Read the attached article and answer the questions:

I only need half page

Attachment: E-Waste–A Global Hazard

1-What new terms were introduced?

2-What e-waste problems were presented?

3-What did you learn?

4-What can you do to help solve the e-waste problems?

ARTICLES AND REVIEWS

E-Waste: A Global Hazard

Devin N. Perkins, BS, Marie-Noel Brune Drisse, MS, Tapiwa Nxele, MS, and Peter D. Sly, MD

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ABSTRACT

Background: Waste from end-of-life electrical and electronic equipment, known as e-waste, is a rapidly growing global problem. E-
waste contains valuable materials that have an economic value when recycled. Unfortunately, the majority of e-waste is recycled in the
unregulated informal sector and results in significant risk for toxic exposures to the recyclers, who are frequently women and children.

Objectives: The aim of this study was to document the extent of the problems associated with inappropriate e-waste recycling
practices.

Methods: This was a narrative review that highlighted where e-waste is generated, where it is recycled, the range of adverse
environmental exposures, the range of adverse health consequences, and the policy frameworks that are intended to protect
vulnerable populations from inappropriate e-waste recycling practices.

Findings: The amount of e-waste being generated is increasing rapidly and is compounded by both illegal exportation and
inappropriate donation of electronic equipment, especially computers, from developed to developing countries. As little as 25%
of e-waste is recycled in formal recycling centers with adequate worker protection. The health consequences of both direct ex-
posures during recycling and indirect exposures through environmental contamination are potentially severe but poorly studied.
Policy frameworks aimed at protecting vulnerable populations exist but are not effectively applied.

Conclusions: E-waste recycling is necessary but it should be conducted in a safe and standardized manor. The acceptable risk
thresholds for hazardous, secondary e-waste substances should not be different for developing and developed countries. However,
the acceptable thresholds should be different for children and adults given the physical differences and pronounced vulnerabilities of
children. Improving occupational conditions for all e-waste workers and striving for the eradication of child labor is non-negotiable.

Key Words: children’s environmental health, developmental toxicology, electronic waste, e-waste, heavy metals

� 2014 Icahn School of Medicine at Mount Sinai. Annals of Global Health 2014;80:286-295

INTRODUCTION

The adverse consequences for health and the ecology
of exposure to waste products from human consump-
tion have long been recognized. A relatively recently
recognized hazardous waste product comes from dis-
carded electrical and electronic equipment (EEE).1

Such products contain costly components that have
economic value if recycled. However, EEE also con-
tains potentially hazardous substances that may be
directly released or generated during the recycling
process, generating what is known as e-waste. The

14-9996/ª 2014 Icahn School of Medicine at Mount Sinai

m the Department of Public Health, Environmental and Social De-
minants of Health, World Health Organization, Geneva, Switzerland
NP, M-NBD, TN); World Health Organization Collaborating Centre for
ildren’s Health and Environment, Queensland Children’s Medical
search Institute, The University of Queensland, Brisbane, Australia
S). Address correspondence to P. D. Sly.; e-mail: p.sly@uq.edu.au

e authors declare that they have no conflicts of interest. Staff members
WHO are responsible for the views expressed in this publication, which
not necessarily represent the decisions, policy, or views of WHO.

p://dx.doi.org/10.1016/j.aogh.2014.10.001

creation and release of hazardous byproducts often
occurs in the so-called “informal” sector of e-waste
recycling where modern industrial processes are not
used and where worker protection often is inadequate.
Unprotected exposure to e-waste is not advisable for
any individual. Of exposed groups, children are
particularly vulnerable to many of the components in e-
waste. In this article, we will review the scope of the
problem associated with discarded EEE and compo-
nent recycling, outline the regulatory approaches to
minimize adverse health effects, and highlight current
areas for improvement.

The Scope of the Problem: Defining,
Quantifying, and Tracking E-waste
EEE includes items that have either a battery or a power
cord. E-waste generated from discarded EEE is commonly
divided into 3 main categories: large household appli-
ances (refrigerators and washing machines), information
technology (IT) and telecom (personal computers, moni-
tors, and laptops), and consumer equipment (TVs, DVD
players, mobile phones, mp3 players, and leisure and
sporting equipment).2 Equipment components including
batteries, circuit boards, plastic casings, cathode-ray tubes,

