Current French health data surveillance systems are not suited to the specific needs of environmental health. To provide a scientific response to concerns raised by the public or policymakers, it is sometimes necessary to establish a health database from scratch, even in crisis situations. Specific surveillance systems tailored to these needs should enable: longitudinal monitoring; detailed geographic analysis; and the characterization of individual environmental exposures. They should also be sufficiently responsive. The only system that theoretically meets all these needs is mandatory disease reporting; it is already operational for two environmental diseases: childhood lead poisoning and Legionnaires’ disease. This option, which could be considered for diseases not currently monitored by existing systems, would, however, require significant involvement and availability from healthcare professionals, who are already under heavy strain. Among the prospects and avenues for progress currently underway are the strengthening of surveillance through cancer registries and the implementation of the multi-source cancer system, which should eventually enable national and responsive monitoring. Finally, a clear understanding of the expected benefits of individual collection of exposure data by healthcare professionals and patients is essential for making progress. (R.A.)