OBJECTIVES: This article aims to describe essential conditions and starting-points for the monetary evaluation of environmentally attributable diseases. Furthermore, a cost calculation within a scenario analysis is conducted for Germany. METHODS: To calculate the costs of environmental health effects we chose a disease-specific perspective. The national statistics of the Federal Statistical Office and the World Health Report burden of disease estimates were used to identify the most important disease categories for Germany. Based on an extensive literature research in computerized databases and the publications of national and international institutions, available costs of illness studies for Germany as well as environmental attributable fractions (EAFs) were identified. Based on these data environmental health costs were calculated with a top-down approach. RESULTS: Direct and indirect environmental costs of illness add up to 15-62 billion euro(2006) per year depending on the specific scenario. From our results a tentative scheme is deduced of how the monetary environmental burden of specific diseases is composed and how it can be assigned to major environmental exposures and economic sectors which can be used in setting intervention priorities and evaluating intervention efficiency. CONCLUSION: Within this article, we were able to calculate environmental health costs for Germany based on available, easy to access data and deduce implications for environmental policy decision-making. However, there are restrictions in data quality, as the aetiology of some diseases with respect to environmental impacts is not very well documented and data has not been collected particularly for Germany.