Evolution of occupational health risks among waste incinerator workers: A four-decade review.

This review synthesizes four decades of global research (1980 to 2025) on occupational health risks among workers in municipal, medical, and hazardous waste incineration facilities. It examines how evolving technologies, waste streams, and regulations have shaped exposure patterns and health outcomes. Early studies reported high exposures to dioxins and heavy metals, linked to respiratory illness, skin conditions, and potential cancer risks. While modern emission controls have substantially lowered exposures, especially in high-income countries, residual risks to the respiratory, cardiovascular, and neurological systems persist. Workers in low- and middle-income countries often face exposure levels comparable to those in developed nations during the 1980s and 1990s. Emerging hazards, including brominated flame retardants, per- and polyfluoroalkyl substances, and microplastics, add complexity to workplace risk. The review concludes that complete elimination of occupational risk is not a realistic objective and that residual risks require sustained surveillance, updated protections, and global cooperation to safeguard incinerator workers' health.