Waste and health impact assessment

Dr Salim Vohra

Not previously published

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Introduction

Communities living near waste facilities or having them sited near them are increasingly

outspoken about the perceived health and wellbeing impacts of landfills, incinerators and waste

transfer stations. Around the UK, many community campaign groups are fighting to gain

information and reassurance about the trucks, their unseen loads and the “hidden” operations of

these waste facilities (Heap, 2006; Vennells, 2003; Prasad, 2002).

On the other hand, for both national and local government, sustainably managing domestic

waste, ideally as close to its creation as practicable, is a priority concern (DEFRA; 2006, 2000;

SEPA; 1999).

Between them both, piggy in the middle, stand waste management businesses who have to

deal with both the insistent demands of government and the concern, protest and conflict that

these demands are generating in affected communities. The question is how can we move

beyond this impasse to a more constructive approach to waste management planning and

siting.

Waste management businesses proactively commissioning health impact assessments (HIAs),

at an early stage, is likely to form a key part of any constructive approach. Health impact

assessment brings together the impact science, community engagement and an understanding

of the factors that drive public perceptions of environmental health risks into a single coherent

package thereby dealing with community concerns in a more open, credible and effective way.

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 Figure 1: Community protest and opposition to the siting of a waste facility

Brief history of waste regulation in the UK

Historically, the amount of waste generated by human populations has been low. However, the

advent of the industrial revolution, in the 18th century, heralded a massive increase in domestic

and industrial waste as people moved from rural to urban areas and industrial manufacturing

replaced agriculture as the dominant economic activity. This waste posed a significant threat to

human health and the local environment making waste regulation and management a priority

societal and political concern (Waste Online 2004).

In the UK, the 1848 Public Health Act began the formalisation of waste regulation and

management. In 1874, the first "destructor" was designed and constructed in Nottingham.

Destructors were incineration plants which burnt mixed fuel producing steam to generate

electricity. Even then they were opposed by local communities because of the ash and dust that

they threw out onto the local area. The 1875 Public Health Act made local authorities

responsible for the removal and disposal of domestic waste.

In 1907, an amendment to the Public Health Act extended waste collection to trade refuse and

allowed local authorities to charge for waste collection. In 1930, the Ministry of Health argued

that the dumping crude refuse without adequate precautions should not be allowed. Similar

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complaints about unsanitary landfill continued into the 1920s. The 1936 Public Health Act ruled

that the accumulation of waste which was prejudicial to health was a Statutory Nuisance. Local

authorities were given powers to prosecute uncontrolled dumping, cesspools and scavenging.

The Act also prohibited development on contaminated land and provided a clearer framework

for managing landfill sites.

In 1947, the Town and Country Planning Act gave local authorities planning powers over new

waste management sites. In 1956, the Clean Air Act led to the decrease in open fires, and the

consequent burning of domestic waste, in homes. In the 1960s, private waste management

businesses began to take over what had until then been a largely public sector activity.

In 1971, drums of cyanide waste were dumped at an abandoned brick kiln near Nuneaton,

causing a big public outcry. This alongside media coverage of waste lorry drivers taking bribes

to dump hazardous waste in inappropriate locations and a Royal Commission report on waste

led to the 1972 Deposit of Poisonous Waste Act and the 1974 Control of Pollution Act.

The 1980s and 1990s, saw increasing public concern over waste disposal which led to the

passing of the Environmental Protection Act in 1990 as well as a range of European Directives:

the Hazardous Waste Directive, the Integrated Pollution Prevention and Control (IPPC)

Directive, the Landfill Directive and the Waste Incineration Directive.

This brief chronology of waste regulation and management shows the importance of public

health and community concerns as major drivers for changes in the regulation and management

of domestic and hazardous waste in the UK.

Health and wellbeing impacts of waste

Though there have been issues with past technology, the majority of current evidence points to

modern waste facilities – provided that they are built, maintained and operated correctly - having

little or no direct negative health impacts on the residents who live near them (DEFRA, 2004).

However, while local communities are not being exposed to chemical or biological agents they

are exposed to the environmental, social and cultural significance of waste (Vohra, 2003).

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Environmentally, the operation of waste facilities means that waste lorries, and other traffic

going to and from the facility, can be seen as impinging on and negatively affecting existing

ways of life.

