Integrated E & H monitoring programs

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The text on this page is taken from an equivalent page of the IEHIAS-project.

The detail information for this material is given in D51 – Revised review on integrated monitoring. It is available on INTARESE website.

There are a large number of existing and planned environment and health monitoring programs in Europe. Some major monitoring programs dealing with health risks of environmental stressors at national level are listed below and some of their features are summarized in Table 1. By concentrating on their use of integrated methodology, we want to focus on (i) the data information, (ii) integrated methodology and (iii) the potential that the integration of existing activity could have for supporting informed policy decision-making. Here, we create a ‘typology of programs’. Based upon this review we have identified three types of programs that followed the same main scheme.

  • International, objectives of documenting trends and comparison across countries include a wide range of indicators, e.g. AMAP-Arctic Monitoring and Assessment Program, and ENHIS-European Environment and Health Information System.
  • National, objectives of documenting general health trends focus on some health based indicators. e.g. GerES-German Environmental Survey, EHMS-the Environmental Health Monitoring System in the Czech Republic, PCBs-PCBs Monitoring and Assessment Projects in Slovakia, and KiGGS-The German Health Interview and Examination Survey for Children and Adolescents.
  • National, objectives of following on a specific risk, including both observation and forecasting, e.g. HWWS-Heat Wave Warning System in France, and ONERC-National Observatory of Climate Change Impact in France.

A total of eight selected existing and planned integrated E & H monitoring network were reviewed in this report (see below). The reviewed information included:

  • Project title
  • Project location
  • Team member name
  • Review date
  • Reviewer
  • Project role
    • Sponsor
    • Project coordinator
    • Project manager
    • Team leader
    • Team members
  • Introduction
  • Objectives
  • Achievement of planned objectives
  • Give details of activities in realization of objectives
  • Time schedule of activities
  • Data information
  • Integrated methodology
  • Budget (if available, per activity)
  • Quality review
  • Lessons learned as a result of the project
  • Recommendations for action in relation to future projects


The AMAP Trends and Effects Program, with a few exceptions, do not prescribe in detail the methods that should be applied in sample collection, pre-treatment or analysis. Rather it lists recommendations and references to internationally accepted methods and guidelines, including those developed under AMAP. It is regarded as convenient for participating laboratories and organizations to consider these recommendations and select methodologies appropriate to their circumstances; in some cases, methods may need to be adjusted to make them suitable for application under Arctic condition. In areas where no international guidelines or recommendations exist, the participants are suggested to try to agree on common and/or comparable methods based on existing experience.


ENHIS methodological guidelines were developed for thirty indicators giving the rationale, definitions, required data elements, calculation methods, data sources, interpretations and policy-relevance. In order to ensure that the information collected on the indicators was consistent and user-friendly, a template for a methodology sheet was designed entailing the justification for the indicator, the definition of the indicator, underlying concepts and definitions, specification of the data needed, data sources, availability and quality, method of computing the indicator, scale of application, interpretation of the result, linkage with other indicators, details of any related data and websites, policy and regulatory context of the indicator and any relevant reporting obligations.


The Environmental Health Monitoring System in Czech Republic (EHMS) is an open system and has been developed continuously in terms of both the range of factors and pollutants monitored and methods of data processing and presentation.

  • Health effects and risks related to air pollution (Subsystem I);
  • Health effects and risks related to drinking water pollution (Subsystem II);
  • Health effects of and annoyance from noise (Subsystem III);
  • Health effects of and risks from dietary exposure to contaminants (Subsystem IV);
  • Health effects of exposure to toxic environmental pollutants, human biomonitoring (Subsystem V);
  • Health status and selected demographic and health statistics indicators (Subsystem VI);
  • Health effects and risks related to the occupational environment (Subsystem VII);
  • Health risks related to urban soil contamination (Subsystem VIII). » Read more

QA/QC system

Quality assurance (QA) and quality control (QC) in the participating laboratories in the Monitoring System have been included in their activities as well as in their home institutions. The participating laboratories serve as analytical units of the public health institutes, created after reorganization of the Public Health Service, private laboratories and laboratories of other institutions.


The German Environmental Surveys (GerES) conducted have provided representative data about the exposure of the adult population and are thus contributing to the environmental related health surveillance system envisaged by the German National Environment and Health Action Program. For children aged 6 to 14 years such data have been collected in GerES II (1990/92). In GerES IV (2003/06), children aged 3 to 14 years were analyzed.


