PROCEEDINGS of the
23rd International Congress on Acoustics
9 to 13 September 2019 in Aachen, Germany

Study on methodology to perform an environmental noise andhealth assessment - a guidance document for local authorities in
EuropeIrene Van Kamp1, Dirk Schreckenberg2, Elise Van Kempen1, Mathias Basner3, Alan Lex Brown4,Charlotte Clark5, Danny Houthuijs1, Oscar Breugelmans1, Annemarie Van Beek1 and Brigit
Janssen-Stelder1
1

Netherlands National Institute for Public Health and the Environment
2

3

ZEUS GmbH

University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA,
USA
4

Griffith School of Environment, Griffith University, Australia
5

ARUP

irene.van.kamp@rivm.nl
ABSTRACTThe Environmental Noise Directive (END) is for local authorities the most important instrument todetermine the levels of noise pollution. The Directive aims at the evaluation of effect of measures andcan make the effects of alternative measures visible. The Directive stimulates the Member States totake action to reduce the aversive effects of environmental noise. In preparation of the update of Annex
III of the Directive, RIVM in collaboration with international partners, has prepared a guidance
document taking the new Environmental Noise Guidelines for the European Region (WHO) as a pointof departure. Not only annoyance and sleep disturbance are addressed as health effects, but also
cardiovascular effects and cognitive impact on children (comprehensive reading impairment). The
guidance document was prepared on request of the EU commission. This paper summarizes the stepsof a health impact assessment and explains the accompanying decisions and conditions. The actual
calculation methods are further explained taking sleep disturbance as an example and are restricted to
the number of people that experiences adverse effects of noise.

1. INTRODUCTION
Annex III of the Environmental Noise Directive 2002/49/EC (END) will describe a method for
calculating the health impacts of exposure to environmental noise levels from different sources.
Currently, Annex III is under revision, following the latest scientific evidence of the health effects ofnoise reviewed for an update of the formerly named Community Noise Guidelines of WHO1 now
referred to as the Environmental Noise Guidelines for the European Region.
In 2010, the European Environmental Agency (EEA) published its “Good practice guide on noise
exposure and health effects (GPG)” 2 which intended to assist policy makers, competent authorities andany other interested party in understanding and fulfilling the requirements of the European Noise
Directive. The main aim of the GPG was to provide end users with practical and validated tools to
calculate the health impacts of noise in strategic noise studies such as the Noise Action Plans (NAPs)of the Directive. However it does not provide guidance on how health and well-being effects can be
estimated, and used to justify or establish priorities within the NAPs.
The main aim of this project was to develop a guidance tool that can be used to assess and evaluate
the (cumulative) health effects at the population level due to environmental noise exposure tocomplement the noise mapping and to inform on the health benefits of the actions foreseen in the noise
action plans performed according to articles 1, 7 and 8 of the Environmental Noise Directive.

7110

Specific objectives of the project were:
1. To select and evaluate environmental health indicators suitable to apply in the END context;
2. To give insight in what data is needed to calculate the environmental health indicators and to
determine the scale level at which they can be applied;
3. To give insight in when and how the different indicators can be used in a health impact
assessment for environmental noise;
4. To develop a methodology and guidance tool at least at city level;
5. To apply the selected indicators in a case study.
This project was based on the following assumptions:- The WHO reviews prepared in the framework of the new Environmental Noise
Guidelines1 are taken as a point of departure;
http://www.mdpi.com/journal/ijerph/special_issues/WHO_reviews.
- Scientific evidence on noise and health published after the timeframe of the reviews
is also accounted for.
- The described methodology considers noise sources separately and integrates healtheffects where relevant.
- The main focus is on adults (18 years and older), but when data is available for
specific groups, like children, this can be used as input for the methodology.
- To apply the disability adjusted life years indicator (DALY) and one or more
additional environmental health indicators in a case study.
- To preferably express the burden of disease in a single value, so it has added value
to the noise maps.
- The methodology to be at least valid at city level (100.000 inhabitants).

