National-level assessments and studies

Guide to Procedures for Handling Local Requests for Investigations

In France, 11.4 million tons of household and similar waste were incinerated in 2000. The fleet of incinerators, which currently comprises 123 units compliant with the decree of January 25, 1991, has undergone significant changes in recent years. This waste treatment method is currently a source of considerable public concern. Regulatory compliance and extensive research have provided some answers to the public’s legitimate questions regarding the associated health risks. However, many doubts remain, and there is often strong local demand for health studies, particularly epidemiological ones.

This document, prepared at the request of the Directorate General of Health and presented in the form of a "guideline," is primarily intended to inform decentralized government agencies and Interregional Epidemiology Units about the public health issues posed by municipal waste incineration plants, and to help them describe and analyze the situation surrounding these facilities at the local level. Readers will thus find scientific arguments that, based on the description of the situation, justify the need (or lack thereof) to conduct specific studies for informed public health management.

The document is structured into three distinct parts. The first part describes the steps to be taken at the local level. The methodological framework is based on: i) analysis of the local situation, ii) the definition of one or more public health questions and an analysis of the utility of conducting one or more health investigations to address them, iii) an analysis of the relevance of a specific type of study to answer the question, and iv) an analysis of the feasibility of this type of study. The second part provides a summary of the various types of health studies and their potential use for decision-making regarding incinerators. These elements are primarily derived from the analysis of studies already proposed and conducted in past local situations. Finally, the third part is devoted to summarizing the available knowledge on incinerators, the regulations to which they are subject, their emissions, and the health effects investigated in the literature regarding municipal solid waste incinerators (MSWIs). It includes a number of elements useful to the reader for understanding the issue and conducting local investigations.

ERRATUM Incinerators and Health: Guide for Action When a Local Request for Health Investigations Regarding a Municipal Solid Waste Incinerator Is Made.Page 92 - 3rd paragraph: "(The circular of October 9, 2002, provides for the implementation of such measures, particularly if livestock farms are located within 4 km of new facilities, and whenever the annual flux of PCDD/F emitted from a site exceeds 0.5 g/year for existing facilities)" Replace with: "(the circular of October 9, 2002 provides for the implementation of such measures, particularly if livestock farms are located within 5 km of new facilities, and whenever the annual PCDD/F emissions from a site exceed 0.5 g/year for existing facilities)"

Study on dioxin exposure among populations

Study of dioxin exposure among populations living near municipal solid waste incineration plants – Study report. Saint-Maurice: Institute for Public Health Surveillance, 2009. 146 p.

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France has the largest fleet of municipal solid waste incineration plants (MSWIPs) in the European Union, with approximately 130 facilities identified. Considerable efforts have been made in recent years to improve this fleet, but many incinerators have in the past been responsible for significant emissions of pollutants. Legitimate concerns among local residents have led public authorities on several occasions to commission local studies to assess exposure and associated risks. The persistence of chemical compounds released into the environment (dioxins and certain metals) and the presence of these substances at high levels in food (milk, eggs, meat) produced near incinerators justified these fears. It quickly became apparent that conducting multiple studies around each incinerator would be ineffective. In 2002, the French Institute for Public Health Surveillance (InVS) and the French Agency for Food Safety (Afssa) launched a national initiative to address the concerns of policymakers and the public. In accordance with the recommendations issued following this initiative, a national study was launched in 2005 by the InVS in collaboration with the Afssa. Its main objective was to determine whether populations living near municipal solid waste incinerators (MSWIs) had higher levels of pollutants emitted by incinerators (dioxins, PCBs, lead, cadmium) in their bodies than those living farther away, and to identify the determinants (dietary or otherwise) of this exposure. This study also provides the first French data on serum exposure to dioxins and PCBs.

Study of dioxin exposure among populations living near municipal solid waste incineration plants. Summary of results. Saint-Maurice: Institute for Public Health Surveillance, 2006. 20 p.

France has the largest fleet of municipal solid waste incineration plants (MSWIPs) in Europe. Their number has been reduced by about two-thirds since 1998, and this reduction has been accompanied by the retrofitting of existing facilities, the closure of a large number of older facilities, and the construction of new facilities. Emissions from MSW incinerators in France have thus decreased significantly since 1998. However, residents living near these facilities have raised questions about their impact on health. These concerns stem, on the one hand, from the persistence of certain chemical compounds released into the environment—notably dioxins and certain metals—and, on the other hand, from the occasional detection of these substances at high levels in foods such as cow’s milk produced near incinerators that have emitted significant amounts of dioxins.

Due to high emission levels at certain sites, the question arose as to whether residents living near MSW incinerators were actually more exposed to dioxins. Studies conducted abroad used biological indicators to estimate dioxin contamination in these residents, a measure reflecting exposure at the organismal level. The results concluded that living near MSW incineration plants had little effect on residents’ serum dioxin concentrations (Evans 2000, Schumacher 1999, Deml 1996, Gonzalez 1998).