Socially, waste management involves a network of individuals and agencies and, for it to work

well, all these individuals and agencies need to work cooperatively and to the highest standards.

Unfortunately, this is not always the case. Substantiated and unsubstantiated reports of the

mixing of domestic waste with hazardous waste, the perceived lack of care and the ‘cutting of

corners’ by operators as well as the perceived indifference of waste regulators to the wellbeing

of communities has sensitised the public to waste issues. Communities therefore tend to be

uncertain, uneasy and distrustful of developers and regulators in general. The siting or

extension of a waste facility therefore becomes the perfect opportunity for local resident’s to

voice this distrust, unease and uncertainty by opposing and protesting against the proposed

plans.

Finally, at a cultural level waste has a deep symbolic dimension, having to live near waste and

others seeing that you have to live near waste can stigmatise both the community and the

neighbourhood. People faced with having to live near a waste facility can genuinely feel that

somehow they, and their families, must be ‘rubbish’ people for having to live near it and that the

planning authority and waste management company must think that they are ‘rubbish’ and that

they ‘deserve’ to live near it otherwise why would they be building this in their neighbourhood.

Community concerns are therefore not just about the direct health effects of exposure to air,

water and soil pollution from dioxins, heavy metals, micro-organisms and the infestation of rats;

they are related to a whole set of interconnected questions. These include what kind of

community they want to live in, what kind of society they are a part of, why this waste is being

placed near them, who decides and how, whether they trust the operators to do the right thing

and whether they trust regulatory agencies to do the right thing. These anxieties and concerns

in themselves generate negative mental health effects that in turn can lead to minor but chronic

physical health effects. They can also cause new and pre-existing health problems to loom large

and become linked to the arrival and closeness of the waste facility.

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Health impact assessment (HIA)

HIA argues that the scientific and technical aspects of assessment are just one part of the

process. The other, equally important, part is engaging with all the relevant stakeholders with

the aim of creating a dialogue where information dissemination and discussion alongside trust

and relationship building takes place. This dialogue and relationship building does not stop with

the impact assessment. It carries on beyond it to ensure that community concerns are allayed

over the short and long terms because a relationship of mutual trust and respect has developed

between communities, waste management organisations and regulatory authorities (see Figure

2).

Figure 3: Public meeting part of a consultation process on the siting of a waste facility.

Health is not easy to define and ways of thinking about it have changed over the decades and

continues to evolve. Three key models of health are the ‘medical model’, the ‘holistic model’,

and the ‘wellness or social model’. In its basic form, the medical model views the body as a

machine that can be fixed when it does not work. Its focus is on diagnosing and treating specific

physical conditions (diseases), and therefore tends to be reactive - dealing with actual health

problems as they occur - rather than proactive - attempting to prevent them occurring in the first

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place. In this model, health is defined as the absence of disease and the presence of high levels

of normal physical functioning (MacDowell, 2003).

The holistic model of health is exemplified by the 1948 World Health Organisation (WHO)

definition, "a state of complete physical, mental and social wellbeing and not merely the

absence of disease or infirmity" (WHO, 1948). This model uses a broader definition of what

health is and encompasses the idea of the positive aspects of health by introducing the concept

of wellbeing. This WHO definition is seen by some as vague, difficult to measure and subjective

because wellbeing can only really be measured by asking a person how they feel.

The social model was developed through the WHO’s 1986 Ottawa Charter for Health Promotion

(see Figure 3). The definition argues that "[Health is] the extent to which an individual or group

is able to realise aspirations and satisfy needs, and to change or cope with the environment.

Health is therefore a resource for everyday life, not the objective of living; it is a positive

concept, emphasizing social and personal resources, as well as physical capacities" (WHO,

1986).

Figure 3: Social model of health; (adapted from Dahlgren and Whitehead, 1992)

HIA uses a mixed model approach that while valuing the biomedical model places more

emphasis on the holistic and social models of health and wellbeing.

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Similar to environmental impact assessment, HIA involves seven main stages:

Screening

A quick review is carried out on the potential of a plan or project to impact on a community’s

health. This helps ensure that effort and resources are targeted appropriately. The type of HIA

that needs to be undertaken is also determined at this stage.

Scoping

The breadth and what aspects will be assessed by an HIA is developed at the scoping stage

usually through a steering group made up of key representatives of the various stakeholder

groups affected by the plan or project.