2. STUDY DESIGN AND METHODOLOGY
2.1

Tasks

Practically the aims and objectives of the project as described above were translated in the following tasks
and deliverables:

Figure 1.1: Overview of tasks and deliverables
2.2 Readers Guide
As can be seen in Figure 1.1 a distinction was made between the Guidance Document parts A, B and
C. Part A describes the key steps in a Health Impact Assessment (HIA) for noise effects on health,theoretical backgrounds and the process of indicator selection and the main decisions to be taken in the7111

HIA process; Guidance Document part B provides guidance for the actual calculation. Part A and B
will be summarized below, while Part C, which gives two practical examples of a HIA in Dusseldorf
will be described elsewhere.

3. GUIDANCE DOCUMENT PART A: Health Impact Assessment
3.1

Steps in the HIA process: a model

Figure 3.1: Steps in evaluation process at different layers
Figure 3.1 describes the different decisions to be made preceding a HIA as well as the key steps ofan impact assessment These steps are accompanied by a set of decisions, on e.g. the quality of
exposure data, availability of the health data and applicability of the ERFs (at a given scale level (seeleft column) and a set of conditions, such as the underlying assumptions, the expertise needed toperform the HIA and the preferred way and scale of presenting the results (right column). After thesedecisions have been made and the conditions as described above are met and the actual HIA can takeplace.
3.1.1
Policy Questions
Starting point of a HIA are the policy questions to be addressed. These questions strongly
determine whether a HIA is a suitable tool to answer the questions and whether a given environmental
health indicator is suitable for the task at hand. These questions of course do not only pertain toenvironmental noise, but often are part of larger questions about the impacts of infrastructural plans or
choices for actions at specific locations. In the context of END we focus on the noise related questions.
Roughly these questions can be subdivided in the following main policy questions:
1. Mapping the current status in terms of exposure and their health effect at different scale levels,and for different social groups.
2. Choice of and prioritization of location of the actions.
3. Choice of mitigating actions with highest impact.
4. Evaluation of noise action plans (NAPS). (Evaluation of the health impact of different actions;evaluation of health impact of deviations from limit values; efficiency analysis of a set ofinterventions .

7112

Since most of the ERFs for the health outcomes for environmental noise are non-linear it isessential that results from different action plans are compared based on the magnitude of the resultant
change in the health effects, not just on the change in noise levels that result from the action plan. A
recent systematic review of transport noise interventions3 and their impact on health noted that, in
decades of environmental noise interventions (or noise management, or noise control), only a verysmall number of studies estimated the effect of the interventions in terms of health outcomes rather
than in noise level changes. The review also provided an intervention framework showing systemcomponents of the path between environmental noise and human health and where different types ofnoise intervention potentially act along that path. To lower the level at the receiver side interventions
on each part of the path can be made. At the source side, emission levels can be changed (road surfacechange or traffic flow change) or time restrictions on use of vehicles can be placed (type Aintervention). In the transmission path, barriers can be placed to change the path between source andreceiver or the building envelope can be insulated (type B intervention). In addition, the location of
dwellings in relation to infrastructure can be changed to make the transmission path from source toreceiver longer (type C intervention). These intervention types are summarized in figure 3.2.3

Figure 3.2: Type of Interventions
3.2 Choice of indicators
The policy questions primarily determine the suitability of the environmental health indicator.
When the question, for example, is aimed at determining hotspots for mitigation actions, detailed noisemaps would suffice, while the evaluation of the health impact (retrospective or prospective) of noise of
mitigating actions demands a HIA by means of an indicator summarizing the impact of noise on
different health outcomes. Three decisions have to be made before an indicator can be chosen: are theassumptions underlying the indicator not violated, is the expertise available to apply the indicator andwhat would be the preferred way to present the results bearing in mind the specific aim of thecalculations, the relevant scale level and the target population.
3.3 Environmental health indicators
In the methods to map environment and health a distinction can be made between more qualitativeand more quantitative methods.4 Broadly, a distinction can be made between the following types of(summary) environmental health indicators: 1. Noise Exposure based indicators 2. Environmental
quality indicator of noise level 3. Integrated environmental quality indicator 4. Number of people
affected NafP (annoyed, disturbed, etc) 5. Integrated health indicators (magnitude of the total healtheffects on people) 6. Other indicators mixing exposure and/or health effects with population
characteristics (like deprivation, demography, etc.). These indicators all have advantages anddisadvantages. For further analysis the following indicators were selected: I Compliance with the
WHO Noise Guidelines II Health effect screening III Cumulative Health based Environmental Risk
Indicator IV Number of people affected and V Disability adjusted Life Years. There is a certain
hierarchy: the indicators move from more simple, qualitative methods (I, II), towards the more
complex ones which quantify exposures and effects, or integrate effects (III-V). The selection was
primarily based on their potential to describe the health effects of exposure to environmental noise in7113

