Prioritizing dumpsite risks and interventions: an overview and framework for action with a focus on LMICs.

Dumpsites represent a major environmental and public health challenge, particularly in low- and middle-income countries (LMICs). Despite increasing global waste generation, many regions still struggle to implement safe and sustainable waste management practices, resulting in significant pollution, greenhouse gas emissions, and health risks due to uncontrolled waste disposal. Dumpsites lack containment measures, allowing pollutants to migrate through environmental matrices and reach different targets (e.g., human receptors). The primary objective of this review was to evaluate existing risk assessment procedures and propose a research direction for a standardized human health risk assessment (HHRA) methodology to prioritize interventions, starting with the most dangerous dumpsites in a given territory. The paper begins by presenting an overview of dumpsites, followed by a discussion on the pathways through which pollutants may migrate from dumpsites to human receptors and the associated health risks. Citing case studies, we explore the available environmental and health risk assessment methodologies, identifying and discussing key characteristics appropriate for dumpsites with a focus on LMICs where such sites are widespread and appropriate approaches are necessary. We identify and further discuss the relative HHRA as the most practical and reliable approach. We conclude with recommendations on research and policy.