Profiling the local area and community

The current social, economic and environmental aspects of the local area and the health and

wellbeing of the local community are profiled and used as the baseline for the assessment.

Community and other stakeholder consultation

Consultations with local residents and other key stakeholder is undertaken to obtain local

contextual information and evidence about the current problems and issues in the community

and neighbourhood; what health concerns local people may have in relation to the plan or

project and, equally importantly, why they may have these health concerns.

Appraisal

A systematic appraisal of the potential impacts of the plan or project is undertaken and evidence

for these impacts is reviewed including evidence from local residents. This appraisal identifies

and assesses the likely impacts, the size and significance of these impacts and the people that

are likely to be most affected.

Mitigation and enhancement

Measures to enhance potential positive and mitigate potential negative impacts are developed.

This includes communicating and discussing with local people the identified health risks, and

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the evidence for them, as well as ways of developing greater trust between the community, the

proposer/developer, the planning authority and regulatory agency.

Options and recommendations

A health impact statement, analogous to an environmental statement, is written and options or

recommendations presented to decision-makers on the best way forward.

Health impact assessments of waste plans

Two examples of HIAs on waste strategies and plan in the public domain, and available on the

web, are the South East Wales Regional Waste Groups HIA on its regional waste plan and the

London Health Commission’s HIA for Mayoral municipal waste strategy for London.

In 2003, the South East Wales Regional Waste Group commissioned the Applied Environmental

Research Centre, to carry out a health impact assessment on the South East Wales Regional

Waste Plan. The HIA investigated the potential health impacts of a range of waste facilities as

well as public perceptions of health impacts and a WISARD life cycle assessment (South East

Regional Waste Group, 2003).

In 2001, the Mayor of London undertook a series of HIAs on the draft mayoral strategies for

London. The HIA for the draft municipal waste strategy involved a review of the research

evidence on the health effects of waste and a half-day appraisal workshop involving forty key

stakeholders from across London (London Health Commission, 2001).

Health impact assessments of waste projects

Two examples of HIAs on waste facilities in the public domain, and available on the web, are

Waste Recycling Group’s HIA carried out as part of an environmental impact assessment for the

Eastcroft energy from waste facility and North Sheffield Primary Care Trust’s (PCT) HIA of the

Parkwood landfill site.

In 2005, a HIA was undertaken, as part of the environmental impact assessment, of the third

line extension of the Eastcroft energy from waste facility. The remit of the HIA was to assess the

potential direct health impacts arising from exposure to the emissions from the waste to energy

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facility. The assessment was a health risk assessment of the potential health impacts of the

emissions from the proposed extension of the facility but this formed part of an overall process

where early discussions with Nottingham City Council were initiated and the local community

consulted six months before a planning submission was made (Waste Recycling Group, 2005).

Between 2002-05, the Director of Public Health for North Sheffield completed a three year HIA

on the Parkwood landfill site and its potential negative health impacts on local communities.

This was a comprehensive epidemiological analysis of the health impacts on residents living

near the landfill and included a perceived health status survey of local residents (North Sheffield

PCT, 2003, 2005).

Conclusion

Many waste operators assume that human health impacts are fully considered under the health

assessment required by the IPPC framework. However, IPPC regulations currently require a

health assessment to be undertaken only on the direct impacts of potential harmful emissions

resulting from a waste facility (Health Protection Agency, 2004). The IPPC health assessment

neither considers the health impacts due to traffic, to and from the site, nor those due to social

and economic factors related to the operation of the waste facility. These issues are expected to

be raised within the planning system when planning permission to site the facility is sought.

Therefore, a HIA undertaken during the planning process complements and feeds into the IPPC

permitting process.

Additionally, primary care trusts, who have responsibility for local community health, face many

other public health demands and hence their timescales for action tend to be longer than those

desired by waste operators. Waste operators proactively undertaking health impact

assessments with the cooperation and participation of local Directors of Public Health can

ensure that health issues are dealt with early. Thereby reassuring communities that they are

considering and addressing the potential negative health impacts arising from the operation of a

new waste facility or proposed extension of an existing one.

The experience of Peter Brett Associates suggests that waste management operators should be

more proactive in tackling the health, wellbeing and quality of life concerns of local communities.

