1 OBJECTION TO PEEL ENERGY LIMITED PLANNING
Transcription
1 OBJECTION TO PEEL ENERGY LIMITED PLANNING
OBJECTION TO PEEL ENERGY LIMITED PLANNING APPLICATION FOR A BIOMASS RENEWABLE ENERGY PLANT AT INCE CWaC PLANNING REFERENCE 11/00040/WAS I, Professor John C. Dearden, of 10 Landscape Dene, Helsby, Cheshire WA6 9LG, hereby object to the above planning application, for the reasons given below. I am Emeritus Professor of Medicinal Chemistry at Liverpool John Moores University, where I have worked for the last 46 years. I hold a B.Sc. in chemical engineering, a M.Sc. and a Ph.D. in physical organic chemistry, and an Associateship of the City & Guilds Institute; I am also an honorary member of the Royal Pharmaceutical Society of Great Britain, for contributions to pharmaceutical research. My prime area of work is in computational toxicology, and I was the 2004 r ecipient of the biennial International QSAR Award for Research in Environmental Toxicology. I am the author of over 250 scientific publications in computational toxicology and related fields. I serve on a European Commission working party in connection with the recent REACH (Registration, Evaluation and Authorisation of Chemicals) legislation, and in 2001 I was invited to give evidence to the Royal Commission on Environmental Pollution. 1. Lack of need Policy EM17 of the North West of England Plan: Regional Spatial Strategy states that there is a requirement in Cheshire for 4MW of biomass generating capacity by 2010, rising to 9MW by 2015 and 2020. However, Cheshire’s current biomass energy generating capacity is about 8MW, according to Peel’s Planning Statement para. 8.9. Furthermore, Fiddlers Ferry power station already has the capacity to generate 200MW from biomass. Hence there is no justification for a plant that would produce 20MW of electricity and with the potential to produce 5MW of heat. Peel’s Planning Statement para. 8.11 s tates that the generation of electricity from wind and wave in the North West is currently 341.1MW, 56.9% of the 2010 target; the same paragraph goes on to state that: “Accordingly, these development proposals will go some way towards making up for the current shortfall in achieving the targets of the NWRSS across other renewable technologies”. I submit that this argument is nihil ad rem, an irrelevance. Biomass electricity generating capacity cannot contribute towards generating capacity requirements for wind and wave. 2. Lack of carbon neutrality Peel claim that the incinerator would be carbon-neutral, because it would simply release back to atmosphere the carbon dioxide (CO 2 ) that the biomass absorbed whilst it w as growing. This is a fallacious argument, for five reasons: (i) (ii) since wood grows slowly, it would take many years before the CO 2 emitted by the incinerator was re-absorbed (a generally accepted figure for the half-life of atmospheric CO 2 is about 40 years, and a recent study [1] has found that it takes about 40 years for a biomass energy plant to become carbon-neutral, whereas the life-time of Peel’s proposed plant is stated to be 25 years); if the wood was recycled instead of being burned, the CO 2 emissions would be much lower, because wood-processing (e.g. to make chipboard and other wastewood products) releases about 380 kg of CO 2 per tonne of wood processed, in contrast to incineration of wood which releases about 1900 kg of CO 2 per tonne of wood processed. The difference (1520 kg of CO 2 per tonne of wood processed) 1 means that the proposed Peel biomass incinerator would emit up to an extra 268,000 tonnes of CO 2 per annum, compared with recycling; Peel ignore the CO 2 emissions of transportation of biomass to Ince. Peel’s nontechnical summary of their Environmental Statement states that there would be a maximum of 36 two-way HGV journeys per day. Peel also state that “approximately 70% of the biomass fuel will consist of waste wood that will primarily be sourced from local markets in the north west region”. The other 30% would be virgin wood. Assuming that an average transportation distance would be 50 miles (100 miles there and back), the HGV mileage per annum would be 1,314,000. Average HGV fuel consumption is 8 mpg, so annual diesel used would be 164,250 gallons, which would release about 2000 tonnes of CO 2 . According to Peel’s figures, about 53,000 tonnes per annum of virgin wood would be burned in the biomass incinerator. Virgin wood is wood that has not been treated, cut or shaped in any way, and can include logs, bark, arboricultural arisings, sawdust and wood chips. However, removal of such waste material from forests, instead of allowing it to rot naturally, weakens the carbon sink capacity of forests, and thus reduces the capacity of forests to absorb atmospheric CO 2 , according to a report from the Finnish Environment Institute [2]. It thus in effect increases atmospheric CO 2 levels. In addition, the CO 2 and other emissions generated by the removal of virgin wood have not been taken into account [2]. Biomass energy plants are among the worst polluters in terms of CO 2 . Based on the figure of 1900kg of CO 2 per tonne of wood burned, the proposed plant would emit 335,350,000 ( 1900 x 176,500) kg pe r annum. The electrical output of the plant would be 20MW, and according to Peel’s Non-Technical Summary the plant would operate for 90% of the time. Hence the annual output would be 157,680 (20 x 8760 x 0.9) MWh. The CO 2 emissions would therefore be 2127 kg/MWh. (iii) (iv) (v) U.S. Department of Energy figures for CO 2 emissions from other types of electricity generating plants are [3]: gas 596kg/MWh; oil 867kg/MWh; coal 960kg/MWh. 2500 2000 1500 1000 500 0 Gas Oil Coal Biomass Figure 1. CO 2 emissions (kg/MWh) from power plants 2 Clearly the biomass plant would be by far the worst polluter in terms of CO 2 emissions. Even if one takes into account the 5MW of heat that might be used, the CO 2 emissions from the proposed Ince biomass plant would still be by far the highest at 1702kg/MWh. I submit that this level of CO 2 pollution is unacceptable. In January 2011 Peel Energy’s website (www.peelenergy.co.uk) compared the parameters of the bio-ethanol and biomass plants: Item Process By-products Stack height Bio-ethanol plant Chemical CO 2 , lignin fuel, distillers grain 30 metres Biomass plant Combustion Ash, steam, hot water 85 metres Note that Peel did not say that the biomass plant would emit CO 2 . Their non-technical summary similarly contains the same omission, as did their public presentations to local authorities. I consider this to be a deliberate attempt to play down the fact that the plant would emit about 335,350 tonnes of CO 2 per annum. 3. The waste hierarchy Annexe C of the Government’s Planning Policy Statement 10 ( PPS10) presents the waste hierarchy, which defines the Government’s preferred options for waste treatment as: 1. Reduction; 2. Re-use; 3. Recycling & Composting; 4. Energy Recovery; 5. Disposal (usually landfill). Waste management should always aim to be as high as possible in the waste hierarchy. Peel’s biomass incinerator proposal falls in the next to lowest level of the waste hierarchy. Since wood can viably be recycled, the proposal goes against the waste hierarchy, and thus conflicts with one of the core objectives in PPS10. PPS10 § 23 makes it clear that Waste Planning Authorities (WPAs) should determine proposals in a way that is consistent with the policies of PPS10, and PPS10 § 3 states that WPAs should deliver strategies that “help deliver the national waste strategy and supporting targets”. The Government’s Waste Strategy for England (2007) promotes adherence to the waste hierarchy. Its Annexe K states that: “In particular, WS2007 makes clear that energy should be recovered only from residual waste that cannot viably be recycled”. Peel’s proposal thus conflicts with WS2007 as well as with PPS10. By going against the waste hierarchy, a grant of permission for Peel’s biomass planning application would conflict with the policy objective enshrined in PPS10, and therefore this application should be refused. Page 9 of WS2007 includes a diagram of the waste hierarchy and goes on to note that: “The dividends of applying the waste hierarchy will not just be environmental. We can save money by making products with fewer natural resources, and we can reduce the costs of waste treatment and disposal. Waste is a drag on the economy and business productivity. Improving the productivity with which we use natural resources can generate new opportunities and jobs.” Paragraphs 20 and 21 of chapter 1 of WS2007 make it clear that adherence to the waste hierarchy encapsulates the Government’s overall objectives for waste policy. The waste 3 hierarchy outlined in Figure 1.3 of WS2007 is consistent with the waste hierarchy in PPS10, and makes it clear that recycling is to be preferred over energy recovery. Chapter 5 of WS2007, § 1 states that: “We need waste to be minimised to the greatest extent practicable, and such waste as does arise to be managed as far up the waste hierarchy as is reasonably achievable. Resources should be recovered in ways that maximise the costeffective reduction in greenhouse gas emissions over the lifecycle.” Chapter 1 of WS2007, § 22 s tates that: “Recent studies have confirmed that the waste hierarchy remains a good general guide to the relative environmental benefits of different waste management options...” As recycling is higher on the waste hierarchy than energy recovery then Peel should be required robustly to demonstrate that either the timber would otherwise go to landfill or that, in this specific instance, the waste hierarchy is mistaken. Peel’s application fails to demonstrate that either: (a) energy recovery would be only from residual waste that cannot viably be recycled; or that (b) there are clear carbon benefits in using the timber for biomass energy recovery, instead of as material available for wood panelling (see below). PPS1 Supplement on Climate Change makes clear that “tackling climate change is a k ey Government priority for the planning system”. Thus Peel’s proposed biomass plant conflicts with WS2007 and PPS1 Supplement on Climate Change, and should therefore be refused planning permission. It should be noted that early in 2011 the Planning Inspectorate rejected an appeal by Resource Recovery Solutions for a 190,000 t onne/year gasification and mechanical biological treatment (MBT) plant in Derby on t he grounds that it ignored the waste hierarchy. The Planning Inspector said: “This facility’s appetite for waste could divert efforts and resources away from the promotion and encouragement of waste reduction, re-use and recycling/composting”. Wood Panelling Wood panels are produced using a range of sources, including small roundwood, chips, sawdust and recycled wood. Each type of panel has various applications in the construction, furniture and do-it-yourself sectors, including cladding, packaging, kitchen worktops and laminate flooring. Panels are vital components that can be replaced only by more expensive and less sustainable products. Subsidies that encourage the use of wood harvest in energy generation are causing tension between the processing industry and the energy sector. The direct use of biomass and wood for energy production is not only reducing the wood supply but is also creating negative consequences for the environment. The hierarchy of use principle would help rationalise the use of wood and define preferred options, i.e. using and recycling wood, with burning only as a last resort. If more and more wood and forest residues go directly to energy plants we are wastefully minimising the carbon cycle of wood. A 2010 report entitled Carbon emissions for end of life scenarios for wood fibres [4] was commissioned by the Wood Panel Industries Federation. This report, which is primarily concerned with net CO 2 emissions arising from competing uses for the U.K.’s scarce and 4 finite timber resources, maps and compares the emissions associated with the processing of one tonne of wood through the wood panel production process and the transport and eventual burning of one tonne of wood to generate electricity. The report explains how, until recently, the wood panel industry has sourced its timber domestically in the UK on a competitive basis. The competitive market began to be undermined in 2002 by the Government’s introduction of a subsidy to compensate electricity generators for burning “renewable” fuel in the form of the Renewables Obligation Certificate (ROC). It is important to note also that this is also forcing up prices in manufacturing and construction industries [5]. A spokesman for furniture manufacturer Senator International, the largest manufacturer of office furniture in the U.K., recently stated: “Biomass burning wood is hitting our industry and any industry that uses wood-based products”. This point is reinforced in a r ecent report by Europe Economics [6]. Also, a P arliamentary debate on 16 March 2011 [7] highlighted the problems that wood biomass burning is causing for the wood products industry, in particular because the large subsidies available for wood biomass burning are distorting the market; the Energy Minister, Greg Barker, responded by saying: “I am very aware of unintended or perverse consequences. We will work harder to look at the consequences for the wood panel industry. Many powerful arguments were made today, not least how it is better to lock up carbon rather than to burn it (my emphasis), and I am mindful of that”. At § 1.5 of Carbon emissions for end of life scenarios for wood fibres it is stated: “As a result of the ROC subsidies, the projected demand for timber in the UK will outstrip supply by 2012. The biological availability of British sourced wood fibre is forecast to increase up t o about 2019 when it reaches just over 20 million tonnes per annum and then it is forecast to start decreasing. Demand during the same period is set to increase to 50 million tonnes as a result of proposed increases in biomass electricity generation.” In Scotland alone there are plans for four huge biomass energy plants [8] that between them would consume at least 5.3 million tonnes of wood per annum – the equivalent of almost two thirds of the U.K.’s annual wood production of 8.4 million tonnes. In Cheshire, Fiddlers Ferry already has the capacity to generate 200MW of electrical power from biomass, which equates to almost 2 million tonnes of wood per annum. 4. Toxic emissions (a) Toxic chemicals. Even virgin wood can produce toxic emissions from combustion, such as dioxins and polycyclic aromatic hydrocarbons (PAHs), both of which are carcinogenic. Some materials used to treat wood, such as chromated copper arsenate and creosote, are also very toxic. Old painted wood may contain lead. The EU Hazardous Waste Directive states that many wood treatments may contain materials that can cause undesirable or dangerous emissions. Peel’s documentation lists, in addition to the above, the following pollutants that would be emitted to atmosphere: nitrogen dioxide (NO 2 ), sulphur dioxide (SO 2 ), carbon monoxide, hydrogen chloride (HCl), hydrogen fluoride (HF), and volatile organic compounds (VOCs). It should be noted that NO 2 , SO 2 , HCl and HF can cause respiratory problems, and NO 2 is a greenhouse gas 300 times as potent as CO 2 . No indication is given in Peel’s documentation as to how, if at all, attempts would be made to avoid burning contaminated wood. Clearly it would be impracticable to examine, test and sort every piece of wood, and thus the likelihood is that contaminated wood would be burned in the Ince biomass plant. Hence there would be, in my view, a significant risk of airborne incineration products exceeding permitted emissions levels. In Peel’s Environmental Statement, predicted emissions of a range of pollutants are given for the biomass plant alone (Table 5.14) and for the whole of the Resource Recovery Park 5 including the biomass plant (Table 5.20). It can be seen that the biomass plant would be responsible for up to 30% of the levels of pollutants from the whole Park, which cannot be dismissed as insignificant against the AQO/EAL limits for nitrogen dioxide (NO 2 ), volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PaHs). S uch a large increase, and the associated health concerns, are unacceptable when set against the dubious requirement for a biomass plant in the broader context of carbon neutrality and waste hierarchy. In Peel’s Environmental Statement there appear to be mathematical errors which have resulted in underestimation of the long-term levels of some heavy metals. T hese call into question the conclusions about impact on air quality of the biomass plant, either alone or with the Ince Park development. In Table 5.17, the concentrations of antimony, arsenic, chromium, cobalt, copper, lead, manganese, nickel and vanadium have, according to section 5.5.26, been calculated assuming that each metal contributes one ninth of the combined limit. The annual mean value for these “other metals” provided by the model and shown in Table 5.14 is 1.82 ng /m3. T hus the contribution of each individual metal is 0.2022 ng/m3 (1.82 ng/m3 ÷ 9), and not 0.0202 ng/m3 as shown in Table 5.17. If this is indeed an error, the corrected level of arsenic is 6.7% of EAL and thus cannot be screened out as insignificant. Also, despite the information in sections 5.5.31 and 5.5.32, the calculated long-term value for chromium (VI) presented in Table 5.17 i s not clear, and I am concerned that there may be mathematical errors leading to underestimation of that metal. The same miscalculation in annual values for heavy metals appears to have been made in Table 5.22, and the same comments apply. I wish to stress in particular the dangers of dioxin emissions. Dioxins are among the most toxic chemicals known, and according to the U.S. Institute of Medicine can cause cancers, diabetes, nerve disease and heart disease in people exposed directly or indirectly, and can cause spina bifida in their children. Dioxins are a family of 75 polychlorinated dibenzo-p-dioxins (PCDDs), the structure of the most toxic of which (TCDD) is shown in Figure 2. This compound is one of the most toxic chemicals known, and is a known human carcinogen and endocrine disruptor. Similar chemicals are polychlorinated dibenzofurans (PCDFs), of which there are 135 (see Figure 2). Other related compounds are polychlorinated biphenyls (PCBs), of which there are 209, many of which are known [9] to be endocrine disrupters; the structure of unsubstituted biphenyl is shown in Figure 2. Yet others are polybrominated diphenyl ethers (PBDEs), of which there are 209, and polybrominated biphenyls (PBBs) of which there are also 209; the structure of unsubstituted diphenyl ether is shown in Figure 2. PBDEs and PBBs are used as flame-retardants for electrical goods, clothing and furniture. They are known to be endocrine disruptors and to cause developmental neurobehavioural defects [10, 11]. The principal cause of their presence in the environment is widely accepted to be incineration [12]. All these compounds are hydrophobic (lipophilic) and therefore tend to accumulate in adipose tissue in the body. They are also chemically very stable and are therefore resistant to metabolic attack, and therefore to excretion, since chemicals need to be reasonably soluble in water in order to be readily excreted. For example, the half-life of dioxins in humans is about seven years. PCBs, PBBs and PBDEs can be present in waste materials. Dioxins (PCDDs and PCDFs) are not normally present in waste, but are formed when chlorine-containing organic substances (e.g. PVC and wood) are burned. If combustion takes place at temperatures of about 850ºC, any dioxins already formed are destroyed, but can re-form again post-combustion. Cunliffe 6 9 1 O 8 2 7 3 O 6 4 5 Dibenzo-p-dioxin, showing the 8 positions that chlorine can occupy (1 – 9, excluding 5) 1 Cl 9 O Cl 8 2 3 7 Cl O 5 4 Cl 6 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), the most toxic chlorinated dioxin 1 9 2 8 7 3 O 6 4 5 Dibenzofuran, showing the 8 positions that chlorine can occupy (1 – 9, excluding 5) 2 1 6 7 3 8 4 5 10 9 Biphenyl, showing the 10 positions that chlorine can occupy 2 6 1 7 O 3 4 5 8 10 9 Diphenyl ether, showing the 10 positions that bromine can occupy Figure 2. Molecular structures of dioxins, furans, PCBs and PBDEs 7 and Williams [13] found that “formation of PCDD/PCDF on f ly-ash deposits in the postcombustion plant of incinerators can result in the release of significant amounts of PCDD/PCDF to the flue gas stream”. Littarru [14] has shown that about 57% of emitted dioxins (in terms of TCDD equivalents) are in the flue gases, with about 43% sorbed on the fly-ash. In 1997 Douben [15] of H.M. Inspectorate of Pollution stated that “MSW incinerators are the dominant source of PCDD/F emissions to atmosphere and are responsible for up to 80% of the inventory”. It is now acknowledged that dioxin emissions from incinerators have fallen considerably in recent years. However, there remain a number of areas of concern. 1. Dioxin emission levels from incinerators are measured once or twice a year by external assessors who have to give prior notice of their visits. It is thus likely that operators ensure that a plant is running under optimal conditions for a visit. If much more frequent or continuous measurements are made, the total dioxin emissions are found to be very much higher than those calculated from biannual measurements. De Fré and Wevers [16] found that emissions measured using the European standard method EN 1948 over a 6-hour period were 30 to 50 t imes lower than the average over a t wo-week continuous period. Reinmann et al [17] showed that use of continuous dioxin sampling enabled operators to reduce dioxin emissions by a factor of 10, through careful control of operating conditions. True dioxin emissions from the proposed Ince biomass plant, which would be subjected only to biannual checks, would probably be very much higher than claimed. 2. Incinerators do not , for various reasons, run under optimal conditions all the time. Grosso et al [18] found that even under steady-state conditions total dioxin release varied between 1.5 and 45 µg TEQ per tonne of waste burned, depending on whether activated carbon was used and how fly-ash was collected. S am-Cwan et al [19] investigated the post-combustion re-synthesis of dioxins, and found that levels at waste heat boiler outlets were 10.8 – 13.6 times higher than at the furnace outlets. Incinerators have to be shut down on oc casion, both for routine maintenance and because of operating problems. It has been observed that during shutdown and startup, the levels of dioxins and other pollutants can be much higher than under optimal operation. Tejima et al [20] tested the dioxin stack emissions of an MSW incinerator under conditions of startup, steady state and shutdown. They found concentrations of WHO-TEQ dioxin of 36 – 709 µg.m-3 during startup, 2.3 µg.m-3 during steady state operation, and 2.5 – 49 µg.m-3 during shutdown. They estimated that 41% of the total annual emissions could be attributed to the startup period, assuming three startups per year. L.-C. Wang et al [21] found that a single start-up could contribute about 60% of the PCDD/F emissions for one whole year of normal operations; hence, assuming three startups per year, 64% of total annual emissions could come from startup. H.C. Wang et al [22] found that during startup the PCDD/F removal efficiency was only 42% with selective catalytic reduction, compared with > 99% during normal operation. It is clear from the above that levels of pollutants emitted from incinerators can vary greatly, and can exceed the statutory limits placed upon t heir emission. (It must be noted here that those limits are generally based on what is achievable and measurable, rather than what is safe, as was pointed out in the House of Commons Environment, Transport and Regional Affairs Committee 5th Report in March 2001). In 2003 there were four incidents of dioxins and furans above permitted levels, and one incident of cadmium emissions above permitted levels. In 2010 two waste incinerators, one on 8 the Isle of Wight and the other at Neath Port Talbot, were shut down by the Environment Agency for persistent exceedances of permitted dioxin levels. 