Large quantities of mismanaged plastic waste threaten the health and wellbeing of billions worldwide, particularly in low- and middle-income countries where waste management capacity is being outstripped by increasing levels of consumption and plastic waste generation. One of the main self-management strategies adopted by 2 billion people who have no waste collection service, is to burn their discarded plastic in open, uncontrolled fires. While this strategy provides many benefits, including mass and volume reduction, it is a form of plastic pollution that results in the release of chemical substances and particles that may pose serious risks to public health and the environment. We followed adapted PRISMA guidelines to select and review 20 publications that provide evidence on potential harm to human health from open burning plastic waste, arranging evidence into eight groups of substance emissions: brominated flame retardants; phthalates; potentially toxic elements; dioxins and related compounds; bisphenol A; particulate matter; and polycyclic aromatic hydrocarbons. We semiquantitatively assessed 18 hazard-pathway-receptor combination scenarios to provide an indication of the relative harm of these emissions so that they could be ranked, compared and considered in future research agenda. This assessment overwhelmingly indicated a high risk of harm to waste pickers, a large group of 11 million informal entrepreneurs who work closely with waste, delivering a circular economy but often without protective equipment or a structured, safe system of work. Though the risk to human health from open burning emissions is high, this remains a substantially under-researched topic.
