainties remain. In many cases, how future research should be developed was not addressed enough. Additionally, the influence of national legislation, characterizing operational standards and technological level, was rarely investigated. Furthermore, WHO [ 1 ] noted that the health effects of waste management and disposal activities are only partly understood. In some cases, it is challenging to apply estimates and evidence from studies related to high levels of emissions from the past to new-generation incineration plants. It has to be highlighted that solid waste legislation influences the technological level and emission limits associated with solid waste management plants, such as landfills and incinerators. Indeed, in many European countries, modern technology has been reducing noxious emissions, and measurable health impacts have, in many cases, become smaller. For example, even the review of Tait et al. [ 17 ], in which the authors focused on incinerators’ publications until 2017, should be renewed, based on more recent and robust studies (e.g., [ 24 , 25 ]). At the same time, it has to be considered that the so-called emerging contaminants (ECs) are not commonly monitored in the environment, but they have the potential to enter the environment and cause known or suspected adverse health effects [ 26 ]. In addition, many new chemicals are constantly approved for commercial use; for example, over 40,000 chemicals are actively being manufactured, processed, and imported in the United States, but the health effects of few of them have been monitored in the population [ 27 , 28 ]. Such substances can easily reach the solid waste phase, leading to underestimated adverse health outcomes. Besides, countries with weak environmental legislations can be affected by additional risks. For instance, some persistent organic pollutants (POPs) are still in production and use in countries that have not ratified the Stockholm Convention, such as in Southern Asia [ 29 ]. Consequently, updated evidence is needed for the policy debate.

Thus, we have undertaken the present systematic review in order to update and expand on previous reviews, based on the PRISMA statement [ 23 ]. Specifically, the objective was to assess and summarize the evidence on the association between municipal solid waste (MSW) management practices and health risks to populations residing nearby. Data were gathered and analyzed in a different way compared with the studies aforementioned. After summarizing the results, the findings are discussed in detail in the Discussion section, considering the influence of national legislation and the technological level in the case of landfills and incinerators. It represents the main novelty of the topic. Furthermore, the update of the recent scientific literature related to MSW and health outcomes using the PRISMA statement was provided, also taking into consideration that some categories, such as dumpsites and vector-borne diseases, were not adequately analyzed in previous reviews. Such a comprehensive approach represented an added value to the manuscript. Finally, we also discussed how further research should be conducted.

The methods used in this review were developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [ 22 , 23 ]. The PRISMA is a procedure that originated in 2009, consisting of a 27-item checklist and a PRISMA flow diagram [ 23 ] that helps authors develop the systematic review in a well-structured way to address recent advances in the science of systematic reviews. The complete procedure is available in the protocol registered on PROSPERO [ 30 ], an international database of prospectively registered systematic reviews.

2.1. Definitions

Some of the technical terms used in this review are defined below.

• Municipal solid waste (MSW): any material from residential, commercial, and institutional activities which is discarded. It is important to note that industrial, medical, hazardous, electronic, and construction and demolition wastes belong to other categories [ 2 ].
• Engineered landfill: site characterized by the registration and placement/compaction of waste. Such landfills typically use daily cover material, surface and ground water monitoring, infrastructure, and a waterproof liner at the bottom [ 6 ].
• Sanitary landfill: site characterized by the registration and placement/compaction of waste. Best practices include a waterproof liner at the bottom, leachate and gas collection systems, daily cover, a final top cover and closure, infrastructure as well as a post-closure plan [ 6 ].
• Dumpsites: open and unregulated areas or holes in the ground with no environmental protection and disposal controls [ 6 ]. Due to lack of controls, dumpsites may receive different waste streams including MSW, sewage sludge, hazardous waste, electronic waste, healthcare waste [ 31 ].
• Transfer stations: facilities in which waste is transferred from smaller vehicles used for waste collection into bigger vehicles for hauling to a disposal or treatment site [ 32 ].
• Incinerators: a specialized engineered system where waste is burned. Through combustion waste is converted into ash, flue gas, and heat. The flue gases are treated to reduce impact of air pollution on environment and health. Energy from an incinerator can be recovered [ 32 ].
• Open burning of waste: burning of solid waste in open areas without air pollution controls [ 32 ].

