Since the early 1990s, a few small-scale community programs in developing countries have been using integrated approaches that address population-health-environment (PHE) links in ecologically fragile areas. These projects have sought to increase access to family planning and health services, while simultaneously helping communities manage their natural resources. Roger-Mark De Souza provides some observations from his decade-long experience with emerging PHE projects around the world, and offers recommendations for future directions in this promising field.