mailto:p.sly@uq.edu.au

http://dx.doi.org/10.1016/j.aogh.2014.10.001

Annals of Global Health 287

activated glass, and lead capacitors also are considered to
be e-waste.2 There are varying estimates as to the amount
of domestic, regional, and global e-waste produced. Ac-
cording to StEP (Solving the E-waste Problem Initiative),
the 2012 global generation of e-waste totaled 45.6 million
metric tons.3 The United Nations Environmental Pro-
gram (UNEP) approximated that the amount of e-waste
produced in 2012 is enough to fill 100 Empire State
buildings and averages to more than 6.8 kg (15 lb) for
every living person. The global population is nearly 7
billion but although there are only 4.5 billion toilets
worldwide, there are estimated to be at least 6 billion
mobile phones.2,4 In 2012 alone, China reportedly
generated 11.1 million tons of e-waste and the United
States produced 10 million tons.5 This means that, on
average, each American generates 29.5 kg of e-waste
compared with the less than 5 kg per person in China.
These numbers likely underestimate the actual total
amounts of e-waste.

The sheer volume of e-waste is problematic, but more
concerning is the rapid increase of this complex, global
waste stream. E-waste is one of, if not the, fastest growing
source of waste worldwide.1,3,6,7 The 2012 UN report
projected that by 2017 global e-waste will increase a further
33% from 49.7 million to 65.4 million tons per annum.8

E-waste from cell phones in India alone is expected to in-
crease 18-fold by 2020.3,9 The total amount of e-waste
produced is exponentially increasing because of multiple
factors. Consumer demand and a high obsolescence rate
lead to frequent and unnecessary purchases of EEE.10 For
example, new cell phone models are released at highly
regular intervals. Not only do cell phone models evolve, but
the accessories, such as chargers, often change with each
new model. Short innovation cycles and low recycling rates
contribute to rapidly rising quantities of e-waste. The
acceptable consumer life span of EEE has been dropping,
causing significant additions to e-waste. The average life
span of computers has reportedly dropped in recent years
by 50% from 4 to 2 years.3,11 Computers and cell phones
are used for a wide variety purposes, including educational
campaigns where a laptop is provided to each student.
Computer access and skills are valuable to education but
such initiatives also have the unintended consequence of
adding to the global burden of e-waste.

E-waste is a global, interregional, and domestic
problem. Of the 20 million to 50 million tons generated
yearly, it is estimated that 75% to 80% is shipped to
countries in Asia and Africa for “recycling” and
disposal.12 Loopholes in current e-waste regulations
allow for the export of e-waste from developed to devel-
oping countries under the guise of “donation” and
“recycling” purposes. The Parties to the Basel Conven-
tion on the Control of Transboundary Movements of
Hazardous Wastes and Their Disposal (The Basel
Convention),13 launched The Partnership for Action on
Computing Equipment (PACE) to facilitate environ-
mentally sound management of used and end-of-life

computing equipment. Among other tasks, PACE has
provided guidelines on what functionality computers and
computer components, including batteries, should have
to be considered usable computers and, as such, suitable
for donation.14 According to PACE, a charitable dona-
tion is the “transfer of computing equipment or its
components, that are not waste, for their intended direct
reuse for purposes of charity without any monetary re-
wards or benefits, or for barter.”13,15 The UNEP
Guidelines on Environmentally Sound Testing, Refur-
bishment and Repair of Used Computing Equipment
provide a set of principles for donations of functioning
used computing equipment. These principles are to:

1. provide a useful product;
2. provide an appropriate product;
3. ensure and verify availability of technical support in

recipient community;
4. test, certify and label functionality;
5. ensure availably of training in recipient community;
6. ensure full transparency, contract, notification, and

consent prior to delivery; and
7. export in accordance with applicable national and

international controls.15

If followed as closely as possible, these principles
could drastically minimize the amount of end-of-life
computing equipment that is mislabeled and exported
as donated “functional used computing equipment” that
is really waste.15

Distinguishing between types of e-waste is essential.
The Basel Convention technical guidelines on trans-
boundary movements of e-waste and used EEE differ-
entiate waste streams based on functionality and the
need or potential for repair (Table 1).16 To test the
functionality of used EEE, specifically computing equip-
ment, one can conduct a Power on Self Test (POST).15