Dumpsites and open burning were categorised together since burning waste in dumpsites is a common practice, especially in low- and middle-income countries [ 5 , 12 ], making it impossible to split it into two separate categories. As the definition of dumpsites suggests, it was not always possible to assure a clear distinction between MSW and other categories of waste. As a consequence, dumpsites were excluded in cases where the sites did not receive MSW but only other categories of solid waste. Furthermore, in many cases it was not possible to find a clear distinction between sanitary and engineered landfills among the publications, as a consequence the two categories were combined. However, as will be discussed later, such definitions of landfills and incinerators need to be contextualised. Indeed, the fast-evolving technologies and more restrictive legislation [ 1 ] can influence the emission limits and the related health outcomes.

2.2. Study Eligibility

As detailed more fully in the review protocol, studies were eligible for inclusion in the review if they met specified criteria for population, exposure, and health effects. The eligible population and exposures were persons, both children and adults, living, studying, or spending time near MSW treatment or disposal sites, such as landfills, dumpsites, incinerators, areas in which open burning of waste is conducted, transfer stations, recycling sites, composting plants, and anaerobic digesters. Eligible comparators were residents who were not exposed, residents with a lower level of exposure and residents located at different distances from MSW treatment or disposal sites. Occupational risks and therefore waste workers (regular or informal) were not assessed, because they were related to a further category, subjected to different exposures also in terms of time. Health effects included mortality, adverse birth and neonatal outcomes, respiratory conditions, cancer, gastroenteritis, vector-borne diseases, mental and social health conditions, and cardiovascular diseases. Studies reporting on human biomonitoring for exposure were also eligible. The inclusion of transfer stations and vector-borne diseases [ 33 ] as an outcome was a modification from the pre-specified protocol submitted to PROSPERO. However, no changes were made to the search strategy as a result of this addition.

Randomized controlled trials (RCTs) and the following non-randomized controlled studies (NRS) were included: quasi-RCTs, non-RCTs, controlled before-and-after studies, interrupted-time-series studies, historically controlled studies, case-control studies, cohort studies, and cross-sectional studies that include a comparison group. Studies were excluded if they reported qualitative data only.

To be eligible for inclusion, studies had to be peer reviewed and published in English.

2.3. Search Strategy; Screening and Data Extraction; Narrative Review

The search for eligible studies was conducted using relevant search engines (i.e., Scopus, ScienceDirect, Google Scholar) with a combination of keywords based on possible MSW exposure and health effects. Further details regarding the electronic search strategy, including the keywords and string, are available in the protocol. Studies published from January 2005 to January 2020 were examined.

Following an initial screening of paper titles and abstracts, the full paper was examined for eligibility by a single reviewer. Thereafter, data were extracted from eligible studies and compiled solely from the paper.

Due to substantial differences between the studies included in terms of settings, populations, study designs, contexts, MSW management practices, exposure assessment, case definitions, outcome definitions and outcome assessment, it was determined that a pooled analysis using meta-analysis or meta-regression was not appropriate. Accordingly, this review adopted a narrative approach.

2.4. Risk of Bias; Quantity and Strength of Evidence

One reviewer assessed the risk of bias associated with experimental studies, based on the Liverpool Quality Assessment Tool (LQAT), an adaptation of the Newcastle-Ottawa Scale [ 34 ]. Observational studies were automatically scored as having a very serious risk of bias due to the many potential sources of bias inherent in the study design.

Finally, the strength of evidence was summarized to develop the different health outcomes as a function of the categories of exposure analyzed (e.g., landfills, dumpsites). The following values were given: (0) no studies; (−) studies, but no evidence of increased risk; (+) studies, providing some evidence of increased risk; (++) studies, with stronger evidence of increased risk. The findings are discussed in detail in the discussion section taking also into consideration the technological level of the units in the case of landfills and incinerators.

3.1. Study Selection

A total of 253 studies, including 33 reviews and reports, were initially identified. After adjusting for duplicates, 236 remained. Of these, 37 studies were discarded after reviewing the abstracts (if any) because it appeared these papers clearly did not meet the criteria. The full text of the remaining 199 publications was examined in more detail. A total of 170 studies did not meet the inclusion criteria previously described. Twenty-nine studies met the inclusion criteria and are included in this review. The PRISMA flow chart describing the process for determining study eligibly appears in Figure 2 below. All studies screened are available in Supplementary Materials .

PRISMA flow diagram summarizing the study selection.

