Reconsidering the relationship between human well-being and environmental quality is central for the management of wetlands and water resources and for public health itself. We propose an integrated strategy involving three approaches. The first is to make assessments of the ecosystem services provided by wetlands more routine. The second is to adopt the 'settings' approach, most developed in health promotion, wherein wetlands are one of the settings for human health and provide a context for health policies. Finally, a layered suite of health issues in wetland settings is developed, including core requirements for human health (food and water); health risks from wetland exposures; and broader social determinants of health in wetland settings, including livelihoods and lifestyles. Together, these strategies will allow wetland managers to incorporate health impact assessment processes into their decisionmaking and to examine the health consequences of trade-offs that occur in planning, investment, development, and decisionmaking outside their direct influence.