The final destination of nearly 70% of e-waste is
either unreported or unknown.17 Approximately 25%
(2.1 million tons) of the estimated 8.7 million tons of e-
waste produced in the European Union (EU) each year is
collected and recycled in formal processing plants where
workers are protected by modern industrial standards.
The remaining 75% is added to the “hidden flow” of
untraced and unreported e-waste.10 The European
Environment Agency estimates that up to 1.3 million
tons of discarded EEE are exported from the EU annu-
ally mostly to Africa and Asia.6 In 2005, 18 European
seaports were inspected and 47% of waste bound for
export was not being exported legally. In 2003, 23,000
metric tons of undeclared e-waste from the United
Kingdom was illegally exported to India, Africa, and
Asia.18 Eighty percent of e-waste generated in the United
States reportedly contributes to the global “hidden flow”
of e-waste; it is not registered meaning it is either unof-
ficially exported, dumped into landfills, or incinerated.19

The 20% of e-waste generated in the United States that is
formally recycled includes the “official” export of e-waste

Table 1. Classifying the Multiple Types of E-waste

Type of Stream Description Classification

New and functioning EEE New products or components being

delivered and shipped between

different countries.

This stream is classified as “non-waste”

by default (new products for

distribution).

Used and functioning EEE suitable for

direct reuse

The equipment needs no further repair,

refurbishment, or hardware

upgrading.

This stream can be classified as “non-

waste”; however, in some countries

export/import restrictions apply.

Used and nonfunctioning but

repairable EEE

Equipment that can be repaired,

returning it to a working condition

performing the essential functions it

was designed for. Testing is required

to determine this condition.

Classification of this stream is under

discussion by Basel Parties, as the

repair process may result in hazardous

parts being removed in the country of

repair, thus possibly resulting in

transboundary movement of

hazardous waste. Some countries

would classify this stream as “waste”;

others classify it as “non-waste.”

Used and nonfunctioning and

nonrepairable EEE

The common form of “e-waste.” Can

be mislabeled as “used EEE.”

Should be classified as “waste.”

WEEE EEE that is waste within the meaning of

the Waste Framework Directive

context, including components and

subassemblies.

Should be classified as “waste.”

EEE, electrical and electronic equipment; WEEE, waste electrical and electronic equipment.
(Adapted ref 16)

288 E-Waste: Global Hazard

to India and China.19 Official e-waste exports from the
United States encompass donated, and often defunct,
EEE.10

The practice of developed countries exporting e-
waste to developing countries has become commonplace
for a variety of reasons. High labor costs and stringent
environmental regulations for hazardous waste disposal
in developed countries encourage the exportation of e-
waste to less developed and less regulated countries.
Importing e-waste for recycling may provide some short-
term economic benefits. However, many developing
countries lack the technology, facilities, and resources
needed to properly recycle and dispose of e-waste.10 Re-
cyclers in developing countries that receive e-waste from
other countries frequently rely on rudimentary tech-
niques to extract valuable materials from e-waste.10 E-
waste is physically dismantled by using tools such as
hammers, chisels, and screw drivers.20 Printed circuit
boards are heated and components are removed.20 Gold
and other metals are recovered from the stripping of
metals in open-pit acid baths.20 Plastics are chipped and
melted without necessary and protective ventilation.20

Burning electrical cables, often in open pits and at
relatively low temperatures, to retrieve copper is one of
the most common crude recycling practices. Such prim-
itive techniques may appear efficient to the untrained
and less equipped recyclers, but they do not ensure
environmental protection or occupational safety. In fact,
these rudimentary methods may lead to the recovery of

materials that are only worth a fraction of the total po-
tential economic return. When developed countries
export e-waste for recycling, the opportunity to establish
more safe, clean, and efficient techniques is lost.

Sources of Exposure
E-waste recycling can lead to direct or indirect exposure
to a variety of hazardous substances that are contained in
EEE or formed and released by unsafe recycling practices
(Fig. 1). Direct exposure entails skin contact with
harmful substances, the inhalation of fine and coarse
particles, and the ingestion of contaminated dust. In-
dividuals who directly engage in e-waste recycling with
poor protection incur high levels of direct, occupational
exposure.3,21,22 Unsafe recycling techniques used to
regain valuable materials often increase the risk for haz-
ardous exposures. There often is a lack of suitable off-gas
treatment during such recycling processes, particularly
smelting.

