This chapter brings together two broad concepts from across the fields of public health and ecological economics to generate a scheme for scoping Health Impact Assessment that more readily represents the ecological determinants of human health. From the Ottawa Charter for health promotion and recent derivations of it we recognize that health outcomes can be best enhanced by foregrounding the settings in which individuals and populations are experiencing health impacts. We reintroduce the notion that the foundational setting is the ecosystem. A useful way of accounting for these health impacts is provided by the ecosystem services concept, where ecosystems can be shown to provide a characteristic set of benefits (as goods and services). When these benefits are traded off, one against the other, health outcomes are affected (either negatively or positively), mediated by the core requirements of how and where food, water and shelter are provided, where exposures to toxicants and diseases occur, and how and where livelihoods are practised and lifestyles are carried out. Using a scenario where a development is proposed, in this instance a hypothetical situation involving a proposal to develop coal seam gas on farmland, we demonstrate the assumptions required for this approach, its utility, and some limitations and challenges for its adoption.