This study was done using a nationwide representative investigation and survey to children and adolescents aged to 0 to 17 by the Robert Koch Institute (RKI). The data collected at an individual level include objective measures of physical and mental health as well as self-reported information regarding subjective health status, health behavior, health care services use, social and migrant status, living conditions and environmental determinants of health. The information was gained from interviews, physical examinations and blood and urine samples. Regional and seasonal factors were excluded by systematized route planning (Kurth, 2007).


The observatory was created in 2001 in France. The objectives were to collect and disseminate information, studies and researches on the risks linked to climate change, to formulate recommendations for action and prevention.


Polychlorinated biphenyls were widely used in industrial and consumer products. Because these compounds are stable and highly lipophilic, their residues are ubiquitous and occur in increasing concentrations moving up through the food chain. In Slovakia, the Chemko – Strazske Chemical Company based in the Michalovce district, produced PCBs between 1959 and 1985. Improper disposal from the Chemko plant via release of effluent directly into the Laborec River resulted in long-term contamination of sediment; several studies in Slovakia between 1987 and 1990 found high levels of PCBs in food. Current data indicate that persons who eat locally raised food – pork, beef, poultry, and eggs – in this district have higher serum concentrations of PCBs.


Following the 2003-heatwave, France developed a plan to prevent heat related health impacts during extreme heat waves. A complex set of intervention measures is activated in case of a alert. A heat warning system was designed to identify adverse weather situations and to trigger alerts. The indicators and thresholds were chosen based on the results of a retrospective analysis of the temperature-mortality relationship on fourteen cities. The system relies on the monitoring of observed and forecasted meteorological indicators, air quality data and health data. Its objective is to identify heat waves that present a potential danger to public health and to orientate management measures.


Table 1 Overview of eight integrated monitoring program in Europe. The abbreviation name is accordance with the name in the text above. The more detail information regarding the review of these eight programs is available in the D51 (
Project acronym Location Period Data information Integrated methodology
AMAP The terrestrial and marine areas north of the Arctic Circle 1991-2012 Environment

Atmospheric contaminants

Marine contaminants


Freshwater and terrestrial contaminants


UV radiation and climate change

Guideline and methodology were developed for each monitoring system, quality control and general monitoring issues
EHIS Europe 2008- Environment

Air quality

Food safety

Chemical safety

Water and sanitation

Mobility and transport


UV and ionizing radiation

Occupational hazards


Exposure of population to environmental stressors

Methodology was developed for thirty indicators giving the rationale, definitions, required data elements, calculation methods, data sources, interpretations and policy-relevance.
EHMS Czech Republic 1994-2006 Environment (136 contaminant factors)

Air pollution

Drinking water pollution


Soil contamination


Dietary exposure and human bio-monitoring

Methodology was developed for monitored factors and indicators and their limits, information system and data processing, and QA/QC system
GerES East-, West-Germany 1985-2006 Environment

Domestic environment: tap water, dust deposit, content of vacuum cleaner bag and indoor air.

Community: water works sample and dust fall outdoors.


Human bio-monitoring, diet and personal air

Methodology was developed for fieldwork, experimental chemical analysis, and data analysis (including checking and revising data, matching different data files, weighting etc.).
KiGSS East-, West-Germany 1990-1992


Health (1990-1992, 4730 participants; 2003 -2006, 17,641 participants)

Measure: physical and mental health

Questionnaire: health status, health behavior, health care utilization, social and migrant status, living conditions


Environmental determinants of health.

Methodology was developed for the participants interviews, physical examinations, blood and urine samples, and data processing
ONERC France 2001 Climate change (15 indicators)

Different sources

Several datasets

Population data

Exposure of population to climate risk

Report on specific themes, e.g. human health, relying on the indicators.
PCBs Michalovce and Svidnik/Stropkov regions, Eastern Slovakia 2001- Pollutants

PCBs and toxic metals.