3.2. MSW Transfer and Treatment Sites

Although the review sought to summarize studies investigating health effects associated with MSW transfer and treatment sites, we did not identify any eligible studies. Specifically, no studies were found that met the review’s inclusion criteria for health effects associated with proximity to transfer stations, recycling centers, composting plants, and anaerobic digesters.

3.3. MSW Disposal Sites

Table 1 , Table 2 , Table 3 , Table 4 , Table 5 and Table 6 summarize the results. In particular, in terms of the methodology used in each paper, the results concerning MSW disposal sites are summarized in Table 1 (landfills), Table 3 (incinerators) and Table 5 (dumpsites and open burning). The studies are listed in alphabetical order by author. In terms of health outcomes, the results are summarized in Table 2 (landfills), Table 4 (incinerators), and Table 6 (dumpsites and open burning). In Table 2 , Table 4 and Table 6 , the results are gathered based on the eight categories of health outcomes previously mentioned (i.e., mortality, adverse birth and neonatal outcomes, respiratory conditions, gastroenteritis, vector-borne diseases, mental and social health conditions, cardiovascular diseases, human biomonitoring). Consequently—in Table 2 , Table 4 and Table 6 —the same research can be cited multiple times if different outcomes were assessed within the same study. Additionally, when an adverse health effect resulted in p < 0.05, it was bolded within the table. However, the publications rarely mentioned technological elements and emission limits characterizing landfills and incinerators in the case study. Therefore, we carried out an additional investigation to address this aspect.

Landfills—methodology characterizing each research.

Health outcomes associated with landfills.

a p < 0.05. Estimated in our systematic review on the basis of 95% Confidence Interval; b The sum of anomalies divided by the total proximal sum of births; c People living beyond the 2-km zone of all known landfill sites represented the reference population; d p < 0.05. Value from regression models. e p -value for test of equality; f Multiple linear regression models were conducted by the authors to determine the associations between health end points and air pollutants.

a The estimated annual average exposure to PM 10 from incinerators in the study areas was 0.96 ng/m 3 in 2003, decreasing to 0.26 ng/m 3 in 2010 because of the improvements of the plant during the study period; b Some weaknesses in the study: controls were residents in 1999, whereas cases were diagnosed between 1996 and 2002, introducing a time lag in the sampling for some matched sets.

Health outcomes associated with incinerators.

a The authors indicated the level of significance only when p -value was lower than 0.05. b period 2003–2010; c p < 0.05. Test conducted by the authors for trend across categories of exposure to incinerator emissions; d period 2007–2010; e The authors reported a p -value of 0.042, for testing the trend of groups 1 and 5 (the highest versus the lowest quintile). It can be noted a significant trend for increases in spontaneous abortions with greater PM exposure. f Per doubling of P M10; g Proximity to the nearest MWI, calculated as a continuous measure of linear distance (km); h p < 0.05. Estimated in our systematic review on the basis of 95% Confidence Interval; i Entire study period; j Operation period: from December 1 1998 to October 31 2002 and from April 1 2006 to December 31 2006; k Shut-down period: from 1 February 2003 to 31 December 2005; l In terms of dioxins, whose long-term exposure increases the risk of cancer and other negative health outcomes including reproductive, developmental and neurodevelopmental effects [ 54 , 55 ]; m Values expressed in terms of Toxic Equivalence (TEQ) were assessed. Indeed, TEQs are calculated values that allow to compare the toxicity of different combinations of dioxins and dioxin-like compounds; in order to calculate a TEQ, a toxic equivalent factor (TEF) is assigned to each member of the dioxin and dioxin-like compounds category. TEFs have been established through international agreements and currently range from 1 to 0.0001 [ 56 ]; n EFSA et al. [ 57 ] considered a threshold value in serum of 7.0 pg/g fat. Furthermore, they established a Tolerable Weekly Intake (TWI) of 2 pg TEQ/kg bw per week. WHO [ 55 ] indicates a provisional tolerable intake of 70 pg/kg bw per month for PCDDs, PCDFs and coplanar PCBs expressed as TEFs. It has to be noted that although several studies showed a positive association with cancer, there was no clear dose–response relationship between exposure and cancer development [ 57 ]; at the same time, WHO [ 55 ] noted since dioxins induce tumors and likely other effects via a receptor-mediated mechanism, tolerable intake guidance based on non-cancer end-points observed at lower doses is considered protective for carcinogenicity. o p < 0.05. When data fit the normal distribution, two independent sample t -tests were performed by the authors to compare the mean levels of the two groups. Otherwise, the Mann–Whitney U test was performed. p p < 0.05. If the data fitted the normal distribution, two independent sample t -tests were performed by the authors to compare the mean levels of the two groups. Otherwise, the non-parametric test was performed.

