DPSEEA has been adopted for: (i) monitoring health impacts of climate change in Europe
[27]; (ii) developing E&H indicators to assess and monitor human health vulnerability, and (iii) measuring the effectiveness of climate change adaptation and mitigation [8].
Therefore, DPSEEA can provide the guidance necessary to develop an IEHM programme to measure and monitor the impact of environmental changes on human health.
The MEME framework (Additional file 3) used by the WHO, was designed to provide the conceptual basis for the development, collection and use of children’s E&H indicators [15,28] (Table 1).
The framework describes the environmental health chain through the following components:
exposure in different environmental settings leads to many different health outcomes (Multiple effects); and individual health outcome may be linked to many different exposures (Multiple exposures).
Both exposures and health outcomes are affected by contextual conditions.
Actions can be targeted at either the exposure or health outcome side, or at underlying contextual factors.
The MEME is both a simplification and an extension of the DPSEEA. It combines the state of the environment, pressure and exposure components, recognizing that indicators of exposure may be assessed more or less directly, with state or pressure components serving as proxies for the actual exposure [29].