The urgent need for health impact assessment: proposing a transdisciplinary approach to the e-waste crisis in sub-Saharan Africa

Prospects and Perspectives of Health Impact Assessment: A Systematic Review of the Peer-Reviewed Literature From June 2007 to January 2023

Objectives

In 2008, an analysis investigating health impact assessment (HIA) practice found that only 6% of HIA-related peer-reviewed publications had a focus on low- and medium-developed countries, whereas 94% were conducted in countries with a high or very high development state. We aimed to update and deepen these observations.

Methods

We conducted a systematic review, searching PubMed and Web of Science for HIA-related papers published in the scientific literature from June 2007 to January 2023. Only applied HIA and papers with HIA as a subject were included.

Results

The search yielded 3,036 publications and the final selection consisted of 1,019 publications. The annual number of total publications increased considerably over the past 15 years. Whereas research-driven HIA (n = 460) showed a steep increase, step-by-step HIA (n = 71) did not show a clear trend.

Conclusion

The gap between the number of HIA-related peer-reviewed publications focusing on low/medium and high/very high developed countries has diminished from 6/94 to 11/89. There is a growing tendency to apply the terminology HIA for health impact modelling studies and quantitative health risk assessments.

Informal E-waste recycling practices and environmental pollution in Africa: What is the way forward?

Globally, e-waste is the fastest growing and most valuable waste-stream. While countries worldwide are increasingly acknowledging the e-waste problem and introducing policies and regulations that deal with e-waste, large quantities of e-waste still go undocumented. Much of these global e-wastes are accumulating in open-dumpsites and landfills in African-countries where they are recycled informally resulting in significant environmental and public-health concerns. Although, there is a plethora of studies on e-waste management and disposal, only a few-studies have focused on African-countries who are major recipients of e-waste. Moreover, despite the attempts to mitigate the problem of e-waste in African-countries, e-waste has remained a major-concern and there are currently very limited workable solutions. This study examines informal e-waste recycling, environmental pollution and the extent of environmental and health impacts in major countries of concern including Ghana, Nigeria, Egypt, Kenya and South Africa. The global e-waste Waste Atlas Report, 2020 identified these countries as major recipients of e-waste. To achieve the aims of this research, previous studies from 2005 to 2022 are collected from various databases and analyzed. Accordingly, this study focuses on environmental pollution and public-health impacts resulting from e-waste dumping and informal recycling practices, illegal transboundary shipment of e-waste to the selected countries, and the interventions of governments and international organizations in reducing the impact of e-waste pollution and informal recycling practices in Africa. Based on the outcomes of this study, practical approaches on the way-forward are recommended. The findings of this study contribute to a growing-body of research on informal e-waste recycling practices in Africa to document that individuals working within e-waste sites and residents in nearby communities are exposed to a number of toxic-substances, some at potentially concerning levels.

Lignin and Keratin-Based Materials in Transient Devices and Disposables: Recent Advances Toward Materials and Environmental Sustainability

Rising concerns and the associated negative implications of pollution from e-waste and delayed decomposition and mineralization of component materials (e.g., plastics) are significant environmental challenges. Hence, concerted pursuit of accurate and efficient control of the life cycle of materials and subsequent dematerialization in target environments has become essential in recent times. The emerging field of transient technology will play a significant role in this regard to help overcome current environmental challenges by enabling the use of novel approaches and new materials with unique functionalities to produce devices and materials such as disposable diagnostic devices, flexible solar panels, and foldable displays that are more ecologically benign, low-cost, and sustainable. The prerequisites for materials employed in transient devices and disposables include biodegradability, biocompatibility, and the inherent ability to mineralize or dissipate in target environments (e.g., body fluids) in a short lifetime with net-zero impact. Biomaterials such as lignin and keratin are well-known to be among the most promising environmentally benign, functional, sustainable, and industrially applicable resources for transient devices and disposables. Consequently, considering the current environmental concerns, this work focuses on the advances in applying lignin and keratin-based materials in short-life electronics and single-use consumables, current limitations, future research outlook toward materials, and environmental sustainability.

