This chapter discusses the development of health impact assessment (HIA) in The Netherlands. HIA in The Netherlands began in the early 1990s and developed along two different lines: one shaped by the public health approach and the other stemming from the environmental field. Public health-based HIA evolved according to the paradigm presented by the Lalonde model of health. The HIAs mainly concerned national policies and addressed a variety of policy fields, ranging from tobacco discouragement and health insurance policy to national housing policy and the high-speed rail link. The environmental-based HIA focused on preventing environmentally related health risks and did not consider health in a broader sense. There is no legal obligation for environmental impact assessments to consider health impacts outside an environmental scope. If a first screening of the planned activity points to large health impacts or many concerns about potential health effects, a more detailed quantitative health impact assessment should be carried out.