World Health Organization (WHO) Regional Office for Europe, Rome Office, Rome, Italy.
Eur J Public Health. 2010 Feb;20(1):21-6. doi: 10.1093/eurpub/ckp216. Epub 2010 Jan 8.
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.
Grey and peer-reviewed literature, published after 1983, was reviewed from Europe and the USA.
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.
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.
与废物相关的暴露对健康的影响的科学证据尚无定论。社会经济地位（SES）导致的废物接触差异通常有记录，但对于政策制定至关重要的环境和社会因素之间的相互作用却知之甚少。本综述旨在探讨健康不平等和不平等在废物管理中的作用。
综述了欧洲和美国 1983 年以后发表的灰色和同行评议文献。
现有数据提供了一致的证据，表明废物处理设施通常更多地位于居民贫困程度较高或少数民族聚居的地区。这适用于垃圾焚烧炉、垃圾填埋场、危险废物场所、合法和非法的。在考虑健康影响的研究（主要来自欧洲）中，使用 SES 进行了标准化来估计风险。这种标准化几乎总是会降低几种癌症和生殖结果的风险估计值。但是，这些研究没有调查效应修饰。
与废物相关的环境压力与 SES 之间的关联模式表明，暴露和健康方面观察到的一些不平等现象代表了环境不公正的情况，因为它们是社会过程的结果，至少可以部分预防。由于方法学的限制，很难厘清可能存在的健康影响。研究弱势群体是否更容易受到影响（即不同社会群体在同一地区生活时风险是否存在差异）似乎很重要。尽管存在这些悬而未决的问题，但公共卫生官员和决策者应确定废物管理政策，以最大程度地减少其潜在的健康影响及其不平等分配。