Plastics are burned, often at low temperatures, to
either dispose of computer casings or to retrieve metals
from electronic chips and other components. Incinera-
tion releases heavy metals such as lead, cadmium, and
mercury.3,21,23 The toxic fumes released by these tech-
niques often contain polyhalogenated dioxins and furans
generated by incomplete combustion at low termper-
atures.3,18,23 Polystyrene form, rubber, tires, crop residue,
or biomass may be used as fuel for these fires and can
cause harmful exposures, independent of the burning

Figure 1. Potential Hazardous E-waste Exposures

Annals of Global Health 289

e-waste. Additionally, the working materials used in
rudimentary recycling can be injurious.3 Working mate-
rials include cleaning solvents and reagents such as cya-
nide and other strong leaching acids. Acid leaching can
lead to direct contact with liquid acid and the inhalation of
acid fumes.24 “De-soldering” of circuit boards to recover
rare and precious metals can release lead-saturated fumes.
The combination of toxic byproducts, working materials,
and the actual e-waste may lead to adverse health
outcomes.

Environmental contamination that is the result of
improper e-waste recycling can lead to indirect exposures
through contamination of soil, air, and water around e-
waste recycling sites. Water contamination has been
documented in areas surrounding e-recycling towns in
China; metal-contaminated sediments and elevated levels
of dissolved metals have been reported in rivers in and
around the e-waste recycling town of Guiyu.3,25,26 The
release of hazardous chemicals into the environment can
lead to bioaccumulation, food contamination, and
widespread ecological exposure.3,21,22 Children may be
exposed in schools, playgrounds, or homes that are near
an e-waste recycling site. Concern surrounding trans-
placental and breast milk exposure is high, although no

direct data on the levels of exposure exists.3,21,22,27

Environmental contamination and resulting ecological
exposure requires intensive research not only because
hazardous e-waste recycling materials have the ability to
spread far distances but they also possess high environ-
mental persistence capabilities. With longer half-lives,
these substances have the ability to remain in the envi-
ronment for extended periods.28 Ecological exposure
may have long-term and widespread health risks.3,23,29

An additional source of indirect exposure to toxi-
cants resulting from improper e-waste recycling processes
is “take-home exposure.”3 This exposure pathway refers
to secondhand exposure to hazardous substances
incurred, especially by children, when the substance is
brought into the home on clothing, materials, or other
objects that have been contaminated with harmful res-
idue from e-waste recycling.30 Take-home exposure has
the capacity to cause low-level, chronic, and long-term
exposure.

E-waste Recycling: Formal and
Informal Sectors
The final destination of discarded EEE is frequently not in
the same country or even on the same continent where the

290 E-Waste: Global Hazard

equipment was purchased or used. Exportation of e-waste
from developed to developing countries is common. It is
estimated that 23% of e-waste generated in developed
countries is exported to 7 developing countries.31 E-waste
recycling can be designated as part of the “formal” or
“informal” economic sector. Formal e-waste recycling en-
tails specially constructed facilities with proper equipment
that allow for the safe extraction of the salvageable mate-
rials. These facilities, for the most part, ensure safe working
conditions. Not surprisingly, these facilities are expensive
to build and run so they rarely exist in less developed
countries. Due to variable safety standards, some workers
in these facilities may still be at risk for low-dose expo-
sures.9 Despite proper construction and technique, the
surrounding communities may still be at risk for envi-
ronmental contamination and exposure.25,26,32,33

“Informal” e-waste recycling is typically characterized as
being beyond the reach of official governance, unregu-
lated, lacking structure, unregistered, and illegal.20

Developed countries sometimes export older EEE as
donations to developing countries. These electronics
often die sooner rather than later only increasing the
total burden of waste in the “donation”-receiving coun-
tries.34 The demand for imported foreign e-waste has
increased as under- or unemployed populations have
discovered the potential economic gains from recycling e-
waste. The demand in Asia for e-waste heightened when
scrap yards found they could extract copper, iron, silicon,
nickel, and gold. A mobile phone is 19% copper and 8%
iron.18 Countries where formal e-waste recycling has
been recorded include China,3,23 India, Vietnam,35

Pakistan, Malaysia, the Philippines, Singapore, Sri
Lanka, Thailand,6 and Kenya.36

Official e-waste recycling facilities should conduct
environmentally sound management (ESM).15 ESM is
defined as “taking all practicable steps to ensure that
used and/or end-of-life products and wastes are managed
in a manner which will protect human health and the
environment.”15 There are 7 designated ESM criteria:

1. top management commitment to a systematic
approach;