the general population.
Based on the literature 5-7 and consultation with experts the following set of criteria was developed,
guiding the selection of indicators per Health Impact Assessment:
The indicator has to be:
1. Relevant to quantify health effects of noise
2. Relevant for policy use
3. Capable to reflect changes in noise exposure
4. Flexible and adaptable to new ERF’s, severity weights and guideline values
5. Scientifically sounda.
Unbiased (not affected by other parameters than noise)b.
Reliable (in the sense that it is robust and unaffected by minor changes)c.
Acceptable (in the sense that it is widely used, not widely criticized)
6. Based on available data of acceptable quality
7. Easy to implement
8. Understandable for the general public
3.4 Final selection of indicators for the END Guidance document
In the next step the indicators and criteria were evaluated by a group of international experts andpolicy makers making use of the Delphi method with three consultation rounds: In total twenty people
have been invited to participate in the first Delphi Round of whom twelve responded. Results areshown in figure 3.3.

Figure 3.3: Scoring of the five indicators on eight criteria
Results show that overall the scoring does not differ that much between the five indicators; thelargest contrasts between indicators are found on criteria 7 and 8 pertaining to simplicity of
implementation and comprehensibility to the general public. Compliance with the WHO guidelines (I)scores highest on these requirements and the DALY (V) the lowest. Requirement 6 (END exposuredata) discriminates least between the five indicators. Taking the two requirements of the European
Commission into account (preferably indicators which summarize the different outcomes and at least
include the DALY), the NafP and the DALY were selected as the key indicators to be elaborated on in
the Guidance document part B and the practical example in Dusseldorf (part C not included here).

4. GUIDANCE DOCUMEN PART B: Calculations
4.1 Steps in the calculations
The actual process of calculating the burden of disease discerns five steps. In view of space thesesteps can only be summarized and the actual calculations will be restricted to the NafP . These steps
include: selection of health outcomes (step 1, see also Figure 3.1). Next the input values that should be
included in the calculations are described; the assessment of population exposure (step 2); the7114

identification of exposure response relations (step 3); the estimation of the number of cases (step 4)
and the calculation of the disease burden (step 5).
Step 1: Selection of health indicators
Based on the recently published WHO reviews8-14 the outcomes a-priori considered for inclusion in
the HIA all had an ERF for noise indicators L den and/or Lnight to relate the noise exposure to thehealth outcome. In this paper only sleep disturbance will be described in more detail.
There is sufficient evidence 8 for sleep disturbance due to environmental noise to be included in the
HIA for the END. In studies investigating the association between noise and sleep disturbance, thepercentage of the population highly sleep disturbed (%HSD) is based on a standardized survey
question referring to noise (per source).
For sleep disturbance at present the percentage of highly sleep disturbed (%HSD) is recommended
as the preferred indicator.
The source-specific ERFs for sleep disturbance show considerable variation over time and between
studies. This indicates that deviations in the %HSD can occur at national/regional/municipal level ascompared to %HSD calculated using the generalised ERFs described in this document
In order to assess the actual number of highly sleep-disturbed people in a study area in theframework of a Noise Action Plans (NAPs), it is recommended to use local data if available: the resultsof survey data or ERFs based on local data. In case these data are not available, generalized ERFs canbe applied. In order to compare the effectiveness of (policy) actions or to prioritize actions in theframework of a noise action plan in terms of an increase/reduction in the fraction of highly sleep
disturbed annoyed people, generalized ERFs can be applied because the comparison is relative.
Step 2: Input data sets
In order to calculate the number of DALYs (step 5), several data are needed including the incidenceof effects (in this case the number of highly sleep disturbed people per year attributable to noise). In
order to calculate these, for sleep the following input data is needed for the study area: 1).The fraction
and number of residents per noise category 2).Demographic data of the study area.
Fraction and number of residents per noise category In combination with fixing the boundary of thestudy area carefully the noise exposure distribution of the population living in the study area is one of
the essential pre-requisites, necessary to quantify the DALYs by environmental noise exposure in agiven area. Given that the study area and study period have been determined, population exposure data
can be obtained in several ways. When the focus is on a limited area and population, noise exposure
could be assessed by direct measurements. But for larger populations and longer periods (which isusually the case in a health impact assessment), noise exposure is usually assessed by means ofcalculations using models, that focus on the noise levels at the façades of the dwellings averaged overa year.
In quantifying the NafP or DALYs the exposure of the population is the starting point. For theinterpretation of the findings it would be helpful to study the (cumulated) maps of the selected area in
addition to the tables also for the lower exposure levels. An extra advantage of producing a map of the
exposure situation is that it illustrates where the hotspots in the study area are located. At the sametime this can give an indication of future health effects.
Demographic data of the study area can usually be obtained from the national statistics agencies. In
case the national statistics agency does not produce population estimates, the statistical office of theEuropean Union (EUROSTAT) is a reliable alternative, that can provide demographic data at bothcountry and regional level (http://ec.europa.eu/eurostat/).
Step 3: Exposure response relations for sleep disturbance. Definition: A disorder of sleep patterns
which may be high enough to interfere with a person’s normal physical, mental and emotional
functioning, comparable to insomnia (ICD-10: F51). The actual percentage or number of highly sleep
disturbed people in the study area can be assessed directly by means of a survey, using a standard
question comparable to ISO/TS 15666:2003, among a representative group of people living in the
study area. The actual number of highly sleep disturbed people can also be assessed indirectly, by7115

