Resource consumption and the associated health risks: a brief overview
Discussions around the concept of the circular economy (CE) often tend to focus on the resources conserved, as well as their economic value. However, the approaches employed in the extraction and processing of raw materials, as well as the inherent biochemical and physical properties of selected waste materials, can lead to risks to public and environmental health. Thus, an examination of these risks and the role that a CE can play in reducing them is vital (WHO, 2016; OECD, 2018; World Bank, 2017).
Globally, the extraction, processing, and use of raw materials is predicted to double from 79 gigatonnes (Gt) in 2011 to 167 Gt in 2060 (OECD, 2018). With regard to waste, the annual generation rate is expected to increase by 70% from 2016 levels to 3.40 billion tonnes in 2050 (Kaza et al., 2018). Non-metallic minerals (e.g., sand, gravel, and limestone) are expected to represent more than half of the overall materials used. The use of fossil fuels, as well as the production of iron, steel, and construction materials, leads to large energy-related emissions of greenhouse gas (GHG) and air pollutants. The increase in the extraction and use of raw materials is expected to lead to GHG emissions rising to 50 Gt CO2c(i per year by 2060. The extraction and use of raw materials is much more polluting than using secondary (e.g., recycled) materials. For example, the extraction and use of metals can result in a wide range of pollution impacts (e.g., toxic effects on humans and ecosystems).
Within the community setting, around 2 billion people across the world have no waste collection and three billion no controlled waste disposal (CIWM and WasteAid UK, 2018). The resulting indiscriminate littering and use of dumpsites (which are particularly common in the Global South, where access to functional landfills is often limited) can lead to the contamination of the land, as well as surface and ground water (Vaccari et al., 2019). More than half (approximately 38 of 50) of the worlds largest uncontrolled dumpsites are in coastal areas; thus, the waste and leachate go directly into the water courses and sea (ISWA, 2016). Open waste burning, especially in rural areas in the Global South, is a key contributor to respiratory health issues (Ikeyna-Bensusan et al., 2018).
Approximately nine million people die each year of diseases linked to either mismanagement of waste or pollutants. It is the vulnerable segments of the population (e.g., children and the elderly) who are often disproportionately affected by these risks. In addition, a higher percentage of women often tend to be involved in the most hazardous elements of waste management activities (e.g., the sorting of the waste). By extension, these risks have negative knock-on impacts on the livelihoods and development potential of families and communities (e.g., United Nations General Assembly, 2015). For example, illness amongst children reduces their potential to attend school. In turn, this limits their future career and livelihood opportunities. These factors are often compounded in many countries in the Global South by limitations in effective governance, enforcement of environmental policies, investment in, and public awareness of effective waste management (Ferronato et al., 2019).
Around 75—90% of the waste produced by healthcare facilities is comparable to municipal waste and is usually termed ‘non-hazardous’ or 'general healthcare waste’ (WHO, 2014). This fraction of the waste arises primarily from areas such as offices, kitchens, and non-intensive care wards and can include items such as packaging and food waste. The remaining 10—25% of the waste is regarded as hazardous and may potentially pose significant risks to human health and the environment. Even though hazardous healthcare waste represents only a small percentage of the overall waste fraction, hazards such as infections (bacteria, viruses, parasites, or fungi), sharps (hypodermic needles, scalpels, and infusion sets), radioactive waste, and chemicals (e.g., cytotoxic and genotoxic waste) can pose significant risks to workers as well as the community (WHO, 2016).
Reducing the risks
Pro-environmental behaviour change is important to reduce the quantity of waste produced in the first place. There is a need for awareness building in order to effect change in values, attitudes, and habits and ultimately in behaviours. If individuals are more aware of the potential hazards and benefits, then they are more likely to engage. In addition, products should be designed for recycling/reuse/remanufacturing. In this way, fewer raw materials need to be extracted, and the inherent value in the existing products is kept within the system.
The use of more environmentally sound waste disposal approaches/technologies and the recovery of value from that produced, especially organic waste, are vital steps to reducing health risks (World Bank, 2019). For example, there is a need to reduce the use of dumpsites and especially the dumping of hazardous materials at these sites (ISWA, 2016). In addition, climate change impacts can be reduced through the adoption of treatment and disposal technologies that capture biogas and landfill gas.
For healthcare waste, there has been an increasing focus on identifying suitable approaches to reduce both the risks and the costs associated with managing these risks (Caniato et al., 2015; Viani et al., 2016; Vaccari et al., 2018). Effective segregation of hazardous and non-hazardous waste is one of the most cost-efficient and effective approaches to reducing risks. Green procurement has for some time been viewed as a crucial tool within the healthcare sector for moving to a more circular approach (Bergsma and Sevenster, 2013). For example, at the international level. Health Care without Harm and the United Nations Development Programme (UNDP) developed the Sustainable Health in Procurement Project (SHiPP), a four-year project in 10 lower and middle-income countries. The project aims to develop and pilot a set of sustainable health procurement practices and policies. It will promote these policies and practices in the health sector and in the United Nations (UN) agencies. The project focuses on the reduction of toxicity of chemicals and materials in health products, the reduction of GHGs in the supply chain, and the conservation of resources.
There are a number of organisations, particularly in Europe and North America, which facilitate the sharing and reuse of used medical equipment (e.g., beds), as well as the sharing of medical services and facilities. These entities usually employ an online platform to enable stakeholders to either offer excess capacity of resources or request these resources.
Polyvinyl chloride (PVC), which is extensively used in healthcare settings, can be recovered, as it is a consistent, high-quality single plastic rather than being a multilayered composite plastic (PVC Med Alliance, 2016). Indeed, a number of PVC-based medical products are safely recycled and reprocessed into various products (e.g., hoses for fire extinguishers).
Finally, in some countries (e.g., in Germany and some states in the United States), reprocessing and reuse of medical devices is permitted, while in others, it is not (e.g., in Italy, France, and the United Kingdom). The use of the concept of designing for reuse (with appropriate sterilisation) and/or remanufacture can serve to reduce the use of single-use instruments.
While the focus for the discussion on the concept of the CE is often on waste reduction and value recovery, the extraction of raw materials and the management of waste are both associated with public and environmental health risks. There is a need, therefore, for a more holistic discussion that takes account of the potential benefits of also addressing these risks.
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