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The health impacts of waste-to-energy emissions: A systematic review of the literature


Cole-Hunter, T and Johnston, FH and Marks, GB and Morawska, L and Morgan, GG and Overs, M and Porta-Cubas, A and Cowie, CT, The health impacts of waste-to-energy emissions: A systematic review of the literature, Environmental Research Letters, 15, (12) pp. 1-18. ISSN 1748-9318 (2020) [Refereed Article]

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2020 The Author(s). Published by IOP Publishing. Original content from this work may be used under the terms of the Creative Commons Attribution Unported (CC BY 3.0) license. ( Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI.

DOI: doi:10.1088/1748-9326/abae9f


Waste-to-energy (WtE) processes, or the combustion of refuse-derived fuel (RDF) for energy generation, has the potential to reduce landfill volume while providing a renewable energy source. We aimed to systematically review and summarise current evidence on the potential health effects (benefits and risks) of exposure to WtE/RDF-related combustion emissions.

We searched PubMed and Google Scholar using terms related to health and WtE/RDF combustion emissions, following PRISMA guidelines. Two authors independently screened titles, abstracts and then full-texts of original, peer-reviewed research articles published until 20th March 2020, plus their relevant references. Overall quality of included epidemiological studies were rated using an amended Navigation framework.

We found 19 articles from 269 search results that met our inclusion criteria, including two epidemiological studies, five environmental monitoring studies, seven health impact or risk assessments (HIA/HRA), and five life-cycle assessments. We found a dearth of health studies related to the impacts of exposure to WtE emissions. The limited evidence suggests that well-designed and operated WtE facilities using sorted feedstock (RDF) are critical to reduce potential adverse health (cancer and non-cancer) impacts, due to lower hazardous combustion-related emissions, compared to landfill or unsorted incineration. Poorly fed WtE facilities may emit concentrated toxins with serious potential health risks, such as dioxins/furans and heavy metals; these toxins may remain problematic in bottom ash as a combustion by-product. Most modelling studies estimate that electricity (per unit) generated from WtE generally emits less health-relevant air pollutants (also less greenhouse gases) than from combustion of fossil fuels (e.g. coal). Some modelled estimates vary due to model sensitivity for type of waste processed, model inputs used, and facility operational conditions.

We conclude that rigorous assessment (e.g. HRA including sensitivity analyses) of WtE facility/technological characteristics and refuse type used is necessary when planning/proposing facilities to protect human health as the technology is adopted worldwide.

Item Details

Item Type:Refereed Article
Keywords:air pollution, energy, health, incineration, waste, waste-to-energy
Research Division:Environmental Sciences
Research Group:Climate change impacts and adaptation
Research Field:Human impacts of climate change and human adaptation
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Johnston, FH (Professor Fay Johnston)
ID Code:143695
Year Published:2020
Web of Science® Times Cited:8
Deposited By:Menzies Institute for Medical Research
Deposited On:2021-03-30
Last Modified:2021-04-26
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