Purpose – The extent to which research into the design and development of environmental health indicators (EHIs) has translated into operational programmes is unclear. The purpose of this paper is to identify EHI initiatives worldwide, distil the EHIs and draw lessons from the experience. Design/methodology/approach – A systematic internet-based review was undertaken. Programmes were selected for inclusion if they: first, had the ability to monitor both the physical environment and associated health outcomes; and second, the parent agency had the ability to influence policies related to the environment and health. Findings – The small number of eligible programmes indicates EHI initiatives are not yet well established, especially in developing countries. The use of indicators was also limited by uncertainties in the exposure-response relationships that they implied, and the consequent inability to translate the indicators into a common measure of health impact. In addition, there is no information on the extent to which the indicators have been applied in decision making, nor on the policy implications of using indicators. Practical implications – More effort is needed to encourage the development and use of more balanced and informative sets of indicators, and to evaluate their use and outcomes in terms of health benefits. Originality/value – The time is right for a substantial review paper on EHIs as they are now being used by a number of organisations and to the knowledge this is the first review of operational EHI programmes worldwide.