Landfill disposal and waste-to-energy (WTE) incineration remain the two principal options for managing municipal solid waste (MSW). One critical determinant of the acceptability of these options is the different health risks associated with each. In this analysis relying on published data and exposure modeling, we have performed health risk assessments for landfill disposal versus WTE treatment options for the management of New York City's MSW. These are based on the realistic scenario of using a waste transfer station (WTS) in Brooklyn and then transporting the untreated MSW by truck to a landfill in Pennsylvania or using a WTE facility in Brooklyn and then transporting the resultant ash by truck to a landfill in Pennsylvania. The overall results indicate that the individual cancer risks for both options would be considered generally acceptable, although the risk from landfilling is approximately 5 times greater than from WTE treatment; the individual non-cancer health risks for both options would be considered generally unacceptable, although once again the risk from landfilling is approximately 5 times greater than from WTE treatment. If one considers only the population in Brooklyn that would be directly affected by the siting of either a WTS or a WTE facility in their immediate neighborhood, individual cancer and non-cancer health risks for both options would be considered generally acceptable, but risks for the former remain considerably higher than for the latter. These results should be considered preliminary due to several limitations of this study such as: consideration of risks only from inhalation exposures; assumption that only volume and not composition of the waste stream is altered by WTE treatment; reliance on data from the literature rather than actual measurements of the sites considered, assuming comparability of the sites. However, the results of studies such as this, in conjunction with ecological, socioeconomic and equity considerations, should prove useful to environmental managers, regulators, policy makers, community representatives and other stakeholders in making sound and acceptable decisions regarding the optimal handling of MSW.