Waste Management and Health in Rural Cambodia
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Proper waste management in any community is crucial for the health of the citizens and the environment. Communities lacking proper waste management techniques, such as recycling of paper and plastics, composting of leftover food, and regulating a waste disposal system, are forced to turn to other means of disposal to prevent the build-up of waste. These methods often include burning plastic, leaving waste in fields or water sources, and collecting waste around living areas. Consequently, food, water, and air become contaminated. Although the danger caused by improper waste management is well known, identification and analysis of the consequences of poor waste management in rural Cambodia and the ensuing issues pertaining to public health remain to be elucidated. The purpose of this study is to provide evidence for the need of a proper waste management program in the Takéo Province of Cambodia by highlighting the primary negative health effects and environmental damage that have transpired as a result of the accumulation and burning of excessive waste. This was conducted through a survey of 55 individuals across 11 villages throughout the Takéo Province. The most predominant finding was that plastics that could be recycled are, instead, causing detrimental health effects and adding to environmental damage along rivers and in fields. It is hopeful that this study will help with the understanding of the waste management problem in developing countries and eventually pave the way for possible solutions.
Keywords: environment, rural, waste management, plastic, Cambodia
In the last decade, especially with the rising presence of climate change, developed countries around the world have strived toward better methods of waste management, including recycling, composting, and regulating a waste disposal system (Matteson, Graves, Hall, Kuy, & Polizzotto, 2016). This task, however, is remarkably more difficult for communities in developing countries for various reasons: lack of clean drinking water (Davies et al., 2015; Matteson et al., 2016; Phan et al., 2019), increased air pollution (Jamrozik & Musk, 2011), and subpar hygiene and sanitation (UNICEF Cambodia, 2019). Ultimately, these issues make it more difficult to allocate time and money toward waste management. Pollution or contamination from landfills (Seng, Hirayama, Katayama-Hirayama, Ochiai, & Kaneko, 2013), burning of plastic, and waste around living areas add to the negative health effects that are already widespread. Cambodia is a developing country that suffers from many of these issues, and their health and environmental well-being would drastically benefit from the implementation of a better waste management system.
In developing countries with agriculturally based economies, such as Cambodia (Barbier, 2010), harmful dioxin chemicals released from waste settled in crops or around waterways pose a cascade of problems ranging from adverse health effects to contamination of the air (Verma, Vinoda, Papireddy, & Gowda, 2016). Air pollution also from noxious gases, a large contributor to asthma, respiratory disease, and lung cancer, not only comes from vehicle and industry emissions, but also from the burning of plastics and wood, coal, or other solid fuels. In addition, burning plastic releases carcinogens into the atmosphere. Those who inhale such chemicals may suffer from dizziness, cough, headaches, and eye damage (Verma et al., 2016). The burning of waste greatly affects the health of individuals and dangerously harms the environment by liberating hazardous halogens, which directly contributes to climate change (Verma et al., 2016). This path of harmful effects will not cease until a more environmentally friendly method of waste management is implemented.
Currently, landfills are the preferred method of waste disposal in the more developed Cambodian cities of Phnom Penh and Siem Reap due to their low cost and ability to accommodate large areas. This approach, however, is not sanitary or environmentally friendly. Transmission of disease, emission of greenhouse gases, and contamination of soil and water arise from the uncovered waste (Seng et al., 2013). Ninety percent of the impoverished population of Cambodia resides in small villages (Ginn, 2019), and here the state of waste management is far worse, as there are no landfills. Instead, piles of waste sit outside homes, in rice fields, and on roads. Although the prevalence of improper waste management and the negative health effects that come from it are well known by researchers, a direct etiology for the problem and how it escalates remains to be elucidated. The aim of this study is to utilize a survey of 11 villages in the Takéo Province of Cambodia to evaluate the primary causes of the escalating waste management problem and the predominant health and environmental effects in this community.
The study was conducted as an in-person survey in the Takéo Province of Cambodia. In each of the 11 villages, five to six citizens were surveyed, with a total N = 57. All participants were residents of the respective villages they were interviewed in. Participants were randomly selected when visiting each village.
A qualitative survey was conducted because the primary objective was to discover the root of the waste management problem in this small rural community and to analyze the problems that the citizens felt were the most troublesome.
The survey consisted of seven yes or no questions, six a–d multiple choice questions, six open response questions, and one Likert-type rating scale with the range from 1 to 10. Questions and answers were asked and written in Khmer. The answers were later translated to English by a fluent English/Khmer bilingual speaker.
