Abstract
Data on which to base the setting of priorities for implementing strategies to reduce public health risks must be of sufficient quality to justify semiquantitative risk assessment. Clusters of negative health outcomes have traditionally alerted authorities at local or national levels to the potential need for regulating suspected environmental hazards, although most initial observations neither reach statistical significance nor uniquely identify putative insults. Four classes of risk factors (environmental and occupational exposures, lifestyle, individual susceptibility, and access to and quality of primary health care) may each account for approximately one quarter of the observed variations in death from the most common causes (e.g. heart and cerebrovascular disease, cancer, and accidents). Preliminary evidence within Europe shows that local mortality from these and other causes can vary by a factor of 2 to 6 regardless of the scale of the region examined, strongly implying a fractile-like structure to the non-uniformity of possibly random health data. This suggests that efforts to identify causes of variations in health outcome cannot be successful without a region-wide, reasonably unified data set of health outcomes and potential risk factors. Several alternative strategies for establishing a Unified European Environmental Health Database are considered, together with possible mechanisms for providing basic information for the management of suspected environmental health hazards and quantified health risks.