3. Incineration produces two forms of solid residue – fly-ash, which is fine particulate matter carried with flue gases, and bottom ash, which falls from the fire-grate. They constitute, between them, about one quarter to one third of the total pre-combustion weight of waste. Fly-ash is known to sorb chemicals from the flue gases. As pointed out earlier, around half of emitted dioxins are sorbed on fly-ash [14]. Fly-ash is also responsible for the so-called dioxin memory effect [13], whereby slow de novo synthesis of dioxins occurs on the surface of the fly-ash; the dioxins then slowly desorb into the flue gases [23] for prolonged periods after the implementation of beneficial changes to the incineration process. Fly-ash is classed as hazardous waste, and has to be disposed of to landfill. There is concern that, because of its dust-like nature, less than extremely stringent handling could disperse dioxins and other pollutants such as metals sorbed on the fly-ash into the atmosphere around the Resource Recovery Park. Bottom ash contains similar proportions of heavy metals (except cadmium, which is lower than in fly-ash). Under the List of Wastes (England) Regulations 2005, incinerator bottom ash is classed as non-hazardous. However, the Environment Agency recently confirmed, in a letter to Mr. Alan Watson of Public Interest Consultants [24], that 12 out of 96 bottom ash samples that they tested met the criteria for hazardous waste. This probably means that all of the bottom ash from the biomass plant would have to be disposed of as hazardous waste, and should not be used for block-making or indeed for any other purpose, which would mean a significant financial disincentive for biomass incineration. All of the above suggest that the dioxin emissions from the proposed Ince biomass plant would be many times those claimed in Peel’s Environmental Statement. A typical daily intake of dioxins is 1-4 picograms per kilogram of body weight per day (14pg/kg.day). That is currently considered acceptable, although the U.S. Environmental Protection Agency (EPA) is about to revise those figures downwards very markedly. A particular problem arises with unborn foetuses and newborn babies, whose systems do not have the ability to protect them against injurious chemicals, and who thus can be damaged irreversibly. Foetuses absorb dioxins from their mothers via the placenta, and newborn babies via their mothers’ milk. The Parliamentary Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment 2001 Report [25] stated that: “In infants under two months of age, the estimated intakes of dioxins and dioxin-like PCBs from breast milk could result in daily intakes of 20-60 times the TDI”. By the time infants’ protective mechanisms have developed, the damage is done. This is why the argument is fallacious that the high doses received in utero and in the first few months of life average out safely over a lifetime. Recent Dutch research has shown that foetuses and neonates whose mothers are exposed even to so-called background levels of dioxins develop a range of problems, including birth defects, decreased lung function, persistent haematological and immunological disturbances, delayed puberty, and dental malformations [26, 27, 28, 29, 30 ]. Thus there appears to be no discernible threshold below which dioxins pose no health risk. But worse than that, recent Finnish research [31] has shown that the carcinogenic effect of dioxins actually increases at low doses, a phenomenon termed hormesis. No information has been provided about the effects of dioxin emissions from the proposed biomass plant on “sensitive receptors”. 9 For the sake of the children of this region in particular, we must not allow any more dioxin-producing industrial plants to be built in north Cheshire. (b) Particulate emissions. Like all incineration, biomass burning produces particulate emissions. Some of these are filtered out, but some (especially the smallest particles, which are the most dangerous) cannot be completely filtered out. These particles can penetrate deep into the lung and cause serious problems. In June 2009 the American Lung Association wrote [32] to the U.S. Government to say that the Association “urges that legislation not promote the combustion of biomass. Burning biomass could lead to significant increases in emissions of nitrogen oxides, particulate matter and sulfur dioxide and have severe impacts on t he health of children, older adults, and people with lung diseases”. A 2010 House of Commons Environmental Audit Committee report on air quality [33] stated that: “In a number of cases the climate change agenda has resulted in measures that increase air pollution. An…example has been the promotion of biomass boilers in urban areas already suffering poor air quality”. It is now accepted that particulate air pollution is a very significant cause of illness and mortality [34, 35, 36]. Airborne particles are classified according to their size. Particles with a diameter of ≤ 10 microns (1 micron (µm) = 1 0-6 metre) are potentially dangerous because they are small enough to be drawn into the lung; such particles are designated PM 10 s. Particles with a diameter of ≤ 2.5 µm are more dangerous because they can be drawn deeper into the lung; they are designated PM 2.5 s. Even smaller particles are even more dangerous. In combustion, toxic chemicals are sorbed by particulates and thus can be inhaled, so that the emitted particles are doubly dangerous. It is argued by the proponents of incineration that fine particulates constitute only a very small fraction by weight of total particulate emissions, so that the danger is very small. However, that argument is false, because it is not the size of particle that is important, but the number of particles and their surface area (because toxic chemicals are sorbed on t o the surface). Atkinson et al [35] have very recently shown that mortality and hospital admissions correlated with numbers of atmospheric particles, but not with their weight. For a given weight concentration of particles, there are more of them if they are smaller; Livingston [37] has estimated that one pound of very fine particles emitted from an incinerator will consist of 140 quadrillion (1,000,000,000,000,000) particles. Another way of appreciating this is to note that about 26,500 PM 2.5 particles would fit on the dot of the letter i in normal print; for PM 0.001 particles the figure would be 160 billion. Also, for a given weight concentration, smaller particles have greater surface area. A given weight of PM 0.1 will have 100 times the surface area of the same weight of PM 10 ; in fact, in terms of surface area, fine particulates constitute almost 50% of the total particulate emissions [38]. A further problem is that, unlike larger particulates, fine particulates cannot be filtered efficiently, and so are released into the atmosphere. No information has been provided by Peel about the effects of particulate emissions from the proposed biomass plant on “sensitive receptors”. The U.K. already suffers from poor air quality, and the European Union is instigating proceedings against the British Government, particularly in respect of levels of particulate emissions [39, 40]. The north of England has worse pollution than does the south, as a recent study published in the British Medical Journal showed [41]. Ellesmere Port had the highest infant death rate in the U.K. in 2006, and Runcorn has one of the highest death rates in England from lung cancer. It is unjustifiable to inflict yet another polluting industrial plant on us. This is discussed in more detail in Section 8 (Environmental Justice) below. 10 There is a vast literature concerning the health effects of airborne particulate matter [42]. It is now established beyond reasonable doubt that particulate air pollution can cause cardiovascular morbidity and mortality [43], cardiopulmonary mortality [44], and respiratory, immunological, haematological, neurological and reproductive/developmental problems [45], sometimes with long time-lags between exposure and health effects. Pope et al [46] found that each 10 µg/m3 increase in fine particulate levels was associated with a 4%, 6% and 8% increased risk of all-cause, cardiopulmonary, and lung cancer mortality respectively. There is particular concern about the effects of particulate pollution on infants. Woodruff et al [47] found increases in infant deaths from respiratory causes with a 10 µg/m3 increase in PM 2.5 s. Pino et al [48] found that a 10 µg/m3 increase in PM 2.5 s was related to a 5% increase in the risk for wheezing bronchitis. Still smaller particles (≤ 0.1 µm (100 nm) diameter) are termed nanoparticles. They are able not only to penetrate most deeply into the lung, but are capable of being taken up systemically, entering cells, disrupting cell signalling and other processes [49, 50, 51]. Howard [38] cited U.S. E.P.A. figures showing that for typical particulate incinerator emissions 48.8% of the surface area is provided by particles of < 0.7 µm diameter. The significance of this for toxicity is that toxic chemicals such as dioxins and heavy metals can be sorbed on to the surfaces of particulate matter and taken into sensitive areas of the body. Howard [38] also quoted figures from Onyx showing that baghouse filter collection efficiency was 95-99% for PM 10 s, 65-70% for PM 2.5 s, and only 5-30% for particles smaller than 2.5 µm, even before the filters become coated with lime and activated carbon. Brown et al [52] have pointed out that long-term exposure to even low concentrations of fine particles may be associated with reduced life expectancy. Cormier et al [53] have reviewed the evidence for potential health impacts of incinerator particulate emissions. They posed a series of questions that require answers: How are combustion-generated fine PM and ultrafine PM formed? How do their chemical properties differ from larger PM? What is the nature of association of chemicals with these particles? How is the chemical and biological reactivity of these chemicals changed by association with the particles? What is the role of PM-associated persistent free radicals in the environmental impacts of fine and ultrafine PM? What is the role of PM on cell/organ functioning at initial sites of exposure? What is the bioavailability of these particles to other tissues? How are these particles translocated to these secondary sites, and do their chemical properties change en route? How does acute/chronic exposure lead to adverse organ pathophysiology? Is developmental timing of exposure important? What effect does exposure have on predisposing to disease states or on disease progression? Most importantly, what are the specific cellular and molecular mechanisms associated with airborne exposures? It is clear from the above that medical science has only very recently started to recognise the serious problems that particulate emissions can cause, and it will be many years before the answers to the questions posed above are available. Meanwhile it is essential that particulate emissions, especially those produced in conjunction with toxic chemicals, are reduced. Because Peel will no d oubt argue that the proposed Ince biomass plant would emit low quantities of particulates, it should be stressed here that cumulative effects on health due to continual exposure to environmental pollutants can be very serious even at levels below the 11 national ambient air quality standards of America [54]. Incineration, whether of waste or biomass, is therefore a dangerous option for waste treatment. (c) Ash. Combustion of wood leaves a solid residue of ash, which can contain metals such as chromium and lead, and dioxins. This means the ash must be treated as hazardous waste, and not (as sometimes happens) used as fertiliser, ingredients in cement, and road base. The Health Protection Agency (HPA) issued a report in 2009 [55], in which they stated: “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 detectable”. In my professional view, as an environmental scientist, that statement is unjustified. The HPA report contains many errors and unjustified assumptions (for example, it gives an incorrect and very misleading discussion of particulates), and refers to only eight peer-reviewed published studies. Those studies were all flawed, for one very simple reason – they failed to take account of wind direction. It is clear that any effects of pollutants emitted to atmosphere will be greater downwind, and yet not one of the studies cited, or indeed any of the numerous other published studies of health effects near incinerators, has taken that into account. Three things follow from that: (i) Any adverse effects found in those non-directional studies must actually be quite significant. Miyake et al [30] found increased prevalence of wheeze, headache, stomach ache and fatigue in children living close to incinerators, after allowing for confounding factors such as socioeconomic status; Cordier et al [26] found an increased risk of birth defects in children born to mothers living near incinerators; Viel et al [56] found increased incidences of soft tissue sarcoma and non-Hodgkin’s lymphoma in the vicinity of a waste incinerator, which was stated as unlikely to be due to confounding factors. (ii) Government agencies are either less than meticulous in their examination of published studies, or are turning a blind eye to flaws and irregularities in those studies. (iii) Peer review does not guarantee that a published paper is scientifically valid. The effect of wind direction is 5demonstrated using the wind-rose for Ellesmere Port: 345 15 355 900 N 335 25 325 1999 35 800 1998 45 700 600 315 1997 2000 55 2001 500 305 65 400 295 75 300 200 285 275 85 100 E 0 95 W 265 105 115 255 245 125 235 135 225 145 215 155 205 195 S 165 175 Figure 3. Wind-rose data for Ellesmere Port for the years 1997-2001 (kindly supplied by the former Ellesmere Port and Neston Borough Council) 12 It can be seen that the majority of directions receive little or no wind. The main winds come from the WNW and just E of S, each encompassing a sector of about 60°, which together make ⅓ of the total 360°. Suppose, for the sake of argument, that cancer risk in the two main sectors is twice that of the remaining 240° because of incinerator emissions. If wind direction is ignored, then the cancer risk for all directions is (2 x ⅓) + (1 x ⅔) = 1.33, w hich is much less than 2, and is probably statistically not significantly different from unity, bearing in mind the uncertainties in epidemiological data. So far as I am aware, the only work on health effects around incinerators that has taken account of wind direction is that of Michael Ryan, and is unpublished. However, it does not attempt to take account of confounding effects. An example is shown in Figure 4. Figure 4. Infant (under 1 year) deaths near the Edmonton incinerator for 2003-2005, showing the effect of wind direction (from Michael Ryan) Clearly, what is still required, and to date has never been done, is an extensive study that takes account of both confounding effects and wind direction. Until such a study is done, we need to take a precautionary approach, which will preclude the siting of incinerators, including biomass incinerators, within, say, 10 km of residential areas. 5. Regulatory controls Peel’s proposed biomass incinerator is a 20 MW plant. It should be noted that whilst stringent emissions standards apply to units over 20 MW, below that there are no regulations that apply across the U.K. It is not known whether Peel’s plant would fall into the former or latter category. It should also be noted that a company called Prenergy, which obtained planning permission for a very large (350 MW) biomass incinerator in Port Talbot, south Wales in 2009, have now applied for permission to increase their emission limits for nitrous oxide from 20 mg/m3 to 40 13 mg/m3, for sulphur dioxide from 10 m g/m3 to 50 m g/m3, and for hydrogen chloride (hydrochloric acid) from 7 mg/m3 to 10 mg/m3, and the Environment Agency Wales has said that it is likely to approve these changes. This is a standard planning dodge, and steps should be taken to ensure that Peel not do this. 6. Visual amenity The proposed biomass plant would replace the bio-ethanol plant. However, the stack height would increase from 30 m etres to 85 m etres, a very significant increase. In addition, the height of the main building would increase from 28 metres to 42 metres – again, a significant increase. It is clear that the biomass plant would have a major visual impact. A further point is that the elevation plans provided by Peel show a height of 49 m etres, not 42 m etres as stated in the Environmental Statement and the Planning Statement. Which height is correct? I consider the statement that the proposed Frodsham Marsh wind farm development will reduce the magnitude of change introduced by the biomass proposal to be quite unjustified. Firstly, the wind farm development has not been granted planning permission, and may be refused. Secondly, in their planning application for the wind farm, Peel argued that it would not be obtrusive and would not damage the openness of Frodsham Marsh. I do not agree with that argument, but Peel cannot have it both ways. 7. Perception of risk In their “Rapid Health Impact Assessment of the proposed Ince Resource Recovery Park”, Western Cheshire Primary Care Trust [57] drew attention to the importance of risk perception by the public relating to the siting and presence of facilities that might be construed as posing a threat to health or amenity. Starr and Whipple [58] developed a quantitative approach to perceived risk assessment, based on the assumption that society achieves, by trial and error, a reasonable balance between risk and benefit. They drew the following conclusions: 1. the acceptability of risk is roughly proportional to the real and perceived benefits; 2. voluntary risks are some 1000 times more acceptable than are involuntary risks; 3. the tolerable level of risk is inversely related to the number of involved persons. Since there appear to be few, if any, benefits from burning biomass, since the risk posed by the biomass plant would be involuntary, and since there are thousands of local residents in Ellesmere Port, Ince, Elton, Thornton-le-Moors, Helsby, Frodsham and Runcorn who would be affected by the plant’s emissions, it is clear that in this case there would be a far from reasonable balance between risk and benefit. According to the Department of Health [59], risks are generally more worrying and less acceptable if perceived: 1. 2. 3. 4. 5. 6. 7. to be involuntary (e.g. exposure to pollution) rather than voluntary (e.g. dangerous sports or smoking); as inequitably distributed (some benefit whilst others suffer the consequences); as inescapable by taking personal precautions; to arise from an unfamiliar or novel source; to result from man-made rather than natural sources; to cause hidden and irreversible damage (e.g. through onset of illness many years after exposure); to pose some particular danger to small children or pregnant women or more generally to future generations; 14 8. 9. 10. 11. to threaten a form of death (or illness/injury) arousing particular dread; to damage identifiable rather than anonymous victims; to be poorly understood by science; as subject to contradictory statements from responsible sources. All of these perceptions apply to the proposed Ince biomass incinerator, and are especially relevant at present with everyone’s attention focussed on t he potential nuclear reactor catastrophe in Japan. Whilst there is no c omparison in terms of magnitude of risk, the Japanese situation has caused all governments to re-assess potential risks, and has lessened the faith of the public in the ability of regulators and companies to control these, and of the authorities to tell them the truth. This can only add to the concerns over the proposed Ince biomass plant. Lima [60] has pointed out that “incinerators represent a solution to urban waste problems in which most of the beneficiaries (those who produce the waste) are not exposed to the risks and to the inconveniences of the facility; on the (other hand), those who live near the site face all the problems during construction and (during) normal functioning of the station. They have to deal with the unpleasant changes to their environment and the uncertainty about the health consequences of the facility, and they consider this situation to be unfair”. Gregory et al [61] have pointed out that incineration is a hazard with characteristics such as dread consequences and involuntary exposure, its impacts are perceived to be inequitably distributed, and its effects are unbounded in the sense that their magnitude or persistence over time is not well known. Lima [60], in a 5-year assessment of the effect of risk perception on the mental health of people living near an incinerator, found that: (i) risk perception is more acute for residents living closer to the site, who also have a less favourable attitude; (ii) there is an habituation effect for those living closer to the incinerator; (iii) psychological symptoms are associated with socio-economic variables (sex and education), but also with environmental annoyance; (iv) for those living close to the site, risk perception and the interaction between risk perception and environmental annoyance significantly increase the prediction of psychological symptoms such as stress, anxiety and depression. This was after the confounding effects of other environmental stressors such as noise and traffic had been allowed for. Lima’s results confirm the Lazarus and Folkman [62] proposal that the health consequences of an environmental stressor depend on t he appraisal of the threat and of the personal resources to deal with it. That is, risk perception per se can modify the quality of life of those living under suspicion of objective risk [63]. Stress effects can persist for many years, as was shown by Matthies et al [64] in a study of people living in an area with contaminated soil. Wandersman and Hallman [65] have pointed out that: “Risk perceptions that do not match scientific estimates of risk are not necessarily irrational. For example, if one believes that regulators cannot be trusted, experts are not well trained, and accidents can easily be caused by human error, then it is rational to view that risk as unacceptable”. Maynard [66], of the U.K. Government’s Department of Health, pointed out that “a risk can only be described as acceptable if the public regard it as acceptable. The role of the scientist is to provide the public with the best possible basis for reaching their decision; it is not for scientists to decide whether a risk is acceptable though they will have their own views on this. It is clear that the acceptability of a risk will depend on t he confidence that the public has in the process that leads to this risk assessment”. Maynard summarised the public’s attitude to risk as: worry = risk x fear. 15 In summary, there is considerable evidence that the presence or proposed presence of facilities that might be construed as posing a threat to health or amenity can cause mental health problems in populations. I believe that perception of risk from the proposed Ince biomass plant is likely to lead to an increase in stress-related disorders in the local population, and thereby place an additional burden on local medical services. 8. Environmental justice A factor related to risk perception is environmental justice, to which the Western Cheshire Primary Care Trust [57] drew attention. Their report pointed out that: “There is a perception amongst the local communities that the area is already overdeveloped and the community is being ‘dumped on a gain’ by industry”. This area indeed has far more than its fair share of heavy and polluting industry: the huge Essar (formerly Shell) oil refinery (including a waste incinerator), GrowHow UK, Quinn Glass, Air Products, Veolia (ES) Cleanaway (with high temperature incinerator), Innospec, Tradebe Waste Management, Greif UK, Electrical Oil Services (with commercial waste oil recovery), IneosChlor, and IneosFluor. In addition, there is planning permission for two huge waste incinerators, one of 600,000 tonne/year capacity at the Ince Resource Recovery Park, and one at Ineos, Runcorn of 850,000 tonne/year capacity. The Scottish Executive [67] has stated that, for environmental justice to be done, “deprived communities which may be more vulnerable to the pressures of poor environmental conditions should not bear a disproportionate burden of negative environmental impacts”. It should be noted here that both Ellesmere Port and Runcorn have areas of significant deprivation; the former has a very high infant mortality rate, and the latter has a v ery high lung cancer mortality rate. A salutary example of the way in which our area has long suffered environmental injustice was reported by Woods [68]. In discussing the expansion of Elton in the 1970s, he quoted a developer who submitted a planning application for residential development in Elton in 1970: “The land around the holding is mostly developed for industrial or residential use. The holding is not large enough to be worked so as to provide a living and the factory effluence in the air does not encourage good grass to grow. In consequence, we feel that residential development is the only logical use to which this land can be put”. The water authority were consulted, and raised no objection, but the Public Health Inspector and the Alkali Inspector were not asked for their views. Cheshire County Council refused the application on G reen Belt grounds. 9. Summary I have shown that there are many reasons for the proposed Ince biomass plant to be refused planning permission. These include lack of need, lack of carbon neutrality, the waste hierarchy, toxic emissions, regulatory controls, visual amenity, perception of risk, and environmental justice. I ask that Cheshire West and Chester Council refuse planning permission for this plant. 16 10. References 1. Walker W., Cardellichio P., Colnes A., Gunn J., Kittler B., Perschel B., Recchia C. and Saah D. Biomass sustainability and carbon policy study. Manomet Center for Conservation Sciences, Brunswick, ME, 2010; www.manomet.org. 2. 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Town Planning and Pollution Control, Manchester University Press, Manchester, 1976, p. 180. 