Questions included general demographics about health (e.g., “How many times do you go to the doctor? How many people live in your home?”) and specific waste management–related topics in the participants’ homes (e.g., “Do you have a trash can in your home? Do you know how to recycle? Are you aware of the negative health effects of burning plastic?”).
Data were analyzed to determine the average responses and standard deviations for the Yes (1) or No (0) questions. Open response answers were compared and the top 2–3 most common answers were recorded, which is further discussed in the “Results” section.
Results and Discussion
Of the 57 participants interviewed, 59% were female. Ages of participants ranged from 15 to 78 years, with an average age of 51 years. Seventy-five percent of participants reported having more than five people living in their home, 18% reported three to four people, and 7% reported only one to two people. When asked about basic health, 21% of participants reported that they never go to the doctor and 34% reported that they go to the doctor more often than twice a year for health ailments. Forty-three percent of participants reported that they never go to the dentist, yet one of the top concerns reported in family health was toothaches or tooth-related pain.
The most frequently reported disposed-of item was plastic (Figure 1). After conducting interviews and visiting the villages, the interviewers were not surprised with this result as they saw plastic sitting in roads, homes, and fields undisposed of until burned. This, unfortunately, is a very common situation in many rural areas of developing countries. Typically, there are not reliable landfills or recycling methods, so citizens are forced to burn it (Hyntze, 2019). Of the 50% of participants who reported not having a trash can in their home, all of them said that they burn their trash instead. Interestingly, though, participants were asked questions about their personal knowledge surrounding proper waste management techniques, and more than 90% reported understanding the negative health effects of burning plastic. After this question, many responded that they “do not have a choice” in their disposal of the plastic.
The immediate environmental and health effects due to this burning and accumulation of plastics are extremely apparent from the open response questions asked. When asked what their top concerns in their community or families were, they answered most frequently with a bad environment, such as “poor air or water quality and lack of good food,” and poor health conditions, including “headaches, cough or sore throats, repeated illness, and eye problems.”
In relation to the environment, incineration of plastics releases extreme amounts of carbon dioxide, a greenhouse gas (North & Halden, 2013). This release contributes directly to the rising issue of global warming, which countries, such as Cambodia, are highly vulnerable to (Davies et al., 2015). Along with this comes more flooding and monsoons during the rainy season, which impairs the ability to grow crops and sustain farms that are integral to the lifestyle and economy in Cambodia. More than 80% of Cambodia’s population of 15.14 million live and work in the rural floodplain regions of the country’s 24 provinces (Chhun, 2011). As such, increased flooding and monsoons detrimentally affect their livelihood. Also, leaving plastic near fields and around water sources contaminates ingested food and drink. Microplastics are capable of entering food and water sources, which can be toxic and carcinogenic (Verma et al., 2016). Although burning plastic is an exceptionally dangerous process, leaving plastic in rice fields or along rivers is not a viable solution either.
In relation to health, all of the conditions reported, including headaches, cough, repeated illness, and eye problems, are evidence of poisoning from plastic contaminants in the air (Ginn, 2019). Of concern is 32% of participants reported going to the doctor more than twice a year for health ailments. There could be extraneous factors contributing to health issues, such as dust in the air from unpaved roads, illness due to bacteria or fecal contamination in the water, or stomach issues and a weakened immune system due to malnutrition (Ginn, 2019). However, as evident from the excess plastic burning and piles of plastic bottles around homes, the improper disposal of this only adds to the health disparities that are already prevalent. From consumed microplastics to toxic chemicals in the air, surpluses of plastic present the opportunity for more cancer, disease, and illness.
The total amount of plastic worldwide has reached 8.3 billion metric tons, and Cambodia’s capital city of Phnom Penh alone uses more than 10 million plastic bags each day (Beresford, Jensen, Edgar, & Sargren, 2018). The environmental effect from this collection is insurmountable. Although Cambodia is starting to implement regulations, such as charging for plastic bags at supermarkets, clean-up efforts to solve the existing problem of plastics in waterways has been slow to catch up. Water contamination here (Matteson et al., 2016; Phan et al., 2019) could be a possible reason for the excess amount of water bottles. Without water running through a system to drink from homes, communities are forced to use purchased plastic water bottles and water tanks. Leaving plastic in waterways only worsens this issue, as local sources of clean drinking water become further polluted.
Knowledge of Waste Management
Recycling and composting are common, yet efficient, methods to manage waste in developed countries. These methods, however, are rarely employed in Cambodia. As previously mentioned, burning of waste, particularly plastic, is the most popular method of disposal in the country (Hyntze, 2019). That being said, it is not surprising that when participants were asked whether they knew how to recycle, only 30% responded “yes.” In terms of knowing how to compost, the percentage of participants who responded “yes” increased to 54% (Figure 2). Nevertheless, a need to promote and implement recycling and composting in communities across Cambodia exists.
