There is an overwhelming need to include health impact as an integral component in the planning of Dams and other major water infrastructure projects. Appropriate capacity in HI (Health Impacts) and community health management needs to be built both within the health sector and in the sectors primarily responsible for Dams. At the international level, the World Health Organization is the indicated agency to provide a framework for the health impact assessment of large, often Tran boundary Dam and river basin development projects. This submission points out that there is scattered information on good practice in Dam design and operation for health. It provides a coarse characterization of the knowledge bases of the health issues associated with Dam projects. The number of successful integrated health risk management experiences in Dam projects is limited, but there is a relatively large body of evidence of singular methods of good practice, which have been proven to be effective under specific eco-epidemiological conditions, with an emphasis on health issues determined by environmental factors. Negative health impacts of Dams represent a hidden cost to the health sector. Taking human health into consideration at the planning stage makes good economic sense. Not only does it allow keeping the additional burden on the health sector limited to a minimum, but it also permits an optimal use of "win-win" opportunities for the Dam operators and public health. Many of the health safeguards that should be considered good practice can be incorporated into Dam projects at minimal additional costs, because they imply design changes that permit a more flexible operation (WHO, 1986). Changes in environmental and social determinants of health, resulting from a Dam project, will also provide an incentive for the health sector to review the delivery of its services and improve performance and efficiency. Three requirements are essential in order to effectively protect and promote health in relation to Dam projects: (1) a supportive policy, (2) an acceptable procedure and (3) a usable method of risk assessment. The health issues associated with Dams can be conveniently represented in six major categories: communicable diseases, non-communicable diseases, injury, malnutrition, psychosocial disorder, and lack of social well being. The existing knowledge bases concerning the impact of Dam construction and operation vary for the different categories. Many of the adverse health outcomes associated with dams and associated infrastructure developments (e.g. irrigation schemes) can be prevented or mitigated if a broader and more holistic view of project construction and operation is taken. Along with a range of insightful engineering approaches should come a recognition for the need to take an integrated, multi-disciplinary approach to environmental, social and health management? This new understanding can lead to the implementation of a range of innovative design and operational features for water infrastructure projects. Such changes may be cost effective and provide the desired health outcomes that formally were considered controllable only through medical intervention or by more drastic environmental control procedures.