20 Environmental Health BioMed Central Open Access Review Systematic review of epidemiological studies on health effects associated with management of solid waste Daniela Porta1, Simona Milani1, Antonio I Lazzarino1,2, Carlo A Perucci1 and Francesco Forastiere*1 Address: 1Department of Epidemiology, Regional Health Service Lazio Region, Rome, Italy and 2Division of Epidemiology, Public Health and Primary Care, Imperial College, London, UK Email: Daniela Porta - porta@asplazio.it; Simona Milani - milani@asplazio.it; Antonio I Lazzarino - a.lazzarino@imperial.ac.uk; Carlo A Perucci - perucci@asplazio.it; Francesco Forastiere* - forastiere@asplazio.it * Corresponding author Published: 23 December 2009 Environmental Health 2009, 8:60 doi:10.1186/1476-069X-8-60 Received: 4 May 2009 Accepted: 23 December 2009 This article is available from: http://www.ehjournal.net/content/8/1/60 © 2009 Porta et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Management of solid waste (mainly landfills and incineration) releases a number of toxic substances, most in small quantities and at extremely low levels. Because of the wide range of pollutants, the different pathways of exposure, long-term low-level exposure, and the potential for synergism among the pollutants, concerns remain about potential health effects but there are many uncertainties involved in the assessment. Our aim was to systematically review the available epidemiological literature on the health effects in the vicinity of landfills and incinerators and among workers at waste processing plants to derive usable excess risk estimates for health impact assessment. Methods: We examined the published, peer-reviewed literature addressing health effects of waste management between 1983 and 2008. For each paper, we examined the study design and assessed potential biases in the effect estimates. We evaluated the overall evidence and graded the associated uncertainties. Results: In most cases the overall evidence was inadequate to establish a relationship between a specific waste process and health effects; the evidence from occupational studies was not sufficient to make an overall assessment. For community studies, at least for some processes, there was limited evidence of a causal relationship and a few studies were selected for a quantitative evaluation. In particular, for populations living within two kilometres of landfills there was limited evidence of congenital anomalies and low birth weight with excess risk of 2 percent and 6 percent, respectively. The excess risk tended to be higher when sites dealing with toxic wastes were considered. For populations living within three kilometres of old incinerators, there was limited evidence of an increased risk of cancer, with an estimated excess risk of 3.5 percent. The confidence in the evaluation and in the estimated excess risk tended to be higher for specific cancer forms such as non-Hodgkin's lymphoma and soft tissue sarcoma than for other cancers. Conclusions: The studies we have reviewed suffer from many limitations due to poor exposure assessment, ecological level of analysis, and lack of information on relevant confounders. With a moderate level confidence, however, we have derived some effect estimates that could be used for health impact assessment of old landfill and incineration plants. The uncertainties surrounding these numbers should be considered carefully when health effects are estimated. It is clear that future research into the health risks of waste management needs to overcome current limitations. Page 1 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 Introduction "Waste management", that is the generation, collection, processing, transport, and disposal of solid waste is important for both environmental reasons and public health. There are a number of different options available for the management and treatment of waste including minimisation, recycling, composting, energy recovery and disposal. At present, an increasing amount of the resources contained in waste is recycled, but a large portion is incinerated or permanently lost in landfills. The various methods of waste management release a number of substances, most in small quantities and at extremely low levels. However, concerns remain about potential health effects associated with the main waste management technologies and there are many uncertainties involved in the assessment of health effects. Several studies of the possible health effects on populations living in proximity of landfills and incinerators have been published and well-conducted reviews are available [1-4]. Both landfills and incinerators have been associated with some reproductive and cancer outcomes. However, the reviews indicate the weakness of the results of the available studies due to design issues, mainly related to a lack of exposure information, use of indirect surrogate measures, such as the distance from the source, and lack of control for potential confounders. As a result, there is great controversy over the possible health effects of waste management on the public due to differences in risk communication, risk perception and the conflicting interests of various stakeholders. Therefore, there is the need for an appropriate risk assessment that informs both policy makers and the public with the information currently available on the health risks associated with different waste management technologies. Of course, the current uncertainties should be taken into account. Within the EU-funded INTARESE project [5], we aimed to assess potential exposures and health effects arising from solid wastes, from generation to disposal, or treatment. A key part in the health impact assessment was selecting or developing a suitable set of relative risks that link individual exposures with specific health endpoints. In this paper, we systematically reviewed the available epidemiological literature on health effects in the vicinity of landfills and incinerators and among workers at waste processing plants to derive usable excess risk estimates for health impact assessment. The degree of uncertainty associated with these estimates was considered. Methods We considered epidemiological studies conducted on the general population with potential exposures from collecting, recycling, composting, incinerating, and landfilling solid waste. We also considered studies of employees of http://www.ehjournal.net/content/8/1/60 waste management plants as they may be exposed to the same potential hazards as the community residents, even if the intensity and duration of the exposure may differ. However, to limit our scope, we did not consider studies on biomarkers of exposure and health effects. Relevant papers were found through computerized literature searches of MEDLINE and PubMed Databases from 1/1/1983 through 31/12/2008, using the MeSH terms "waste management" and "waste products" and the subheading "adverse effects". We identified 144 papers with this method. We also conducted a free search with several combinations of relevant key words (waste incinerator or landfill or composting or recycling) and (cancer or birth outcome or health effects), and 285 papers were identified. In addition, articles were traced through references listed in previous reviews [1-3,6-9], and in publications of the UK Department for Environment, Food and Rural Affairs [10]. Finally, we used information from two recent reviews of epidemiological studies on populations with potential exposures from toxic and hazardous wastes for reproductive [4], and cancer [11] outcomes, respectively. The eligibility of all papers was evaluated independently by three observers, and disagreements were resolved by discussion. As indicated, studies on sewage treatment and on biological monitoring were not included. We also excluded articles in languages other than English, not journal articles, and six studies [12-17] conducted at the municipal level (usually small towns) where it was not possible to evaluate the extent of the population potentially involved and the possibility of exposure misclassification was high. Papers were grouped according to the following criteria: • waste management technologies: recycling, composting, incinerating, landfilling (considering controlled disposal of waste land and toxic or hazardous sites); • health outcomes: cancers (stomach, colorectal, liver, larynx and lung cancer, soft tissue sarcoma, kidney and bladder cancer, non-Hodgkin's lymphoma, childhood cancer), birth outcomes (congenital malformations, low birth weight, multiple births, abnormal sex ratio of newborns), respiratory, skin and gastrointestinal symptoms or diseases. We have reported in the appropriate tables (in the online additional files) for each paper: study design (e.g. geographical, cohort, cross-sectional, case-control study, etc.), population characteristics (subjects, country, age, sex), exposure measures (e.g. occupational exposure to waste incinerator by-products, residence near a landfill, etc.), and the main results (including control for major Page 2 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 http://www.ehjournal.net/content/8/1/60 confounders) with respect to the quantification of the health effects studied. For each study we have evaluated the potential sources of uncertainty in the results due to design issues. In particular, the possibility that selection bias, information bias, or confounding could artificially increase or decrease the relative risk estimate has been noted in the tables using the plus/minus scale to indicate that effect estimates are likely to be overestimated (or underestimated) up to 20% (+/-), from 20 to 50% (++/--) and more than 50% (+++/---). Uncertainties were graded by two observers (SM and FF), who discussed the inconsistencies. cial, etc, are variously applied in different countries and time periods to designate non-household wastes. In earlier time periods definitions were even less clear and some disposal sites may have switched categories (e.g. if they used to take industrial waste they may now only take municipal waste). Since two systematic reviews were already available for toxic wastes [4,11], we did not replicate the literature search, but summarized the evidence reported in the available reviews and tried to compare and discuss the results with studies where mainly municipal solid wastes were landfilled. The additional file 1 contain several details of the studies reviewed. After a description of the available studies, the overall evaluation of the epidemiological evidence regarding the process/disease association was made based on the IARC (1999) criteria, and two categories were chosen, namely: "Inadequate" when the available studies were of insufficient quality, consistency, or statistical power to determine the presence or absence of a causal association; "Limited" when a positive association was observed between exposure and disease for which a causal interpretation is considered to be credible, but chance, bias, or confounding could not be ruled out with reasonable confidence. There were no instances where the category "sufficient" evidence could be used. Only when the specific process/disease association was judged as limited (suggestive evidence but not sufficient to infer causality) we decided to evaluate the strength of the association and to measure appropriate relative risks. For this purpose, we considered the set of studies providing the best evidence and assigned an overall level of scientific confidence of the specific effect estimate based on an arbitrary scale: very high, high, moderate, low, very low. This evaluation was made by three assessors (SM, DP, and FF). Cancer Russi et al. [11] carried out Medline searches of the peerreviewed English language medical literature covering the period from January 1980 to June 2006 using the keywords "toxic sites" and "cancer", and identified articles from published reviews. They included 19 articles which fit the following selection criteria: 1) the study addressed either cancer incidence or cancer mortality as an endpoint, 2) the study was carried out in a community or a set of communities containing a known hazardous waste site; 3) the study had to address exposure from a specific waste site, rather than from a contaminated water supply resulted from multiple point sources. As the authors recognized, some of the location investigated included both toxic wastes and municipal solid wastes as in the study from Goldberg et al. [18] or Pukkala et al. [19]. There are two investigations considered in this review that are important to evaluate because of the originality of the approach (cohort study, [19] and due to the large size [20]. Results A total of 49 papers were reviewed: 32 concerning health effects in communities in proximity to waste sites, and 17 on employees of waste management sites. The majority of community studies evaluated possible adverse health effects in relation to incinerators and landfills. We found little evidence on potential health problems resulting from environmental or occupational exposures from composting or recycling, and very little on storage/collection of solid waste. A description of the main findings follows. Studies of communities near landfills One of the main problems in dealing with studies on landfill sites (an to some extent also for incinerators) is the distinction between sites for municipal solid wastes and sites for other wastes. The definition of different types of waste is far from being standardised across the world. The terms hazardous, special, toxic, industrial, commer- In Finland, Pukkala et al. [19] studied whether the exposure to landfills caused cancer or other chronic diseases in inhabitants of houses built on a former dumping area containing industrial and household wastes. After adjusting for age and sex, an excess number of male cancer cases were seen, especially for cancers of the pancreas and of the skin. The relative risk slightly increased with the number of years lived in the area. However, some uncertainties were likely to affect the results of the study with regards to the exposure assessment (-), outcome assessment (+) and presence of residual confounding (-). Jarup et al. [20] examined cancer risks in populations living within 2 km of 9,565 (from a total of 19,196) landfill sites that were operational at some time from 1982 to 1997 in Great Britain. No excess risks of cancers of the bladder and brain, hepato-biliary cancer or leukaemia were found, after adjusting for age, sex, calendar year and deprivation. The study was very large and had high power, however misclassification of exposure could have decreased the possibility of detecting an effect (--). Page 3 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 Based on the findings and on the evaluation of the quality of the studies, Russi et al. [11] concluded that epidemiological studies of populations living in the vicinity of a toxic waste site have not produced evidence of adequate quality to establish a casual link between toxic waste exposures and cancer risk. In our terms, the evidence may be considered as "inadequate". In addition to the articles reviewed by Russi et al. [11], we reviewed the article by Michelozzi et al. [21], which investigated the mortality risk in a small area of Italy (Malagrotta, Rome) with multiple sources of air contamination (a very large waste disposal site serving the entire city of Rome, a waste incinerator plant, and an oil refinery plant). Standardised Mortality Ratios (SMRs) were computed in bands of increasing distance from the plants, up to a radius of 10 km. No association was found between proximity to the sites and cancer of various organs, in particular liver, lung, and lymph haematopoietic cancer, however, mortality from laryngeal cancer declined with distance from the pollution sources, and a statistically significant trend remained after adjusting for a four-level index of socio-economic status. The main uncertainty of the study is related to the exposure assessment (--) since only distance was considered thus decreasing the possibility of detecting an effect. There are also uncertainties in using mortality to estimate cancer incidence in proximity to a suspected source of pollution (+). On the other hand, even though the authors did adjust for an area-based index of deprivation, residual confounding (+) from socioeconomic status was likely. In summary, there is inadequate evidence of an increased risk of cancer for communities in proximity of landfills. The three slightly positive studies from Goldberg et al. [18], Pukkala et al. [19] and Michelozzi et al. [21] are not consistent. Birth defects and reproductive disorders Saunders [4] reviewed 29 papers examining the relationship between residential proximity to landfill sites and the risk of an adverse birth outcome. The review included either studies on municipal waste or on hazardous waste. Eighteen papers reported some significant association between adverse reproductive outcome and residence near a landfill site. Two of the strongest papers conducted on hazardous waste landfill sites in Europe (EUROHAZCON) found similarly moderate but significant associations between residential proximity (within 3 km) to hazardous waste sites and both chromosomal [22] (Odds Ratio, OR: 1.41, 95%CI: 1.00-1.99) and non-chromosomal [23] (OR: 1.33, 95%CI: 1.11-1.59) congenital anomalies. http://www.ehjournal.net/content/8/1/60 Included in the Saunders's review [4] is the national geographical comparison study on landfills in the UK by Elliott et al. [24]. This study investigated the risk of adverse birth outcomes in populations living within two km of 9,565 landfill sites in Great Britain, operational at some time between 1982 and 1997, compared with those living further away (reference population). The sites included 774 sites for special (hazardous) waste, 7803 for non-special waste and 988 handling unknown waste; a two km zone was defined around each site to detect the likely limit of dispersion for landfill emissions, including 55% of the national population. Among the 8.2 million live births and 43,471 stillbirths, 124,597 congenital anomalies (including miscarriage) that were examined, there were: neural tube defects, cardiovascular defects, abdominal wall defects, hypospadias and epispadias, surgical correction of gastroschisis and exomphalos; low and very low birth weights were also found , defined as less than 2500 g and less than 1500 g, respectively. The main analysis, conducted for all landfill sites during their operation and after closure, found a small, but still statistically significant, increased risk of total and specific anomalies (OR: 1.01, 95%CI: 1.005-1.023) in populations living within 2 Km, and also an increased risk of low (OR: 1.05, 95%CI: 1.047-1.055) and very low birth weight (OR: 1.04, 95%CI: 1.03-1.05). Additional analyses were carried out separately for sites handling special waste and non-special waste, and in the period before and after opening, for the 5,260 landfills with available data. After adjusting for deprivation and other potential confounding variables (sex, year of birth, administrative region), there was a small increase in the relative risks for low and very low birth weight and for all congenital anomalies, except for cardiovascular defects. The risks of all congenital anomalies were higher for people living near special waste disposals (OR: 1.07 CI95%:1.04-1.09) compared to non-special waste disposals (OR: 1.02, CI95%:1.01-1.03). There was no excess risk of stillbirth. On these bases, the author [4] concluded that while most studies reporting a positive association are of good quality, over half report no association with any adverse birth outcome and most of the latter are also well conducted. The review considered that the evidence of an association of residence near a landfill with adverse birth outcomes as unconvincing. After the review by Saunders [4], we considered four additional studies examining reproductive effects of landfill emissions. Elliot et al. recently updated the previous study [25] in order to evaluate whether geographical density of landfill sites was related to congenital anomalies. The analysis was restricted to 8804 sites operational at some time between 1982 and 1997. There were 607 sites handling special (hazardous) waste and 8197 handling non-special or Page 4 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 http://www.ehjournal.net/content/8/1/60 unknown waste type. The exposure assessment took into account the overlap of the two km buffers around each site, to define an index of exposure with four levels of increasing landfill density. Several anomalies (hypospadias and epispadias, cardiovascular defects, neural tube defects and abdominal wall defects) were evaluated. The analysis was carried out separately for special and nonspecial waste sites and was adjusted for deprivation, presence or absence of a local congenital anomalies register and maternal age. The study found a weak association between intensity of hazardous sites and some congenital anomalies (all, cardiovascular, hypospadia and epispadias). retardation. The major limit of the study is the low specificity of the exposure definition. The studies conducted in the United Kingdom suffer from the same limitations, namely the possibility that misclassification of exposure could have decreased the relative risk estimates to some extent (--); on the other hand, there are several uncertainties related to the quality of reporting and registration of congenital malformations. In the latter case, a positive bias is more likely (++). For the recent report by Elliott et al. [25], location uncertainties and differential data reliability regarding the sites, together with the use of distance as the basis for exposure classification, limit the interpretation of the findings (--). Respiratory diseases A study conducted by Pukkala et al. [19] in Finland evaluated prevalence of asthma in relation to residence in houses built on a former dumping area containing industrial and household wastes. Prevalence of asthma was significantly higher in the dump cohort than in the reference cohort (living nearby but outside the landfill site). Unfortunately, this study has not been replicated and the overall evidence may be considered inadequate. In Denmark, Kloppenborg et al. [26] marked the geographical location of 48 landfills and used maternal residence as the exposure indicator in a study of congenital malformations. The authors found no association between landfill location and all congenital anomalies or of the nervous system, and a small excess risk for congenital anomalies of the cardiovascular system. Potential confounding from socioeconomic status is the major limitation of this study (+++). Jarup et al. [27] studied the risk of Down's syndrome in the population living near 6829 landfills in England and Wales. People were considered exposed if they lived in a two-km zone around each site, people beyond this zone were the reference group. A two-year lag period between potential exposure of the mother and her giving birth to a Down's syndrome child was allowed. The analysis was adjusted for maternal age, urban-rural status and deprivation index. No statistically significant excess risk was found in the exposed populations, regardless of waste type. Finally, Gilbreath et al. [28] studied births in 197 Native Alaskan villages containing open dumpsites with hazardous waste, scoring the exposure into high, intermediate and low hazard level on the basis of maternal residence. The authors found an association between higher levels of hazard and low birth weight and intrauterine growth In summary, an increased risk of congenital malformations and of low birth weight has been reported from studies conducted in the UK. When compared with the results from studies conducted in proximity of hazardous waste sites, studies in proximity of non-toxic waste landfills provide lower effect estimates. The main uncertainty of these studies is the completeness of data on birth defects, the use of distance from the sites for exposure classification, and the classification as toxic and non-toxic waste sites. Studies of landfills workers Only one study on landfill workers was reviewed. Gelberg et al. [29] conducted a cross-sectional study to examine acute health effects among employees working for the New York City Department of Sanitation, focusing on Fresh Kills landfill employees. Telephone interviews conducted with 238 on-site and 262 off-site male employees asked about potential exposures both at home and work, health symptoms for the previous six months, and other information (social and recreational habits, socio-economic status). Landfill workers reported a significantly higher prevalence of work-related respiratory, dermatological, neurologic and hearing problems than controls. Respiratory and dermatologic symptoms were not associated with any specific occupational title or task, other than working at the landfill, and the association remained, even after controlling for smoking status. Studies of communities living near incinerators Twenty-one epidemiologic studies conducted on residents of communities with solid waste incinerators have been reviewed and their characteristics are listed in the additional file 2. Cancer Eleven studies have been reviewed on cancer risk in relation with incinerators, usually old plants with high polluting characteristics. The studies are reported below by country. Page 5 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 In the United Kingdom, Elliott et al. [30] investigated cancer incidence between 1974 and 1987 among over 14 million people living near 72 solid waste incinerator plants. Data on cancer incidence among the residents, obtained from the national cancer registration programme, were compared with national cancer rates, and numbers of observed and expected cases were calculated after stratifying for deprivation, based on the 1981 census. Observedexpected ratios were tested for decline in risk up to 7.5 km away. The study was conducted in two stages: the first involved a stratified random sample of 20 incinerators and, based on the findings, a number of cancers were then further studied around the remaining 52 incinerators (second stage). Over the two stages of the study there was a statistically significant (p < 0.05) decline in risk with distance from incinerators for all cancers, stomach, colorectal, liver and lung cancer. The use of distance as the exposure variable in this study could have led to some degree of misclassification (--). On the other hand, the same authors observed that residual confounding (+) as well as misdiagnosis (+) might have increased the risk estimates. When further analyses were made, including a histological review of liver cancer cases [31], the risk estimates were lower (0.53-0.78 excess cases per 105 per year within 1 km, instead of 0.95 excess cases per 