title: Inequalities, inequities, environmental justice in waste management and health.
abstract: BACKGROUND
  The scientific evidence on the health effects of waste-related exposure is not conclusive. Differential exposure to waste by socio-economic status (SES) is often documented, but the interplay between environmental and social factors, crucial for policy making, is not well known. This review aims at investigating the role of health inequalities and inequities in waste management.
  
  
  METHODS
  Grey and peer-reviewed literature, published after 1983, was reviewed from Europe and the USA.
  
  
  RESULTS
  Available data provide consistent indications that waste facilities are often disproportionally more located in areas with more deprived residents, or from ethnical minorities. This applies to waste incinerators, landfills, hazardous waste sites, legal and illegal. In studies considering health effects (mainly from Europe), risks are estimated with standardization for SES. Such standardization almost always decreases risk estimates for several cancers and reproductive outcomes. However, effect modification is not investigated in these studies.
  
  
  CONCLUSIONS
  The patterns of association between waste-related environmental pressures and SES suggest that some of the observed inequalities in exposure and health represent a case of environmental injustice as they are the result of social processes and may be prevented, at least partly. Disentangling the possible health effects remains difficult, due to limitations in the methodology. It seems important to investigate if disadvantaged people are more vulnerable, i.e. risks differ in different social groups living in the same area. Notwithstanding these open questions, public health officers and decision makers should identify waste management policies to minimize their potential health impacts and their unequal distribution.
authors.affiliation: World Health Organization (WHO) Regional Office for Europe, Rome Office, Rome, Italy. mam@ecr.euro.who.int
authors.forename: Marco
authors.initials: M
authors.lastname: Martuzzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Mitis
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D004781:Environmental Exposure / Q000517:prevention & control*; D054625:Healthcare Disparities; D006801:Humans; D012111:Residence Characteristics; D012935:Social Justice; D012959:Socioeconomic Factors; D014481:United States; D018505:Waste Management