Dumpsites and open burning—methodology characterizing each research.

a The authors did not write how many of the people interviewed lived in zone (a), (b), (c).

Health outcomes associated with dumpsites and open burning.

a p < 0.05. The authors indicated the p -value when it was lower than 0.05; b The authors categorized counts of reported cases into groups for each health outcome and then used a chi-square test to test for differences. No significant differences were found; c The % is an approximate value taken from a figure in the article; d Comparing three temporal distances between people and disposal sites: (a) less than 5 min, (b) 5–10 min, (c) 11–15 min.

3.3.1. Landfills

We identified nine studies relating to landfills ( Table 1 ). These were mainly conducted in Europe (5) and North America (2). Only one was from Asia (China) and one from Africa (South Africa). Five papers were retrospective cohort studies and four were cross-sectional studies.

The overall evidence of health risks associated with residing near a landfill is mixed ( Table 2 ). Considering results with a significance of p < 0.05, there is some evidence increased risk of mortality for lung cancer [ 35 ], births with congenital anomalies [ 36 ], and negative respiratory conditions in people aged ≤14 years, considering both all respiratory diseases and only acute respiratory infections [ 35 ], association between increase of PM 2.5 concentration and reduction of forced vital capacity in children aged 6–12 years [ 37 ], mucosal irritation and upper respiratory symptoms [ 38 ], and other mild symptoms [ 39 , 40 ]. There was also some evidence of worsening mental and social health conditions, such as alteration of daily activities or negative mood states [ 38 ]. Other studies, however, found no evidence of mortality or adverse health effects. Indeed, Mataloni et al. [ 35 ] did not find evidence of increased mortality for other specific cancers (i.e., colorectal, kidney, liver, pancreas, larynx, bladder, stomach, brain, and lymphatic tissue) as well as for cardiovascular, digestive, ischemic heart, respiratory, and urinary system diseases. For congenital anomalies, no evidence of increased cases was found by Elliott et al. [ 41 ]. Jarup et al. [ 42 ] found no evidence of increased risk of birth with Down’s Syndrome. No evidence of increased specific cardiovascular diseases (cardiac, ischemic, and cerebrovascular) was found by Mataloni et al. [ 35 ]. Neither evidence of increased risk of asthma [ 35 , 39 ] nor gastrointestinal symptoms [ 38 ] was found.

3.3.2. Incinerators

Table 2 summarizes the evidence related to incinerators. A total of 13 studies were identified, 10 of which were conducted in Europe and three in Asia. Seven papers were retrospective cohort studies, one was a prospective cohort study, three were case-control studies and two were cross-sectional studies.

Considering results with a significance of p < 0.05, like landfills, the evidence of increased health risks from residing near an incinerator is mixed. A study reported increased risk of mortality in women for various health outcomes, including cancer [ 44 ]. There is also evidence of adverse birth and neonatal outcomes—i.e., preterm births [ 45 ], congenital heart defects, genital system defects and hypospadias [ 25 ], urinary tract birth defects [ 46 ]. Furthermore, human biomonitoring studies suggest higher levels of dioxins found in residents near incinerators [ 9 , 47 ]. Other studies, however, found no evidence of adverse health effects. In particular, Viel et al. [ 48 ] found no evidence of increased invasive breast cancer in women aged 20–59 years, even founding a significant reduction in invasive breast cancer in women aged 60 years and over. Ranzi et al. [ 44 ] found no evidence of increased cancer diseases both in men and women. Several studies reported no evidence of many adverse birth outcomes [ 24 , 25 , 45 , 46 , 49 , 50 , 51 ]. Ranzi et al. [ 44 ] found neither evidence of increased risk of cardiovascular diseases nor respiratory issues. There was also no evidence of increased mortality in men for various health outcomes, including cancer.

3.3.3. Dumpsites and Open Burning

Table 3 summarizes the effects of residing near dumpsites and open burning. This includes a total of seven studies, one of which was carried on in Latin America, two in North America and four in Africa. Three were retrospective cohort studies, and four were cross-sectional studies.