105 as previously estimated). Using data on municipal solid waste incinerators from the initial study by Elliott et al. [30], Knox [32] examined a possible association between childhood cancers and industrial emissions, including those from incinerators. From a database of 22,458 cancer deaths that occurred in children before their 16th birthday between 1953 and 1980, he extracted 9,224 cases known to have moved at least 0.1 km in their life time, and using a newly developed technique of analysis, he compared distances from the suspected sources to the birth addresses and to the death addresses. The childhood-cancer/leukaemia data showed highly significant excesses of moves away from birthplaces close to municipal incinerators, but the specific effects of the municipal incinerators could not be separated clearly from those of nearby industrial sources of combustion. Misclassification of exposure is the main limit of this paper (--). In France, Viel et al. [33] detected a cluster of patients with non-Hodgkin's lymphoma (NHL) and soft tissue sarcoma around a French municipal solid waste incinerator with high dioxin emissions. To better explore the environmental origin of the cluster suggested by these findings, Floret et al. [34] carried out a population-based case-control study in the same area, comparing 222 incident cases of NHL diagnosed between 1980 and 1995 and controls randomly selected from the 1990 census. The risk of developing lymphomas was 2.3 times higher among individuals http://www.ehjournal.net/content/8/1/60 living in the area with the highest dioxin concentration than among those in the area with the lowest concentration. Given that a model was used to attribute exposure to cases and controls, a random misclassification could have reduced the effect estimates (--). Based of these results, a nationwide study on NHL was conducted [35]. A total of 13 incinerators in France were investigated and dispersion modelling was used to estimate ground-level dioxin concentration. Information about the exposure levels and potential confounders was available at the census block level. A positive association between dioxin level and NHL was found with a stronger effect among females. Although the study represents an improvement regarding exposure assessment compared to investigations based on distance from the source, it should be noted that the analysis was conducted at the census block level and the possibility of misclassification of the exposure (-) as well as of residual confounding from socioeconomic status (+) remains. Viel et al. [36] have recently reported the findings from a case-control study on breast cancer. There was no association or even a negative association between exposure to dioxin and breast cancer in women younger or older than 60 years, respectively, living near a French municipal solid waste incinerator with high exposure to dioxin. Design issues and residual confounding from age and other factors (---) limit the interpretations of the study. In Italy, Biggeri et al. [37] conducted a case-control study in Trieste to investigate the relationship between multiple sources of environmental pollution and lung cancer. Based on distance from the sources, spatial models were used to evaluate the risk gradients and the directional effects separately for each source, after adjusting for age, smoking habits, likelihood of exposure to occupational carcinogens, and levels of air particulate. The results showed that the risk of lung cancer was inversely related to the distance from the incinerator, with a high excess relative risk very near the source and a very steep decrease moving away from it. The main problem of the study is the difficulty to separate the effects of other sources of pollution based on distance, and the possibility of potential confounding from other sources remains (++). An excess risk of lung cancer was also found in females living in two areas of the province of La Spezia (Italy) exposed to environmental pollution emitted by multiple sources, including an industrial waste incinerator [38]. Again in this study the limited exposure assessment could have decreased the risk estimates (--), but positive confounding from other sources is very likely. A case-control study by Comba et al. [39] showed a significant increase in risk of soft tissue sarcomas associated with residence within two km of an industrial waste incin- Page 6 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 erator in the city of Mantua, with a rapid decrease in risk at greater distances. There is a slight likelihood that increased attention to the diagnosis for this form of cancer in the vicinity of the plant could have introduced a small bias (+) in the risk estimate. Another case-control study, carried out in the province of Venice by Zambon et al. [40] analyzed the association between soft-tissue sarcoma and exposure to dioxin in a large area with 10 municipal solid waste incinerators. The authors found a statistically significant increase in the risk of sarcoma in relation to both the level and the length of environmental modelled exposure to dioxin-like substances. The results were more significant for women than for men. In summary, although several uncertainties limit the overall interpretation of the findings, there is limited evidence that people living in proximity of an incinerator have increased risk of all cancers, stomach, colon, liver, lung cancers based on the studies of Elliott et al. [30]. Specific studies on incinerators in France and in Italy suggest an increased risk for non-Hodgkin's lymphoma, and soft-tissue sarcoma. Birth defects and reproductive disorders Six studies examined reproductive effects of incinerator emissions (see additional file 2). Jansson et al. [41] analysed whether the incidence of cleft lip and palate in Sweden increased since operation of a refuse incineration plant began. The results of this register study, based on information from the central register of malformations and the medical birth register, did not demonstrate an increased risk. A study by Lloyd et al. [42] examined the incidence of twin births between 1975 and 1983 in two areas near a chemical and a municipal waste incinerator in Scotland: after adjusting for maternal age, an increased frequency of twinning in areas exposed to air pollution from incinerators was seen. In the same study areas, Williams et al. [43] investigated gender ratios, at various levels of geographical detail and using three-dimensional mapping techniques: analyses in the residential areas at risk from airborne pollution from incinerators showed locations with statistically significant excesses of female births. To investigate the risk of stillbirth, neonatal death, and lethal congenital anomaly among infants of mothers living close to incinerators (and crematoriums), Dummer et al. [44] conducted a geographical study in Cumbria (Great Britain). After adjusting for social class, year of birth, birth order, and multiple births, there was an increased risk of lethal congenital anomaly, in particular spina bifida and heart defects. http://www.ehjournal.net/content/8/1/60 Subsequently, Cordier et al. [45] studied communities with fewer than 50,000 inhabitants surrounding the 70 incinerators that operated for at least one year from 1988 to 1997 in France. Each exposed community was assigned an exposure index based on a Gaussian plume model, estimating concentrations of pollutants per number of years the plant had operated. The results were adjusted for year of birth, maternal age, department of birth, population density, average family income, and when available, local road traffic. The rate of congenital anomalies was not significantly higher in exposed compared with unexposed communities; only some subgroups of congenital anomalies, specifically facial cleft and renal dysplasia, were more frequent in the exposed communities. Tango et al. [46] investigated the association of adverse reproductive outcomes with mothers living within 10 km of 63 municipal solid waste incinerators with high dioxin emission levels (above 80 ng international toxic equivalents TEQ/m3) in Japan. To calculate the expected number of cases, national rates based on all live births, fetal deaths and infant deaths occurred in the study area during 19971998 were used and stratified by potential confounding factors available from the corresponding vital statistics records: maternal age, gestational age, birth weight, total previous deliveries, past experience of fetal deaths, and type of paternal occupation. None of the reproductive outcomes studied showed statistically significant excess within two km of the incinerators, but a statistically significant decline in risk with distance from the incinerators was found for infant deaths and for infant deaths with congenital anomalies, probably due to dioxin emissions from the plants. In sum, there are multiple reports of increased risk of congenital malformations among people living close to incinerators but there are no consistencies between the investigated outcomes. The overall evidence may be considered as limited. The study by Cordier et al. [45] provides the basis for risk quantifications at least for facial cleft and renal dysplasia. Quantification for other reproductive disorders is more difficult. Respiratory and skin diseases or symptoms Four studies examined respiratory and/or dermatologic effects of incinerator emissions (see additional file 2). Hsiue et al. [47] evaluated the effect of long-term air pollution resulting from wire reclamation incineration on respiratory health in children. 382 primary school children who resided in one control and three polluted areas in Taiwan were chosen for this study. The results revealed a decrement in pulmonary function (including forced vital capacity and forced expiratory volume in one second) of those residents in the vicinity of incineration sites. Page 7 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 Shy et al. [48] studied the residents of three communities having, respectively, a biomedical and a municipal incinerator, and a liquid hazardous waste-burning industrial furnace, and then compared results with three matchedcomparison communities. After adjustment for several confounders (age, sex, race, education, respiratory disease risk factors), no consistent differences in the prevalence of chronic or acute respiratory symptoms resulted between incinerator and comparison communities. Additionally, no changes in pulmonary function between subjects of an incinerator community and those of its comparison community resulted from the study by Lee et al. [49], based on a longitudinal component from the Health and Clean Air study by Shy et al. [48]. Miyake et al. [50] examined the relationship between the prevalence of allergic disorders and general symptoms in Japanese children and the distance of schools from incineration plants, measured using geographical information systems. After adjusting for grade, socio-economic status and access to health care per municipality, schools closer to the nearest municipal waste incineration plant were associated with an increased prevalence of wheeze and headache; there was no evident relationship between the distance of schools from such plants and the prevalence of atopic dermatitis. The main factors that may have affected the relative risk estimates in this study could be reporting bias (++) and residual confounding from socioeconomic status (++). In sum, although the intensive study conducted by Shy et al. [48] did not show respiratory effects, there are some indications of an increased risk of respiratory diseases, especially in children. However, the uncertainty related to outcome assessment and residual confounding is very high and the overall evidence may be considered inadequate. http://www.ehjournal.net/content/8/1/60 Bresnitz et al. [52] studied 89 of 105 male incinerator workers in Philadelphia, employed at the time of the study in late June 1988. Based on a work site analysis, workers were divided into potentially high and low exposure groups, and no statistically significant differences in pulmonary function were found between the two groups, after adjusting for smoking status. A similar study was conducted by Hours et al. [53]: they analysed 102 male workers employed by three French urban incinerators during 1996, matched for age with 94 male workers from other industrial activities. The exposed workers were distributed into 3 exposure categories based on air sampling at the workplace: crane and equipment operators, furnace workers, and maintenance and effluent-treatment workers. An excess of respiratory problems, mainly daily cough, was more often found in the exposed groups, and a significant relationship between exposure and decreases in several pulmonary parameters was also observed, after adjusting for tobacco consumption and centre. The maintenance and effluent group, and the furnace group had elevated relative risks for skin symptoms. In the same year, Takata et al. [54] conducted a cross-sectional study in Japan on 92 workers from a municipal solid waste incinerator to investigate the health effects of chronic exposure to dioxins. The concentrations of these chemicals among the blood of the workers who had engaged in maintenance of the furnace, electric dust collection, and the wet scrubber of the incinerator were higher compared with those of residents in surrounding areas, but there were no clinical signs or findings correlated to blood levels of dioxins. In sum, there are some studies that suggest increased gastric cancer and respiratory problems among incinerators workers. However, there are a great number of uncertainties, which make it difficult to derive conclusions. Occupational studies on incinerator employees Four studies conducted on incinerator employees were reviewed (see additional file 3). In 1997, Rapiti et al. [51] conducted a retrospective mortality study on 532 male workers employed at two municipal waste incinerators in Rome (Italy) between 1962 and 1992. Standardized mortality ratios (SMRs) were computed using regional population mortality rates. Mortality from all causes resulted significantly lower than expected, and all cancer mortality was comparable with that of the general population. Mortality from lung cancer was lower than expected, but an increased risk was found for stomach cancer: analysis by latency since first exposure indicated that this excess risk was confined to the category of workers with more than 10 years since first exposure. Epidemiological studies of health effects of other waste management processes Twelve epidemiologic studies on the potential adverse health effects of other waste management practices are reviewed and listed in additional file 4. Waste collection Ivens et al. [55] investigated the adverse health effects among waste collectors in Denmark. In a questionnairebased survey among 2303 waste collectors and a comparison group of 1430 male municipal workers, information on self-reported health status and working conditions was collected and related to estimated bioaerosol exposure. After adjusting for several confounders (average alcohol consumption per day, smoking status, and the psychosocial exposure measures support/demand ), a dose- Page 8 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 response relationship between level of exposure to fungal spores and self-reported diarrhoea was indicated, meaning that the higher the weekly dose, the more reports of gastrointestinal symptoms. In contrast with these results, a study of 853 workers employed by 27 municipal household waste collection departments in Taiwan did not find an excess of gastrointestinal symptoms [56]. The workers answered a questionnaire and were classified into two occupational groups by specific exposures based on the reported designation of their specific task. The exposed group included those working in the collection of mixed domestic waste, front runner or loader, collection of separated waste and special kinds of domestic waste (paper, glass, etc.), garden waste, bulky waste for incineration, and the vehicle driver; the control group included accountants, timekeepers, canteen staff, personnel, and other office workers. No significant differences were found in the prevalence of gastrointestinal symptoms, but results indicated that all respiratory symptom prevalence, except dyspnoea, were significantly higher in the exposed group, after adjusting for age, gender, education, smoking status, and duration of employment. Composting facilities In a German cross sectional study by Bünger et al. [57], work related health complaints and diseases of 58 compost workers and 53 bio-waste collectors were investigated and compared with 40 control subjects. Compost workers had significantly more symptoms and diseases of the skin and the airways than the control subjects. No correction was performed for the confounding effect of smoking, as there were no significant differences in the smoking habits of the three groups. A subsequent study in Germany by Herr et al. [58] examined the health effects on community residents of bio-aerosol, emitted by a composting plant. A total of 356 questionnaires from residents living at different distances from the composting site, and from unexposed controls were collected: self-reported prevalence of health complaints over past years, doctors' diagnoses, as was residential odor annoyance; microbiological pollution was measured simultaneously in residential outdoor air. Reports of airway irritation were associated with residency in the highest bio-aerosol exposure category, 150-200 m (versus residency >400-500 m) from the site, and periods of residency more than five years. Bünger et al. [59] conducted a prospective cohort study to investigate, in 41 plants in Germany, the health risks of compost workers due to long term exposure to organic dust that specifically focused on respiratory disorders. Employees, exposed and not exposed to organic dust, http://www.ehjournal.net/content/8/1/60 were interviewed about respiratory symptoms and diseases in the last 12 months and had a spirometry after a 5year follow-up. Exposure assessment was conducted at 6 out of 41 composting plants and at the individual level. Eyes, airways and skin symptoms were higher in compost workers than in the control group. There was also a steeper decline of Forced Vital Capacity among compost workers compared to control subjects, also when smoking was considered. Materials recycling facilities There are no epidemiological studies of populations living near materials recycling facilities; only studies on employees are available. In the already-quoted study by Rapiti et al. [51] on workers at two municipal plants for incinerating and garbage recycling, increased risk was found for stomach cancer in employees who had worked there for at least 10 years, while lung cancer mortality risk was lower than expected. In the study by Rix et al. [60], 5377 employees of five paper recycling plants in Denmark between 1965 and 1990 were included in a historical cohort, and the expected number of cancer cases was calculated from national rates. The incidence of lung cancer was slightly higher among men in production and moderately higher in short term workers with less than 1 year of employment; there was significantly more pharyngeal cancer among males, but this may have been influenced by confounders such as smoking and alcohol intake. Sigsgaard et al. [61] conducted a cross-sectional study to examine the effect of shift changes on lung function among 99 recycling workers (resource recovery and paper mill workers), and correlated these findings with measurements of total dust and endotoxins. Exposure to organic dust caused a fall in FEV1 over the work shift, and this was significantly associated with exposure to organic dust; no significant association was found between endotoxin exposure and lung function decreases. The same authors [62] also analysed skin and gastrointestinal symptoms among 40 garbage handlers, 8 composters and 20 paper sorters from all over Denmark, and found that garbage handlers had an increased risk of skin itching, and vomiting or diarrhoea. In a nationwide study, Ivens et al. [63] reported findings of self-reported gastrointestinal symptoms by selfreported type of plant. A questionnaire based survey among Danish waste recycling workers at all composting, biogas-producing, and sorting plants collected data on occupational exposures (including questions on type of plant, type of waste), present and past work environment, Page 9 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 the psychosocial work environment, and health status. Prevalence rate ratios adjusted for other possible types of job and relevant confounders were estimated with a comparison group of non-exposed workers, and an association was found between sorting paper and diarrhoea, between nausea and work at plastic sorting plants, and non-significantly between diarrhoea and work at composting plants. The health status of workers employed in the paper recycling industry was also studied by Zuskin et al. [64]. A group of 101 male paper-recycling workers employed by one paper processing plant in Croatia, and a group of 87 non-exposed workers employed in the food packing industry was studied for the prevalence of chronic respiratory symptoms, and results indicated significantly higher prevalence of all chronic respiratory symptoms were found in paper workers compared with controls. Gladding et al. [65] studied 159 workers from nine materials recovery facilities (MRFs) in the United Kingdom. Total airborne dust, endotoxins, (1-3)-beta-D-glucan were measured, and a questionnaire-survey was completed. The results suggest that materials recovery facilities workers exposed to higher levels of endotoxins and (1-3)-betaD-glucan at their work sites experience various workrelated symptoms, and that the longer a worker is in the MRF environment, the more likely he is to become http://www.ehjournal.net/content/8/1/60 affected by various respiratory and gastrointestinal symptoms. Choosing relative risk estimates for health impact assessment of residence near landfills and incinerators The reviewed studies have been used to summarize the evidence available, as indicated in table 1. When the overall degree of evidence was considered "inadequate" we decided not to propose a quantitative evaluation of the relative risk; when we arrived to a conclusion that "limited" evidence was available, relative risk estimates were extracted for use in the health impact assessment process. Table 2 summarizes the relevant and reliable figures for health effects related to landfills and incinerators. For each relative risk the distance from the source has been reported as well as the overall level of confidence of the effect estimates based on an arbitrary scale: very high, high, moderate, low, very low. Landfills From the review presented above and following the work already made by Russi et al. [11], it is clear that the studies on cancer are not sufficient to draw conclusions regarding health effects near landfills, both with toxic and non-toxic wastes. The largest study conducted in England by Jarup et al. [21] does not suggest an increase in the cancer types that were investigated. Investigations of other chronic dis- Table 1: Summary of the overall epidemiologic evidence on municipal solid waste disposal: landfills and incinerators. HEALTH EFFECT All cancer Stomach cancer Colorectal cancer Liver cancer Larynx cancer Lung cancer Soft tissue sarcoma Kidney cancer Bladder cancer Non Hodgkin's lymphoma Childhood cancer Total birth defects Neural tube defects Orofacial birth defects Genitourinary birth defects Abdominal wall defects Gastrointestinal birth defects§ Low birth weight Respiratory diseases or symptoms LEVEL OF EVIDENCE LANDFILLS Inadequate Inadequate Inadequate Inadequate Inadequate Inadequate Inadequate Inadequate Inadequate Inadequate Inadequate Limited Limited Inadequate Limited* Inadequate Inadequate Limited Inadequate INCINERATORS Limited Limited Limited Limited Inadequate Limited Limited Inadequate Inadequate Limited Inadequate Inadequate Inadequate Limited Limited** Inadequate Inadequate Inadequate Inadequate "Inadequate": available studies are of insufficient quality, consistency, or statistical power to decide the presence or absence of a causal association. "Limited": a positive association has been observed between exposure and disease for which a causal interpretation is considered to be credible, but chance, bias, or confounding could not be ruled out with reasonable confidence. * Hypospadias and epispadias ** Renal dysplasia § The original estimates were given for "surgical corrections of gastroschisis and exomphalos" Page 10 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 http://www.ehjournal.net/content/8/1/60 Table 2: Relative risk estimates for community exposure to landfills and incinerators Health effect Landfills Congenital malformations [24] All congenital malformations Neural tube defects Hypospadias and epispadias Abdominal wall defects Gastroschisis and exomphalos* Low birth weight [24] Very low birth weight Incinerators Congenital malformations [45] Facial cleft Renal dysplasia Cancer [30] All cancer Stomach cancer Colorectal cancer Liver cancer Lung cancer Soft-tissue sarcoma Non-Hodgkin's lymphoma Distance from the source Relative Risk (Confidence Interval) Level of confidence** Within 2 km Within 2 km Within 2 km Within 2 km Within 2 km Within 2 km Within 2 km 1.02 (99% CI = 1.01-1.03) 1.06 (99% CI = 1.01-1.12) 1.07 (99% CI = 1.04-1.11) 1.05 (99% CI = 0.94-1.16) 1.18 (99% CI = 1.03-1.34) 1.06 (99% CI = 1.052-1.062) 1.04 (99% CI = 1.03-1.06) Moderate Moderate Moderate Moderate Moderate High High Within 10 km Within 10 km 1.30 (95% CI = 1.06-1.59) 1.55 (95% CI = 1.10-2.20) Moderate Moderate Within 3 km