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Diets adhering to food based dietary guidelines did not substantially reduce GHG emissions compared to the current Dutch diet, when these diets stayed as close to the current diet as possible. Omitting meat from these healthy diets or consuming only foods with relatively low associated GHG emissions both resulted in GHG emission reductions of around a third. These findings may be used to expand food based dietary guidelines with information on how to reduce the environmental impact of healthy diets.

Food consumption patterns affect the environment as well as public health, and monitoring is needed. The aim of this study was to evaluate the Dutch food consumption patterns for environmental (greenhouse gas (GHG) emissions and blue water use) and health aspects (Dutch Healthy Diet index 2015), according to age, gender, and consumption moments. Food consumption data for 4313 Dutch participants aged 1 to 79 years were assessed in 2012 to 2016, by two non-consecutive 24-h recalls. The environmental impact of foods was quantified using a life cycle assessment for, e.g., indicators of GHG emissions and blue water use. The healthiness of diet, operationalized by the Dutch Healthy Diet index 2015, was assessed for 2078 adults aged ≥19 years. The average daily diet in the Netherlands was associated with 5.0 ± 2.0 kg CO2-equivalents of GHG emissions and 0.14 ± 0.08 m3 of blue water use. Meat, dairy and non-alcoholic beverages contributed most to GHG emissions, and non-alcoholic beverages, fruits, and meat to blue water use. More healthy diets were associated with a lower GHG emission and higher blue water use. Different associations of environmental indicators (GHG emissions and blue water use) with health aspects of diets need to be considered when aligning diets for health and sustainability.

Sustainability assessments can play an important role in decision making. This role starts with selecting appropriate methods for a given situation. We observed that scientists, consultants, and decision-makers often do not systematically perform a problem analyses that guides the choice of the method, partly related to a lack of systematic, though sufficiently versatile approaches to do so. Therefore, we developed and propose a new step towards method selection on the basis of question articulation: the Sustainability Assessment Identification Key. The identification key was designed to lead its user through all important choices needed for comprehensive question articulation. Subsequently, methods that fit the resulting specific questions are suggested by the key. The key consists of five domains, of which three determine method selection and two the design or use of the method. Each domain consists of four or more criteria that need specification. For example in the domain "system boundaries", amongst others, the spatial and temporal scales are specified. OPEN ACCESSSustainability 2015, 7 2491The key was tested (retrospectively) on a set of thirty case studies. Using the key appeared to contribute to improved: (i) transparency in the link between the question and method selection; (ii) consistency between questions asked and answers provided; and (iii) internal consistency in methodological design. There is latitude to develop the current initial key further, not only for selecting methods pertinent to a problem definition, but also as a principle for associated opportunities such as stakeholder identification.

To evaluate the applicability of disability adjusted life-years (DALYs) as a measure to compare positive and negative health effects of drinking water disinfection, we conducted a case study involving a hypothetical drinking water supply from surface water. This drinking water supply is typical in The Netherlands. We compared the reduction of the risk of infection with Cryptosporidium parvum by ozonation of water to the concomitant increase in risk of renal cell cancer arising from the production of bromate. We applied clinical, epidemiologic, and toxicologic data on morbidity and mortality to calculate the net health benefit in DALYs. We estimated the median risk of infection with C parvum as 10-3/person-year. Ozonation reduces the median risk in the baseline approximately 7-fold, but bromate is produced in a concentration above current guideline levels. However, the health benefits of preventing gastroenteritis in the general population and premature death in patients with acquired immunodeficiency syndrome outweigh health losses by premature death from renal cell cancer by a factor of > 10. The net benefit is approximately 1 DALY/million person-years. The application of DALYs in principle allows us to more explicitly compare the public health risks and benefits of different management options. In practice, the application of DALYs may be hampered by the substantial degree of uncertainty, as is typical for risk assessment. Key work: bromate, Cryptosporidium parvum, disinfection, drinkmg water, ozone, quality of life, risk assessment. Environ Health Perspect 108: 315-321 (2000).[Online 21 February 2000] htp:/lle/hpnetl.nie,hs.nih.gov/docs/2OOO/108p315-321havelaar/abstract.htmIThe microbiologic safety of drinking water is of paramount importance to public health (1). Source protection is generally accepted as the primary strategy to obtain microbiologically safe drinking water. However, many sources (surface waters in particular) are highly polluted and need extensive treatment before distribution to the consumer. Chemical disinfection is prominent in these treatment schemes. Highly oxidizing chemicals such as chlorine and ozone kill a variety of pathogenic microorganisms during treatment, and chlorine is applied in many countries as an additional safeguard in the distribution system. An important drawback of the use of these chemicals is the generation of disinfection by-products, which have suspected adverse effects on human health. This situation calls for a formal quantitative framework to compare the positive and negative health effects of drinking water disinfection and to assist in the design and operation of treatment plants (2).Microbiologic risks are expressed as the annual individual probability of infection for a given consumption of drinking water. Chemical risks related to genotoxic carcinogens are usually associated with an increase in cancer incidence attributable to a lifetime exposure. The public health impact of these disease end points is very different and cannot be compared directly. Hen...

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This paper presents a screening tool for the location-specific prioritization of human pharmaceutical emissions in Europe, based on risk quotients for the aquatic environment and human health. The tool provides direction towards either monitoring activities or additional research. Its application is illustrated for a set of 11 human antibiotics and 7 antineoplastics. Risk quotients for the aquatic environment were highest for levofloxacin, doxycycline and ciprofloxacin, located in Northern Italy (Milan region; particularly levofloxacin) and other densely populated areas in Europe (e.g. London, Krakow and the Ruhr area). Risk quotients for human health not only depend on pharmaceutical and location, but also on behavioral characteristics, such as consumption patterns. Infants in eastern Spain that consume locally produced food and conventionally treated drinking water were predicted to run the highest risks. A limited comparison with measured concentrations in surface water showed that predicted and measured concentrations are approximately within one order of magnitude.

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