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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: 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:

  • Foreword

    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

  • Final Version

    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.


    Calum MacDonald

    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:



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