Once again, the evidence of adverse health effects from the exposure is mixed. Considering results with a significance of p < 0.05, there is some evidence suggesting that residing near dumpsites is associated with increased risk of adverse birth or neonatal outcomes in terms of low birth weight [ 58 ]. However, most studies found no evidence of adverse health effects, including mortality [ 59 ], and congenital malformations [ 60 ]. In terms of gastroenteritis, all studies were from Africa and cross-sectional [ 20 , 61 , 62 , 63 ], but the results were mixed and not statistically significant. Malaria was the only vector-borne disease that studies were identified for. The same four studies that reported on gastroenteritis also reported on malaria, and the evidence suggested that there may be an increased risk of malaria for nearby residents, although none of the results were statistically significant.

3.4. Study Quality

All studies that met the established inclusion criteria for this review were observational studies, and thus were automatically scored as having a very serious risk of bias due to the many potential sources of inherent bias with these study designs. In particular, many included studies suffered from deficiencies such as lack of control for potential confounders, small sample size, unclear case definitions, reliance on self-reported data, and/or the inclusion of several different health outcomes which could increase the type I error rate.

3.5. Summary of Results

Table 7 summarizes the quantity and strength of the evidence related to MSW sites and health outcomes by type of MSW exposure and outcome. In general, there is a paucity of evidence, with no studies for certain exposures and outcomes. This is particularly true in the case of mental health and social health conditions and in biomonitoring, and for most health outcomes associated with dumpsites and open burning. Only mortality and adverse birth outcomes have at least one study for each type of exposure.

Evidence to develop health outcomes among residents living nearby landfills, incinerators, and dumpsites/open burning.

a Human biomonitoring studies measured dioxins, whose long-term exposure increases the risk of cancer and other negative health outcomes including reproductive, developmental, and neurodevelopmental effects [ 54 , 55 ]; b Strength of evidence: 0: no studies; (−): No evidence of increased risk; (+): Some evidence of increased risk; (++): Strong evidence of increased risk. The number in parentheses beside each symbol represents the total number of studies that assessed each health outcome (which are reported in detail in Table 2 , Table 4 and Table 6 ). Although the evidence for some outcomes was mixed, this number includes all the available studies, including both studies finding evidence and studies finding no evidence of an increased risk for each outcome.

In addition to the dearth of evidence, the results are mixed. There was evidence to suggest an increased risk of adverse birth and neonatal outcomes for all types of MSW sites, whereas for other outcomes there was either a lack of evidence for one or more MSW site type or varied evidence of health effects for different kinds of MSW sites. There was also some evidence of health outcomes for landfills and incinerators compared to dumpsites or open burning sites. However, legislation that could characterize landfills and incinerators in each country should be taken into account. This aspect is addressed in the Discussion section below.

4. Discussion

We conducted a systematic review of literature published within the past 15 years (January 2005 to January 2020) to assess and summarize the epidemiological evidence on the association between MSW treatment or disposal sites and health risks to resident populations. The 29 studies that met the inclusion criteria investigated the health effects associated with living nearby landfills (9 studies), incinerators (13 studies), and dumpsites or open burning sites (7 studies). Health outcomes included a large range of conditions, including mortality, cancer, adverse birth and neonatal conditions, cardiovascular diseases, respiratory conditions, gastroenteritis, vector-borne diseases, and mental health conditions. Three studies reported on biomarkers of disease rather than actual health conditions.

Overall, the results were mixed or limited. The most consistent evidence was on the adverse birth and neonatal outcomes, with studies identifying increased risks associated with living near all three types of MSW disposal sites. There was some evidence of increased risk of mortality associated with living near landfills or incinerators. We found no evidence suggesting an increased risk of cancer, cardiovascular diseases, gastroenteritis, or vector-borne diseases. There were no studies on these outcomes in respect of landfills or dumpsites and cancer, dumpsites/burning and cardiovascular diseases, or incinerators and gastroenteritis, and landfills or incinerators and vector-borne diseases. Mental health conditions were investigated only in the case of landfills, where there was evidence of adverse effects. Similarly, human biomonitoring was explored only in the case of incinerators where there was evidence of an increased level of PCDD/F in children’s blood and mother’s breast milk in studies in China [ 9 , 47 ] but not in Spain [ 53 ]. As outlined, the publications rarely mentioned technological elements and emission limits regarding solid waste management for the case studies. Therefore, we carried out additional investigations to fill this gap.

