Small island tourism areas are highly vulnerable to environmental health risks due to limited infrastructure for municipal solid waste and wastewater management. In this study, we applied an Environmental Health Risk Assessment (EHRA)-based environmental monitoring approach to evaluate sanitation conditions, community behavior, and health risk levels in two small island tourism destinations in Selayar Islands Regency, Indonesia, namely Pasi Gusung Island and Bahuluang Island. A quantitative ecological study design using an EHRA-based environmental monitoring approach was conducted across 295 households selected through multistage random sampling. Data collection primarily involved direct field observation, environmental sanitation inspection, infrastructure verification, and EHRA-based environmental scoring, supported by limited household validation forms and guided interviews. The results showed that access to clean water sources was relatively high, with 72.4% of households on Pasi Gusung Island and 88.5% on Bahuluang Island classified in the good category. Similarly, latrine ownership was also high, reaching 78.6% on Pasi Gusung Island and 98.1% on Bahuluang Island. However, household solid waste management remained predominantly poor, affecting 74.9% and 73.1% of households, respectively. In addition, inadequate wastewater disposal systems were observed in 66.7% of households on Pasi Gusung Island and 53.8% on Bahuluang Island. Although handwashing with soap was reported as good among most households (95.1% on Pasi Gusung Island and 100% on Bahuluang Island), substantial gaps in solid waste and wastewater management remained and were reflected in moderate EHRI values of 2.23 and 2.33, respectively. The findings indicate that sanitation improvements are uneven and that behavioral interventions alone may be insufficient to reduce environmental health risks without corresponding infrastructure development. This study highlights that integrated municipal solid waste and wastewater management are important determinants of reducing faecal–oral exposure risks in small island tourism settings. The EHRA-based monitoring approach provides a practical tool for identifying priority sanitation interventions to support sustainable health risk reduction and environmental protection in vulnerable coastal tourism areas.
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