Should we be concerned about how medical waste is disposed of?

Haverford, Pa.

Medical waste is defined as the "biological byproduct of the diagnosis, treatment or immunization of human or animal patients" and includes so-called "sharps" (needles and scalpels), lab cultures and stocks, blood and blood products and any other wastes generated from sick patients or patients with infectious diseases. Such wastes have traditionally been disposed of by burning, either onsite at large medical or veterinary facilities, or offsite by licensed contractors that specialize in handling infectious materials. In most cases, incineration has been found to be effective in neutralizing potentially infectious agents.

But incineration, whether for medical or other purposes, doesn’t come without its health and environmental risks. The process generates some highly noxious pollutants, such as mercury and dioxin. Despite modern pollution control equipment on smokestacks, some of this discharge becomes airborne, where it can foul the air and end up in waterways. And the incinerator ash left over after burning is usually sent to local landfills, where the pollutants can seep into soils and groundwater if not properly contained.

Given such problems, many of the nation’s largest medical waste incinerators have been shut down in recent years in the face of more stringent regulations promulgated under the U.S. Clean Air Act. In their place a wide assortment of alternative methods, including autoclaving (steam sterilization), chemical disinfection, irradiation and enzymatic (biological) processes have emerged. Today more than 100 different technologies are in use in place of incineration. Once medical waste has been decontaminated by any of these methods, it usually ends up in landfills alongside regular municipal solid waste.

Most of us never even thought about medical waste until it started washing up on beaches in New Jersey in 1987 and 1988 in an event that became known as the "Syringe Tide." The event hit the New Jersey tourism industry hard, costing it almost $1 billion in lost revenues. It also served as the basis for Barbara Ehrenreich’s book, "The Great Syringe Tide," and reportedly was the inspiration for the line "hypodermics on the shores" in Billy Joel’s 1989 hit, "We Didn’t Start the Fire."

While there were few if any cases of people getting sick from exposure to such waste on beaches — medical waste poses a far greater risk to health-care workers than to casual beachgoers — the events served as a wake-up call to federal and state governments charged with ensuring public safety. In response, Congress passed the Medical Waste Tracking Act (MWTA) in 1988, which classified different types of medical waste and called for the creation of a "cradle-to-grave" tracking system requiring medical facilities and waste haulers to account for the proper handling and whereabouts of the waste they handled.

Congress only funded MWTA for two years, but various states have since enacted their own laws and protocols based on standards set by the original legislation. Not surprisingly, the toughest laws are in place in New Jersey and other Northeast shoreline states.

CONTACT: Medical Waste Tracking Act of 1988, epa.gov/epaoswer/other/medical/mwpdfs/mwta.pdf.

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The history of paving dates back to Roman times if not earlier, but our modern society has taken the practice to the extreme. Originally conceived as a way to make dirt- and mud-covered thoroughfares passable, roads (and parking lots) now cover the majority of urban and suburban areas around the world. In the United States alone, pavement covers some 60,000 square miles, or about 2 percent of the nation’s total surface area. One out of every 10 acres of arable land is paved over.

Beyond larger issues like urban sprawl and the loss of farmland, paving itself is an environmental scourge, preventing the natural seepage of rainwater at the soil surface, and increasing the volume and speed of water run-off. The result is often severe soil erosion on adjacent unpaved areas. Also, paving reduces the total area through which the soil absorbs rainwater, forcing pollutant-laden run-off quickly to lower ground, increasing the risk of flooding accordingly.

Another environmental problem created by our overzealous application of asphalt is that, because the soil underneath paved areas absorbs very little water, natural aquifers below can dry up, reducing the overall amount of potable water available to people, wildlife and the larger ecosystem. Paving also prevents the growth of plant life and destroys wildlife habitat.

According to the nonprofit American Farmland Trust, which works to preserve farmland and promote healthier farming practices, Americans lose 3 acres of productive farmland to new paving every single minute of every day. The group reports that since the first Earth Day in 1970, the United States has lost more than 40 million acres of farmland to development. With Americans now spending upwards of $200 million a day building and rebuilding roads, such problems are only getting worse.

In response to such concerns, a diverse coalition of 170 community groups, individuals and businesses came together in 1990 as the Alliance for a Paving Moratorium (APM), with the goal of addressing the "tremendous environmental, social and economic damage caused by endless road building." The group charges that our society’s obsession with paving and road-building draws public funds away from alternative transportation projects in service to the automobile, destroys inner cities as it promotes sprawl, fouls the air and water, contributes to global warming and — because most asphalt is a product of fossil fuels — plays into ongoing conflicts in the Middle East.

Jan Lundberg, a former oil-industry insider and transportation policy analyst who helped create APM, sees a bright future in putting less emphasis on paving and roads: "Money would immediately become available for public transportation and making cities more walkable. It could also go toward refurbishing existing downtown buildings so that people could live in them. Parking lots could be de-paved to make gardens and parks. Cities can be pleasant places, you know."

CONTACTS: American Farmland Trust, farmland.org; "The High Costs of Paving," culturechange.org/issue19/high_costs.htm.

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