With respect to proximity to landfills, there was evidence of an increased risk of congenital anomalies in a retrospective cohort study by Palmer et al. [ 36 ]; while in another cohort study Elliot et al. [ 41 ] did not find evidence of increased risk. However, Palmer et al. [ 36 ] and Elliot et al. [ 41 ] studied landfills that were operational between the early 1980s and the late 1990s in the UK. Landfills in the UK were regulated by the Control of Pollution Act [ 64 ], replaced by the Waste Management Licensing Regulations in 1994 [ 65 ], and, the UK only fulfilled the European Landfill Directive [ 66 ] to improve standards and reduce adverse effects on the environment in 2002. As a consequence, the two studies were related to the impact of old landfills, i.e., from the previous generation used in the UK. There appears to also be an increased risk in mortality for lung cancer and respiratory diseases, as well as increased morbidity related to respiratory diseases, mainly among youths and children [ 35 , 37 , 38 ]. In particular, Mataloni et al. [ 35 ] considered the association to landfill H 2 S exposure (used as a tracer in the air). When they repeated the analysis using the distance from landfill instead of H 2 S concentration, there were no significant associations between mortality outcomes and living 0–2 km from a landfill compared to 3–5 km. Models that consider the pathways of contaminants instead of only focusing on the distance are likely more accurate. However, Mataloni et al. [ 35 ] considered the health effects of landfills in Italy between 1996 and 2008, and the European Landfill Directive [ 66 ] was implemented in 2003 [ 67 ] in Italy, and by 2009 the landfills that were already operational had to be adapted to the new legislation. All landfills included in Mataloni et al. [ 35 ] were activated before the new Italian legislation. Consequently, it can be assumed that the findings refer to the effect of the old generation landfills in the country. Furthermore, the study of Gumede and Savage [ 37 ] was carried out in South Africa, in which the operational standards related to landfills are less restrictive than the most recent European directives [ 68 ]. In addition, Heaney et al. [ 37 ] found an increased risk of alteration of daily activities and negative mood states, but the cross-sectional study included only 23 participants. However, the research of Heaney et al. [ 38 ] was carried out in North Carolina (USA) in 2009, but the Federal Regulation concerning MSW landfills was revised in 2011, addressing some major aspects including operating practices and composite liners requirements [ 69 ]. Therefore, even in this case, the adverse health outcomes related to new generation landfills in the USA could be lower. In the studies included in this systematic review, there was no other evidence of increased risks related to other kind of diseases. In addition, it must be noted that none of the studies on landfills explicitly focused on potential leachate pollution and related human health risks. Indeed, even modern landfills with good quality geomembranes can sometimes leak leachate due to thermal expansion of the material, folds generated during installation or initial defect density, causing potential risk for water bodies and its consumers; as a consequence, the risks related to landfills are not only due to air emissions [ 70 ].

