1. OCCUPATIONAL AND ENVIRONMENTAL HEALTH ISSUES OF SOLID WASTE MANAGEMENT IN DEVELOPING COUNTRIES by Sandra Cointreau

2. HEALTH RISK FACTORS OF SOLID WASTE:  Feacal Matter, Blood, Body Fluids and Diseased Dead Animal Matter  Particulates, Bioaerosols  Hazardous Chemicals, Heavy Metals  Volatile Organics, Volatilized Heavy Metals  Lifting Exertion, Vibration  Slides, Accidents, Fires  Noise

3. El Salvador, 1998 Bombay, India, 1995

4. Seoul, Korea, 1990 Izmir, Turkey, 1994

5. POORER COUNTRIES have greater Occupational Health Risks for Solid Waste Workers  Collection is by labor-intensive systems with no protection  Recycling is on exposed piles of mixed waste with no protection  Most waste pickers are children or women of child-bearing age  Disposal is by open dumping, usually with open burning Mauritius, 1998

6. POORER COUNTRIES have greater Public Health Risks from Uncollected Waste  Collection service levels are low in poorer countries:  30-60% in Low Income Countries  50-80% in Middle Income Countries  90-100% in High Income Countries

7. POORER COUNTRIES have greater Public Health Risks from Unsafe Disposal  Safe Disposal is not prevalent in poorer countries:  0-5% safe disposal in Low Income Countries  5-10% safe disposal in Middle Income Countries  90-100% safe disposal in High Income Countries

8. The Relative Risk Of Solid Waste Work Can Be Significant  Solid Waste Workers in Denmark are 1.5 times more likely to have Occupational Disease and Injury than other workers (Denmark country-wide statistics, 1995)  Risks to Solid Waste Workers in low income countries are expected to be much higher because worker protection is not required

9. OCCUPATIONAL DISEASE RISK (RR= Relative Risk):  6 RR of Infectious Disease (Denmark country data)  2.6 RR of Allergic Pulmonary Disease (Denmark country data)  2.5 times more risk of Chronic Bronchitis (Switzerland study)  1.2-1.4 times more risk of Hepatitis (Italy study)  3 times more risk of Parasites (India study)  2 times more risk of Coronary Disease Events (USA study) RR means “relative risk” and refers to increased risk levels based on statistically valid and controlled studies

10. Intestinal Parasite Infection Among Waste Pickers:  65% incidence in Bangkok, Thailand  98% incidence in Manila, Philippines (child waste pickers only)  97% incidence in Olinda, Brazil  92% incidence in Calcutta, India Bombay, India, 1995

11. Bio-aerosol Levels:  10-1000 times Higher near the truck loading hopper (Switzerland, Denmark local studies)  2-10 times Higher inside materials recovery plants (USA, Finland local studies)  2-4 times Higher at sanitary landfills (Italy local studies) Izmir, Turkey, 1994

12. Particulate Levels:  2-25 times Higher at open dumps (Thailand, Philippines local studies)  4-10 times Higher at materials recovery sorting stations (Finland local study) Dominican Republic, 1998

13. Pulmonary Function:  23% Dumpsite Workers with Abnormal Pulmonary Function (India local study)  40% Dumpsite Waste Pickers with Abnormal Pulmonary Function (Thailand local study)  53% Dumpsite Child Waste Pickers with Abnormal Pulmonary Function (Philippines local study)

14. Blood Lead Levels:  70% Dumpsite Children Pickers above WHO lead guideline --children pickers mean lead was 2.5 times higher than in control slum children (Philippines local study)  1.5-3 times Higher in MSW Incineration Workers than in Heating Plant Workers (USA local study) Quezon City, the Philippines, 1995

15. OCCUPATIONAL INJURY RELATIVE RISK (RR= Relative Risk):  5.6 RR for Accidents (Denmark country data)  10 risk for Accidents (USA, local study 20 years ago)  1.9 RR for Musculoskeletal Problems (Denmark country data)  4 risk for Musculoskeletal Restrictions from Arthritis (USA local study) Quito, Ecuador, 1994

16. Dumpsite Injuries:  Calcutta, India quarterly injuries among waste pickers:  69% with cuts  33% with pin pricks  16% with eye injuries  49% with dog bites  16% with rat bites  Bangkok, Thailand sources of injuries:  88% from glass  73% from needles  30% from bamboo  25% from metal Tema, Ghana, 1998

17. Slides at Open Dumps:  Istanbul, Turkey  39 killed, 1993  O Portino, Spain  1 killed, 250 evacuated, 1994  Calcutta, India  2 killed, 1992  Bogota, Colombia  no deaths, 1997  Manila, the Philippines  over 50 killed, 2000 Tashkent, Uzbekistan, 2001

18. Hazardous Gases at Solid Waste Facilities:  benzene, toluene, ethylbenzene, methylene chloride, dichloromethane, carbon tetrachloride in landfill gas  chlorinated and brominated dioxins and furans in incinerator stack gas  volatilized heavy metals at burning open dumps  elevated levels of carbon monoxide at landfills

19. PUBLIC HEALTH RELATIVE RISK (RR):  1.3-1.8 risk of Cancer for residents with 4 km of 20 year old Landfill (Canada local study)  1.4 risk of Liver Cancer for residents within 2 km of Incinerators (Great Britain country study)

20. Diseases from Vectors in Contact with Solid Waste:  Hanta Virus, Plague, and Leptospirosis increase with exposure to rat droppings and urine -- more solid waste means more rats  Dengue Fever increases where uncollected solid waste (i.e., tires, cans) holding water provides mosquito breeding sites  Bacterial Infections spread by houseflies which have come in contact with feacal material in solid waste

21. Diseases from Eating Undercooked Meat from Animals Raised in Contact with Solid Waste:  Trichinosis increases where pigs and bear feed on solid waste with uncooked meat containing whipworm  Taeniasis increases where pigs, beef and dogs feed on solid waste with human and animal feacal matter containing tapeworm Dominican Republic, 1998

22. New Initiatives Point the Way  Private Subscription by hospitals with licensed private operators to handle segregated biomedical wastes Hyderabad, India, 2001

23. New Initiatives Point the Way Manila, the Philippines, 1996  Private Subscription for biomedical wastes

24. New Initiatives Point the Way  Protective Gear for workers specified in service agreements Khulna, Bangladesh (syringes), 2001Tema, Ghana, 1998

25. New Initiatives Point the Way  Neighborhood composting systems lessen the need to transport waste to disposal.  Composting produces less greenhouse gas than landfill disposal, and also destroys disease micro- organisms. Dakha, Bangladesh, 2001

26. New Initiatives Point the Way  Greater containment of waste from the source to the point of transport lessens worker contact with waste.  Containers sized for easier lifting lessen back injuries. Ahmedebad, India, 2001

27. New Initiatives Point the Way  Yr. 2000 Indian Law mandates biodegradation of putrescible organics in waste  Composting (aerobic decomposition)  Vermi-composting (worm decomposition)  Biomethanization (anaerobic decomposition) Trivandum, India, 2001

28. New Initiatives Point the Way  Yr. 2000 India Law mandates upgrading of all open dumps to sanitary landfill standards  Leachate control  Landfill gas control  Stable slopes  Compaction and cover  Recultivation Ahmedabad, India, 2001