E-Waste in Africa: A Serious Threat to the Health of Children

Waste electronic and electrical equipment (e-waste) consists of used and discarded electrical and electronic items ranging from refrigerators to cell phones and printed circuit boards. It is frequently moved from developed countries to developing countries where it is dismantled for valuable metals in informal settings, resulting in significant human exposure to toxic substances. E-waste is a major concern in Africa, with large sites in Ghana and Nigeria where imported e-waste is dismantled under unsafe conditions. However, as in many developing countries, used electronic and electrical devices are imported in large quantities because they are in great demand and are less expensive than new ones. Many of these used products are irreparable and are discarded with other solid waste to local landfills. These items are then often scavenged for the purpose of extracting valuable metals by heating and burning, incubating in acids and other methods. These activities pose significant health risks to workers and residents in communities near recycling sites. E-waste burning and dismantling activities are frequently undertaken at e-waste sites, often in or near homes. As a result, children and people living in the surrounding areas are exposed, even if they are not directly involved in the recycling. While toxic substances are dangerous to individuals at any age, children are more vulnerable as they are going through important developmental processes, and some adverse health impacts may have long-term impacts. We review the e-waste situation in Africa with a focus on threats to children's health.

Environmental Health Research in Africa: Important Progress and Promising Opportunities

The World Health Organization in 2016 estimated that over 20% of the global disease burden and deaths were attributed to modifiable environmental factors. However, data clearly characterizing the impact of environmental exposures and health endpoints in African populations is limited. To describe recent progress and identify important research gaps, we reviewed literature on environmental health research in African populations over the last decade, as well as research incorporating both genomic and environmental factors. We queried PubMed for peer-reviewed research articles, reviews, or books examining environmental exposures and health outcomes in human populations in Africa. Searches utilized medical subheading (MeSH) terms for environmental exposure categories listed in the March 2018 US National Report on Human Exposure to Environmental Chemicals, which includes chemicals with worldwide distributions. Our search strategy retrieved 540 relevant publications, with studies evaluating health impacts of ambient air pollution (n=105), indoor air pollution (n = 166), heavy metals (n = 130), pesticides (n = 95), dietary mold (n = 61), indoor mold (n = 9), per- and polyfluoroalkyl substances (PFASs, n = 0), electronic waste (n = 9), environmental phenols (n = 4), flame retardants (n = 8), and phthalates (n = 3), where publications could belong to more than one exposure category. Only 23 publications characterized both environmental and genomic risk factors. Cardiovascular and respiratory health endpoints impacted by air pollution were comparable to observations in other countries. Air pollution exposures unique to Africa and some other resource limited settings were dust and specific occupational exposures. Literature describing harmful health effects of metals, pesticides, and dietary mold represented a context unique to Africa. Studies of exposures to phthalates, PFASs, phenols, and flame retardants were very limited. These results underscore the need for further focus on current and emerging environmental and chemical health risks as well as better integration of genomic and environmental factors in African research studies. Environmental exposures with distinct routes of exposure, unique co-exposures and co-morbidities, combined with the extensive genomic diversity in Africa may lead to the identification of novel mechanisms underlying complex disease and promising potential for translation to global public health.

Rapid Health Impact Assessment of a Proposed Poultry Processing Plant in Millsboro, Delaware

In 2013, Allen Harim Foods purchased the former site of a Vlasic Pickle plant in Millsboro, Delaware, and proposed to convert the site into a poultry processing plant that would process approximately two million birds weekly. This generated concerns about the proposed plant’s potential to impact health and quality of life among residents. We conducted a rapid health impact assessment (HIA) of the proposed plant to assess baseline environmental health issues in the host community and projected impacts. The scoping and baseline assessment revealed social, economic, and health disparities in the region. We also determined that residents in the area were already underserved and overburdened with pollution from multiple environmental hazards near the proposed plant including two sites contaminated with hazardous wastes, a power plant, and another poultry processing plant. The projected size and amount of poultry to be processed at the plant would likely cause increased levels of air, soil and water pollution, additional odor issues, and increased traffic and related pollution and safety issues. The information generated from the HIA formed the basis of a campaign to raise awareness about potential problems associated with the new facility and to foster more engagement of impacted residents in local decision-making about the proposed plant. In the end, the HIA helped concerned residents oppose the new poultry processing plant. This case study provides an example of how HIAs can be used as a tool to educate residents, raise awareness about environmental justice issues, and enhance meaningful engagement in local environmental decision-making processes.