Within 3 km Within 3 km Within 3 km Within 3 km Within 3 km Within 3 km 1.035 (95% CI = 1.03-1.04) 1.07 (95% CI = 1.02-1.13) 1.11 (95% CI = 1.07-1.15) 1.29 (95% CI = 1.10-1.51) 1.14 (95% CI = 1.11-1.17) 1.16 (95% CI = 0.96-1.41) 1.11 (95% CI = 1.04-1.19) Moderate Moderate Moderate High Moderate High High *The original estimates were given for "surgical corrections of..". **The following scale for the level of confidence has been adopted: very high, high, moderate, low, very low. eases are lacking, especially of respiratory diseases, yet there is one indication of an increased risk of asthma in adults [19], but with no replication of the findings. Overall, the evidence that living near landfills may be associated with health effects in adults is inadequate. A slightly different picture appears for congenital malformations and low birth weight, where limited evidence exists of an increased risk for infants born to mothers living near landfill sites. The relevant results come from the European EUROHAZCON Study [23] and the national investigation from Elliott et al. [24]. In the UK report, statistically significant higher risk were found for all congenital malformations, neural tube defects, abdominal wall defects, surgical correction of gastroschisis and exomphalos, and low and very low birth weight for births to people living within two km of the sites, both of hazardous and non-hazardous waste. Although several alternative explanations, including ascertainment bias, and residual confounding cannot be excluded in the study, Elliott et al. [24] provide quantitative effect estimates whose level of confidence can be considered as moderate. from socioeconomic status near the incinerators and a concern of misdiagnosis among registrations and death certificates for liver cancer. The histology of the liver cancer cases was reviewed, re-estimating the previously calculated excess risk (from 0.95 excess cases 10-5/year to between 0.53 and 0.78 excess cases 10-5/year). We then graded the confidence of the assessment for these tumours as "moderate" with the exception of liver cancer (high) since the misdiagnosis was reassessed and the extent of residual confounding was lower. In the study by Elliott et al. [30] no significant decline in risk with distance for non-Hodgkin's lymphoma and soft tissue sarcoma was found. However, the studies of Viel et al. [33] and Floret et al. [34] conducted in France and the studies from Comba et al. [39] and Zambon et al. [40] in Italy provide some indications that an excess of these forms of cancers may be related to emissions of dioxins from incinerators. As a result, we provided effect estimates in table 2 also for non-Hodgkin's lymphoma and soft tissue sarcoma as derived from the conservative "first stage" analysis conducted by Elliott et al. [30]. We graded the level of confidence of these relative risk estimates as "high". Incinerators Quantitative estimates of excess risk of specific cancers in populations living near solid waste incinerator plants were provided by Elliott et al. [30]. We have reported in table 2 the effect estimates for all cancers, stomach, colon, liver, and lung cancer based on their "second stage" analysis. There was an indication of residual confounding With regards to congenital malformations near incinerators, Cordier et al. [45] provided effect estimates for facial cleft and renal dysplasia, as they were more frequent in the "exposed" communities living within 10 km of the sites. Other reproductive effects, such as an effect on twinning rates or gender determination, have been described; however the results are inadequate. Page 11 of 14 (page number not for citation purposes) Environmental Health 2009, 8:60 http://www.ehjournal.net/content/8/1/60 Conclusions Additional file 2 We have conducted a systematic review of the literature regarding the health effects of waste management. After the extensive review, in many cases the overall evidence was inadequate to establish a relationship between a specific waste process and health effects. However, at least for some associations, a limited amount of evidence has been found and a few studies were selected for a quantitative evaluation of the health effects. These relative risks could be used to assess health impact, considering that the level of confidence in these effect estimates is at least moderate for most of them. Studies on incinerators. The data provided represent a brief description of the studies on populations living near incinerators. Click here for file [http://www.biomedcentral.com/content/supplementary/1476069X-8-60-S2.XLS] Additional file 3 Studies on occupational exposures among incinerators and landfills workers. The data provided represent a brief description of the studies on workers of waste management plants. Click here for file [http://www.biomedcentral.com/content/supplementary/1476069X-8-60-S3.XLS] Most of the reviewed studies suffer from limitations related to poor exposure assessment, aggregate level of analysis, and lack of information on relevant confounders. It is clear that future research into the health risks of waste management requires a more accurate characterization of individual exposure, improved knowledge of chemical and toxicological data on specific compounds, multi-site studies on large populations to increase statistical power, approaches based on individuals rather than communities and better control of confounding factors. Additional file 4 Studies on other waste management processes. The data provided represent a brief description of the studies on population living near plants using waste management technologies different from landfills and incinerators. Click here for file [http://www.biomedcentral.com/content/supplementary/1476069X-8-60-S4.XLS] List of abbreviations used Acknowledgements EU: European Union; INTARESE: Integrated Assessment of Health Risks of Environmental Stressors in Europe; NHL: non-Hodgkin's Lymphoma; OR: Odds ratio; TEQ: Toxic Equivalent. This study was funded by the INTARESE project. INTARESE is a 5-year Integrated Project funded under the EU 6th Framework Programme - Priority 6.3 Global Change and Ecosystems. We thank Margaret Becker for a linguistic revision the text. We are in debt to Martine Vrijheid for her comments on an earlier version of the manuscript. Competing interests The authors declare that they have no competing interests. Authors' contributions DP participated in the design of the study, conducted the systematic review and drafted the manuscript. SM conducted the systematic review and contributed to draft the manuscript. AIL participated in the systematic review and contributed to draft the manuscript. CAP helped to conceive of the study and to write and revise the manuscript. FF conceived and coordinated the study and helped to write and revise the manuscript. All authors have read and approved the final manuscript. Additional material Additional file 1 Studies on landfills. 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J Occup Environ Med 1998, 40:986-993. Gladding T, Thorn J, Stott D: Organic dust exposure and workrelated effects among recycling workers. Am J Ind Med 2003, 43:584-591. Publish with Bio Med Central and every scientist can read your work free of charge "BioMed Central will be the most significant development for disseminating the results of biomedical researc h in our lifetime." Sir Paul Nurse, Cancer Research UK Your research papers will be: available free of charge to the entire biomedical community peer reviewed and published immediately upon acceptance cited in PubMed and archived on PubMed Central yours — you keep the copyright BioMedcentral Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp Page 14 of 14 (page number not for citation purposes) Human Health and Chemical Mixtures: An Overview developed countries, Figure 1 shows a chromatogram of urine extracted from wet diapers of two infant boys 1 year of age. The peaks in the chromatogram are David 0. Carpenter, Kathleen F. Arcaro, Brian Bush, identified single PCB congeners and the dichlorodiphenyltrichloroethane metaboWilliam D. Niemi, Shaokun Pang, and Dilip D. Vakharia lite dichlorodiphenyldichloroethylene. Department of Environmental Health and Toxicology, School of Public One infant (upper trace) was breast fed, while the other (lower trace) was not. The Health, University at Albany, Rensselaer, New York; Wadsworth Center, analyses were conducted to determine New York State Department of Health, Albany, New York whether the breast-fed infant had more Unlike laboratory animals, people are rarely exposed to a single hazardous chemical. However, PCBs and pesticides in his urine than the most of the information documenting adverse human health effects from environmental and non-breast-fed infant, as breast milk occupational contaminants has come from studies focused on exposure to single chemicals, and reflects the composition of lipophilic subthere is little information available on how two or more contaminants affect humans. Most stances present in a mother's body fat. information on the effects of mixtures comes from animal systems and limited investigations of What is important is that these chroisolated human cells in culture, even though the study of mixtures in such systems has also been matograms show that both infants at 1 neglected. Two or more compounds may show additive, antagonistic, or synergistic interactions year of age already had significant evior may act on totally different systems and thus not interact. Furthermore, even a single chemical dence of exposure to a large number of may have multiple effects and affect more than one organ system. Effects may vary with age, chemicals even though their dietary intake and metabolites may have totally different actions from the parent compound. This paper will at this age was limited. These substances review the variety of health effects in humans that may result from environmental contaminants are lipophilic and are retained in body fat. and discuss how such contaminants may interact with each other. We will also present examples What is excreted in urine is only a small on how different contaminants interact from toxicologic studies of polychlorinated biphenyls reflection of total exposure and body burperformed as part of our Albany, New York, Superfund Basic Research Program project. den. The question of importance for the - Environ Health Perspect 106(Suppl 6):1263-1270 (1998). http.//ehpnet1.niehs.nih.gov/docs/ health of these boys is not simply what 1998/Suppl-6/1263-1270carpenter/abstract.html chemical X does to their development and Key words: metals, PCBs, estrogen disruptors, thyroid, cancer, birth defects, persistent health, but rather what the impact is of all organics, neurobehavioral effects of these chemicals acting together. Health Effects of Mixtur Some of the major broad categories of human diseases that are suspected to result from exposure to environmental contaminants are cancer, birth defects, immune system defects, reduced intelligence quotient (IQ), behavioral abnormalities, decreased fertility, altered sex hormone balance, altered metabolism, and specific organ dysfunctions (2). Almost every organ system may be affected by one or more substances commonly found in our environment. The diseases listed are abstracted from many studies of both humans and animals, and in most cases these investigations were focused on a single contaminant. Some of these diseases, when expressed in a given individual, are difficult to ascribe with certainty to a particular exposure (3). This is true for This paper is based on a presentation at the Conference on Current Issues on Chemical Mixtures held 11-13 cancer, birth defects, and many of the August 1997 in Fort Collins, Colorado. Manuscript received at EHP 17 February 1998; accepted 24 June 1998. Supported by National Institute of Environmental Health Sciences Superfund Basic Research Program grant endocrine disruptor and nervous system actions. But others, such as the specific P42 ES04913. Address correspondence to D.O. Carpenter, School of Public Health, One University Place, Rensselaer, NY organ system dysfunctions seen with kid12144. Telephone: (518) 257-2025. Fax: (518) 525-2665. E-mail: carpent@cnsvax.albany.edu ney disease following lead exposure (4), or Abbreviations used: Ah receptor, aryl hydrocarbon receptor; CYP, cytochrome P450; DES, diethylstilbestrol; E2, 17,1-estradiol; [,-gal, f-galactosidase; hER, human estrogen receptor; EC50, median effective concentration; the loss of particular neurons following HxCB, hexachlorobiphenyl; IC50, concentration that inhibits 50%; IQ, intelligence quotient; LTP, long-term methylmercury exposure (5), are clearly potentiation; PAHs, polycyclic aromatic hydrocarbons; PB, phenobarbital; PCB, polychlorinated biphenyl; PeCB, attributable to particular exposures. Many pentachlorobiphenyl; PTU, propylthiouracil; 2,3,7,8-TCDD, 2,3,7,8 tetrachlorodibenzo-p-dioxin; TeCB, tetraof the effects of contaminants on humans chlorobiphenyl; TEFs, toxic equivalent factors; Th, T helper; TrCB, trichlorobiphenyl. Human exposure to environmental contaminants is omnipresent. It does not occur only in individuals who live next to hazardous waste sites or just the disadvantaged and poor who live in inner cities or third-world countries. Everyone carries a burden of lead in his or her bones, mercury in their hair, and dioxins and polychlorinated biphenyls (PCBs) in their body fat. Environmental contamination is a global issue, and contaminants in one country often are transported to others via air, water, foodstuffs, manufactured products, and travelers. Environmental contaminants may be natural substances such as metals or radioactive materials, or they may be manufactured products that are useful to humans but still have toxic effects. Contaminants may be manufactured or they may be unintentional by-products of human activity, as in the case of combustion or incineration products or the generation of chloroform as a result of chlorination of drinking water. Many contaminants are mixtures of related chemicals such as polycyclic aromatic hydrocarbons (PAHs), crude and refined petroleum products, and polychlorinated aromatics; in some of these cases even the individual components have not been examined for toxicity. As documentation of the widespread degree of contamination, especially in Environmental Health Perspectives * Vol 106, Supplement 6 * December 1998 1 263 CARPENTER ET AL. or, Figure 1. Gas spectrometry chromatograms of urine extracts from diapers from two infants at 1 year of age, showing presence of various single PCB congeners and pesticides. Analysis was made as described by Bush et al. (1). The infant in the upper trace was breast fed, while that in the lower trace was not. Each peak is an identified PCB congener or pesticide. are subtle and difficult to quantify. This is particularly true for alterations that occur during development and are thus irreversible, as are many of the effects on the nervous system and organs that are hormonally regulated. There are a number of factors that complicate the toxicologic evaluation of mixtures. Two or more compounds may have additive effects as a result of acting at the same site, altering the same process by different mechanisms, or as a result of one compound altering the metabolism of the second in such a way as to generate a toxic metabolite. They may also have antagonistic effects or may be synergistic in that the two together give much greater response than the sum of either alone. However, they also may have absolutely no interactions, with each substance acting independently. In this case the net effect of the lack of interaction is that a person experiences the sum of the different organ toxicities of the different contaminants. There are several complications that must be recognized when generalizing about mixtures and coming from what we know about how single compounds act. First, a single compound may have multiple sites of action and these may be mediated by totally different mechanisms. Second, many substances, including metals, are changed to metabolites or conjugates in the body, and 1264 these new products may also have biologic activity that may or may not be similar to the parent compound. Thus even a single compound may become a functional mixture, as will be demonstrated for a single PCB congener and its hydroxylated metabolites. Third, there may be different effects of a single environmental contaminant at different ages. Lead is a clear example in that levels of blood lead that appear to have little effect on neurobehavioral function in an adult can cause an irreversible decrement in IQ and trigger altered behavior when impacting the developing nervous system in the prenatal or early postnatal period. Environmental Diseases Resulting from Genetic Damage As shown in Figure 2, there are extensive interactions among many of the various organ systems, such that alteration of one may influence the function of others. Central to many of the influences on biologic systems are effects that occur at the level of genes. Genes control almost everything, not just the eye color of our children. Cancer is a disease of genetic disruption. Cancer results from mutations in genes, some induced by a variety of environmental factors and some inherited from mutations in previous generations. Cancer genes may either be such as to promote generation of cancer (oncogenes) perhaps more frequently, are mutations that result in the loss of cancer suppressor functions. Many different environmental contaminants are carcinogenic, including some metals and organics. Mutations can cause birth defects, as normal development is under the control of genetics. But there can be other kinds of effects of environmental contaminants mediated by genetic dysfunction. During normal development genes are activated or inactivated at different stages, usually under the control of growth factors and hormones. Environmental contaminants may interfere with this developmental process. For example, many of the effects of diethylstilbestrol (DES), the estrogenic substance given to many pregnant women some years ago, were the result of altered expression of genes regulating sexual functions (6). Genes regulate many aspects of hormonal production, brain development and function, immune system balances, and organ physiology, as well as cancer and birth defects. Environmental Contaminants and the Immune System There are also many direct effects of environmental contaminants on various organ systems. The immune system, for example, is suppressed by some substances such as dioxin, coplanar PCBs, and PAHs (7). But the immune system is affected very differently by some metals, which promote hypersensitivity, rashes, and autoimmunity (8). An exciting developing area of investigation suggests that the dominance of different populations of T helper (Th) lymphocytes is a major factor in an individual's immune responsiveness. In individuals with normal immunity, it appears that the ThI lymphocytes predominate; these lymphocytes produce a particular profile of cytokines. Individuals with hyperimmunity (showing asthma, skin rashes, and autoimmune syndromes) have predominately Brain Hormones - Genes 4 Reproductive ,< system Immune system Figure 2. Diagrammatic interactions between genetic information and various organ systems intimately involved in the effects of environmental agents. Environmental Health Perspectives * Vol 106, Supplement 6 * December 1998 HUMAN HEALTH AND CHEMICAL MIXTURES Th2 lymphocytes, which produce different cytokines (9). It has recently been demonstrated that environmental contaminants such as lead and mercury can alter the balance between the Thl and Th2 lymphocytes (10) and there is speculation that contaminant exposure early in life may cause permanent or at least prolonged abnormalities in immune function. The immune system is also intertwined with the other hormonal systems and the nervous system. Children exposed prenatally to DES show an altered immune function (6). There is also extensive interaction between the nervous and immune systems, even to the point of a common use of messengers. Although neurotransmitters and cytokines have traditionally been considered specific to only one system or the other, we now know that both are used at both sites (11). Sex Steroids and the Nervous System Estrogen has direct effects on neurons, such that estrogen alters synthesis of some transmitters (12), can alter neuronal structure (13,14), influences memory function (15,16), can trigger taste aversions (17), and can alter neuronal ionic currents (18). Furthermore, estrogens protect neurons against glutamate excitotoxicity (19). Environmental Contaminants and the Nenrous System The nervous system is a frequent target of toxic action. A number of organic and inorganic compounds will cause abnormalities of peripheral sensory or motor nerves, resulting either in loss of sensation, abnormal sensation, or muscle weakness (20). Since the studies of Needleman and colleagues in 1979 (21), it has been accepted that lead at remarkably low concentrations can cause a decrement in IQ and also behavioral problems in children exposed prenatally and in the early postnatal years. More recent studies have suggested that these actions are irreversible (22). The exact mechanisms for these nervous system actions are not known. Evidence from several laboratories suggests that PCBs have similar effects; prenatal exposure has resulted in decrements in cognitive function and behavior (23,24) that appear irreversible (25). Polychioinated Biphenyls as Chemical Mixue Polychlorinated biphenyls are interesting compounds for illustration of the multiple effects of both individual chemicals and mixtures; throughout the rest of this paper, examples of results of PCB research from our group in Albany, New York, will be interposed. There are 209 possible PCBs and 75 dioxins, depending on the number and position of the chlorines on the base biphenyl or dioxin rings. PCBs were made as commercial mixtures with varying degrees of chlorination. Although their manufacture and use in the United States ceased in 1977 when they were recognized to be persistent both in the environment and in the body, they continued until recently to be manufactured and used in many countries of the world. Although they are persistent, they are altered by both physical and biologic processes because they are vulnerable to both anaerobic and aerobic biodegradation (26-28) and metabolism within the body (29). In most cases these various forms of metabolism alter the numbers and positions of the chlorines and do not totally degrade the PCB. Therefore, the number of different chemical compounds that can affect human and animal health is not limited to the approximately 150 congeners that were commercially produced. Historically, PCBs have been considered weak dioxins. Indeed, some PCB congeners (those that can assume a coplanar configuration having chlorine atoms only in the meta and para positions to the biphenyl bridge) are weak activators of the aryl hydrocarbon (Ah) receptor, which is known to mediate many of the effects of 2,3,7,8 tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD), the most toxic polychlorinated dioxin congener (30). On the basis of this assumption, some have concluded that the PCBs that cannot assume a coplanar configuration are nontoxic (31), but this has now been proven incorrect. Results from our laboratories and those of a number of other researchers (32-42) clearly show that many of the 209 possible PCB congeners have discrete profiles of toxic actions and each congener may indeed have multiple actions at different sites. ortho-substituted and lower chlorinated PCBs are neurotoxic and at least three different forms of direct neurotoxic actions have been demonstrated. Shain et al. (32) showed that congeners with two or more ortho chlorines inhibit the enzyme tyrosine hydroxylase, which is the rate-limiting enzyme for the synthesis of the neurotransmitter dopamine. Kodavanti et al. (33) and Carpenter et al. (34) showed that orthosubstituted, but not coplanar, congeners kill cerebellar granule cells by a mechanism that probably involves disruption of calcium homeostasis. Finally, Niemi et al. (35) demonstrated that both ortho and coplanar congeners are capable of blocking the process of long-term potentiation (LTP), an electrophysiologic measure in the brain that is thought to be correlated with cognitive function (43). In addition to the direct effects of estrogens on neurons discussed above, other endocrine systems are important to nervous system function. One such system is the thyroid. The thyroid controls the rate of metabolism and is essential to organ development as well as daily function. Congenital hypothyroidism, even if treated after birth, results in a syndrome of minimal brain dysfunction (44). One end of the structure of the thyroid hormone shows some steric features similar to PCBs and dioxins and their hydroxylated metabolites. These substances interfere with normal thyroid function in a variety of ways, as outlined in Figure 3. Several Hypothalamus T TRH Effects of PCBs Pituitary TSH Increased Thyroid gland Altered structure, increased weight T4 Decreased due to T3 Binding proteins increased excretion because of decreased binding and increased glucuronidation Blocks binding, (3-8x} than T4 Target Weak agonists receptors and antagonists Physical growth and metabolism Reduced growth and metabolism Brain development Minimal brain dysfunction syndrome Organ maturation Abnormal testicular development Figure 3. Diagrammatic indication of sites in which polychlorinated biphenyls alter thyroid hormone function and influence development. Abbreviations: T3, 3,3',5'-triiodothyronine; T4, thyroxine; TRH, thyrotropinreleasing hormone; TSH, thyrotropin-stimulating hormone. Data from Porterfield (44), Byrne et al. (45), and Visser et al. (46). Environmental Health Perspectives * Vol 106, Supplement 6 * December 1998 1 265 CARPENTER ET AL. studies have shown that PCBs cause hypothyroidism in animals (45), but there are a number of possible tar1get sites that have been identified and it iis likely that different congeners act at diifferent sites (46). Some PCB congeners do not alter thyroid function (36) but thie pattern of those that do and those that do not is not as simple as positioning the chlorines on the PCBs at sites comparable to those for the iodines on thyroid hormonies. Hypothyroidism results in reduced cognitive function and we hav,e shown that animals made hypothyroid (during postnatal development with the aigent propylthiouracil (PTU) have a reduceed LTP (47). Figure 4 shows results from aln experiment in which we tested whether tlhere was any interaction between the reducction of LTP induced directly by acute e)Kposure to a PCB congener (2,4,4'-trichl orobiphenyl [TrCB]) and that caused by c-hronic PTU treatment. Clearly the effects are additive. In this experiment the hyp othyroidism was not secondary to PCB e:xposure, but previous publications (36,4'5-47) document the fact that PCB exposi ure can cause hypothyroidism. This observanion suggests an important principle whenLconsidering biologic responses to env ironmental 100a 80- T No 244 244 a- E 60 W 40- ._E :c 20- .