2. risk assessment;
3. risk prevention and minimization;
4. legal requirements;
5. awareness, competency, and performance measure-

ment;
6. corrective action; and
7. transparency and verification.15

Facilities and recyclers should strive to refurbish and
reuse discarded EEE. Dismantling and extracting valu-
able materials should occur only if reuse is not possible.
Within the e-waste recycling facility there are suggested
steps to ensure safe refurbishment or disposal (Fig. 2).
Facilities in the Organization for Economic Cooperation
and Development (OECD)-member countries should
follow recommendations from the OECD.15,37

Some companies offer free take-back services for old
electrical and electronic products. In China, for example,
Nokia and Lenovo were among the first companies to do
so.20 Despite the lack of a formal e-waste recycling network
in China, there are multiple certified e-waste treatment
plans in many of the major cities including 2 in Beijing, 6 in
Tianjin,7 inShanghai,4 inSuzhou,1 inHuizhou, and 1 in
Harbin.20 There are 2 e-waste recycling sites in China that
have been subject to a number of a studies on the potential
hazards of e-waste recycling: Guiyu in Guangdong province
and Taizhou region in Zhejiang province.3,21,38-41 These
towns typify e-waste recycling sites in China. Guiyu has
around 150,000 inhabitants and 80% of families are
involved in e-waste recycling.21 E-waste recycling reportedly
began in Guiyu in the late 1980s. Laqiao is a town of
400,000peopleinTaizhouandisthemaine-wasterecycling
site. At least 10% ofthe population in Laqiao participates in
e-waste recycling which first started in the 1970s.3,21 There
are also e-waste recycling sites in Bengaluru and Delhi,
India.22 West Africa has e-waste recycling sites in Nigeria
(Lagos) and Ghana (Accra, Agbogbloshie).3,6,29

The informal sector of e-waste recycling is well
supplied, mostly unregulated, and largely unknown.
Tracking the “hidden flow” of global e-waste is difficult
and costly. Informal e-waste recycling often is conducted
by people with little to no protective equipment or
technology.25,26 Informal e-waste recycling is often home-
based and family-run.15 Individuals, families, and com-
munities that dismantle e-waste often have made the
choice of poison over poverty.42

Some e-waste workers are not fully, if at all, aware of
the potential health risks involved with e-waste recycling.
Among some communities, e-waste recycling is considered
more desirable than scavenging through nonelectronic
waste. Much of the informal e-waste recycling done in
scrap yards and homes is done by children. E-waste is
informally processed in many countries, but a high-volume
of informal e-waste recycling has been reported in China,
Ghana, Nigeria, India, Thailand, the Philippines, and
Vietnam.43 China and India are among the countries
where the largest amounts of e-waste is informally pro-
cessed.6,29 In India, an estimated 25,000 workers are
employed at unregulated e-waste scrap yards in Delhi
alone, where 10,000 to 20,000 tons of e-waste is processed
annually. The informal sector thrives under slack envi-
ronmental regulation, high demand for second-hand EEE,
and home collection of used EEE by individual recyclers.
Some countries, such as China, do not have a municipal
e-waste collection network system in place.20 This absence
creates opportunities for home-based e-waste collection
and recycling. The informal and formal sectors of e-waste
recycling are interdependent. Not only is informal e-waste
recycling likely hazardous for human health and the
environment, but it also leads to supply deficiencies in the
formal sector.20 Currently, e-waste scavenging provides
a source of livelihood, albeit a risky one, to large numbers
of people in developing countries.13,44

Figure 2. Desired flow diagram for ESM of used EEE within a recycling facility. Abbreviations: EEE, electrical and electronic equipment;
ESM, environmentally sound management. (Adapted from ref 15.)

Annals of Global Health 291

Vulnerable Populations
Marginalized populations bear a disproportionate
amount of the negative effects of improper e-waste prac-
tices. Most e-waste recyclers, in either the formal or
informal sector, are poor and less educated than the
respective population average.12,44 E-waste recycling
provides a source of income for people who have few
other economic opportunities. E-waste recycling, espe-
cially in the informal sector, is geared toward high
throughput and output. Occupational safety and envi-
ronmental protection are not prioritized. Poor children
and women, especially those living in urban areas,
represent a large portion of e-waste recyclers.20 Due to
the gaps in data, particularly in the informal sector, the
total number of children exposed to occupational health
and safety risks from e-waste is difficult to estimate.3,6

However, the International Labor Organization has re-
ported that e-waste workers are often children.6,12,42,44

Children are considered ideal e-waste workers because
they have small, dexterous hands that help them easily
dismantle discarded EEE.

