The 'land of fires': epidemiological research and public health policy during the waste crisis in Campania, Italy

Abstract

The region of Campania, South Italy rose to prominence in the mid-2000s due to the illegal disposal of waste by the Camorra during the local waste management crisis. Several lines of evidence have identified a link between exposure to toxic waste and adverse health outcomes in the local populations. Critically, studies since 2017 have strongly suggested that this link is causal in nature. The uncertainty of evidence polarised the Italian epidemiological community and partly undermined the precautionary principle in public health policy, leading to years of delay in the deployment of appropriate interventions. The crisis also sparked concerns about pollution of soil, water, and agricultural products. The contrast between political responses and protests from local communities shows analogies with environmental emergencies of a larger scale. Beyond law enforcement actions to prosecute illegal waste disposal activity, future mitigation of risks for affected populations will require coordinated efforts in environmental policy (land reclamation, improved waste management) and public health (i.e. extensive epidemiological surveillance, screening and prevention programs). By summarising evidence over the last two decades, this review aims to construct a cohesive interdisciplinary narrative of the events in the Campanian waste crisis.

Keywords: Biomonitoring; Campania; Cancer mortality; Environmental exposure; Epidemiological risk; Illegal waste dumping; Indigenous knowledge; Precautionary principle; Public health; Toxic waste.

Figure 1

Hazardous waste disposal sites in the Campanian waste crisis [2007-8]. The density of contaminated waste sites is clearly highest in the Naples and Caserta provinces. Adapted from: Mazza A et al. Heavy Environmental Pressure in Campania and Other Italian Regions: A Short Review of Available Evidence. Int J Environ Res Public Health. 2018;15(1).

Figure 2

Age-adjusted SMRs in Campanian provinces (1998–2001). Data from: Mazza A et al. L. Illegal Dumping of Toxic Waste and Its Effect on Human Health in Campania, Italy. Int J Environ Res Public Health. 2015;12(6):6818-31.

Figure 3

Timeline of political responses to the Campanian waste emergency. Adapted from: Armiero M. Is there an indigenous knowledge in the urban north? Re/inventing local knowledge and communities in the struggles over garbage and incinerators in Campania, Italy. Estudos de Sociologia. 2014;1.