means of calculations where source-specific ERFs are combined with population exposure
distributions. ERFs can be based on data from local studies of sufficient quality or from thegeneralised Erf. In case ERFs based on local data are not available, one could assess the percentage or
number of highly sleep disturbed people by applying generalized ERFs. It is also possible that insteadof presenting the actual situation, it is needed to prioritise/choose between mitigating measures. In thatcase both ERFs based on local data and generalized ERFs can be applied, depending on what isavailable. The most recent generalised source-specific exposure response equations for highly sleep
disturbed are presented in Figure 4.2.

Figure 4. 2 Percentage of highly sleep disturbed from aircraft, road traffic and railway noise8
Step 4 and 5: Calculations of number of people with high sleep disturbanceFor the actual formulas we refer to the full publication
4.2 In – or exclusion of Annoyance and sleep disturbance in DALY calculation?
While both high sleep disturbance and high annoyance were part of the WHO estimate of theburden of disease due to environmental noise 15, a later document excluded annoyance and included
high sleep disturbance using the ICD code for insomnia.16 In the literature several arguments can befound why annoyance might not qualify as a health endpoint in DALY calculations. Of these, the mostprominent is that annoyance does not have an ICD9 or ICD10 code.17, 18 However, there are manyarguments to include annoyance, as a very important end point in itself and a determinant of stressrelated long term effects. When deciding to include high annoyance and high sleep disturbance in the
DALY calculations, one has to be aware that the resulting DALYs cannot necessarily be compared with
DALYs calculated according to the new GBD method, which currently does not include highannoyance nor high sleep disturbance. Since the Bod noise report15,16 the methodology of theassessment of DWs for burden of disease studies has been improved and standardised. In 2015 a study
was published with DWs for Europe for a set of 255 health states among a representative population of
about 30,000 people from four European countries.19 For insomnia a DW of 0.023 was estimated witha confidence interval of 0.017 to 0.028. Based on the latest results 19 a DW disability weight for highly
sleep disturbed of 0.0175 is recommended (0.63 to 0.90 times the disability weight of primary
insomnia).

5. CONCLUSIONS
Based on the latest evidence this paper summarized the Guidance document, aimed at giving
guidance regarding the inputs needed for a HIA. With a stepwise explanation of the methodology andactual calculations of health impacts of noise, the document hopes to support local authorities toquantify the health impacts of their noise action plans and compare the impact against alternative
solutions.

7116

ACKNOWLEDGEMENTS
This study was commissioned by the European Commission, DG Environment, Directorate A,
Policy, Coordination and Resources under Contract Number: 070203/SER/2017/771430/ENV.A.3
Title Contract: “Study on methodology to perform environmental noise and health assessment"
https://www.rivm.nl/publicaties/study-on-methodology-to-perform-environmental-noise-and-healthassessment-a-guidance.

