This paper deals with the environmental characterization of a large and densely populated area, with a poor reputation for contamination, considering the contribution of environmental features (air, soil, soil hydraulic and groundwater) and the potential effects on human health. The use of Geographic Information System (GIS) has made possible a georeferenced inventory and, by overlaying environmental information, an operational synthesis of comprehensive environmental conditions. The cumulative effects on environmental features were evaluated, taking into account superposition effects, by means of the spatial multicriteria decision analysis (S-MCDA). The application of the S-MCDA for converging the combination of heterogeneous factors, related to soil, land and water, deeply studied by heterogeneous groups of experts, constitutes the novelty of the paper. The results confirmed an overall higher potential of exposure to contaminants in the environment and higher mortality rates in the study area for some tumours, but hospital admissions for tumours were generally similar to the regional trend. Besides, mortality data may be strictly dependent on the poor socioeconomic conditions, quality of therapy and a lack of welfare in the area relative to the rest of Italy. Finally, as regards the possible relationship between presence of contaminants in the environment and health conditions of the population no definite conclusions can be drawn, although the present study encourages the use of the new proposed methods, that increase the possibilities for studying the combined effect of more environmental factors.

In response to the complex social, environmental and economic situation caused by the "Terra dei Fuochi" phenomenon, the IZSM collaborated closely with the Terra dei Fuochi working group, carrying out additional monitoring surveys both on food (QR Code Campania project[30]), and on the environment (Campania Trasparente project[31]). This model was developed in the context of the experience accumulated in the field of environmental and food monitoring, and represents an innovative tool aimed at increasing knowledge of the environmental context of the Campania Region through an objective, integrated and organic synthesis of complex environmental phe-nomena and territorial dynamics. The model proposed here is useful for the global and synthetic assessment of environmental pressure on a municipal basis. As shown, it can also be applied to aggregations of municipalities. Furthermore, it can be used in the context of institutional actions for the planning and monitoring of improvements on a local or regional scale. Finally, the pro-posed municipality-based environmental pressure index represents the basis for geo-stratification of the sample in the context of population biomonitoring studies on a regional scale, as in the described biomonitoring study design applicable to the Campania Region.