The exploitation of children within the e-waste
recycling industry is especially concerning given the
physiological attributes that contribute to a child’s
vulnerability. Exposures to hazardous substances, such as
polychlorinated biphenyls and dioxins, at e-waste sites
are higher for children than for adults. Children are still
growing so their intake of water, food, and air in pro-
portion to their height and weight is significantly higher
compared to the intake of adults.3,45 Children also have
a much larger ratio of surface area to body weight than
adults, resulting in an elevated risk for dermal absorp-
tion.3,45 Additionally, children have a decreased ability to
detoxify substances. During growth, a child’s developing

systems are significantly more sensitive to damage.
Children often spend more time outdoors where haz-
ardous exposures are within closer proximity. From
a behavioral standpoint, young children typically exhibit
hand-to-mouth behavior and crawl on the ground, which
predictably leads to the direct ingestion of potentially
harmful substances. Children have an underdeveloped
risk perception that can lead to harmful exposures from
e-waste.46 Finally, children have a longer life expectancy
during which they would live with the handicaps that
injuries or exposure to toxic substances can provoke.

Effects of Exposure
The short- and long-term effects of exposure to hazardous
e-waste substances are not fully understood, however,
there is research on the association between e-waste
exposure and higher levels of chemicals and metals in
human-derived biological samples.3,47,48 The toxicity of
many individual substances found in e-waste is well
documented, however, the toxicity of the mixtures of
substances likely to be encountered through e-waste
recycling is less well known. Heavy metals and haloge-
nated compounds appear to have a major influence on
potential health risks.3,24

The potential adverse health effects of exposure to e-
waste have been reviewed recently and may include changes
in lung function, thyroid function, hormone expression,
birth weight, birth outcomes, childhood growth rates,
mental health, cognitive development, cytotoxicity, and
genotoxity.3,28,43 It is also possible that exposure to haz-
ardous chemicals produced by e-waste recycling may have
carcinogenic effects and endocrine disrupting properties
that could lead to lifelong changes dueto neurodevelopment
anomalies, abnormal reproductive development,

292 E-Waste: Global Hazard

intellectual impairment, and attention difficulties.28,49

Elevated levels of 8-hydroxydeoxyguanosine, a urinary bio-
maker of generalized, cellular oxidative stress, were observed
in the post-work-shift urine of e-waste workers.47 One study
of Chinese e-waste workers documented significantly higher
levels of serum polybrominated diphenyl ethers (PBDEs)
and thyroid-stimulating hormone (TSH) than found in the
control group.48 The increased exposure to PBDEs from e-
waste recycling may lead to interference with the thyroid
hormone system and other adverse health effects.48

Decreased lung function has been observed in boys aged
8 to 9 years living in an e-waste recycling town but not in
boys living in a control town.43 Significant negative corre-
lations between forced vital capacity, a measure of lung
function, and blood chromium concentrations have been
reported.43 Lead is also an established neurotoxicant that
can lead to intellectual impairment and damage to the ner-
vous, blood, and reproductive systems. Research findings
indicate there is no threshold below which lead exposure
does not have adverse effects on a developing nervous sys-
tem.3,50 Brominated flame retardants have a long half-life
and reportedly lead to impaired learning and memory
function; altered thyroid, estrogen, and hormone systems;
behavioral problems; and neurotoxicity. Cadmium tends to
bioaccumulate and can be highly toxic, especially to kidneys
and bones. Mercury is thought to cause damage to the brain
and central nervous system, particularly during early devel-
opment. The number of harmful substances that humans
could be directly or indirectly exposed to by e-waste is vast
and difficult to quantify. The concentrations of these ma-
terials are variable but often are notably high, especially
within the actual e-waste sites. Even if the concentrations of
these substances are low, the chemicals are often still toxic to
humans and persistent in the environment. The heteroge-
neous nature of hazardous exposures contributes to the
difficulties surrounding the study of the effects e-waste
exposures.

There are additional aspects of e-waste exposure that
may lead to adverse health outcomes. Even if daily
exposure is low, cumulative exposure is often high and
extremely hard to measure.3,21 Even when the effects of a
single chemical at certain levels are well studied the ef-
fects of the mixtures of hazardous e-waste substances are
not well known. Within a mixture of chemicals, some
substances may have synergistic or modifying effects that
could be extremely harmful.3,22 The reagents used in the
recycling process, such cyanide and other strong leaching
acids, may contribute to the hazardous chemical e-waste
mixtures. Not only do the daily and cumulative doses of
exposure matter when calculating risk, but also the
timing, or “life stage of exposure” is highly significant.51

Clearly, dismantling e-waste can also directly lead to
injury. Certain individuals, such as children, are more
vulnerable given the sensitivity of their developing sys-
tems. The timing of exposure also may indicate the ex-
pected duration of certain resulting health effects of
exposure.