However, these studies did not account for either the fallout zone of the incinerator plume or the primary known route of exposure to dioxins, namely dietary intake. Two studies examined the local dietary intake of residents living near MSW incinerators with high dioxin emissions: a) a Taiwanese study (Chen 2006) which showed slightly higher dioxin exposure among residents living near incinerators who consumed local products and lower exposure among vegetarians, and b) a Belgian study (Fierens 2003) which showed that the consumption of animal fats from locally sourced products (meat, eggs, or dairy products obtained within the incinerator plume’s fallout zone) was associated with increased serum dioxin concentrations in local residents.

In 2004, the French Institute for Public Health Surveillance (InVS), in collaboration with the French Agency for Food Safety (AFSSA), launched a national study, funded under the Cancer Plan, to answer the following question: Are populations living near household waste incineration plants more exposed to dioxins than those living farther away? And if so, why?

The objectives of the study are to:

  • estimate dioxin exposure among populations living near a municipal solid waste incineration plant (MSWIP) and compare it to a non-exposed population that did not live near an incinerator,

  • identify the factors influencing this exposure among populations living near an MSWIS.

A key feature of this study is to better understand the role of dietary habits on dioxin exposure, particularly the influence of consuming local products. This is an exposure study, which does not aim to investigate the health impacts of dioxins—a task that would require different methods.

To date, the only available French data on dioxin exposure in the general population are levels in breast milk measured in 1998 (InVS 2000). In addition to the stated objective, this study will provide the first data on dioxin levels measured in serum in the general French population, based on levels observed in the population not exposed to the incinerator. This study stands out from all other international studies on the subject due to its scope and the specificity of its highly detailed dietary approach.

Recommendations regarding epidemiological studies aimed at improving knowledge of the health impacts of incinerators. Saint-Maurice: Institute for Public Health Surveillance, 2003. 52 p.

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The Institute for Public Health Surveillance convened a group of experts to propose areas of epidemiological research on the health impacts on populations living near municipal solid waste incineration plants (MSWIPs). The work focused on health effects for which responding to public and government demands is most challenging due to persistent scientific uncertainties.

The health effects identified are:

  • cancers: in adults and children, solid tumors (particularly: liver, soft tissues, skin) and malignant hematological diseases (particularly: leukemias, non-Hodgkin lymphomas),

  • effects on reproduction (particularly congenital malformations).

Specific recommendations are made for the implementation of a multicenter study on cancers and the continuation of research on congenital malformations in the vicinity of municipal solid waste incinerators.

Areas for further research are also identified (studies on sexual maturation processes, occupational studies). Further details are provided regarding the need for continued discussion on the implementation of surveillance of populations living near MSW landfills.

Cancer incidence

Study of cancer incidence near municipal solid waste incineration plants. (Study report and summary). March 2008. 139 p. This geographic ecological study, conducted as part of the 2003–2007 Cancer Plan, aims to analyze the relationship between cancer incidence in adults and exposure to air emissions from municipal solid waste incineration plants. It covers cancers diagnosed in the Haut-Rhin, Bas-Rhin, Isère, and Tarn departments between 1990 and 1999. Nearly 135,000 cancer cases were collected over approximately 25 million person-years. The exposure of statistical units (Iris) during the 1970s and 1980s was quantified through modeling of atmospheric dispersion and accumulated surface deposition of dioxins emitted by 16 incinerators. The results are expressed as relative risks that compare the risks of developing cancer in highly exposed areas with those observed in low-exposure areas.

A statistically significant association is observed between exposure to incinerator plumes and the incidence, among women, of all cancers combined, breast cancer, and non-Hodgkin’s lymphomas. A significant association is also found for non-Hodgkin’s lymphomas in both sexes combined and for multiple myeloma in men only.

This study does not establish causality for the observed associations, but it provides compelling evidence to the body of epidemiological arguments highlighting the impact of incinerator emissions on health. As it pertains to a past situation, its results cannot be extrapolated to the present. They confirm the validity of the regulatory measures to reduce emissions that have been applied to these industrial facilities since the late 1990s

Incidence of Cancers Near Municipal Waste Incineration Plants. Exposure to Incinerators During the 1970s–1980s. Final Results. (Brochure). 2008. 4 p. By demonstrating an impact of atmospheric emissions from municipal waste incinerators on the risk of certain cancers between 1990 and 1999, this study confirms the effectiveness of the measures to reduce pollutant emissions that have been imposed on these industrial facilities since the late 1990s. We can therefore expect a decrease in cancer risk among populations exposed to current emission levels. However, given the uncertainty regarding the latency periods for cancer onset, we cannot rule out the possibility that past exposures dating back to the 1970s may still contribute to the development of cancer today.