- 0- || T contaminants: Even a single compound may influence a particular outcome by additive effects through totally different mechanisms. In this case PCBs may reduce LTP by causing hypothyroidism, but in addition PCBs may reduce LTP by a direct action such that the net effect may be additive. Endocrine disruption via interference with sex steroid hormones is a topic of intense interest, although it is not clear that these actions are necessarily more significant biologically than those actions that alter general metabolism via disruption of thyroid function. Many different chemicals show estrogenic, antiestrogenic, androgenic, or antiandrogenic activities (37, 38,48-50). Based to a great degree on the human experiments with DES (6) as well as on extensive information from wildlife (51), the sex steroid endocrine disruptive effects of xenobiotics have been suggested as causes of the reported decline in sperm count and general fertility (3), causes of birth defects of the reproductive system, contributors or causes of cancers of endocrine systems, and the causative agents for the perceived increase in alteration in sexual preferences (52). Further studies must be done, however, before it can be assumed that these conclusions apply to human populations. Figure 5 shows the variety of ways in which xenobiotics can alter sex steroid function. Substances can mimic or antagonize endogenous hormones. They may alter the rates of synthesis or metabolism of the endogenous hormone or they may directly or indirectly alter the expression of receptors for the steroid (53). These various interactions may be complex in chemical mixtures, with each individual compound potentially having multiple actions and different compounds in the mixture potentially acting at different sites that influence the same final outcome. Figure 6 illustrates ways in which PCBs influence estrogenic function. Those coplanar PCBs that, like 2,3,7,8-TCDD, activate the Ah receptor, cause the induction of cytochrome P450s (CYP) of the CYPIA and CYPIB gene families. These P450s appear to catalyze the metabolism of many PCB congeners and other aromatic moieties such as endogenous hormones, including estradiol. They are all estradiol hydroxylases but insert the hydroxyl group at different sites: CYPJAl at the 2 position and CYPIB1 at the 4 position (54,55). Estradiol can be oxidized at several positions, and the products are reactive, rapidly metabolized further, and excreted. Measurement of the 2- and 4-hydroxylated metabolites indicates the relative activity of the two forms of P450. When metabolism of estradiol is increased, functional levels fall and an altered estrogenic function ensues. A number of the ortho-substituted PCBs, but not the coplanars, produce a pattern of enzyme induction similar to that elicited by phenobarbital (56). Although the precise biochemical mechanisms and protein factors involved in this induction process are not well characterized, elevated levels of CYP2B, CYP2C, and CYP3A enzymes result and have the same effect in increasing metabolism and excretion. These enzymes are primarily expressed in the liver, although there may be limited expression in other tissues. Elevated rates of Induction of -1 B Ah receptor CCYP1A,- Cytochromes P450 -20 Control n=6 Substrates, inhibitors PTU n=4 metabolism Figure 4. Additive effects of hypothyroidism induced by chronic treatment of developing animals with PTU, as described by Niemi et al. (47), and acute exposure of isolated hippocampal brain slices to 2,4,4'-TrCB on LTP, recorded in hippocampal area CA1, as described by Niemi et al. 135). Each bar represents the magnitude and SEM of the increase in the population excitatory postsynaptic potential (EPSP) induced by a tetanic activation of the synaptic input, which reflects LTP. Acute incubation of the brain slice with 1 pM 2,4,4'-TrCB resulted in about 50% reduction of LTP (right). Slices obtained from animals exposed to PTU postnatally, as described by Niemi et al. (47), also showed about 50% reduction in LTP as compared to control slices (no 244). When slices prepared from animals exposed to PTU were acutely incubated in the PCB congener, there was no LTP whatsoever (left, 244). 12Z66 Increased Cvol"Xo;z^~~~~~~~~ndcto ofA;n Exclusive oinding at gene regulatory elements PCBs /Induction of CYP2B, -2C, -23A Estrogenic or antiestrogenic PCB metabolites IF Estrogen receptor * Estradiol Altered estrogen PB receptor Altered estrogenic function Figure 5. Ways in which different substances can cause endocrine disruption. Figure 6. Sites of action of polychlorinated biphenyls in altering estrogenic function. PB, phenobarbital. Environmental Health Perspectives * Vol 106, Supplement 6 * December 1998 HUMAN HEALTH AND CHEMICAL MIXTURES hepatic metabolism of estradiol are by 2,3,7,8-TCDD and by direct determiobserved in animals exposed to PCBs (57). nation of inhibition of cDNA-expressed In contrast to CYP2B, CYP2C, and human CYPIBI by 3,3',4,4',5,5'-HxCB CYP3A enzymes, CYP1A1 and CYPIBI in 3,3',4,4',5-PeCB. Thus these two appear to be inducible in a number of congeners have opposing actions in this extrahepatic tissues including breast, pathway-inducing mRNA for synthesis of an enzyme that they then directly inhibit. uterus, and pituitary (58,59). Some of the metabolites produced, Several other important conclusions especially mono- and dihydroxy PCBs, come from this investigation. Previous may have estrogenic or antiestrogenic studies of toxic equivalent factors (TEFs) activities of their own (39). In addition to of PCB congeners relative to 2,3,7,8inducing P450s, however, some PCBs can TCDD have been conducted primarily directly inhibit these enzymes. Although using rodents or rodent-derived cell lines. some lightly chlorinated PCBs bind to the The values obtained from human cells active site of the P450s and hydroxylation are quite different, and the highest TEF of the compound occurs, some of the is about an order of magnitude less more heavily chlorinated congeners bind than that derived from rodent studies. but are difficult to hydroxylate, so they are However, the different human cell lines very effective inhibitors. Finally, through also behave somewhat differently dependactivation of the Ah receptor, 2,3,7,8- ing on which P450s they express. Thus TCDD and probably also coplanar PCBs the problem of extrapolation from animay have inhibitory effects on estrogen- mals to humans is complex. Also, the regulated gene transcription by exclusive most potent PCB congener in stimulating binding at gene regulatory elements found estradiol metabolism in this study is in the 5' flanking regions of estrogen- 3,4,4',5- tetrachlorobiphenyl (TeCB), an responsive genes. The ligand-bound Ah environmentally relevant congener that receptor appears to disrupt the estrogen has not been previously identified as havreceptor-Sp 1 complex that is involved in ing high Ah receptor binding affinity nor transcriptional activation of human assigned a TEF value (62). Although most of the antiestrogenic cathepsin D by interaction at an overlapping xenobiotic response element (60). actions of PCBs can be explained by effects There may be similar negative regulation on estrogen metabolism, there is also the of other estrogen-regulated genes by the clear possibility of action at estrogen recepAh receptor. tors. Furthermore, the effects of PCB Recent work in our laboratories using metabolites may be different from that of cultured human cells (61) has demonstrated the parent compound. For example, Pang how complex these interactions can be. and co-workers (40) found that 3,4,5Pang and co-workers measured CYPlAI TrCB was a potent inducer of CYPlAl and CYPIBI mRNA in several human cell and CYPIBI mRNA and a promoter of lines including MCF-7 cells, a human breast estrogen metabolism by both 2- and 4cancer line (40). They demonstrated that a hydroxylation. However, this compound is number of coplanar congeners increased metabolized to a 4-biphenylol (Figure 7). both CYPlAI and CYP1Bi mRNAs but Gierthy and colleagues (39,63) use the ortho-substituted congeners did not. They MCF-7 cell focus assay to identify estrothen investigated estradiol metabolism by genic and antiestrogenic properties of measuring levels of 2- and 4-methoxyestra- xenobiotics; results with this parent comdiol, produced through the action of cate- pound and its metabolite are shown in chol-0-methyl transferase after estradiol is Figure 8. In this assay, 3,4',5-TrCB is hydroxylated, by gas chromatography/mass antiestrogenic, probably as a result of spectrometry in the media of exposed cells. induced metabolism of estradiol. However, Although for some of the congeners there the 4-hydroxy metabolite, 3,4',5-TrCB-4was a good correlation between the mRNA OH, has no antiestrogenic activity but levels and the degree of estrogen metabo- shows clear estrogenic activity. Thus a parlism, for others (especially 3,3',4,4',5,5'- ent compound and a metabolite may have hexachlorobiphenyl [HxCB] and 3,3',4,4',5- diametrically opposite actions. Figure 9 shows evidence that these pentachlorobiphenyl [PeCB]), metabolism was much less than otherwise expected. This processes occur in whole animals and again difference reflected a direct inhibition of the emphasizes how the different organ systems P450, which they showed by demonstrating are interconnected. Compound 3,3',4,4'that both of these congeners block the TeCB is a coplanar congener that is antielevation of estradiol metabolism induced estrogenic (37,38). This congener has no effect on tyrosine hydroxylase activity (32). However, 3,3',4,4'-TeCB is metabolized to a hydroxylated compound that is estrogenic. When developing rats are exposed to 2,2',4,4'-TeCB, an ortho-substituted Cl QQci Cl 3,4',5-Trichlorobiphenyl HI 3,4',5-Trichloro-4-biphenylol Figure 7. Structure of 3,4',5-trichlorobiphenyl and its metabolic product 3,4',5-trichloro-4-biphenylol. A n11 n M1 E2 100- ~ incn E0 r a) X 80- i 60- ,ca. CO E h". 3,4',5-TrCB-4-0 ._ x1 E 4020- 20-L-$. 0 3,4',5-Trc 0/ 1-12 10-11 10-T 10- 10- 10-7 10- 10-5 B 120 - 2a'c 100- '0cm 0. 3,4',5-TrCB-4-OH 10-9M E2 cO 80E a) oLU 60=- F LY 156758 E ._ 3,4',5-TrCB o E 20O LL E o- v - / 0 10-12 10-11101 10 -10 10-7 10-6 10-5 Molarity Figure 8. Estrogenicity and antiestrogenicity of 3,4',5trichlorobiphenyl and one of its metabolic products, tested in the MCF-7 cell focus assay as described by Gierthy et al. (39,63). (A) Dose-response relation for foci formation induced by E2 and the biphenylol. Note the lack of estrogenic activity of the parent compound. 3,4',5-trichloro-4-biphenylol is estrogenic at 5 pM and is thus 50,000 times less potent than estradiol. (B) Antiestrogenicity tested in the presence of 10-9 M E2. The parent PCB is antiestrogenic, whereas the hydroxylated metabolic product shows no activity. Compared to the specific estrogen receptor blocker LY 156758, the parent PCB is approximately 100 times less potent. Environmental Health Perspectives * Vol 106, Supplement 6 * December 1998 1267 CARPENTER ET AL. 0.08 - ) 0.080 T 1_ _* T T _ _ _ _ _ _ T .E _ _ _ _ 0.02 _ _ _ _ 0 0.02_ _ _ 0 _ _ _ _ _ _ _ _ 0.00 - _ _ O O.1 1 3.4e3',4'-TeCB 0 1 10 20 2,4t2',4'-TeCB Dose, mg/kg/day Figure 9. Dopamine concentrations in rat frontal cortex of animals exposed perinatally to various concentrations of 3,4,3',4'- or 2,4,2',4' tetrachlorobiphenyl, as described by Seegal et al. (41). Note that although the ortho-substituted 2,4,2',4'-TeCB resulted in a significant reduction in brain dopamine levels, the coplanar 3,4,3',4'-TeCB caused a significant increase in dopamine levels. The former result is thought to be due to direct inhibition of the rate-limiting enzyme for dopamine synthesis (tyrosine hydroxylase), whereas the latter effect is a result of the activity of the hydroxylated degradation product, which is estrogenic. *p< 0.05, **p< 0.01, ***p 0.01. 1.47 1.28 1.10- > 0.92= 0.73LU 0.550.37 0.18n nnU.U-L- _14 _10 -5 0 5 10 14 Days Figure 10. The normal variation of serum estrogen levels during the ovulatory cycle. The area between the upper and lower traces represents the range of E2 profiles in normally ovulating women. Data derived from Diagnostic Products Corporation (68) and Thorneycroft et al. (69). congener that inhibits tyrosine hydroxylase activity, there is a reduction in the level of brain dopamine in the adults. However, when animals are developmentally exposed to 3,3',4,4'-TeCB, exactly the opposite result is found; dopamine levels are increased in adults, which may be due to the estrogenic activity of the hydroxylated metabolite of 3,3',4,4'-TeCB (41). The recent report by Arnold et al. (64) of synergistic actions of weak environmental estrogens has focused attention on the possibility that weakly active and especially persistent substances might have effects in combination that far exceed those expected by simple addition of effects. Although the results of this study have been questioned by its authors and others (42,65,66), there remains some evidence from behavioral studies that synergism does occur (67). Table 1 shows results from the study by Arnold et al. (64) (columns 2 and 3) as contrasted with those from Arcaro et al. (42) (columns 4 and 5), using the MCF-7 focus assay and a competitive receptor binding assay with purified recombinant human estrogen receptor (hER). Arnold et al. (64) used purified recombinant receptor directly (column 3) or expressed this receptor in yeast together with the 13galactosidase (>-gal) reporter gene (column 2) to test the estrogenlike activity of hydroxylated PCBs and pesticides. Results in column 2 and 3 show that both the EC50 for ,B-gal activity and the IC50 for binding the hER are significantly lower for a combination of the two hydroxylated PCBs than for either compound alone, indicating that in combination the hydroxylated PCBs are significantly more potent. Similar conclusions were drawn for the pesticides dieldrin and endosulfan. In the study by Arcaro et al. (42), in both the MCF-7 cell focus assay and the hER binding assay, hydroxylated PCBs alone showed estrogenlike activity. However, mixtures were not more potent, indicating that no synergy occurred. Of the pesticides studied, only endosulfan was weakly estrogenic and the combination with dieldrin was not synergistic. The most important question with regard to weak environmental estrogens is whether they interact with endogenous estradiol. This is an important question not only for women of reproductive age, who have high and fluctuating estrogen levels, but especially for children, postmenopausal women, and men, whose estrogen levels are low. Figure 10 illustrates the typical fluctuations of estradiol concentration during the ovulatory cycle. Figure 11 shows results of the estrogenic response in MCF-7 cells to estradiol alone, tested at 10-12 to 10-8 M, and with three different concentrations of the estrogenic PCB metabolite 2,4,6-TrCB4'-OH. It is important to note that there is no evidence of any synergistic effect of estradiol and 2,4,6-TrCB-4'-OH on the response of MCF-7 cells. We conclude that different amounts of this estrogenic PCB metabolite together with varying physiologic concentrations of estradiol do not exhibit any synergism in the in vitro situation. However, this in vitro study does not negate the synergism study in turtles (67), although it does pose a challenge for building a stronger case that synergism between environmentally relevant estrogenic substances occurs in humans. In summary, it is difficult to study chemical mixtures because of the variety of ways in which the components may interact. However, even single compounds can have complex actions at multiple sites, varying with stage of development, and 120° (D 100- c0 80- E E' LJ 60c4 0 Table 1. Estrogenic and synergistic effects of weak xenoestrogens and mixtures. f-gal activity, -0.E hER binding, development, EC50 pMb * E2 alone 5 x 10 6M 2,4,6-1 v5 x 10-7M 2,4,6-T 015 x 10OAM 2,4,6-T 0 hER binding2 Chemical EC50 pMa IC50 pMa IC50 pMb 17,B-estradiol 0.0001 0.001 0.0003 0.0005 2,4,6-TCB-4'-OH 0.0070 0.055 0.22 0.079 2,3,4,5'-TCB-4'-OH 0.0180 0.12 0.72 0.015 2,4,6-TCB-4-OH and 2,3,4,5-TCB-4'-OH 0.0015 0.005 0.18 0.015 Dieldrin >33 > 50 ND ND Endosulfan >33 > 50 >10 ND Dieldrin and endosulfan 0.092 0.324 >10 ND Abbreviations; EC50, median effective concentration; IC50, concentration that inhibits 50%; ND, not detectable. "Data from Arnold et al. (64). bData from Arcaro et al. (42). 1 268 40 - MCF-7 focus 20 - I 0- T// - 0 I -12 -11 -10 -9 -8 Log molarity of E2 Figure 11. The estrogenic effects of three concentrations of 2,4,6-trichloro-4'-biphenylol alone and together with dose-response curves of E2 in the MCF-7 cell focus assay, as described by Arcaro et al. (42). The data show no synergistic effect when the biphenylol at various concentrations was added together with E2. Environmental Health Perspectives * Vol 106, Supplement 6 * December 1998 HUMAN HEALTH AND CHEMICAL MIXTURES may become functional mixtures in the body as a result of metabolism. In reality people are exposed to mixtures and if we are ever to understand the human diseases that people develop from exposure to environmental contaminants, we must study and understand the interactions that occur in mixtures. At the same time, it will probably not be possible to understand the complexity of mixtures without understanding the mechanisms whereby individual contaminants and their metabolites act, recognizing all of the problems associated with species and organ specificities, age-dependent actions, dose-response relationships, and the enormous interdependence of the various organ systems that can lead to indirect as well as direct effects. REFERENCES AND NOTES 1. 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Pang S, Cao JQ, Katz BH, Hayes CL, Sutter TR, Spink DC. Inductive and inhibitory effects of non-ortho-substituted polychlorinated biphenyls on estrogen metabolism and human cytochromes P450 lAI and IBI. Biochem Pharmacol (in press). Seegal RF, Brosch KO, Okoniewski RJ. Effects of in utero and lactational exposure of the laboratory rat to 2,4,2',4'- and 3,4,3',4'-tetrachlorobiphenyl on dopamine function. Toxicol Appl Pharmacol 146:95-103 (1997). Arcaro KF, Vakharia DD, Yang Y, Gierthy JF. Lack of synergy of weakly estrogenic hydroxylated polychlorinated biphenyls and pesticides. Environ Health Perspect 106(Suppl 4):1041-1046 (1998). Gomez RA, Passo Miller LD, Aoki A, Ramirez OA. Long-term potentiation-induced synaptic changes in hippocampal dentate gyrus of rats with an inborn low or high learning capacity. Brain Res 537:293-297 (1990). Porterfield SP. Vulnerability of the developing brain to thyroid abnormalities: environmental insults to the thyroid system. Environ Health Perspect 102(Suppl 2):125-130 (1994). Byrne JJ, Carbone JP, Hanson EA. Hypothyroidism and abnormalities in the kinetics of thyroid hormone metabolism in rats treated chronically with polychlorinated biphenyl and polybrominated biphenyl. Endocrinology 121:520-527 (1987). Visser TJ, Kaptein E, van Toor H, van Raaij JAGM, van den Berg KJ, Joe CTT, van Engelen JGM, Brauwer A. Glucuronidation of thyroid hormone in rat liver: effects of in vivo treatment with microsomal enzyme inducers and in vitro assay conditions. Endocrinology 133:2177-2186 (1993). Niemi WD, Slivinski K, Audi J, Rej R, Carpenter DO. Propylthiouracil treatment reduces long-term potentiation in area CAl of neonatal rat hippocampus. Neurosci Lett 210:127-129 (1996). Spink DC, Lincoln DW, Dickerman HW, Gierthy JF. 2,3,7,8Tetrachlorodibenzo-p-dioxin causes an extensive alteration of 1713-estradiol metabolism in MCF-7 breast tumor cells. Proc Natl Acad Sci USA 87:6917-6921 (1990). Gierthy JF, Spink BC, Figge HL, Pentecost BT, Spink DC. Effects of 2,3,7,8-tetrachlorobidenzo-p-dioxin, 12- O-tetradecanoylphorbol- 13-acetate and 17p-estradiol on estrogen receptor regulation in MCF-7 human breast cancer cells. J Clin Biochem 60:173-184 (1996). Li MH, Hansen LG. Enzyme induction and acute endocrine effects in prepubertal female rats receiving environmental PCB/PXDF/PCDD mixtures. Environ Health Perspect 194:712-722 (1996). Colborn T, vam Saal FS, Soto AM. Developmental effects of endocrine-disrupting chemicals in wildlife and humans. Environ Health Perspect 101:378-384 (1993). Colborn T, Dumanoski K, Myers JP. Our Stolen Future: Are We Threatening Our Fertility, Intelligence and Survival? A Scientific Detective Story. New York:Dutton, 1996. Flouriot C, Pakdel F, DuCouret B, Valotaire Y. Influence of Environmental Health Perspectives - 54. 55. 56. 57. xenobiotics on rainbow trout liver estrogen receptor and vitellegenin gene expression. 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Vol 106, Supplement 6 * December 1998 Comments by Salford City Council on the Determination of an Application for the Environmental Permit for Barton Renewable Energy Plant Ref No EPR/SP3234HY Our ref: 95814 th Date: 9 August 2012 This consultation refers to the draft Determination of Application decision document and permit for the Barton Renewable Energy Plant, operated by Peel Energy Limited and located in Trafford. The reference number is EPR/SP3234HY. A list of the documents considered is provided in Appendix 1. These comments are further to those submitted in 2011 and a meeting with the Environment Agency in June 2012 to clarify points on the decision document. A copy of our draft comments is attached in Appendix 2. Background Detailed comments were submitted to the Environment Agency on 9 March 2011 raising concerns about the impact of emissions from the plant. The Environment Agency has carefully considered the issues raised, carrying out their own assessment and other points by their in house modelling team, the Air Quality Modelling and Assessment Unit (AQMAU). The conclusion and recommendations can be found in the documents C704 and AQMAUC748/776-RP02. Installation Peel Energy Ltd have applied for a permit to operate a waste to energy plant under the Environmental Permitting Regulations Section 1.1. The plant also falls under the Waste Incineration Directive (WID). The plant burns waste wood materials and the products of combustion, after being treated to reduce emissions, are discharged through a 44.23 metre stack. These comments relate to air quality and the impact on the local environment which is in an air quality management area declared for exceedence of the annual nitrogen dioxide (NO2). The main area of concern is the emission of nitrogen dioxide; other pollutants are emitted and although not discussed here, it does not mean that they are inconsequential to the environment or opinions express elsewhere by members of the public or agencies. Emissions Limits and Modelling Results The WID sets a daily emission limit value of 200 mg/m3; Peel Energy modelled the emissions at a lower limit of 125 mg/m3. The modelling predicts where the maximum concentration from the stack will land and at selected receptors in Salford and Trafford. The Environment Agency (Ref 1) recommends that the annual mean values are corrected by 1.11 which has been applied to the summary table below. As hourly mean values are estimated over a shorter time period this correction does not need to be applied. Table 1 shows predicted annual mean and hourly exceedence at the point of maximum impact in Salford and the nearest receptor. In brackets is the % exceedence of the air quality standard. Table 1 Summary of annual mean results for air quality modelling, Results µ/m3 Nitrogen dioxide Annual Mean* Hourly mean ** Point of maximum impact 2.19 (5%) 17.9(9%) Nearest property Tindall Street 0.77(2%) 3.55(2%) * corrected by 1.11 ** no correction Air Quality Standard (AQS) Annual mean 40 µ/m3 Hourly mean 200 µ/m3 Impact on Salford The results in Table 1 show that the worst case exceedence is 5 % of the air quality standards and 2 % at the nearest receptor in Salford. Salford has the highest annual mean receptor and Trafford has the highest hourly mean value of 9% at a property in Bent Street. The installation is sited in an air quality management area for exceedences of the annual mean NO2. The area is also significantly above the air quality objective and EU limit value for nitrogen dioxide with monitoring results indicating it experiences some of the highest concentrations in Greater Manchester. In Greater Manchester there is a prevailing south-westerly wind direction, resulting in the plume falling in the residential area in Barton and adjacent wards. This will increase the roadside and background levels of NO2 in the immediate area. The cumulative effect of this and other developments will result in increasing levels of background concentration. Background Concentration The Environment Agency submitted additional information dated 25 July 2012, received 31 July 2012 regarding background concentrations. The data reviewed by the applicant and the Environment Agency considered two nearby NO2 tubes, and real time monitoring sites Eccles, M60 and Bury Radcliffe. The M60 site, being located by the M60 best represents the local environment for the Barton plant. Results from Liverpool Road and the M60 have an annual mean above the recommended of 40 µ/m3 set by the national and European legislation. Concentrations are 50% above the standard for sites SA34 and the M60. The long term tends shown that NO2 emissions have not decreased as expected from improvements in vehicle emissions. Table 2 Summary of Background Concentrations, Results µ/m3 Year 2009 2010 2011 3 Year Average SA34 Liverpool Rd (Diffusion Tube) 62.2 63.6 52.1 59 SA35 Trevor Rd (Diffusion Tube) 41.4 42.8 36.9 40 Salford Eccles (Continuous Monitor) 39 42 33 38 Salford M60 (Continuous Monitor) 70 60 64 65 On the basis of these results it is difficult to determine a background concentration that is representative of the locality, in an area that is significantly over the AQS. The United Utility plant will add to the background concentrating as indicated in Para 3.8 (Ref 2), adding further uncertainty to the background concentrations and the calculation of the Process Contribution (PC). This is a key parameter for informing the determination of the permit. Its reliability due to the uncertainty in background data and applying it to an area where the air quality standard is significantly exceeded is not appropriate as it does not consider the overall environmental standards. As a result the assessment by the Applicant and the Environment Agency does not adequately consider the cumulative effect of the two plants, (Barton Biomass and United Utilities combustion plant), which will result in the background concentrations increasing. With regard to the reference made, in the draft determination document, to Defra Environmental Permitting Guidance – The IPPC Directive Part A(1) Installations and Part A(1) Mobile Plant March 2009 version 21, we believe that the wrong paragraph has been used for deciding whether the Permit should be granted. Para 4.54 (from 2009 Defra Guidance) refers to the contribution to the Environmental Quality Standard from Existing Plant. The Barton Biomass Plant is of course a New Installation and therefore para 4.50 is more appropriate:4.502. For a new installation (or a substantial change to an existing installation, where the effect of the change bears significantly on a Community EQS), if environmental quality before the installation begins to operate meets the requirements of a Community EQS, then this must remain so after the 1 2009 Version 2 guidance was updated in March 2010 to Version3 and then in March 2011 to Version3 existing installation from 7/1/2013 and new installations from 7/1/2013. The Decision Document uses the 2009 DEFRA guidance and to keep continuity we have used the same document. 