Much research is needed on e-waste exposure and
potential adverse health effects. Strong evidence that
links occupation exposure of hazardous e-waste sub-
stances to health effects is lacking. The potential causal
relationship between exposure and observed negative
effects requires additional, extensive research. Also, the
combination of e-waste secondary chemicals and bio-
logical agents is unknown. For example, the interaction
between lead and mercury with the malaria parasite re-
quires further investigation.52 On a very basic, human
level, research and development of treatment measures
for those exposed to hazardous e-waste materials is
essential. Research on e-waste hazards can be limited by
poor access to uncontrolled settings, limited resources,
and political and ethical concerns. Monitoring and sur-
veillance, especially of informal e-waste recycling opera-
tions, is sparse. Despite these research obstacles, further
studies are vital. Not only are risk assessments of e-waste
exposure critical, but also research that will help informal
local, regional, and global e-waste recycling policy is ur-
gently needed.

How the Health Care Sector
Contributes to E-waste
By definition, health care waste encompasses all waste
produced from health care facilities, research centers,
and laboratories, as well as waste from medical activities.
Approximately 80% of the waste generated by health care
facilities is similar to general, domestic waste and is
considered “nonhazardous.” The remaining 20% is
considered “hazardous” as it may pose a chemical,
radioactive, or physical hazard to the environment and to
human health. Although the common form of health
care waste includes syringes, needles, and expired phar-
maceuticals, it is the discarded electrical health care
equipment that comprises health care e-waste.53 Health
care facilities use, and thus discard, more specialized
medical devices and equipment. Examples of such
include, but are not limited to, sphygmomanometers,
electrocardiograms, spectrophotometers, and micro-
scopes.54 Some of these devices and appliances come
into direct contact with various chemicals and biologic
agents that may be harmful to human health. Before
disposal, medical equipment requires technical and safe
treatment,55 which includes disinfection before repair or
recycling.54 More research on the management practices
of health care e-waste is essential.

There is a global effort, prompted by the Minamata
convention,56 to discontinue the use of mercury in health
care by 2020. Mercury-containing thermometers and
sphygmomanometers are being replaced with their
respective electronic counterparts. This system-wide
replacement of mercury-containing devices may, in the
long run, increase the amount of health care e-waste.
Health care facilities management needs to consider the
life span of the medical devices they procure and then
discard. E-waste management must be integrated into

Annals of Global Health 293

hospital management policies and plans. It is also essential
that health care facilities establish waste registers for their
EEE alongside the nonelectrical medical equipment in-
ventories.57 Health care facilities, organizations, providers,
and professionals must not only follow proper e-waste
management procedures but they must also encourage the
use of regulated and safe e-waste recycling paths in an effort
to ensure health at all levels.

E-waste Regulation and Policy
In the past, most e-waste regulations have been prompted
by and focused on environmental protection. Recently, e-
waste guidelines have been adopted and enforced because
of human health concerns.43 The 1989 Basel Convention,
which has been ratified by 181 countries, prohibits the
export of e-waste.14 Despite export regulations this
convention has a loophole that permits e-waste exportation
if it is intended for “re-use.” This detail leads to a large
quantity of near end-of-life EEE being exported. These
older electronic products have short life spans, if any at all,
once they reach the export countries. As a result, the e-waste
designated for “re-use” only ends up contributing to the e-
waste problem in the developing, recipient countries.42

Within the EU, the Waste Electrical and Electronic
Equipment Directive requires manufacturers and im-
porters within member states to take back their products
from consumers and ensure sound environmental
methods are used to dispose of the e-waste.7,17

One of the first steps toward e-waste regulation was
made in 1988 when 4000 tons of toxic waste from Italy
was dumped in Koko Port, Nigeria. This led to the
promotion of the Harmful Waste Decree 4, which
criminalized the transportation, deposit, import, selling,
buying, or negotiating that involved trade of harmful
waste in Nigeria. Failing to abide by this decree could
lead to a life sentence in prison. Nigeria had a notable
influence on the text of the Basel Convention and was
also the first African country to sign and ratify the
agreement.58 Despite these actions, Nigeria currently
faces considerable threats from e-waste. The Bamako
Convention on the ban of the import into Africa and the
control of transboundary movement and management of
hazardous wastes within Africa is a treaty among African
countries that prohibits the import of hazardous wastes
into member countries.17

