Approaches to integrated monitoring for environmental health impact assessment

Integrated Environmental Health Monitoring (IEHM) is essential for identifying key stressors on the environment, to assess the state of the environment, and to evaluate the health impact of environmental changes [1]. Currently, there is no agreed definition of IEHM. The European Union (EU) funded project INTARESE (Integrated Assessment of Health Risks of Environmental Stressors in Europe) explored ways of linking and integrating various information sources and technologies to provide a more unified approach to IEHM.The aim of IEHM is to provide unbiased data of appropriate quality and quantity for IEHIA (Integrated environmental health impact assessment), defined as ‘an inclusive and, as far as feasible, comprehensive assessment of the risks to, and impacts on, human health as a result either of exposures to a defined set of environmental hazards or of the effects of policies or other interventions that operate via the ambient or living environment’ [2,3]. Accordingly, information is required about the nature, the causes, and the inter-linkages between existing environmental health risks. In the past, research studies and policy actions often addressed single-pollutant and single-effect relationships, and there was no integration of data on exposure and impact of environmental changes on human health [4]. Recently however, efforts to understand the links between multiple stressors and multiple health effects are rapidly increasing. Experience has shown that integrated studies are often limited by the lack of data, or by the fact that different data collection systems have different goals and are, therefore, not easily combined.The key issue for IEHM is to consider monitoring as a tool to measure, analyse and interpret the impact of environmental changes on human health, to support more effective decision-making. Ideally, a systematic, iterative process based on the knowledge of the cause-effect chain is needed to describe the interconnected environment and health (E