2 Defra 2009 guidance installation comes into operation. If the necessary ELVs cannot be met then the permit must be refused. However, there may be ways to reduce emissions from other sources in such a circumstance, thus rendering ELVs and other permit conditions for the installation viably achievable. Where a new installation would only make a minor contribution to a breach of a Community EQS, it will normally be more desirable for regulators to work together to control the other, main sources of pollution, thus ensuring the EQS is met. Taking the above guidance into account this permit should NOT be granted unless it can be proved that the contribution to the EQS from the plant is “minor” and that other emissions sources are controlled through permit conditions to ensure compliance with the EQS. The contribution from the new United Utilities Plant has not been taken into account nor does the EA have any control over the contribution made by the traffic using the motorway network and link roads. The major contributor to the exceedences of the EQS is traffic and consequently is outside the control of the EA and therefore by granting this permit the EA will be condoning a creeping background level that already exceeds the EQS. The detail contained in Annex 5 Addendum to the draft decision does refer to New Plant and quotes para 4.52 of the above guidance; 4.513. If a Community EQS is already being breached in a particular area, then a permit should not be issued to any new installation that would cause anything beyond a negligible increase in the exceedance. Again, however, if it is clear that a combination of controls on the proposed installation and measures to reduce emissions from other sources will achieve compliance with the EQS, then the installation may be permitted. There is disagreement with the EA’s interpretation of “negligible”. This, “small” contribution is large enough to interfere with any headway that may be gained by any proposed Low Emission Zone (discussed later). Again the EA does not have the powers to reduce emissions from all other contributors, other than the UU Plant and other permitted processes, to make this a suitable location for the Biomass plant. Furthermore as the European Commission has recently refused the UK’s application to extent the NO2 compliance date, it is much more important to prevent additional sources increasing background levels and delaying our compliance. United Utilities (UU) The decision documents (p59) indicates a 1-2 % increase in the annual mean, concluding that the contribution will be negligible due to the conservative nature of the modelling. However overall this will add to the total NO2 concentration in the area making it harder to achieve the standard. The 3 Defra 2009 guidance conservative approach is also weakened by the proximity of the plants and the overlap of the plumes, (which are not shown). The accumulative affect of Barton and UU range from 5% to 7% in the worst case condition and this is not adequately considered in the decision document and neither is its effect on background levels included in the PC calculation. This is relevant, given the issues raised in the previous section and the proximity of the background concentration to the air quality objective. The inclusion of this data will further reduce the headroom available. Regarding the short term hourly objective there are recorded of exceedences at the M60 which is not considered by the applicant even though it is operated to same standard as Glazebury and Eccles. Also where tube concentration exceeds 60 µg/m3 as at SA34, hourly exceedences may occur. Due to the proximity of the stacks, it cannot be guaranteed that the two plumes, under the right weather conditions will contribute or cause exceedences of the hourly standard. A more rigours approach is therefore required to access the impact of the two plants. Meeting European Commission Limit Values The increased levels of NO2 will cause the size of the air quality management area to increase and also delay compliance with the objective. The costs of these delays by non compliance may result in fines from the EU being cascaded to local authorities by central government . Since the publication of the decision document, the European Commission has refused the UK government an extension of the deadline to 2015 for the achievement of annual mean NO2. This places greater emphasis and urgency on the UK government to develop plans to attain the target values. The EU also states that to due to public health impacts postponements should be as short as possible, suggesting that where possible we should not be delaying attainment where the AQS is breeched. The local authorities and other regulating bodies such as the Environment Agency and Highways Agency will have to work with the UK government to develop effective plans to reduce NO2 levels and attain the European and national standards as soon as possible. The contribution from both plants, Barton Biomass at 5% and United Utilities at 1-2% and therefore may be as high as 7%, and are a significant source of new emissions. Significance of the Plant’s Emission on Complying with European Limit Values DEFRA prepared, as part of the submission for the EU extension, the improvement to be gained if a Low Emission Zone (LEZ) were to be introduced in Greater Manchester and other affected areas across the UK. In this scenario all HGVs / buses would be required to meet Euro IV emissions standards for NOx and PM10 in 2015 and would apply to most roads in a Local Authority but not strategic roads like the M60. Comparison of the scenarios prepared in the DEFRA report for this region indicates a gain of 1.6 µg/m3 in 2015; therefore the additional impact of 0.69 µg/m3 (0.76 µg/m3 if factored by 1.11) is a significant portion of the projected gain being taken away and subsequently weakening national and local air quality plans. The United Utilities emissions will place additional constraints on meeting the target. Health Impacts The areas affected by the plume are some of the poorest areas in Salford, with a high deprivation index. Due to the high background concentrations the impact of the emissions will have a greater affect in these areas than an emission of similar size in an area where air quality is below the air quality standard. The costs assessment concludes that the additional reduction achieved in NO2 in the AQMA is negligible. The assessment fails to include the cost of NO2 emissions to the environment, action plans to reduce emissions and any fines from the EU. DEFRAi provide a calculator to estimate the monetised impact of emissions. The annualised cost of abating NOx is presented in Table 3 for two different abatement techniques. Selective Catalytic Reduction (SCR) reduces the maximum contribution by 44% but at a higher operating cost however the cheaper option is preferred. The assessment does not consider heath costs, environmental damage or the costs of any fines by not meeting the EU standard and should be included to show all the cost in the cost benefit analysis. If included this will reduce the margins between the two techniques thereby justifying the use of SCR. Table 3 Annualised Cost of Abatement System Technique SCR SNCR Annualised Maximum Contribution Cost4 µg/m3 £748,121 1.1 £192,575 1.97 Difference µg/m3 % Difference 0.87 44 Furthermore the 0.87 µg/m3 reduction achieved with SCR is significant when compared with the gains predicted if a Low Emission Zone (LEZ) is implemented. The cost, based on per NOx reduced, of implementing an LEZ is likely to significantly outweigh the additional cost incurred by using SCR. Overall the additional cost of implementing SCR is not excessive compared to fully costed assessment incorporating health impacts and action plan 4 Source: Decision Document p 75 measures to mitigate these reductions. It is therefore recommended that, if the EA are minded to permit this process, SCR is included as the preferred abatement technique as part of the additional measures to achieve Best Available Technique (BAT) and to meet the statement set out in p 35 of the Decision Document which states “Additional measure will also be included in the process design to control the emissions to a level significantly below that required by the WID.” Particulate Analysis It is recommended that particulate analysis is undertaken on regular intervals and when these is a significant change in the feed stock. The following species should be reported PM 10, PM2.5, PM1.0 and PM0.1. (See 5.24 p 36 Ref 4) Arsenic Arsenic emissions data reported have a wide range of values, (3.91 µg/m3 to 40.47 µg/m3, at Wilton) suggesting a large uncertainty in the results due to sampling technique or the impact of different raw materials. Further clarification on the source of the variance is needed. (See 5.2.25 p 36) Scientific Evidence The Audit commission report that over 50,000 people a year may die prematurely from poor air quality. This should be included in the review of evidence available. (See 5.3 p 39-42 Ref 4) Port Salford / Salford Reds Stadium The air quality assessment reportii prepared by AQC on behalf of Peel modelled air quality in the area for 2010 by predicting changes in emissions from a base year of 2005. The factors used for this have now been shown to be over optimistic and it is widely acknowledged by DEFRA that long term trends have not fallen as predicted. Nonetheless the report indicated that the worst affected area would see an increase of up to 1.2 µg/m3. The concentration predicted for SA34 in 2010 is 52 µg/m3 versus a measure concentration of 64 µg/m3. The model has therefore overestimated the reductions in emissions. The local authority are responsible for updating and incorporating the AQMA which is undertaken by running a county wide air quality model at periodic intervals at a time suitable to all 10 Greater Manchester districts. This statement is therefore misleading and should be amended. (See 5.6.2 p60 ref 4) Previous Comments There are a number of concerns regarding this application, raised previously, including among other concerns: • • • Modelling: surface roughness, The effect of Barton Bridge. The location of a operating plant in an area where air quality standards are significantly exceeded with some of the highest levels in greater Manchester The work done by the AQMAU has shown that surface roughness does not significantly affect the outcome and we are in agreement with this. The Barton Bridge is considered to have no impact on the plume from the stack but no supporting evidence is provided for this statement. Further justification is required to demonstrate that it does not interfere or affect the plume trajectory. Conclusions The location of the plant and the impact of the emissions remain a serious concern in terms of health impacts and compliance with the air quality standards. The Environment Agency’s assessments provide an accurate and comprehensive appraisal of our comments and the applicant’s proposal. A number of points have been clarified and adequately dealt with in reference 2 and 3, however some remain justified and the broad issues raised by the operation of the plant therefore still exist. These are: • • • • • • that the plant worsens air quality in the area that already has poor air quality and is likely to continue to do so for some time, it prevents the fulfilment of Salford’s air quality action plan it contributes to the exceedences of the EU air quality limit values for nitrogen dioxide and delays its attainment it further delays the attainment of the nationally set air quality standard for nitrogen dioxide to protect human by the UK government, it’s likely to contribute to the number of hourly exceedences of the air quality objective nitrogen dioxide a number of technical issues and opinions that are different to Environment Agency’s remain which should be addressed. Recommendations It is recommended that the permit is not granted. The EA should give further consideration to DEFRA Environmental Permitting Guidance for Part A(1) Installations, in particular para 4.46 – 4.55. Para 4.495 promotes co-operation between regulators and the aim of improving areas of poor environmental 5 Defra 2009 guidance quality. By allowing this permit the EA are not following this aim. Para 4.50 refers to new installations and that the new installation should only be permitted if it makes a minor contribution and that regulators can work together to control the other main sources, thus ensuring that the EQS is met. There is a disagreement that this installation is a minor contributor and the fact that major contributor, the motorway network, is out of the control of both the EA and the Local Authority, where the LEZ, if implemented, will have limited effect on vehicle emissions from the M60. It is also recommended that the EA give greater weight to the uncertainty in the background concentrations of NO2 versus the actual air quality with no significant decline and the consequential heath effects. Should the EA decide not to follow our recommendation and grant the permit precedence should be given to technologies e.g. that will give the largest reduction in NO2 emissions to air as area where there is the greatest uncertainly and health impacts. It will also help reduce a creeping background. Selective Catalytic Reduction (SCR) gives lower NOx emissions and this or better techniques should be specified in the permit. This is in accordance with para 4.486 of the above guidance. It is also recommended that the Operator should supply annually mass emissions, in addition to others, for NO2, PM10, PM2.5 and PM.1 Periodic particulate monitoring for the fractions PM10, PM2.5, PM1 and PM0.1 should be undertaken at regular intervals or when there is a change of feedstock. For comments please contact Lynda Stefek Gerard Steadman i http://uk-air.defra.gov.uk/library/reports?report_id=639 Port Salford Environmental Statement 2nd Supplement – Vol. 2 and 3: date 27.07.06 ii 6 Lynda.stefek@salford.gov.uk Gerard.steadman@salford.gov.uk Defra 2009 guidance Appendix 1 Document List No 1 Name S1100-0011-0009SMO AQA BREP rev4.pdf 2 C704 Barton REP RP01.pdf (17.01.2011) C748-776 Barton REP RP02.pdf (12.5.2011/28.6.2011) 3 4 Barton-Permit_DD-SP3234HYDRAFT_decision-May_12.pdf 5 Review of Background Air Monitoring Data (25.07.12) Details Peel Energy Environmental Assessment Document Rev 4 Response to NPS audit request AQMAU comments on Applicant’s response to first audit Determination of an Application for an Environmental Permit under the Environmental Permitting (England & Wales) Regulations 2010 Appendix 2 Comments on the Determination of an Application for the Environmental Permit Ref No EPR/SP3234HY (used at meeting 25/6/12 with Environment Agency) Our ref: 95814 This consultation refers to the determination of application on permit reference no EPR/SP3234HY Detailed comments were submitted to the Environment Agency dated 9 March 2011 raising concerns about the impact of emissions from the plant. Since these comments have been submitted additional work has been undertaken by either the Environment Agency and or the applicant, Peel Energy Ltd and information exchanged. Theses reports, listed below are available on the public register, but were not available at the time of writing. Copies of the information have been requested 11 May 2011 (Ref: S1100-0011-0021AMW) 18 January 2012 (Ref: S1100-0420-0051RSS) 2 March 2012 Email from Fichtner AQMAU report (Ref: C704, dated 21/03/11) AQMAU report (Ref:AQMAUC748/776-RP02), dated 23/08/11) To clarify abnormal emissions There are a number of concerns regarding this application, raised previously, including: • • • Modelling: surface roughness, The effect of Barton Bridge. The location of a operating plant in an area where air quality standards are significantly exceeded with some of the highest levels in greater Manchester None of the above have been adequately consider in this report. The operation of the plant will increase the air quality management area and delaying compliance with the EU and national standards. The costs of these delays by non compliance may result in fines from the EU being cascaded to local authorities. Further evidence and information is required to substantiate the statement made in section 5.1.2. that emissions at the permitted limits would ensure a high level of human protection, for the reason outline below: Section/page Comment 5.2.1./29 The site is referred to as flat when there is a bridge and other large buildings at the same height that may impact on the modelling. Turbulence from the bridge will affect the trajectory of the plume and areas affected, so the effects of local dispersion have not been taken into account. Insufficient information given to justify this statement. Further evidence e.g. Papers on previous studies or wind tunnels studies are suggested. 5.2.2./30 5.2.2. / p34/5 5.2.4/36 5.2.5 5.3/39-42 No information is provided on surface roughness and the effect of it. The original study selected a low value for a rural area. i.e. choice not justified given complexity of territory. The Agency’s decision to adopt a conservative approach for the conversion of NOx toNO2 of 70% is supported. The applicant reports a contribution of 1.7% at worst case residential receptor (location not given) but the maximum impact predicts an increase of 1.97 µg/m3 µin the annual mean, a 5% change. ( Table 12.21)1 There is a considerable range of values possible. The report refers to Para 4.48 and 4.54 of the Defra Guidance2Part A(1) regarding the impact of local IPPC process. No information on local process and there respective contributions is provided. National information on PM10 emissions is provided on page 46. Trafford Park and surrounding area has a large number of industrial processes emitting NOx and particulates and therefore greater weight given to IPPC processes in this area. Recommended that particulate analysis size distribution is periodically undertaken and when there is a substantial change in raw material. Arsenic emissions data reported have a wide range of values, (3.91 µg/m3 to 40.47 µg/m3, at Wilton) suggesting a large uncertainty in the results due to sampling technique or the impact of different raw materials. The studies mainly examine the effect of cancer and do not consider other effects. Evidence from the Audit Commission states that ...”Poor air quality reduces the life expectancy of everyone in the UK by an average of seven to eight months and up to 50,000 people a year may die prematurely because of it”. This evidenced should form part of the 5.6.1 / 5.6.2 /59 5.6.2. /60 assessment. Recent trends at Eccles have seen an increase in NO2 see information below. Averaging results reduces the maximum impact which is 42 µg/m3 in 2010. The increasing emissions due to Part A process will delay the attainment of the standards. Cumulative impact of Carrington and United Utilities (UU) has been considered by an audit of the air quality reports. The impact of the Carrington plant will be less significant that Unitised Utilities which is adjacent to the installations The conclusion reached is that the NO2 concentration will increase by 1-2%. Is this from the UU site or the impact of both sites together? 1-2% exceeds the significance long term criteria and therefore the assessments should be based on modelling not auditing. The Environment statement for Port Salford concludes that these developments would not lead to amendments of the AQMA from the report. This is not our understanding of the assessments neither is it our understanding of how acknowledged increases in emissions do not lead to an increased in local concentrations and therefore to an 1 BREP Environmental Statement Volume 1 2 Part A(1) installations 5.6.2. /60 6.2.2./74 6.2.2/75 increased / change in the AQMA. This statement needs to be reassessed. Misleading? The impact of the Biomass plant is taken at the maximum impact of Port Salford. The impact should report the maximum impact of the biomass emissions on Liverpool road which may be different. There are concerns about the ability of the applicant to meet the tough NOx emission standards of 125 mg/Nm3 (WID Limit is 200 mg/Nm3). The letters of support by boiler manufactures all suggest a high level of complexity and bespoke design to achieve these standards. Process controls will need to be precise and responsive to meet the standards. There remains high level of uncertainty that the limits will be met. Will the techniques suggested affect the plume buoyancy and trajectory and has the modelling adequately consider these different systems particular during abnormal conditions and start-up/shutdown The costs assessment concludes that the additional reduction achieved in NO2 in the AQMA is negligible. The assessment fails to include the cost of NO2 emissions to the environment. (3See links below). The costing should include all costs especially those calculated from the Inter Departmental Group on the Costs and Benefits of Air Quality Damage Cost Calculator. Not withstanding the environmental damage the full impact to health has not been included in an area which levels exceed the annual limit by 50% and hourly exceedences are highly likely. The cost model should take account of the modelling uncertainties and the range of concentrations possible e.g. maximum ground level concentration in NO2 from the combined impact of UU and the installation for a full understanding. Table 1 Nitrogen Dioxide Results Automatic Stations (µg/m3) Year 2008 2009 2010 2011 Glazebury AURN 17.3 16 19.4 18.3 Salford Eccles AURN 36 39 42 33 Salford M60 Cal Club 68 70 60 64 Trafford Cal Club 32 34 33 26 Trafford A56 Cal Club 46 44 46 41 Rolling average ( 3 years) Eccles 3 2006/8 35 2007/9 36 2008/10 2009/11 39 http://uk-air.defra.gov.uk/reports/cat19/1102150857_110211_igcb-damage-cost-calculator.xls http://uk-air.defra.gov.uk/library/reports?report_id=639 38 Policy Analysis pubs.acs.org/est Public Health Impacts of Combustion Emissions in the United Kingdom Steve H. L. Yim and Steven R. H. Barrett* Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States S Supporting Information * ABSTRACT: Combustion emissions are a major contributor to degradation of air quality and pose a risk to human health. We evaluate and apply a multiscale air quality modeling system to assess the impact of combustion emissions on UK air quality. Epidemiological evidence is used to quantitatively relate PM2.5 exposure to risk of early death. We find that UK combustion emissions cause ∼13,000 premature deaths in the UK per year, while an additional ∼6000 deaths in the UK are caused by non-UK European Union (EU) combustion emissions. The leading domestic contributor is transport, which causes ∼7500 early deaths per year, while power generation and industrial emissions result in ∼2500 and ∼830 early deaths per year, respectively. We estimate the uncertainty in premature mortality calculations at −80% to +50%, where results have been corrected by a low modeling bias of 28%. The total monetized life loss in the UK is estimated at £6−62bn/year or 0.4−3.5% of gross domestic product. In Greater London, where PM concentrations are highest and are currently in exceedance of EU standards, we estimate that non-UK EU emissions account for 30% of the ∼3200 air quality-related deaths per year. In the context of the European Commission having launched infringement proceedings against the UK Government over exceedances of EU PM air quality standards in London, these results indicate that further policy measures should be coordinated at an EUlevel because of the strength of the transboundary component of PM pollution. 