Bridges can be subjected to damaging environmental actions due to flooding and seismic hazards. Flood actions that result in scour are a leading cause of bridge failure, while seismic actions that induce lateral forces may lead to high ductility demand that exceeds pier capacity. When combined, seismic actions and scour can lead to effects that depend on the governing scour condition affecting a bridge. Loss of stiffness under scour can reduce the ductility capacity of a bridge but can also lead to an increase in flexibility that may reduce seismic inertial forces. Conversely, increased flexibility can lead to deck collapse due to support loss, so there exists some uncertainty about the combined effect of both phenomena. A necessary step towards the performance assessment of bridges under flooding and seismic actions is to calibrate numerical models that can reproduce structural responses under different actions. A further step is verifying the achievement of performance goals defined by codes. Structural health monitoring (SHM) techniques allow the computation of performance parameters that are useful for calibrating numerical models and performing direct checks of performance goal compliance. In this paper, various strategies employed to monitor bridge health against scour and seismic actions are discussed, with a particular focus on vibration-based damage identification methods.