Likewise, there is mixed and limited evidence on the health effects associated with living near incinerators. It is also important to consider the type of incinerators and emissions control technologies being implemented when assessing health effects. MSW incinerators operating in Europe before the Waste Incineration Directive [ 71 ] can be considered from the old generation of incinerators. After the implementation of the directive, that existing plants needed to comply with by the end of December 2005, the corresponding incinerators can be assumed to be from the new generation. Further improvements were made in 2018 when the new Best Available Techniques (BATs) for waste treatment was adopted by the European Commission [ 72 ], and the MSW incinerators that were already operational have four years to comply with the new standards. Thus, the last category can be assumed as the newest generation, for which no epidemiological studies exist. Regarding the research included in Table 4 , two retrospective cohort studies [ 24 , 45 ] assessing European incinerators between 2003 and 2010 obtained different results for preterm births. Compared to Ghosh et al. [ 24 ], Candela et al. [ 45 ] used a smaller buffer zone around each incinerator, namely 4 km instead of 10 km. According to Ghosh et al. [ 24 ] this difference in approach may have led to fewer outcomes with a lower estimated exposure included. Additionally, in Candela et al. [ 45 ], which was carried out in Italy, the estimated annual average exposure to PM 10 from incinerators in the study areas was 0.96 ng/m 3 in 2003, decreasing to 0.26 ng/m 3 in 2010 because of the improvements of the incineration plant during the study period. However, the annual average exposure to PM 10 estimated in Ghosh et al. [ 24 ] was in the same order of magnitude. In terms of birth with congenital anomalies of the genital system, Parkes et al. [ 25 ] found an association with distance from incinerators but not PM 10 . Ghosh et al. [ 24 ] and Parkes et al. [ 25 ] assessed an intermediate period between old and new generation plants; indeed, for the existing plants the new directive became operational in the end of December 2005. Therefore, although the epidemiological studies mentioned above are among the widest and most recent, their findings can be assumed to be a transition period, between old and new generation plants. Updated research is necessary, only focusing on emissions from new and newest generation plants. In a retrospective cohort study involving residents in Forly (Italy), Ranzi et al. [ 44 ] found a general higher rate of mortality in women and also a higher rate of mortality considering all types of cancer in women. However, the authors analyzed a cohort of people until 2003. As a consequence, the results are only related to old generation plants. Furthermore, Cordier et al. [ 46 ] found an increased risk of urinary track birth defects (UTBD) in infants exposed to MSW incineration dioxins (both atmospheric and deposits). In addition, the findings of Cordier et al. [ 46 ] suggested that consumption of local food modified the risk, increasing it in exposed areas. However, the authors analyzed the outputs between 2001 and 2004; therefore, the incinerators belonged to the old generation sites [ 73 ]. Noteworthy, Parkes et al. [ 25 ] found no evidence of increased risk of UTBD, and their study analyzed more recent incinerators. Regarding biomonitoring studies, Xu et al. [ 9 , 47 ] found higher levels of dioxins in residents near incinerators in China. In contrast, the values from a study conducted in Spain [ 53 ] were uncertain, varying over the years and often being greater in unexposed groups. However, it is important to highlight in the studies of Xu et al. [ 9 , 47 ] that the samples were collected in China in 2013, i.e., before the approval of more restrictive legislation for MSW incinerators emissions in 2014 [ 74 ]. The new Chinese legislation has standards comparable to those of the European Union [ 74 ]. Consequently, updated studies are necessary.

As highlighted in the studies discussed above, the definitions of landfills and incinerators need to be contextualized based on the evolving technologies and national/international legislation [ 1 ]. For example, European incinerators’ current emission limits are more restrictive than a couple of decades ago. Therefore, many health outcomes related to such new generation plants appear to be lower than in the past. However, the results from such old generation plants can continue to be suitable in areas where less restrictive limits continue to be applied, such as in some developing countries [ 75 ].

Many results are also consistent with the systematic review of Ncube et al. [ 16 ], in which the authors found landfills and incinerators presented adverse health endpoints even if epidemiological evidence in reviewed articles were often inadequate. However, as discussed above, although the operational standards have changed over time, they were not considered by Ncube et al. [ 16 ].

As many dumpsites also practice open burning, it was not possible to assess the effects of these separately. An increased risk of adverse birth outcomes was found for low birth weight and intrauterine growth retardation. However, the main related study [ 58 ] did not expressly specify if the dumpsites were all for MSW. The lack of studies on dumpsites and open burning is especially noteworthy given the widespread prevalence of these methods for disposing of MSW [ 5 ].

In addition, four studies assessed the association between vector-borne diseases and dumpsites [ 20 , 61 , 62 , 63 ]. Although these were cross-sectional studies with small sample sizes, making the evidence too weak to link to an increased risk, they analyzed important health outcomes rarely taken into account. Besides, an increased risk of malaria in people residing closer to dumpsites was noted by some authors [ 20 , 62 , 63 ], offering some suggestive evidence of this adverse health effect. Still, more robust studies are needed.

Overall, many of the studies that were identified and included in this review were of low quality, therefore the potential for causal inference from the studies is limited. While randomized controlled trials of these conditions are probably not possible, there may be opportunities for future studies to use natural experiments or time series analyses. All of the included studies followed observational study designs and presented significant potential for bias and confounding. For example, important measures of exposure such as length of time, activity, technological characteristics, and distance to the hazard, were not always controlled. Case definitions were not always clear, and the methods for case ascertainment in some cases was reported rather than clinically confirmed. In addition, given the range of types of studies and the exposures and outcomes measured, the use of a narrative, as opposed for example, to a meta-analysis or meta-regression was effective in searching, screening, and extracting the necessary data for the review.