Several initiatives have attempted to raise awareness
of the need for appropriate regulation to protect against
the health consequences of improper e-waste recycling
practices, including the following:

� the Libreville Declaration framed during the first Inter-
Ministerial Conference on Health and Environment
in Africa in 2008;

� the Busan Pledge for Action on Children’s Environ-
mental Health (2009);

� the Strategic Approach to Integrated Chemical Man-
agement’s expanded Global Plan of Action, issued at

the International Conference on Chemical Manage-
ment (2012); and

� the Geneva Declaration on E-waste and Children’s
Health (2013).

A growing number of international organizations
and initiatives have been formed to encourage adequate
monitoring and regulation e-waste recycling, including
the StEP Initiative; the Basel Action Network; the Silicon
Valley Toxics Coalition; Toxics Link India; SCOPE
Pakistan; and Greenpeace China. UNEP, United Na-
tions University (UNU), PACE, the Federal Ministry for
the Environment (Germany), the Nature Conservation
and Nuclear Safety (Germany), and the National Insti-
tute of Environmental Health Sciences (US) are all
involved with international research, advocacy, and
regulation.34 The World Health Organization’s Chil-
dren’s Environmental Health team is working on e-waste
and the effects on child health. This coordinated effort
seeks to raise awareness, develop tools, and investigate
solutions to children’s exposures.34

There are several suggested methods to help guide
the improvement and strengthening of e-waste policy.
These methods entail Extended Producer Responsibility
(EPR), Life Cycle Assessment (LCA), Material Flow
Analysis (MFA) and Multi Criteria Analysis (MCA).10

EPR promotes the “3 Rs”: “Reduce, Reuse, and
Recycle” and shifts the responsibility of safe e-waste
recycling pathways from the municipal authorities to the
producers.59 As defined by The OECD this environ-
mental policy approach provides a strong incentive for
companies to produce easily recycled and less toxic
electronics.59 EPR is difficult to implement given the
resistance of financially endowed producers. The LCA
uses a “cradle-to-grave” approach to consider the envi-
ronmental and total impact of a specific product. Ob-
stacles arise from the lack of inventory data, particularly
in developing countries, which is required to complete
this assessment. The MFA traces a substance from pro-
duction to application to recycling and disposal. As ex-
pected, it can be challenging to trace products. The
MCA is a critical analysis tool for decision making as it
provides a complete picture of alternative scenarios and
solutions. Criteria are ranked according to shared pri-
orities. With this technique, stakeholders can weigh the
cost and benefits for all involved parties. Regulating
recycling, particularly within the informal economic
sector, is challenging. Banning informal recycling is
typically ineffective because the practice is easily relocated
due to the nonexistent requirements on labor or facil-
ities. Incentive-based policies that protect human health
and the environment must be proactive and practical.

CONCLUSION

E-waste recycling is necessary but it should be conducted
in a safe and standardized manor. When possible, e-

294 E-Waste: Global Hazard

waste should be refurbished and reused as a complete
product instead of dismantled.15 When refurbishment in
not possible, e-waste should be dismantled by trained,
protected, and well-compensated workers in technologi-
cally advanced e-waste recycling facilities in both devel-
oped and developing countries.42 There are several
fundamental principles from which all e-waste regulation
should be based on. First, acceptable risk thresholds for
hazardous, secondary e-waste substances should not be
different for developing and developed countries. How-
ever, the acceptable thresholds should be different for
children and adults given the physical differences and
pronounced vulnerabilities of children.51 Completely
eliminating the presence of toxic components in EEE,
although efficient, is not realistic. Although there are
research needs, educational and awareness programs on
the potential risks of e-waste recycling also should be
developed and implemented. These programs are of vital
importance in developing countries.51 Improving occu-
pational conditions for all e-waste workers and striving
for the eradication of child labor is non-negotiable. In-
terventions should be specific to the local culture, the
geography, and the limitations of the particularly
vulnerable communities. Policies that would provide in-
centives to promote safe, regulated, and recompensed
recycling for e-waste should be universal.42

ACKNOWLEDGMENTS

The authors acknowledge Federico Magalini (UNU)
and, Matthias Kern (UNEP), Evelyn Kortum (WHO),
and Graham Alabaster (WHO) for their contributions.

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