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To reduce community distrust, protest and conflict they need to demonstrate in a variety of ways

that they care about and are willing to do as much as possible to deal positively and

constructively with residents’ concerns. A comprehensive HIA by bringing together the science,

the community and the human factor into one holistic approach is one key way of doing this.

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References

Dahlgren, G. and Whitehead, M. (1991). Policies and strategies to promote social equity in

health. Stockholm, Institute for Future Studies.

Department of Environment, Food and Rural Affairs - DEFRA (2006); Review of England’s

waste strategy. London. HMSO.

Department of Environment, Food and Rural Affairs - DEFRA (2004) Review of the

environmental and health effects of waste management. London. HMSO.

Department of Environment, Food and Rural Affairs - DEFRA (2000); Waste strategy 2000 for

England and Wales; London. HMSO.

Health Protection Agency (2004), Integrated pollution prevention and control (IPPC) a guide for

Primary Care Trusts and Local Health Boards Vol. 1: Introduction to IPPC, Birmingham.

Health Protection Agency (2004), Integrated pollution prevention and control (IPPC) a guide for

Primary Care Trusts and Local Health Boards Vol. 2: Responding to IPPC applications,

Birmingham.

Heap, T. (2006); Is energy from waste viable; BBC, London.

London Health Commission (2001); HIA – The mayor’s draft municipal waste strategy. Last

accessed 23 March 2006 http://www.londonshealth.gov.uk/pdf/waste.pdf

MacDowell I (2003); Measurement on health; University of Ottawa; Canada. Last accessed 23

March 2006

http://courseweb.edteched.uottawa.ca/epi5251/Index_notes/Definitions%20of%20Health.htm

North Sheffield Primary Care Trust (2005); Parkwood landfill site health impact assessment

Vol. 2. Last accessed 23 March 2006 http://www.sheffield.nhs.uk/healthdata/4-2-2.php

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North Sheffield Primary Care Trust (2003); Parkwood landfill site health impact assessment

Vol 1. Last accessed 23 March 2006 http://www.sheffield.nhs.uk/healthdata/4-2.php

Prasad, R. (2002); Heap of abuse; Guardian; London.

Scottish Environment Protection Agency - SEPA (1999); National waste strategy; HMSO.

South East Wales Regional Waste Group (2003); South East Wales regional waste plan health

impact assessment. Last accessed 23 March 2006

http://www.sewaleswasteplan.org/newpdfs/Agreeddocs/ part2/ HEALTH_I.PDF

Vennells L. (2003); Fury over Parkwood health study; Burngreave Messenger; Sheffield.

Vohra S. (2003). "Understanding public perceptions of environmental and health Risks and

integrating them into the EIA, siting and planning process", PhD thesis, London School of

Hygiene and Tropical Medicine, London, UK.

Waste Online (2004); History of waste and recycling. Last accessed 23 March 2006

http://www.wasteonline.org.uk/ resources/ InformationSheets/HistoryofWaste.htm

Waste Recycling Group (2005); Health impact assessment for the proposed third line extension

of the Eastcroft energy from waste plant. Last accessed 23 March 2006

http://www.wrg.co.uk/eastcroft/eastcroft-energy-from-waste-facility.asp?link=87

World Health Organisation (1986); Ottawa Charter for Health Promotion. Last accessed 23

March 2006 http://www.euro.who.int/AboutWHO/Policy/20010827_2

World Health Organisation (1948); Preamble to the Constitution of the World Health

Organization as adopted by the International Health Conference, New York, 19-22 June, 1946;

signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health

Organization, no. 2, p. 100) and entered into force on 7 April 1948.

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Author & presenter’s details

Name: Dr Salim Vohra

Title: Principal Health Impact Assessor

Affiliation: Peter Brett Associates,

Address: Caversham Bridge House,

Waterman Place,

Reading,

Berkshire.

RG1 8DN

DD: +44 (0)118 952 0299

Tel: +44 (0) 118 950 761

Fax: +44 (0)118 959 7498

E-mail: svohra@pba.co.uk

Website: www.pba.co.uk

Biography

Salim is a public health specialist with expertise in health impact assessment, stakeholder

consultation and community perceptions of environmental and health risks.

He has worked with a diverse range of public and private sector agencies on health impact

issues. Most recently he has worked, on secondment to the Wales Centre for Health, on a

European Commission research project on ‘Improving the Implementation of Environmental

Impact Assessment’.

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