This review focused on health effects associated with residing near MSW sites and our findings are limited to only nearby resident populations. A limitation of this work is that it does not consider the health of the larger community in relation to solid waste management or the differential health effects associated with varying levels of MSW management. For example, even if there are some negative health risks for nearby residents of MSW sites, appropriate solid waste management could overall be helpful for the health of populations at large. Living near unmanaged solid waste could also lead to greater negative health impacts than living near a managed solid waste site and this review did not perform a comparative analysis for different types of solid waste management situations (such as no waste management, poorly managed MSW sites, well management MSW sites, and reduced waste generation).

In future, in addition to epidemiological studies, consideration should be given to conducting biomonitoring research. Indeed, focusing on the burning of solid waste (both in incinerators and through uncontrolled open burning) most general population exposure to dioxin (PCDD/F) is through ingestion of contaminated foods of animal origin [ 55 ], with approximately 80–90% of the total exposure via fats in fish, meat, and dairy products [ 76 ]. Generally, levels of dioxins in air are very low, except close to sources such as inefficient incinerators or open burning. Releases into the air ends up contaminating soil and aquatic sediments and can lead to bioaccumulation and bioconcentration through food chains [ 55 ]. Furthermore, dioxins decompose very slowly in the environment, remaining there for very long periods [ 76 ]. Thus, the biomonitoring of the presence of dioxins as well as other persistent pollutants in farm animals and their derivatives nearby incinerators would be useful. Some works have already been carried out and can be taken as references for future research. For example, Cordier et al. [ 46 ] analyzed the association between local food consumption, dioxin deposits generated by MSW incinerators and risk of urinary tract birth defects. More recently, Xu et al. [ 9 ] studied the concentration of dioxins on eggs close to an MSW incinerator in China.

In addition, the biomonitoring studies should be extended to other waste practices. The work of Scaramozzino et al. [ 77 ] can be considered as well. The authors conducted the first proposal for a standardized protocol for farm animal biomonitoring that can be useful for both environmental and human risk assessments.

Furthermore, technical aspects influenced by national legislation should be investigated further. This would allow for easier comparisons between evolving technologies for which environmental and health impacts tend to decrease.

5. Conclusions

In conducting this systematic review, 29 studies were identified that met the inclusion criteria of our protocol, assessing health effects only associated with proximity to landfills, incinerators, and dumpsites/open burning sites. Compared to most previous reviews, national legislation’s influence—characterizing operational standards and technological level—was investigated. There was some evidence of an increased risk of adverse birth and neonatal outcomes for residents near landfills, incinerators, and dumpsites/open burning sites. There was also some evidence of an increased risk of mortality, respiratory diseases, and negative mental health effects associated with residing near landfills. Additionally, there was some evidence of increased risk of mortality associated with living near incinerators. However, in many cases, the evidence was inadequate to establish a strong relationship between a specific exposure and outcomes. Additionally, most landfills and incinerators investigated referred to the old generation of technologies, although studies on new generations’ plants are starting to be published. Therefore, future research should focus on new generation landfills and incinerators, to have a more specific analysis of these upgraded MSW practices. Additionally, the health effects related to the open burning of waste need further investigation, and the association between dumpsites in developing countries and vector-borne diseases require more robust epidemiological studies.

However, none of the 29 studies that we identified investigated the health effects associated with MSW transfer and treatment, such as transfer stations, recycling centers, composting plants, and anaerobic digesters. This appears to be a major gap in the literature since transfer and treatment facilities are widespread and could pose health risks including exposure to toxins, particulate or infectious agents via direct contact, and aerosolization or other pathways. Since these health risks are potentially different from those associated with MSW disposal sites, future research must address this gap to assess relative risks associated with various management and disposal options.

Acknowledgments

V.B. and T.C. were funded in part by a grant to Emory University from the World Health Organization. V.B. was supported by a grant from the National Institute of Environmental Health Sciences, USA (T32ES012870 to VB). The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

Supplementary Materials

The following are available online at https://www.mdpi.com/article/10.3390/ijerph18084331/s1 : List of the studies screened (excluding duplicates)—in alphabetic order.

Author Contributions

Conceptualization, G.V., V.B., T.C., K.M., T.T., C.Z., and M.V.; Methodology, G.V., V.B., T.C., and M.V.; Papers identification, screening and eligibility, G.V.; Data extraction, G.V.; Risk of bias assessment, V.B.; Data analysis, G.V. and V.B.; Writing—first version, G.V., V.B., and T.C.; Writing—revised version, G.V., V.B., and T.T.; Supervision, T.C., K.M., T.T., C.Z., and M.V. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

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