For the participants who did not know how to recycle or compost, another question was asked to determine their overall awareness of the terms. Of the participants who did not know how to recycle initially, 44% have heard of the term before. Of the participants who did not know how to compost initially, 50% have heard of the term before. So, there is a sizable proportion of the participant population who have never heard of both or either of the terms.
This lack of awareness for recycling and composting can be attributed to the country’s poverty and minimal opportunities in education (Barbier, 2010; Khidhir, 2019). Receiving quality or even basic education in Cambodia is a major challenge, especially for rural families who do not have enough money to send their children to school. Instead of attending school, most children spend their time assisting their families with farm work, domestic duties, or businesses.
Although recycling and composting rates have increased over the past few years, proper waste management remains an issue in Cambodia and countries similar to it (Environmental Protection Agency [EPA], 2019). Fortunately, initiatives supporting recycling and composting have appeared. One initiative comes from the nonprofit organization, Green Umbrella, which is located in the same area where the study was conducted—the Takéo Province. Green Umbrella’s impact on the community stems from a bottom-up method of education, meaning that they are teaching the youngest children of the villages about the importance of health, the environment, and waste management. These dedicated students then bring this knowledge to the less educated population and will eventually be old enough to initiate their own recycling and composting projects.
Living Conditions and Waste Management
Of all the participants surveyed, more than 75% reported that they have over five people living in their homes, despite the fact that only 43% of participants reported owning a trash can in their home. Compared to an average of 2.58 members per household in the United States (Khidhir, 2019), the average household size in Cambodia is 4.6 (EPA, 2019). Although the average household size is almost double than that in the United States, about half of the participants interviewed do not have a single trash can in their home. Many reported just “leaving a pile [of waste] in the backyard” or “burning the waste when it gets to be too much.”
Another interesting finding was that the most common responses for the amount of times waste is disposed of were either once a day or once every 2–3 days (Figure 3). It was evident that there is enough garbage accumulated to be disposed of from the home, but there is simply no safe or sanitary way to do so. The aforementioned dangers of burning plastic add to the already prevalent health and environmental disparities. In such tight living conditions, and in many homes without power or a water purification system, the accumulation of waste in these areas only compounds this problem.
Living with plastics and decaying food scraps can cause a variety of health problems in itself. Plastics are capable of releasing carcinogens, carbon dioxide, and various substances that are harmful to the health of those left around it. Disposed-of or rotten food can attract bacteria, microbes, and insects that are capable of carrying disease (Byrd-Bredbenner, Abbot, & Quick, 2010). Containing all of this within the house is inevitably detrimental to health.
This study presents a snapshot of the waste management problem and its impact on health and the environment in one Cambodian community. It does not include the urban population, so we cannot speak for the entire country, but it does help clarify some of the sources of the problem and the extent of its effects. It does, also, have the potential to be generalizable to rural populations in surrounding countries. Plastics and paper that could be recycled are, instead, causing detrimental health effects and adding to the cycle of environmental damage along rivers and in fields. As the water quality in Cambodia is not reliable for consumption, communities are forced to use excessive amounts of plastic water bottles and water tanks to stay hydrated. This surplus contributes the most to the waste that is not properly disposed of, in that it only ends up getting burned. Furthermore, lack of education on the importance of recycling and composting adds to the problem. All of these stressors build up over time, eventually leading to the health effects that were most commonly reported, including frequent illness, cough, eye problems, and headaches.
Future research should include a more representative sample of the whole country of Cambodia and a sample from rural areas of the surrounding countries. It should also explore more solutions and advocacy for the waste management problem, similar to the Green Umbrella Organization’s initiatives. Simply removing all of the waste is not a feasible solution. Cambodia, as a developing country, is forced to find sustainable solutions that can be enforced with little economic investment and a lot of intrinsic expenditure. This is because, especially in rural areas, they do not have the funds or infrastructure to support an entire urbanized garbage disposal system, for example.
Instead, education from the bottom up is one possible solution to this problem. If students are able to enlighten the rest of their community about the importance of the environment and health and how their improper methods of waste management are contributing to these, then a movement toward change is more likely. In addition, educating the youth allows them to start their own projects and motivate their peers to care about the problem as well.
The authors would like to thank the Green Umbrella Organization and volunteer students who were available to help conduct interviews. They would also like to thank Vouchnea Chun, Raksmey Sar Soc, Samrath Chhoy, and Venerable Sokrath for all their support and time invested in this project.
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