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Incineration of Waste and Reported
Human Health Effects
Health Protection Scotland
Health Protection Scotland is a division of NHS National Services Scotland. Health Protection Scotland website: http://www.hps.scot.nhs.uk Citation for this document Health Protection Scotland, Scottish Environmental Protection Agency Incineration of Waste and Reported Human Health Effects. Health Protection Scotland, Glasgow, 2009. Published by Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN. ISBN: 978-1-873772-29-4 First published October 2009 Health Protection Scotland 2009 The Health Protection Scotland has made every effort to trace holders of copyright in original material and to seek permission for its use in this document. Should copyrighted material have been inadvertently used without appropriate attribution or permission, the copyright holders are asked to contact the Health Protection Scotland so that suitable acknowledgement can be made at the first opportunity. Health Protection Scotland consents to the photocopying of this document for professional use. All other proposals for reproduction of large extracts should be addressed to: Health Protection Scotland Clifton House Clifton Place Glasgow G3 7LN Tel: +44 (0) 141 300 1100 Email: NSS.HPSEnquiries@nhs.net
The Scottish Environment Protection Agency (SEPA) acknowledges Health Protection
Scotlands review of the evidence currently available on human health effects associated with
the thermal treatment of waste.
SEPA requested this review to support its work in improving the regulation of thermal treatment
of waste facilities. Part of this is about ensuring that both the health and environmental impacts
of incineration are examined and addressed in line with our regulatory responsibilities. SEPA
have also reviewed the thermal treatment guidelines published in 2004, and have replaced the
2004 version with the Thermal Treatment of Waste Guidelines 2009.
Thermal treatment technologies have had a limited role in Scotland, however, thermal treatment
plays an important part in waste management and treatment infrastructure in many countries.
Thermal treatment is important for producing energy, thereby reducing the use of fossil fuels
and mitigating climate change. The technology associated with thermal treatment has evolved
quickly over recent years and, as the technology has advanced, so has the means by which
emissions are controlled.
The regulatory requirements relating to the operation of these plants and the emissions they
produce have also tightened in line with technological developments. The Waste Incineration
(Scotland) Regulations 2003 provide a firm and robust foundation to ensure that existing and
future thermal treatment of waste facilities will be regulated to ensure a high level of protection
for the environment and human health. This regulation includes setting stringent operational
conditions, technical requirements and emission limits in order to prevent or limit potential
effects on the environment and human health.
The thermal treatment of waste, in the form of incineration, is one of several options for the
disposal of waste. In the Zero Waste plan currently out for consultation (final version expected in
2010) Scottish Government promotes minimising the production of waste, as well as increasing
recycling and reuse. The Zero Waste plan objectives include increasing the value recovery of
waste and reducing the amount of waste going for final disposal, either to landfill or alternative
treatment, including energy from waste. The thermal treatment of waste with energy recovery is
recognised as a necessary part of sustainable waste management.
SEPA asked Health Protection Scotland to consider scientific studies on health effects
associated with the incineration of waste; specifically non-occupational health effects and health
effects from different waste streams such as clinical, hazardous, industrial and municipal. We
also requested that the review take any recent studies (post 2004) into account, particularly
those not included in the Defra publication Review of Environmental and Health Effects of
Waste Management and after implementation of the revised European Waste Incineration
This report recognises that in older studies there remains uncertainty associated with the heath
effects of incineration. However, it is important to note that the magnitude of any past health
effects on populations living near incinerators is likely to have been small. Also, levels of
airborne emissions from individual incinerators should be lower now than in the past, due to
stricter legislative controls and improved technology, therefore further reducing risks to human
health. This is in line with the recently published HPA review The impact on Health of Emissions
to Air from Municipal Waste Incinerators, which states that While it is not possible to rule out
adverse health effects from modern, well regulated municipal waste incinerators with complete
certainty, any potential damage to the health of those living close-by is likely to be very small, if
The recommendations in this report highlight inherent variations and weaknesses in existing
studies, which creates a challenge when determining an overall conclusion on current health
impacts. SEPA therefore acknowledge that any new studies, if commissioned, should be
encouraged to focus on specific aspects of incineration and, where possible, examine non-
occupational health effects.
SEPA is content with the recommendation that the current precautionary regulatory approach is
continued. Present controls are designed to protect human health and they are precautionary
due to a level of uncertainty; therefore there is little rationale for an even more precautionary
approach. SEPA will continue to apply the precautionary approach when regulating new and
existing thermal treatment plants, and will take any new evidence into account.
We are grateful to Health Protection Scotland for its support, and we hope this joint working will
continue to protect and improve Scotlands environment and human health.
SEPAs Director for Environmental and Organisational Planning
Final Version i
Introduction The Scottish Environment Protection Agency (SEPA) requested a report from HPS on
the evidence of human health effects associated with incineration to complement their
issue of updated guidance on incineration (SEPA 2009). Previously published reviews
on this topic have generally focused on health effects associated with incineration of
municipal waste. SEPA requested that this report should consider evidence from
studies of health effects associated with incineration of clinical, hazardous, industrial
and municipal waste streams, particularly non-occupational health effects.
Background Thermal Treatment of Waste (TTW) is the technical term which covers a wide variety
of technologies and processes involving the heat treatment of waste (e.g. direct
combustion (incineration), pyrolysis, gasification) and is one of a number of options for
the treatment of waste included in Scottish Government proposals for waste
management. This Zero Waste strategy promotes a comprehensive approach to
minimising the production of waste, recycling, reuse and final disposal of residual
waste. The overall objective is to prevent waste, increase value recovery of resources
and minimise the amount of waste going for final disposal, especially to landfill. This
is supported by the Scottish Government commitment to limit the amount of municipal
waste to be treated by energy recovery incineration, to no more than 25% of total
waste municipal arisings by 2025.
The term incineration (i.e. direct combustion of waste) is the term generally used
(rather than TTW) in the literature on human health effects, usually without specifying
precisely what actual technology or process is in use. Incineration of waste requires
high temperatures, 850c to1200c, which can produce airborne stack emissions and
ash as its final outputs. The focus of interest regarding possible (non-occupational)
adverse human health effects associated with incineration relates mainly to the
airborne emission of hazardous chemicals, especially dioxins and other combustion
products, including particulates.
Final Version ii
Methods A systematic search of the literature on human health impacts of incineration was
carried out including peer-reviewed primary publications, reviews, government and
non-governmental reports and other grey literature. The majority of identified material
focussed on municipal solid waste (MSW) (or its equivalent), with a smaller research
output identified on clinical, industrial and hazardous waste streams. A wide range of
human health indicators and effects have been studied in both occupational and non-
occupational populations including: