Editing Sewage sludge (section)

== Health risks ==
In 2011, the EPA commissioned a study at the [[United States National Research Council]] (NRC) to determine the health risks of sludge.<ref>{{cite web|url= https://www.commondreams.org/view/2012/03/18-2|title= New Toxic Sludge PR and Lobbying Effort Gets Underway|last= Jerving|first= Sara|date= 18 March 2012|website= CommonDreams|agency= PRWatch|access-date= 2 June 2017}}</ref> In this document the NRC pointed out that many of the dangers of sludge are unknown and unassessed.

The NRC published "Biosolids Applied to Land: Advancing Standards and Practices" in July 2002. The NRC concluded that while there is no documented scientific evidence that sewage sludge regulations have failed to protect public health, there is persistent uncertainty on possible adverse health effects.<ref>{{cite book|author= <!--Staff writer(s); no by-line.-->|url= https://www.nap.edu/read/10426/chapter/1|title= Biosolids Applied to Land: Advancing Standards and Practices|publisher= [[National Academy of Sciences]]|location= Washington, DC|year= 2002|isbn= 978-0-309-57036-7|doi= 10.17226/10426}}</ref> The NRC noted that further research is needed and made about 60 recommendations for addressing public health concerns, scientific uncertainties, and data gaps in the science underlying the sewage sludge standards. The EPA responded with a commitment to conduct research addressing the NRC recommendations.<ref>{{cite web|url= http://www.epa.gov/waterscience/biosolids/nrcreprestfs.htm|title= Use and Disposal of Biosolids|website= [[United States Environmental Protection Agency|EPA]]|access-date= 5 June 2017|archive-url= https://web.archive.org/web/20080326073717/http://www.epa.gov/waterscience/biosolids/nrcreprestfs.htm|archive-date= 26 March 2008|date= 2016-11-08}}</ref>

Residents living near Class B sludge processing sites may experience [[asthma]] or pulmonary distress due to [[bioaerosol]]s released from sludge fields.<ref>{{cite journal |doi=10.1093/annhyg/meg032 |title=Bioaerosol Health Effects and Exposure Assessment: Progress and Prospects |year=2003 |last1=Douwes |first1=J. |journal=Annals of Occupational Hygiene |volume=47 |issue=3 |pages=187–200 |pmid=12639832 |last2=Thorne |first2=P |last3=Pearce |first3=N |last4=Heederik |first4=D|doi-access=free }}</ref>

A 2004 survey of 48 individuals near affected sites found that most reported irritation symptoms, about half reported an infection within a month of the application, and about a fourth were affected by ''[[Staphylococcus aureus]]'', including two deaths. The number of reported S. aureus infections was 25 times as high as in hospitalized patients, a high-risk group. The authors point out that regulations call for protective gear when handling Class B biosolids and that similar protections could be considered for residents in nearby areas given the wind conditions.<ref name="LewisEtAl - Pathogens">{{cite journal |doi=10.1186/1471-2458-2-11 |year=2002 |last1=Lewis |first1=David L |last2=Gattie |first2=David K |last3=Novak |first3=Marc E |last4=Sanchez |first4=Susan |last5=Pumphrey |first5=Charles |display-authors=3|journal=BMC Public Health |volume=2 |page=11 |pmid=12097151 |title=Interactions of pathogens and irritant chemicals in land-applied sewage sludges (biosolids) |pmc=117218 |doi-access=free }}</ref>

