A cost-of-illness framework was applied to health and income data to quantify the health burden from illnesses associated with exposure to polluted recreational marine waters. Using data on illness severity due to exposure to polluted coastal water and estimates of mean annual salaries and medical costs (adjusted to 2001 values) for residents of Orange County, California, we estimated that the economic burden per gastrointestinal illness (GI) amounts to 36.58 dollars, the burden per acute respiratory disease is 76.76 dollars, the burden per ear ailment is 37.86 dollars, and the burden per eye ailment is 27.31 dollars. These costs can become a substantial public health burden when millions of exposures per year to polluted coastal waters result in hundreds of thousands of illnesses. For example, exposures to polluted waters at Orange County's Newport and Huntington Beaches were estimated to generate an average of 36,778 GI episodes per year. At this GI illness rate, one can also expect that approximately 38,000 more illness episodes occurred per year of other types, including respiratory, eye, and ear infections. The combination of excess illnesses associated with coastal water pollution resulted in a cumulative public health burden of 3.3 million dollars per year for these two beaches. This paper introduces a public health cost variable that can be applied in cost-benefit analyses when evaluating pollution abatement strategies.