Waste management and public health: the state of the evidence

Recommendations

In his review of epidemiological studies on the health effects of hazardous wastes, Miller (Miller 1996) points out that we “…face a stark choice. We can largely depend on analogy, as many have done in the past. This involves acknowledging that evidence exists of adverse effects … using the large body of data available on the toxicity and carcinogenicity of substances identified in hazardous waste sites, relating this knowledge to that known on human exposure, inferring a problem, and finally acting. This basis for risk assessment may be refined a little by epidemiology, but we must recognise that the majority of studies from the past – published or remaining unpublished – are inconclusive. Alternatively, we can refine our methodology and make valiant efforts to increase the knowledge base.”

Recommendations and research programmes to increase the epidemiological knowledge base are made by many agencies, including the Department of Health (Environmental Chemical Unit 1999), the Department of the Environment (DOE 1994), the Environment Agency's Waste Regulation and Management Research Programme and the World Health Organisation (WHO European Centre for Environment and Health 2000, WHO Meeting 1998). Recommendations focus on:

 

•        refining exposure assessment and modelling;

•        improving health outcome datasets, including GIS, geographical information systems;

•   determining the teratogenicity of substances emanating from waste disposal sites.

 

This report acknowledges the importance of increasing and strengthening the evidence base but recognises the inevitable uncertainty of epidemiological evidence in this field. It recognises also the pressing need to make public policy decisions when the evidence remains inconclusive. This report recommends the development of democratic, health-protective decision making techniques which incorporate the epidemiological evidence base as well as public values and concerns.