In 2007, a health survey of persons living in close proximity to Class B sludged land was conducted.<ref name="KhuderEtAl-HealthSurvey">{{cite journal |doi=10.3200/AEOH.62.1.5-11 |title=Health Survey of Residents Living Near Farm Fields Permitted to Receive Biosolids |year=2007 |last1=Khuder |first1=Sadik |last2=Milz |first2=Sheryl A. |last3=Bisesi |first3=Michael |last4=Vincent |first4=Robert |last5=McNulty |first5=Wendy |last6=Czajkowski |first6=Kevin |display-authors=3|journal=Archives of Environmental & Occupational Health |volume=62 |pages=5–11 |pmid=18171641 |issue=1|bibcode=2007ArEOH..62....5K |citeseerx=10.1.1.534.8483 |s2cid=14867023 }}</ref> A sample of 437 people exposed to Class B sludge (living within {{convert|1|mi|km|adj=on}} of sludged land) - and using a control group of 176 people not exposed to sludge (not living within {{convert|1|mi|km|adj=on}} of sludged land) reported the following: {{quote|"Results revealed that some reported health-related symptoms were statistically significantly elevated among the exposed residents, including excessive secretion of tears, abdominal bloating, jaundice, skin ulcer, dehydration, weight loss, and general weakness. The frequency of reported occurrence of bronchitis, upper respiratory infection, and giardiasis were also statistically significantly elevated. The findings suggest an increased risk for certain respiratory, gastrointestinal, and other diseases among residents living near farm fields on which the use of biosolids was permitted."|sign=Khuder, et al.|source=''Health Survey of Residents Living near Farm Fields Permitted to Receive Biosolids''<ref name="KhuderEtAl-HealthSurvey" />}} Although [[cum hoc ergo propter hoc|correlation does not imply causation]], such extensive correlations may lead reasonable people to conclude that [[precautionary principle|precaution]] is necessary in dealing with sludge and sludged farmlands.

Harrison and [[Summer Rayne Oakes|Oakes]] suggest that, in particular, "until investigations are carried out that answer these questions (...about the safety of Class B sludge...), land application of Class B sludges should be viewed as a practice that subjects neighbors and workers to substantial risk of disease."<ref name="Cornell-Sludge" /> They further suggest that even Class A treated sludge may have chemical contaminants (including [[heavy metal (chemistry)|heavy metals]], such as [[lead]]) or [[endotoxin]]s present, and a precautionary approach may be justified on this basis, though the vast majority of incidents reported by Lewis, et al. have been correlated with exposure to Class B untreated sludge and not Class A treated sludge.

A 2005 report by the state of [[North Carolina]] concluded that "a surveillance program of humans living near application sites should be developed to determine if there are adverse health effects in humans and animals as a result of biosolids application."<ref>{{cite web|url=http://sludgevictims.com/NC-Human-health-risk.html|title=Human Health Risk|website= Sludge Victims|access-date= 5 June 2017|archive-url= https://web.archive.org/web/20160304121906/http://sludgevictims.com/NC-Human-health-risk.html|archive-date= 4 March 2016}}</ref>

Studies of the potential uses of sewage sludge around homes, such as covering lead-contaminated soil in Baltimore, have created debates over whether participants should have been informed about potential risks, when there remains uncertainty about those risks.<ref>{{Cite news |last=Heilprin |first=John |date=2008-04-14 |title=Sludge tested as lead protection in poor areas |url=http://archive.boston.com/news/nation/articles/2008/04/14/sludge_tested_as_lead_protection_in_poor_areas/ |access-date=2018-10-26 |work=Boston.com}}</ref>

The chain of sewage sledge to biosolids to fertilizers has resulted in [[PFASs]] ("forever chemicals") contamination of farm produce in Maine in 2021<ref>{{cite news |url=https://www.theguardian.com/environment/2022/mar/22/i-dont-know-how-well-survive-the-farmers-facing-ruin-in-americas-forever-chemicals-crisis |title='I don't know how we'll survive': the farmers facing ruin in America's 'forever chemicals' crisis |website=The Guardian |date=22 March 2022 |publisher=Guardian News & Media Limited |access-date=28 March 2022 |last1=Perkins |first1=Tom }}</ref> and beef raised in Michigan in 2022.<ref>{{cite web |url=https://abcnews.go.com/US/wireStory/toxic-forever-chemicals-found-michigan-farms-beef-82543453 |title=Toxic 'forever chemicals' found in Michigan farm's beef |website=abcNEWS |publisher=ABC News Internet Ventures |access-date=28 March 2022 }}</ref>  The EPA '''PFAS Strategic Roadmap''' initiative, running from 2021 to 2024, will consider the full lifecycle of PFAS including health risks of PFAS in wastewater sludge.<ref>{{cite web |title=PFAS Strategic Roadmap: EPA's Commitments to Action 2021-2024 |date=14 October 2021 |url=https://www.epa.gov/pfas/pfas-strategic-roadmap-epas-commitments-action-2021-2024 |access-date=2022-03-24 |publisher=EPA}}</ref>