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Incinerators and Health

Introduction

Public Health Issue
The Solution: A National Process

Public Health Issue

In France, incineration has been the primary source of municipal solid waste disposal since 1975, representing on average roughly 40% of refuse disposal. At the turn of the 21st Century, France still has the greatest number of municipal solid waste incineration plants of all European Union countries, in spite of a decrease in the number of facilities, from 300 in 1990 to 128 in 2006.

The 1999 assessment study of the risks associated with air pollution from municipal solid waste incinerators, conducted by the Société française de santé publique, did not foresee any alarming health problem for exposed populations. It however warranted the conduct of individual studies for plants associated with the highest emitting levels and therefore the highest risk levels. Following several epidemiological reviews, the team led by Jean-François Viel published in July 2000 a study on the Besançon incinerator. The authors noted excess cases of soft tissue sarcoma and non-Hodgkin’s malignant lymphoma from 1980 to 1995 amongst people living in the vicinity of the plant, whose emissions at times reached a dioxin ratio of 16.3 ng l-TEQ/m 3. Yet, no causal link could be clearly established between the noted excess cancer cases and the high levels of emitted pollutants.

The health concerns of people living in the vicinity of incinerators then intensified after dioxin environmental contamination was detected near old and small-scale facilities. Eager to find out if “their” incinerator could be the source of health problems, associations, individuals and elected representatives called upon local authorities. The Gilly-sur-Isère incinerator, near Albertville in the Savoie district, was a turning point. It was widely recognized that these industrial facilities did not comply with existing standards when elected representatives and a doctor from the nearest village notified public authorities in 2001 of an abnormally high number of cancer cases. Ensuing chemical analyses having revealed high dioxin concentrations, the incinerator was shut down prior to a massive slaughtering of cattle and the recall of contaminated food products and hay. Given the emergency, four health studies were initiated in 2002, under supervision of the Lyons Interregional Epidemiology Unit, the regional branch of the French Institute for Public Health Surveillance (InVS).

At the same time, French regulation pertaining to incinerator refuse became increasingly stricter. Indeed, the September 20 th 2002 Ministerial Order, adapted from the December 4 th 2000 European Directive, established new rules for all existing plants, to be applied prior to December 2005 and which included a 0.1 ng I-TEQ/m 3 dioxin-emitting limit. A widespread program was then implemented to backfit incineration plants or shut them down.

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The solution: A national process

In 2002, the Health General Directorate asked InVS to identify and recommend studies to better assess the impact of air emissions from incinerators on public health. Based on people’s questions and existing knowledge, it seemed relevant to fix the following objectives for upcoming epidemiological studies:

• Measure in populations living near incinerators the actual contribution of this exposure source to overall emitted dioxin and other pollutant exposure (including heavy metals and volatile compounds).
• Assess the relative contribution of the various exposure routes to these pollutants: The Besançon study, as well as additional epidemiological research, did raise the potential role of the respiratory route for dioxin exposure, even though nutrition was deemed the quasi-exclusive route.
• Characterize the potential cancer and other health problem risks associated with prior exposure to incinerator refuse.

The InVS published three (3) reports in 2003 to shed light on these issues.

The first one, written in collaboration with the French Food Safety Agency (AFSSA), summarized all available data on population exposure to dioxins and recommends a protocol for conducting a national study of dioxin concentration in residents living in the vicinity of incinerators.

The second one provided a recap and analysis of epidemiological studies conducted near incinerators and recommends that a national study be conducted to assess the impact of exposure to incinerator emissions on cancer incidence.

Finally, a Methodological Manual was drafted to advise local stakeholders on public health issues associated to incinerators and to help them assess the situation near such facilities.

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SUMMARY

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