Impact statement

Plastic pollution is a global health emergency. This article summarises some of the scientific evidence linking plastic pollution to human health harms, and demonstrates that plastics pose serious health risks across the full life cycle. The article recommends that the global plastics treaty applies the precautionary principle in order to minimise and prevent human health risks. The article also highlights the unequal burden of health harms from plastic pollution and reminds that a right to health is a fundamental human right. It argues that human health must be considered throughout the treaty and should be explicitly addressed in relevant treaty provisions. The article discusses opportunities to reduce plastic use in the healthcare setting, and outlines the important role of the healthcare sector in shaping and implementing an ambitious and effective treaty.

Do no harm: The precautionary principle and known health impacts of plastics and plastic pollution

The precautionary principle “enables decision-makers to adopt precautionary measures when scientific evidence about an environmental or human health hazard is uncertain and the stakes are high” (EU Parliament Think Tank, 2015). The evidence that plastics harm human health is, in fact, clear. The treaty must be ground truthed in robust science and the precautionary principle.

We are all impacted by plastic pollution, but some are more impacted than others

The health risks associated with plastics and plastic pollution are unequally distributed, with economically and politically marginalised populations often experiencing the greatest harms (UNEP, 2023). The 1.1 billion people who reside in informal settlements and slums are among the world’s most vulnerable to plastic pollution. An ambitious treaty must take a human rights–based approach, mainstreaming a right to health as a fundamental human right throughout the treaty, as enshrined in the Universal Declaration of Human Rights (1948) and in line with the World Health Organisation (WHO) Constitution (1948), a legally binding agreement for international health cooperation.

Plastics in the health sector

No one (to the author’s knowledge) is suggesting that all medical plastics should be banned, nor should there be a blanket exemption for medical plastics within the treaty (Street et al., Reference Street, Stringer, Mangesho and Ralston2024). However, we do need to ensure that medical plastics are safe and more sustainable. Exemptions need to be phased and prioritised so that safe and affordable medical plastics are available to all.

Recent years have seen a big rise in the use of disposable single-use medical plastics such as gloves, gowns, catheters and syringes (Rizan et al., Reference Rizan, Mortimer, Stancliffe and Bhutta2020), and reducing single-use plastics in medical settings is challenging due to sterility and safety concerns. However, we need to recognise and support opportunities to boost innovation and take a more circular approach when designing and manufacturing safe medical products. Thirty to fifty percent of healthcare waste is plastic, of which only 5% is recycled (Rizan et al., Reference Rizan, Mortimer, Stancliffe and Bhutta2020).

To reduce plastics in healthcare, we need to differentiate between essential and non-essential single-use plastics and switch to reusable alternatives where possible. Life cycle assessments of disposables vs reusables used in healthcare settings evidence the reduced environmental impact of reusables compared to single-use, and suggest that adopting reusable devices is more sustainable than continuing to use disposable items (Keil et al., Reference Keil, Viere, Helms and Rogowski2023).

A major barrier to efficient waste disposal in healthcare is the improper disposal of non-hazardous materials as clinical waste. By clearly separating hazardous from non-hazardous medical waste, we can improve recycling rates, decrease reliance on incineration and reduce waste management costs (Cho et al., Reference Cho, Withana, Rhee, Lim, Lim, Park and Ok2024). Excessive packaging, often double or triple-wrapped, contributes substantially to plastic waste generated in healthcare settings. We need to eliminate unnecessary wrapping, redesign packaging to minimise waste and use more sustainable materials where possible and safe.

Inclusion of the health sector in global treaty negotiations

WHO plays a critical leadership role in supporting an ambitious global treaty to protect human health and has been present and engaging in the treaty negotiations since INC-1. In 2023, the 76th World Health Assembly adopted a resolution calling on the WHO to scale up efforts to address the impact of chemicals, waste and pollution – including plastics – on human health, and in 2024 the WHO submitted a briefing note to INC-5 entitled “Ensuring the integration of health aspects within the international legally binding instrument on plastic pollution, including in the marine environment” (UNEP, 2024).

To support treaty implementation, the WHO can play a key role in developing evidence-based guidelines and policies on sustainable healthcare practices. These should include recommendations for procurement, the adoption of safe and effective reusable alternatives to single-use plastics and segregation and disposal of medical waste, and should provide technical support and build capacity within health systems to implement these practices effectively. By leveraging global networks, the WHO can assess the state of the science with regard to the health impacts of plastics and provide robust global health-related data sets which can be used to monitor the effectiveness of treaty article implementation. The wider healthcare sector can support the generation of new scientific evidence relating to plastic pollution and seek opportunities for reducing the use of plastics in healthcare settings, as well as lobbying and advocating for ambition within the treaty and the implementation thereof.

Priorities for an ambitious treaty to protect human health

There is clear and growing evidence that plastic poses serious risks to human health. Yet the approach to health protection in the future treaty still hangs in the balance. In order to operationalise the global plastics treaty objective to “protect human health and the environment from plastic pollution,” the treaty must directly address human health impacts in the core obligations of the treaty. The current Chair’s Text includes two options for doing so: Option 1 proposes strengthening and adding references to human health throughout the treaty; Option 2 proposes a standalone article on health. However, these options need not be binary; an ambitious treaty should include a dedicated article on health protection in Article 19, as well as consider complementary approaches in all relevant provisions of the treaty. In light of the range of impacts discussed above, it is imperative to consider and address these impacts across a range of key provisions in the treaty text, including – without limitation – in relation to the most harmful plastic products and chemicals of concern in plastic products (Article 3), to ensure safer and more sustainable plastic product design (Article 5), address releases and leakages, including of microplastics and chemicals of concern (Article 7) and ensure environmentally sound waste management practice that also protect human health (Article 8).

Research into the human health impacts of plastic pollution continues apace. It is vital that the treaty includes mechanisms to update lists of chemicals of concern and other health risks of plastics and microplastics, according to new scientific evidence. Clear criteria must be set with regard to the identification and classification of chemicals of concern, and problematic, unnecessary and avoidable plastics and plastic products. An ambitious treaty should take a precautionary approach, phase out the most harmful plastic products, problematic plastics and plastics containing harmful additives. We need transparency across the value chain. Given that toxic plastic pollutants respect no boundaries, we need globally harmonised rules.

It is likely that INC-5.2 will end with many details yet to be developed before the first Conference of the Parties. It is essential that the treaty includes a process for strengthening treaty mandates through future decisions at the Conference of the Parties. INC-5.2 is not the end; it is the beginning. There is still plenty of work to be done, and health professionals, scientists and the healthcare sector have a key role to play.