REFERENCES
1.
2.

WHO World Health Organization. Environmental noise guidelines for the European region (2018)
Babisch W, Dutilleux G, Paviotti M, Backman A, Gergely B, McManus B, Bento Coelho L, Hinton J,
Kephalopoulos S, van den Berg M, Licitra G. Good practice guide on noise exposure and potential
health effects. European environmental agency (EEA) Technical report. 2010(11):2010
3. Brown AL and Kamp I van, WHO Environmental noise guidelines for the European Region: asystematic review of transport noise interventions and their impacts on health. International Journal ofEnvironmental Research and Public Health, 2017. 14(8): p. 873.
4. Fast, T(2016) Instrumenten gezondheid en leefomgeving Fast Advies in Dutch
5. Briggs D, Corvalan C, and Nurminen M, Linkage methods for environment and health analysis. General
guidelines. A report of the Health and Environment Analysis for Decision-making (HEADLAMP)
project. 1996, United Nations Environment Programme, United States Environmental Protection Agency,
World Health Organization: Geneva.
6. van Kempen, Beoordeling van gezondheid in de Milieueffectrapportage Advies aan het Ministerie vanVerkeer en Waterstaat RIVM Rapport 630015001/2009 in Dutch only.
7. The Local Government Management Board, United Kingdom, 2016.
8. Mathias Basner and Sarah McGuire WHO Environmental Noise Guidelines for the European Region: A
Systematic Review on Environmental Noise and Effects on Sleep Int. J. Environ. Res. Public Health2018, 15(3), 519; doi:10.3390/ijerph15030519
9. Guski R, Schreckenberg D, Schuemer R. WHO Environmental Noise Guidelines for the European
Region: A Systematic Review on Environmental Noise and Annoyance. International journal ofenvironmental research and public health. 2017 Dec 8;14(12):1539.
10. Clark C, Paunovic K. WHO Environmental Noise Guidelines for the European Region: A Systematic
Review on Environmental Noise and Cognition. International journal of environmental research andpublic health. 2018 Feb 7;15(2):285.
11. Kempen van EEMM, et al., Cardiovascular and metabolic effects of environmental noise. Systematic
evidence review in the framework of the development of the WHO environmental noise guidelines for
the European Region. 2017, RIVM: Bilthoven.
12. Kempen van EEMM, Casas M, Pershagen G, Foraster M. WHO Environmental Noise Guidelines for theEuropean Region: A Systematic Review on Environmental Noise and Cardiovascular and Metabolic
Effects: A Summary. International journal of environmental research and public health. 2018 Feb
22;15(2):379.
13. Nieuwenhuijsen MJ, Ristovska G and Dadvand P. WHO Environmental Noise Guidelines for theEuropean Region: A Systematic Review on Environmental Noise and Adverse Birth Outcomes. Int. J.
Environ. Res. Public Health 2017, 14(10), 1252; doi:10.3390/ijerph14101252
14. ĝliwiĔska-Kowalska, M and Zaborowski K. WHO Environmental Noise Guidelines for the European
Region: A Systematic Review on Environmental Noise and Permanent Hearing Loss and Tinnitus. Int. J.
Environ. Res. Public Health 2017, 14(10), 1139; doi:10.3390/ijerph14101139
15. WHO (2011): Burden of disease from environmental noise. Copenhagen.
16. WHO Regional Office for Europe. Methodological guidance for estimating the burden of disease fromenvironmental noise. Hellmuth T, T Classen, R Kim and S. Kaphalopoulos (editors). WHO Regional
Office for Europe, 2012
17. Murray CJL, et al., Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions,
1990-2010: a systematic analysis for the Global Burden of Disease study 2010. The Lancet, 2012. 380: p.
2197-2223.
18. Mathers CD, Vos T, Lopez AD, Salomon J, Ezzati M (ed.) 2001. National Burden of Disease Studies: A
Practical Guide. Edition 2.0. Global Program on Evidence for Health Policy. Geneva: World HealthOrganization.
19. Haagsma JA, et al., Assessing disability weights based on the responses of 30,660 people from four
European countries. Population Health Metrics, 2015. 13: p. 107117