This article draws together three issues—the environment, health, and (in)justice—with the overall purpose of articulating an agenda for policy and research that works towards improved justice and sustainability in the environmental health arena. Considerable research in the United States and elsewhere has shown that both environmental exposures and poor health are more prevalent in populations that are marginalized by race and social class (typically measured as income). The logical next step has been to attempt to establish concrete cause-effect links between health effects and environmental exposures in order to mobilize government action to reduce these disparities. However, we caution against pursuing such causal links alone as a necessary precondition for just and sustainable environmental health policy. We instead argue for a framework that considers both environmental justice and health inequality in terms of compounded disadvantage at the community level. We support a precautionary approach to action that simultaneously pays due attention to the processes leading to injustices/inequities as well as remediating current patterns of injustice/inequity.