We present a framework to aggregate divergent health impacts associated with different types of environmental exposures, such as air pollution, residential noise, and large technologic risks. From the policy maker's point of view, there are at least three good reasons for this type of aggregation: comparative risk evaluation (for example, setting priorities), evaluation of the efficiency of environmental policies in terms of health gain, and characterizing health risk associated with geographical accumulation of multiple environmental exposures. The proposed impact measure integrates three important dimensions of public health: life expectancy, quality of life, and number of people affected. Time is the unit of measurement. "Healthy life years" are either lost by premature death or by loss of quality of life, measured as discounted life years within a population. Severity weights (0 for perfect health, 1 for death) are assigned to discount the time spent

BackgroundPublic health policies aim to improve and maintain the health of citizens. Relevant data and indicators are needed for a health policy that is based on factual information. After 14 years of work (1998–2012), the multi-phase action on European Community Health Indicators (ECHI) has created a health monitoring and reporting system. It has generated EU added value by defining the ECHI shortlist with 88 common and comparable key health indicators for Europe.MethodsIn the 2009-2012 Joint Action for ECHIM project the ECHI shortlist was updated through consultation with Member State representatives. Guidelines for implementation of the ECHI Indicators at national level were developed and a pilot data collection was carried out.Results67 of the ECHI Indicators are already part of regular international data collections and thus available for a majority of Member States, 14 are close to ready and 13 still need development work. By mid-2012 half of the countries have incorporated ECHI indicators in their national health information systems and the process is ongoing in the majority of the countries. Twenty-five countries were able to provide data in a Pilot Data Collection for 20 ECHI Indicators that were not yet (fully) available in the international databases.ConclusionsThe EU needs a permanent health monitoring and reporting system. The Joint Action for ECHIM has set an example for the implementation of a system that can develop and maintain the ECHI indicators,, and promote and encourage the use of ECHI in health reporting and health policy making. The aim for sustainable public health monitoring is also supported by a Eurostat regulation on public health statistics requiring that health statistics shall be provided according to the ECHI methodology. Further efforts at DG SANCO and Eurostat are needed towards a permanent health monitoring system.

OBJECTIVES: This study estimated the burden of disease due to 48 major causes in the Netherlands in 1994 in disability-adjusted life-years (DALYs), using national epidemiologic data and disability weights, and explored associated problems and uncertainties. METHODS: We combined data from Dutch vital statistics, registrations, and surveys with Dutch disability weights to calculate disease-specific health loss in DALYs, which are the sum of years of life lost (YLLs) and years lived with disability (YLDs) weighted for severity. RESULTS: YLLs were primarily lost by cardiovascular diseases and cancers, while YLDs were mostly lost by mental disorders and a range of chronic somatic disorders (such as chronic nonspecific lung disease and diabetes). These 4 diagnostic groups caused approximately equal numbers of DALYs. Sensitivity analysis calls for improving the accuracy of the epidemiologic data in connection with disability weights, especially for mild and frequent diseases. CONCLUSIONS: The DALY approach appeared to be feasible at a national Western European level and produced interpretable results, comparable to results from the Global Burden of Disease Study for the Established Market Economies. Suggestions for improving the methodology and its applicability are presented.

All this points to the fact that establishing an indicator list which is actually used by Member States is a continuously developing process. This process is now continued by the first strand of the new EU Public Health Action Programme.

Genotoxic chemicals can damage the genetic material of humans as well as that of organisms living in the environment. With respect to adverse effects, alterations induced in the germ line, leading to alterations in the genetic make-up of populations, are of primary concern in ecosystems, because somatic changes, even if they lead to a loss of individuals, will not be critical in populations with a large reproductive surplus. This is different in human toxicology where genetic alterations in germ cells as well as in somatic cells of any individual are of concern. Increased frequencies of mutations and related genetic alterations in the gene pools of individual species or populations in ecosystems have to be judged against the background of spontaneous mutations that have enabled species to survive and adapt in changing environments since the beginning of life on our planet, and which have played an important role as the substrate for evolutionary developments. Examples of the selection of altered phenotypes (and genotypes) in response to environmental pollution and environmental stress are melanism in moth populations, metal resistance in plants, insecticide resistance in insects and malaria resistance in humans. Pollution, in general, can represent a stress factor selectively leading to a change in genetic make-up. In addition, environmental genotoxins can directly alter gene pools. A change in the genetic constitution may be advantageous for certain populations living in stressful conditions, but may present a disadvantage for others, including man. Examples are (i) the induction of (pesticide) resistance, (ii) the increased virulence of pathogens, (iii) alterations of host ranges of pathogenic forms or the appearance of new virus types and (iv) subtle changes in parasite-host or predator-prey relationships. Basically the release of genotoxins into the environment should be avoided because massive exposures may affect the reproductive capacity of many species, and modest exposures may lead to an enhanced instability of ecosystems and may provoke specific adaptations to stressful situations. Furthermore, the uncontrolled presence of genotoxins in any compartment of the natural environment is an unwanted situation, in particular also from a human point of view. In addition we need novel quantitative approaches in order to make quantitative risk estimates possible.