An environmental health indicator represents the relationship between the environment and health. Various instruments can be used to gain an insight into the nature and scope of health effects in relation to the quality of the living environment. These instruments are known under the collective name of 'Health Impact Assessment' (HIA), or 'Gezondheidseffectschattingen' in Dutch. Below we examine three types of Health Impact Assessments.

Environment-related disease burden

This is a compound criterion for loss of health which comes from the public health domain and consists of two components, namely the years lost in the population due to premature death (lost years of life) and the years living with illness. The outcome is expressed in DALYs (Disability Adjusted Life Years). For example, a disease burden exists of approximately 120,000 DALYs which occur annually in the Dutch population due to premature death in conjunction with particulate matter. This means that, in total, approximately 120,000 years of life are lost due to particulate matter. The development of the DALY was commissioned by the World Bank.

Health Effect Screening

The Health Effect Screening is an instrument/method which provides an insight into the various external factors which can affect the health of (future) residents. Having a Health Effect Screening carried out at the start of a new construction or reorganisation project creates clarity regarding the health-related bottlenecks caused by environmental burden.

The party implementing a Health Effect Screening requires all kinds of data on existing sources which may affect the environment and people's health, such as industrial and agricultural businesses, roads, railways, air traffic, soil contamination and high-voltage power lines. The Maximum Permissible Risk per environmental factor is determined on the basis of the latest policy-related standards and the most recent scientific dosage response relationships. This level was awarded a Health Effect Screening score of 6 (insufficient environmental health quality) for all environmental factors. After that, the other Health Effect Screening scores were derived using a logical sequence. The aim is to make the health and nuisance effects of the various types of exposure per Health Effect Screening score comparable so that the various environmental factors can be compared. The intention is for a Health Effect Screening score of 4 for noise to have the same health significance as a Health Effect Screening score of 4 for air pollution by particulate matter.

The ministries of VWS and VROM commissioned the development of the Health Effect Screening in 2000 for the Municipal Public Health Services. The most important aim of Health Effect Screening is to take account of health interests during decision-making and then in such a way that the policymakers receive the right information about health effects in clear language at the right point in time. A Health Effect Screening is therefore a way of producing health recommendations.

The Health Effect Screening is normative, meaning that a value is assigned to it. Those values are displayed on the maps in colours and terms, including shades of greenery, yellow, red and purple. The corresponding terminology provides a value judgement from good, via moderate and insufficient, to very insufficient. These are then referred to as Health Effect Screening scores.

The Health Effect Screening scores are based on standards per risk factor. For example, the value 6 or more means a standard has been exceeded.

Environmental Health Risk

RIVM is currently developing the Environmental Health Risk scoring system. The Environmental Health Risk makes it possible to show the environmental quality from a health perspective at a specific location. The Environmental Health Risk is based on the DALY and expresses the risk of environment-related disease burden as a percentage of the total expected disease burden. The Environmental Health Risk is based on particulate matter, nitrogen dioxide, traffic noise, ozone, lead, formaldehyde, passive smoking, dioxines, benzene and radon. A certain health effect (1 or more) is recorded for each exposure. For example, in the case of lead, two health effects are included: IQ loss and raised blood pressure.

The Environmental Health Risk is an integral indicator for health risks. The Environmental Health Risk shows the risk of health effects by environmental factors at local level and, at the same time, provides a picture of the consequences of an accumulation of environmental factors. This enables the effects of the underlying environmental factors to be calculated and compared.

The Environmental Health Risk is currently still being developed. During the coming years we will assess it in more detail and, most probably, maps of Environmental Health Risk scores will also be included in the Atlas. In contrast to the Health Effect Screening scores, the Environmental Health Risk is not normative.
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Scores as a guide

Environmental health indicators can be an important guide for government bodies, citizens and companies. Using clear scores enables everyone to see where the bottlenecks are with regard to people's health. What is more, the indicators make it possible - by means of scenarios - to investigate the possible health effects as early as during the planning phase of spatial developments. The use of such indicators is therefore a tool which municipalities can use during the permit granting process.

Many of the current standards for the quality of the living environment come from environmental policy. Those standards have usually been drawn up per sector and per substance and that conceals their mutual relationship. Comprehensive, but nevertheless simplified, indicators are a handy tool for getting a clearer view and provide a better insight into people's health and safety of the living environment. By using certain indicators (which have been drawn up by experts) everyone can get a 'feeling' of how his/her living environment is doing.

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Obligations and goals

In the case of Rijkswaterstaat projects it is obligatory, in accordance with the EIAR Directive, to have Health Effect Screening scores (or Dalys) calculated. Gradually the spotlights are also focusing on the Environmental Health Risk scores. What is more, policymakers have been able, up to now, to decide whether they want to use and apply health indicators.

From a policy point of view, three goals can be identified as regards the use of health indicators:

  • It makes policymakers aware of the relationship between health and the physical, social and economic environment.
  • It supports policymakers in recognising and assessing possible health effects and optimising their decisions.
  • It can enable those to which the policy applies to contribute to the decision-making process.

Participation by parties

What is more, the government's role is changing. It is less dominant, is trying to reduce red tape and is making citizens and companies take responsibility. Citizens, companies and social parties also want to share ideas, join in decision-making and participate more and more. Health indicators can help the parties outside the government participate more easily in the discussions.

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The task of the Municipal Public Health Services

Drawing up Health Effect Screening scores is a task for government bodies and Municipal Public Health Services. In many cases they use the Health Effect Screening Handbook.

If you would like information about Health Effect Screening scores in your living environment, please contact your Municipal Public Health Services.