Systematic Literature Review of Health Impact Assessments in Low and Middle-Income Countries

Health Impact Assessments (HIAs) motivate effective measures for safeguarding public health. There is consensus that HIAs in low and middle-income countries (LMICs) are lacking, but no study systematically focuses on those that have been successfully conducted across all regions of the world, nor do they highlight factors that may enable or hinder their implementation. Our objectives are to (1) systematically review, geographically map, and characterize HIA activity in LMICs; and (2) apply a process evaluation method to identify factors which are important to improve HIA implementation in LMICs. A systematic review of peer-reviewed HIAs in 156 LMICs was performed in Scopus, Medline, Web of Science, Sociological abstracts, and LILACs (Latin American and Caribbean Health Sciences) databases. The search used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and covered HIAs across all type of interventions, topics, and health outcomes. HIAs were included if they reported a clear intervention and health outcome to be assessed. No time restriction was applied, and grey literature was not included. The eligible studies were subjected to six process evaluation criteria. The search yielded 3178 hits and 57 studies were retained. HIAs were conducted in 26 out of 156 countries. There was an unequal distribution of HIAs across regions and within LMICs countries. The leading topics of HIA in LMICs were air pollution, development projects, and urban transport planning. Most of the HIAs reported quantitative approaches (72%), focused on air pollution (46%), appraised policies (60%), and were conducted at the city level (36%). The process evaluation showed important variations in the way HIAs have been conducted and low uniformity in the reporting of six criteria. No study reported the time, money, and staff used to perform HIAs. Only 12% of HIAs were based on participatory approaches; 92% of HIAs considered multiple outcomes; and 61% of HIAs provided recommendations and fostered cross-national collaboration. The limited transparency in process, weak participation, and inconsistent delivery of recommendations were potential limitations to HIA implementation in low and middle-income countries. Scaling and improving HIA implementation in low and middle-income countries in the upcoming years will depend on expanding geographically by increasing HIA governance, adapting models and tools in quantitative methods, and adopting better reporting practices.

Genomic instability in adult men involved in processing electronic waste in Northern China

BACKGROUND

Managing and recycling electronic waste (e-waste), while useful and necessary, has resulted in significant contamination of several environments in China. The area around Tianjin, China has become one of the world's largest e-waste disposal centers, where electronics are processed by manually disassembly or burning, which can result in serious exposure of workers to a multitude of toxicants.

OBJECTIVE

The present study assessed potential genomic damage in workers involved in recycling e-waste.

METHODS

To detect cytogenetic and DNA damage, chromosomal aberrations (CA), cytokinesis blocking micronucleus (CBMN) and the comet assay were performed. Concentrations of some trace elements, markers of oxidative stress and polychlorinated biphenyls (PCBs) in whole blood or serum were measured, and relationships among the markers described above, age, and duration of exposure were analyzed. The profiles of expression of genes in lymphocytes in peripheral blood were assessed to determine the status of the regulation of genes involved in genome stability.

RESULTS

Concentrations of 28 PCB congeners in the whole blood of the exposed group were significantly (P<0.001) greater than those in the control individuals. Frequency of CA (8.01%) and CBMN (26.3‰) in lymphocytes and the level of DNA damage in the lymphocytes and spermatozoa of the exposed men were also significantly (P<0.0001) greater than those of the controls. There were significant relationships between CA, CBMN, DNA damage and duration of exposure. Concentrations of malondialdehyde (MDA) and lead (Pb) in the blood serum were significantly greater, but activities of superoxide dismutase (SOD), glutathione (GSH) and concentrations of calcium (Ca) and magnesium (Mg) were lower in the serum of the exposed men. MDA, Pb, Ca and Mg were associated with the duration of exposure to handling e-waste. In males involved in handling of e-waste, there were 13 genes - ATM, ATR, ABL1, CHEK1, CHEK2, GADD45A, CDK7, GTSE1, OGG1, DDB1, PRKDC, XRCC1 and CCNH - for which expression of mRNA was up-regulated and 7 genes - BRCA1, GTF2H1, SEMA4A, MRE11A, MUTYH, PNKP and RAD50 - for which the expression of mRNA was down-regulated.

CONCLUSIONS

A strong correlation between indicators of damage of DNA, which could result in instability of the genome, and duration of processing e-waste was observed. If proper procedures are not followed, there are significant risks to the health of the individuals involved in such activities.