On 24 January 2014 at the World Economic Forum in Davos, the EU, together with 13 other WTO members pledged to launch negotiations to liberalise global trade in environmental goods (EGs). The negotiations are employing the Asia-Pacific Economic Cooperation (APEC) list of environmental goods as a starting point with the intent of expanding it to liberalise a 'broad range of additional products'.1 The relevance of the agreement in terms of the size and scope of potential impacts is significant: states currently engaging in the plurilateral negotiations (the G-17)2 account for approximately 90 per cent of global trade in the environmental goods sector.
Medical waste, management and disposal
Waste generated by health care activities includes a broad range of materials, from used needles and syringes to soiled dressings, body parts, diagnostic samples, blood, chemicals, pharmaceuticals, medical devices, heavy metals and radioactive materials. According to the World Health Organisation (WHO), approximately 20% of the waste generated by health care activities is considered hazardous material that may be infectious, toxic or radioactive839. Poor management of health care waste potentially exposes health care workers, waste handlers, patients and the community to harm, and risks polluting the environment. It is therefore essential that all medical waste materials are segregated at the point of generation, appropriately treated and disposed of safely.
At present, there is no generally accepted international (ISO) standard for general medical waste management and disposal. While the WHO has issued a number of guidance documents, including the Safe management of wastes from health-care activities840 and supporting tools for medical waste managers and policy-makers, medical waste management and disposal is governed country-by-country and standards differ. There are several options available to dispose of medical waste, each with their own benefits and risks:
- Incineration: According to the United States Environmental Protection Agency (EPA), over 90% of medical waste in the United States is incinerated841 which creates greenhouse gas (GHG) emissions. Accordingly, the EPA promulgated emission standards for medical waste incinerators (MWIs) built after June 20, 1996. Incineration, particularly when poorly operated, releases other pollutants into the air, including volatile metals, and known carcinogens such as dioxins842.
- Autoclave: Autoclave and other steam disinfection treatment produce post-treatment water containing various contaminants that are discharged into sewage systems843.
- Landfill: Disposal in landfills can contaminate ground water and drinking-water sources if the facility is not properly constructed844. Occupational risks exist for workers and people on site at disposal facilities that are not well designed, run, or maintained845.
Given the public health and environmental risks posed by current waste disposal options, the WHO has called for longer term solutions that reduce the externalities of medical waste disposal. The WHO has called for scaled-up promotion of non-incineration technologies to prevent the disease burden from: (a) unsafe health-care waste management; and (b) exposure to dioxins and furans846. Emerging technologies include microwave and ozone for sterilizing, and alkaline hydrolysis and supercritical water oxidation for treating chemical and pharmaceutical wastes847.