Water utilities dealing with drinking water, wastewater, and stormwater have public health in their missions. In the mid-19th century, public sanitation improvements increased life expectancy from 35 to 80 years by bringing clean water to people’s homes and reducing communicable disease, such as cholera. Now, chronic conditions (such as heart disease, cancer, respiratory diseases, diabetes, and depression) are the most prevalent health issues in the United States, Canada, and other nations, and preventing them is the public health challenge of our time. Green infrastructure can be part of the solution, but improving public health is hard work. It means being intentional about engaging community, locating sites for green infrastructure, and selecting designs that improve physical activity, mental health, social cohesion, air quality, and other health factors.