Cumulative Environmental Health Risk Indicator for Outdoor stressors (CHERIO)

The CHERIO is based on the DALY. It indicates the loss of healthy years of life (disease burden) per person per year resulting from a certain level of environmental burden as a percentage of the total expected loss per person per year.

The CHERIO depends on the level of environmental burden. If the burden of one or more environmental factors is known for a particular location or address, then the environmental health risk for that location or address can be depicted. This enables the identification of locations where, on the basis of the cumulative environmental burden, current or future residents are at high risk. The information can also be aggregated to a larger area, such as a neighbourhood, municipality, or region/province. Local differences in environmental health impacts can thus be compared at different levels of aggregation. The CHERIO score can be broken down according to environmental factor (air pollution, noise, etc.) and also according to source (for example, road and rail traffic), or according to the nature of the health impact.


The CHERIO gives users insight into the degree to which local environmental factors contribute to which health risks and thus also indicates the prospects for action in terms of measures and their priorities, or the adjustment of plans or projects. It is a useful tool for forming a vision in which considerations must be broader and include health impacts. The CHERIO is currently focused on air pollution and noise - environmental factors which, when aggregated to the entire Netherlands, contribute substantially to the environment-related disease burden. The indicator does not yet include local sources such as soil pollution, safety risks from industry or odour from livestock farming. It is still unclear whether the risks and impacts of external safety can be accommodated within the CHERIO. RIVM (the National Institute for Public Health and the Environment) is currently collecting data in order to be able to broaden the CHERIO (in relation to the so-called “green theme”) and to test it in cases relating to infrastructural intervention. There also seem to be opportunities for extending the CHERIO with the effects of physical exercise.

The method’s advantage is that impacts of different types can be totalled and the environmental health risk can be expressed in the level of environmental burden. On the map, a value for the CHERIO can then be shown for each location for which the environmental burden is known. Disadvantages are that, just as in the case of DALYs, the CHERIO can be calculated only for health impacts for which there is sufficient information, and the uncertainty around the CHERIO is sometimes great. Research still needs to be done on whether the CHERIO is easier to interpret than the DALY.