Health (8 indicators)

Thyroid gland, glucose homeostasis and neurodevelopmental disorders

Report on specific themes, e.g. human health, relying on the indicators.
HWWS France 2003- Environmental variables

Temperature and air quality (O3, PM10)



I. Analysis of the temperature data, including the probability of being above threshold

II. If the probability are medium to high, analysis of additional risk factors

III. During a heat wave or immediately after, analysis of the health data to orientate the actions.


  • Holling, H., Erhart, M., Ravens-Sieberer, U., Schlack, R. 2007. Behavioural problems in children and adolescents. First results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 50:784-793.
  • Kamtsiuris, P., Lange, M., Schaffrath-Rosario, A. 2007. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): sample design, response and nonresponse analysis. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 50 (5– Kolossa-Gehring, M., Becker, K. 2006. German Environmental Survey for Children (GerES IV). Symposium: Human Biomonitoring (HBM) as a key tool in environment and health. ISEA 2006, Paris, France, September 2-6, 2006. Abstract Book, 307
  • Kurth, B-M. 2007. The German health and examination survey for children and adolescents (KiGGS): an overview of its planning, implementation and results taking into account aspects of quality management. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 50:533-546.
  • Kurth, B-M., Kamtsiuris, P., Holling, H., Schlaud, M., Dolle, R., Ellert, U., Kahl, H., Knopf, H., Lange, M., Mensink, GB., Neuhauser, H., Rosario, AS., Scheidt-Nave, C., Schenk, L., Schlack, R., Stolzenberg, H., Thamm, M., Thierfelder, W., Wolf, U. 2008. The challenge of comprehensively mapping children’s health in a nation-wide health survey: design of the German KiGGS-study. BMC Public Health. 8:196
  • WHO.1999. Environmental health indicators: framework and methodologies. 119pp.

See also

Integrated Environmental Health Impact Assessment System
IEHIAS is a website developed by two large EU-funded projects Intarese and Heimtsa. The content from the original website was moved to Opasnet.
Topic Pages

Boundaries · Population: age+sex 100m LAU2 Totals Age and gender · ExpoPlatform · Agriculture emissions · Climate · Soil: Degredation · Atlases: Geochemical Urban · SoDa · PVGIS · CORINE 2000 · Biomarkers: AP As BPA BFRs Cd Dioxins DBPs Fluorinated surfactants Pb Organochlorine insecticides OPs Parabens Phthalates PAHs PCBs · Health: Effects Statistics · CARE · IRTAD · Functions: Impact Exposure-response · Monetary values · Morbidity · Mortality: Database

Examples and case studies Defining question: Agriculture Waste Water · Defining stakeholders: Agriculture Waste Water · Engaging stakeholders: Water · Scenarios: Agriculture Crop CAP Crop allocation Energy crop · Scenario examples: Transport Waste SRES-population UVR and Cancer
Models and methods Ind. select · Mindmap · Diagr. tools · Scen. constr. · Focal sum · Land use · Visual. toolbox · SIENA: Simulator Data Description · Mass balance · Matrix · Princ. comp. · ADMS · CAR · CHIMERE · EcoSenseWeb · H2O Quality · EMF loss · Geomorf · UVR models · INDEX · RISK IAQ · CalTOX · PANGEA · dynamiCROP · IndusChemFate · Transport · PBPK Cd · PBTK dioxin · Exp. Response · Impact calc. · Aguila · Protocol elic. · Info value · DST metadata · E & H: Monitoring Frameworks · Integrated monitoring: Concepts Framework Methods Needs
Listings Health impacts of agricultural land use change · Health impacts of regulative policies on use of DBP in consumer products
Guidance System
The concept
Issue framing Formulating scenarios · Scenarios: Prescriptive Descriptive Predictive Probabilistic · Scoping · Building a conceptual model · Causal chain · Other frameworks · Selecting indicators
Design Learning · Accuracy · Complex exposures · Matching exposure and health · Info needs · Vulnerable groups · Values · Variation · Location · Resolution · Zone design · Timeframes · Justice · Screening · Estimation · Elicitation · Delphi · Extrapolation · Transferring results · Temporal extrapolation · Spatial extrapolation · Triangulation · Rapid modelling · Intake fraction · iF reading · Piloting · Example · Piloting data · Protocol development
Execution Causal chain · Contaminant sources · Disaggregation · Contaminant release · Transport and fate · Source attribution · Multimedia models · Exposure · Exposure modelling · Intake fraction · Exposure-to-intake · Internal dose · Exposure-response · Impact analysis · Monetisation · Monetary values · Uncertainty