1. INTRODUCTION Poor air quality adversely impacts human health.1,2 In particular, long-term exposure to fine particulate matter results in an increased risk of premature mortality,1,3−5 with the likelihood of a causal link estimated at 90%.6,7 Although other anthropogenic air pollutants are known to cause adverse health impacts, long-term exposure to PM2.5 (particulate matter with an aerodynamic diameter of less than 2.5 μm) is understood to be the air pollution exposure metric that is most consistently and independently associated with early death, and which accounts for the majority of the health costs of air pollution.1,4 In 2009, the Committee on the Medical Effects of Air Pollutants (COMEAP) estimated that there were ∼29,000 early deaths in the UK in 2008 due to anthropogenic PM air pollution.4 This corresponds to ∼340,000 life-years lost per year.4 The COMEAP approach was based on a combination of modeling and measurements of PM concentrations with a scheme designed to achieve “mass closure” relative to measured concentrations. Stedman et al.8 developed the method applied by COMEAP to map PM concentrations across the UK at background and roadside locations by summing modeled and empirical components. In addition to the aforementioned health impacts, the UK is currently not in compliance with the legally binding EU PM air quality standard on account of exceedances in London.9 Because of this, the European Commission has recently launched infringement proceedings against the UK Govern© XXXX American Chemical Society ment for this continuing breach, with the potential for unlimited fines subject to ruling by the European Court of Justice.9 Results of Whyatt et al.10 indicate that emissions control of primary PM alone would not be sufficient to meet European Union (EU) limit values for PM concentrations. Andersson et al.11 estimated the contribution of different European regions to population PM exposure and premature mortality. In the UK, the costs and benefits of the past and potential mitigation policies for electricity generation and road transport were estimated using a combination of dispersion modeling and empirical components for secondary PM.12 While these studies have added to understanding of PM concentrations in the UK, the attribution of air quality-related premature mortalities to different sectorsboth within the UK and from the rest of the EUhas not previously been quantified. The primary control the UK has on its PM concentrations is by influencing domestic (i.e., within the UK) combustion emissions, although a significant fraction of impacts may be transboundary.11 The predominant sources of anthropogenic PM pollution are combustion emissions of primary PM and precursors of secondary PM. Here we estimate the number of Received: November 12, 2011 Revised: March 12, 2012 Accepted: March 21, 2012 A dx.doi.org/10.1021/es2040416 | Environ. Sci. Technol. XXXX, XXX, XXX−XXX Environmental Science & Technology Policy Analysis Simulated baseline concentrations are validated against UK National Air Quality Archive time series data from 79 O3, 79 NO2, 61 PM10, and 4 PM2.5 measurement stations. See Section 3 of the SI for further information on the air quality simulation and validation. 2.3. Health Impacts. The relationship between long-term exposure to particulate matter and health has been quantified in epidemiological studies.21−26 These studies have consistently found that long-term exposure to particulate matter less than 2.5 μm in diameter (i.e., PM2.5) is associated with increased risk of premature mortality. Assessing long-term PM2.5 exposure is thought to capture ∼80% of monetized health impacts of air pollution.27 We therefore focus on long-term PM2.5 exposure and associated increased risk of premature mortality. Concentration−response functions (CRFs) relate changes in PM2.5 exposure to changes in premature mortality risk. A U.S. EPA expert elicitation study reported a 1% (with a range of 0.4−1.8%) decrease in annual all-cause deaths per μg/m3 decrease in annual average PM2.5 exposure.1 Results are similar to an EU expert elicitation study.28 We apply the EPA CRF to estimate early deaths in UK due to long-term exposure of sector-attributable PM2.5 for adults over 30 years of age. The UK all-cause baseline death incidence rate is based on WHO Health Statistics and Health Information Systems (2004). Population density data are derived from the Gridded Population of the World (GPWv3) at a 2.5′ resolution.29 domestic early deaths per year attributable to UK combustion emissions from sectors including power generation, commercial, institutional, residential and agricultural sources, industry, and transport. We also quantify the contribution of non-UK EU emissions to air quality-related deaths in the UK, and vice versa. The purpose of this is to inform UK and EU air quality and emissions policy development. 2. MATERIALS AND METHODS Our overall approach is to derive a temporally, spatially, and chemically resolved emissions inventory for the UK (at high resolution) and the EU (at low resolution) suitable for use in a state-of-the-science atmospheric chemistry-transport model. We evaluate meteorological and baseline air quality simulations to quantify the extent to which the modeling approach reproduces observed meteorological fields, total PM, and other species concentrations due to all emissions. Scenarios are modeled in which each sector’s combustion emissions are removed in-turn. We attribute the difference between the resultant PM concentrations for each sector simulation and the simulation of total PM to the respective sector. Nonlinearities are assessed for UK emissions by modeling a case where all UK combustion emissions are removed. The impact of UK combustion emissions on EU air quality and vice versa are also simulated. Premature mortality impacts of each sector are estimated by overlaying sector-attributable PM concentrations onto population density, and multiplying the resultant exposure by a concentration−response function. 2.1. Emissions. Emissions in the UK are derived from the 2007 National Atmospheric Emissions Inventory (NAEI),13 which has a horizontal resolution of 1 km ×1 km. In the rest of Europe, the 2007 European Monitoring and Evaluation Programme (EMEP)14 inventory is applied for area sources. EMEP has a horizontal resolution of 50 km ×50 km. Point source emissions outside the UK are from the European Pollutant Release and Transfer Register (E-PRTR).15 We calculate plume rise in-line for each point source according to Briggs et al.16 Emissions are divided into United Nations Economic Commission for Europe (UNECE) source categories (“sectors” in this paper): (a) power generation; (b) commercial, institutional, residential, and agricultural sources; (c) industry; (d) road transport; and (e) other transport. Uncertainties in the emissions inventories, and temporal and vertical emissions profiles are described in Section 1.4 of the Supporting Information (SI), along with assumed chemical speciation profiles for VOCs, NOx, SOx, and primary PM emissions. 2.2. Meteorological and Air Quality Modeling. The Weather Research and Forecasting Model (WRF)17 is used to derive meteorological fields, driven by six-hourly ECMWF reanalysis for the year 2005.18 European meteorology is simulated at a resolution of 40.5 km, with a two-way nest to a 13.5 km domain encompassing the UK. Meteorology is validated with reference to 106 wind stations and 139 temperature stations in the UK. See Section 2 of the SI for further information on the meteorological simulation and validation. The regional chemistry-transport model CMAQ19 is applied to simulate air quality in Europe at a resolution of 40.5 km, with a nested 13.5 km grid for the UK. The global chemistrytransport model GEOS-Chem20 is applied for 2005 to provide boundary conditions to the CMAQ 40.5 km European domain. 3. RESULTS AND DISCUSSION 3.1. Model Evaluation. A set of statistical measures as recommended by U.S. EPA is estimated30 including index of agreement. An index of agreement of 1 indicates perfect agreement between the model and observations, while 0 indicates no agreement. On average, the WRF model achieved 0.83 indices of agreement for both wind speed and temperature. The simulated mean wind speed has a bias of +18% and temperature (in °C) −6% relative to observations. Further statistical parameters are given in Table 4 in the SI. Average indices of agreement for O3, NO2, PM10, and PM2.5 are 0.63, 0.53, 0.5, and 0.7, respectively. Other model evaluation metrics are shown in Tables 5 and 6 of the SI. The annual mean PM2.5 modeling bias for all stations is −28% or −20% excluding the roadside station, where the greatest bias is −52% and the smallest is −9%. We note that the average bias for PM10 in the UK is −65%, likely due to incomplete representation of coarse PM in our PM2.5-focused setup. We represent the uncertainty in our CMAQ results for PM2.5 as having a nominal bias of −28% with an uncertainty range of −65% to −9%, where the lower bound has been extended to capture the mean bias in PM10. This assumed bias is due to a combination of emissions and atmospheric modeling uncertainty. (See Section 3 in the SI for further discussion on emissions uncertainty and assessment of modeling biases.) 3.2. PM2.5 Impacts. Figure 1 depicts the annual average ground-level PM2.5 concentration due to different combustion sources. A gradient from northwest to southeast is observed which is consistent with the finding in Stedman et al.8 Road transport contributes the highest proportion of the annual average ground-level PM2.5 concentration among all sectors, especially in southeast England. The population-weighted PM2.5 concentration attributable to road transport in the UK is 0.75 μg/m3. Figure 2 illustrates annual average ground-level soot (black carbon (BC)) and nitrogen dioxide (NO2) concentrations attributable to road transport. The groundB dx.doi.org/10.1021/es2040416 | Environ. Sci. Technol. XXXX, XXX, XXX−XXX Environmental Science & Technology Policy Analysis Figure 3. Annual average (a) BC concentration due to UK other transport and (b) SO4 concentration due to UK power generation emissions. representing approximately half of total national SOx emissions. Figure 3b depicts the annual average ground-level sulfate concentration due to power generation. The Northern East Midlands region has a ground-level sulfate perturbation of up to 1 μg/m3. This is likely attributable to the five major (>1900 MW capacity) power plants located in that region. In part due to the southwesterly prevailing winds in southeast England, the population-weighted ground-level PM2.5 concentration in London due to power generation is 0.38 μg/m3a third of road transport’s impact. Finally, combustion emissions from commercial buildings, institutional, residential, agriculture, and industries together contribute 0.26 μg/m3 to the population-weighted PM2.5 concentration in the UK. Impacts are approximately even throughout southern and central England. 3.3. Health Impacts (Nominal Estimates). Applying the central CRF (a 1% increase in risk of premature mortality per μg/m3 of long-term exposure to PM2.5) to our CMAQ results we calculate “nominal” estimates of early deaths per year attributable to each sector, which are shown in Table 1. A total Figure 1. Annual average PM2.5 concentration due to combustion emissions from (a) power generation; (b) commercial, institutional, residential, and agricultural sources; (c) industry; (d) road transport; (e) other transport; and (f) all UK combustion sources. Figure 2. Annual average (a) BC and (b) NO2 concentration due to UK road transport emissions. Table 1. Central Estimates for Early Deaths Per Year in the UK by Combustion Sector Calculated Using the High Resolution Modeling Domaina level [BC] and [NO2] perturbation due to road transport has local peaks in cities due to the localized nature of BC and NOx emissions and their direct (i.e., non-secondary) impacts. By contrast, the total (primary + secondary) PM2.5 impacts of road transport are relatively diffuse (Figure 1a). Population-weighted [PM2.5] due to road transport in London is 1.21 μg/m3, which is 1.6 times higher than the UK average for populationweighted [PM2.5] due to road transport. Other transport is the second highest contributor to population-weighted annual average ground-level [PM2.5] (closely followed by power generation). According to the NAEI, other transport produces 21% (0.02 Tg (−20 to +30%)) of UK annual primary PM2.5 emissions, ahead of other sectors. Figure 3a shows the annual average ground-level [BC] due to other transport. It illustrates the local peaks of BC at (marine) ports and airports. Other transport contributes 0.42 μg/m3 to population-weighted [PM2.5] in the UK. It is calculated that the London population-weighted [PM2.5] attributable to other transport emissions is 0.51 μg/m3. This is partly associated with the London airports, including Heathrow, Luton, Gatwick, Stansted, and London City. Combustion emissions from power generation result in an average population-weighted PM2.5 concentration of 0.4 μg/m3 in the UK. Among different PM2.5 species due to power generation, sulfate aerosol accounts for 62% of the total population-weighted PM2.5. According to the NAEI, power generation is responsible for 0.29 Tg (±4%) of SOx emissions, sector power generation commercial, institutional, residential and agriculture industry road transport other transport all UK combustion nominal early deaths/year (UK) corrected central estimate and uncertainty (90% CI) 1700 1100 2500 (1400−3800) 1600 (850−2400) 560 3300 1800 9000 830 (440−1200) 4900 (2600−7200) 2600 (1400−4000) 13,000 (6900−20,000) a Note that results from simulations of individual sectors do not sum exactly to results from a simulation of all UK combustion sectors due to nonlinearities. (Nonlinearities result in a 6% discrepancy in early deaths when comparing the sum of sector simulations to the all-sector simulation results.) of 9000 UK premature mortalities are estimated to be attributable to UK combustion emissions, of which 3300, 1800, and 1700 deaths per year are due to road transport, other transport, and power generation emissions, respectively. We note that the road transport estimate in particular is likely to be an underestimate, as the peaks in roadside PM2.5 may not be accurately represented due to our model resolution. For example, while CMAQ underestimates [PM2.5] by 20% on average at the non-roadside PM monitoring stations, it C dx.doi.org/10.1021/es2040416 | Environ. Sci. Technol. XXXX, XXX, XXX−XXX Environmental Science & Technology Policy Analysis underestimates the average PM2.5 concentration by 52% at the London Marylebone Road station (located 1 m from the curb). We use ArcGIS to overlay CMAQ gridded results for each sector onto UK administrative regions. The nominal estimate for number of premature deaths caused by different combustion sources in different UK administrative districts is shown in Section 5 of the SI, along with the definition of districts. We find that power generation has greater health impacts than other transport in South Yorkshire districts and Yorkshire and the Humber region; however, compared to power generation, other transport causes more combustion emissions-attributable premature mortalities in the South West and East districts, Merseyside district, and London. Road transport contributes 27−50% (36% on average) of the total combustion emissions-attributable premature mortalities across the different districts. In particular, the results show that road transport causes 660 premature mortalities in Greater London, representing half of total premature mortalities in the city associated with all combustion emissions. For London, we calculate that the premature mortalities associated with the other transport and power generation are 280 and 200, respectively. The higher health impacts due to other transport compared to power generation may be associated with airports around Londonespecially Heathrow to the west and Gatwick to the southand the prevailing southwesterly wind. This means that power generation emissions, which are predominantly to the northeast of major population centers and have higher effective emissions heights, are less damaging on a per unit emission basis to UK public health. 3.4. Uncertainty Estimation. We estimate the uncertainty in the premature mortality calculations. The uncertainty in the CRF is accounted for with a triangular probability distribution of multipliers with (low, nominal, high) values of (0.355, 1.06, 1.81),23 where the low, nominal, and high values correspond to the vertices of the distribution function. The bias and uncertainty in modeling PM concentrations is represented by a triangular distribution of multipliers with (low, nominal, high) values of (1.09, 1.25, 1.65). A uniform distribution with range (1, 1.06) is selected to account for the uncertainty due to the nonlinearities when comparing the sum of sector simulations to the all-sector simulation results. The ∼10% probability of no causal link between PM2.5 exposure and premature mortality has not been accounted for quantitatively. Uncertainty ranges and corrected central estimates accounting for biases in modeling are shown in Table 1, where ranges are 90% confidence intervals. For example, the corrected central estimate for premature mortalities attributable to road transport emissions is 4900 per year with a range of 2600−7200, which can be compared to the nominal estimate of 3300. Estimates for other sectors are given in Table 1. We note that a potentially significant unquantified uncertainty is the differential toxicity among PM species. Expert committees have concluded that there is currently no strong basis for an alternative to the assumption of equal toxicity among PM species.30 However, BC is likely more toxic than other PM constituents,31 which indicates that the health impact of road transport is likely to be further underestimated. 3.5. Transboundary Impacts. Understanding transboundary air pollution is of importance when considering environmental policy measures at an EU level. Figure 4a illustrates the annual average PM2.5 concentration associated with combustion emissions from non-UK EU sources. We find that the PM2.5 Figure 4. Impact of non-UK EU combustion emissions on the UK expressed as (a) an absolute perturbation, and (b) the percentage of total UK PM2.5 contributed by non-UK EU combustion emissions. perturbation due to non-UK EU combustion emissions is approximately 2 μg/m3 in the southeast of the UK and ∼1 μg/ m3 in the Midlands. This result is consistent with the finding of Malcolm et al.32 The population-weighted PM2.5 concentration in London due to non-UK EU combustion emissions is 1.17 μg/m3, which is approximately equal to the impact of UK road transport emissions (1.21 μg/m3). We estimate that 4100 (nominal estimate) early deaths are associated with non-UK EU combustion emissions, of which 650 are in London as shown in Table 2. (A corrected central estimate and uncertainty range is also given in Table 2.) Figure 4b shows the percentage of total UK PM 2.5 contributed by non-UK EU combustion emissions. (Here “total” is the sum of PM2.5 caused by UK plus non-UK EU combustion emissions.) It can be seen that the minimum value is 30% in the Midlands and the Central Belt in Scotland, while in the Highlands >70% of [PM2.5] is due to non-UK EU emissions. Our results show that [PM2.5] attributable to nonUK EU combustion emissions accounts for approximately 40% of the total along parts of the south and east coasts of England. The PM2.5 concentration at monitoring stations at Rochester, Barcombe Mills, Southampton, Yarner Wood, and Stoke Ferryanalyzed in Malcolm et al.also indicates that ∼40% of total [PM2.5] comes from outside UK. Table 2 depicts the nominal and corrected central estimates (with uncertainty ranges) for early deaths per year in the UK and the rest of the EU. Results for the rest of the EU are based on the lower resolution (40.5 km) CMAQ results. Non-UK EU combustion emissions result in 4100 (nominal estimate) premature deaths in the UK per year, while UK combustion emissions account for 8500 early deaths in the UK. This indicates that transboundary pollution accounts for one-third of the combustion emissions-attributable deaths per year in the UK. Conversely, UK combustion emissions cause 3100 premature mortalities per year in other EU member states, or 2% of the total 130,000 early deaths per year in the non-UK EU. As non-UK EU emissions are higher than the UK alone, this implies that on a per unit emission basis, the UK “exports” more public health damage to the rest of the EU than it “imports”. This is consistent with prevailing southwesterly/ westerly winds. 3.6. Implications for Policy. The road transport sector is found to be the major contributor to PM2.5 exposure in the UK, and the resulting premature mortalities are comparable to the 2946 deaths due to road accidents in 2007,33 indicating that the D dx.doi.org/10.1021/es2040416 | Environ. Sci. Technol. XXXX, XXX, XXX−XXX Environmental Science & Technology Policy Analysis Table 2. Central Estimates for Early Deaths Per Year in the UK and the Rest of the EU Calculated Using Results from the LowResolution Domain for Non-UK Deaths and the High-Resolution Domain for UK Deathsa emissions sources removed all UK combustion all non-UK EU combustion total a UK early deaths/year non-UK EU early deaths/year greater London early deaths/year 8460 [12,000 (6800−19,000)] 4100 [6000 (3200−9000)] 12,560 3100 [4500 (2400−6700)] 130,000 [190,000 (100,000−290,000)] 133,100 1500 [2200 (1100, 3300)] 650 [960 (530−1400)] 2150 Corrected central estimates and uncertainty ranges are shown in italics. Notes public health impacts of road transport are likely to be 50% greater than fatal accidents as measured by attributable premature mortalities. (The number of deaths on UK roads decreased to 1850 in 2010.) We note that an air quality-related mortality is not equivalent to a fatal road accident in terms of life years lost on average. For example, approximately half of those who died on UK roads in 2007 were under 40, implying a loss of life of ∼35 life years per mortality, compared to the ∼12 life years lost per air quality mortality estimated by COMEAP. This means that road accidents are still likely to result in a greater loss of life years than road transport emissions. Approximately one-sixth of PM2.5 exposure attributable to transport (as a whole) is BC (see Tables 7 and 8 in the SI). This can be compared to 1−2% for other sectors and is indicative of the extent to which road transport has localized impacts due to the positive correlation between road transport emissions and population density. On the other hand, sulfate impacts of road transport represent 1% of the sector’s total PM2.5 impact, which can be compared to figures of 10% for industry to 62% for power generation. This is consistent with the low sulfur fuel used in road transport in the UK and the high sulfur coal-fired power stations in use. Taken together, these findings suggest further efforts to reduce UK power station SOx emissions should be assessed for their costs and benefits, while for road transport the planned reductions in allowable primary PM emissions may have significant health benefits. In terms of economic impacts, we estimate that combustion emissions cost the UK £6−62bn/year. This corresponds to 0.4−3.5% of UK gross domestic product in 2007. The bounds correspond to medians of typical EU and U.S. approaches to monetizing early deaths (see Section 6 of the SI). The extent of transboundary pollution between the UK and other EU member states can be illustrated by noting that (i) one-third of premature mortalities in the UK caused by combustion emissions are due to emissions from other EU member states, and (ii) UK combustion emissions cause onethird again as many early deaths in the rest of the EU as they do in the UK. These results indicate that further policy measures should be coordinated at an EU-level because of the strength of the transboundary component of PM pollution, and that the EU as a whole is responsible for air quality in any given member state. ■ The authors declare no competing financial interest. ■ ACKNOWLEDGMENTS This work was started under the Energy Efficient Cities initiative at the University of Cambridge, funded by EPSRC. We thank EPSRC for initial funding and MIT for supporting the conclusion of the work. ■ ASSOCIATED CONTENT * Supporting Information S Further discussion, analyses, and results. This material is available free of charge via the Internet at http://pubs.acs.org. ■ REFERENCES (1) USEPA. The Benefits and Costs of the Clean Air Act: 1990 to 2020, Final Report of U.S. Environmental Protection Agency Office of Air and Radiation; 2011; pp 5−10. (2) Amann, M.; Derwent, D.; Forsberg, B.; Hurley, O.; Hurley, F; Krzyzanowski, M.; de Leeuw, F.; Liu, S. 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