Richard Nixon’s signing of the National Environmental Policy Act in 1970 sent a clear signal that the U.S. federal government was going to play a major role in environmental protection. Chapter 2 summarizes some of the key federal laws passed during the 1970s and early 1980s. What is less well known is that within a decade, efforts were made to pull back from these commitments by returning more authority to the states and by reducing the federal part of the budget. Post-hoc evaluations of EPA priorities by senior EPA staff showed a mismatch between scientific measures of risk and government allocation of funds. The 50 states are markedly different in their willingness to support environmental health issues. We developed a typology of state environmental health innovation with data from 1970 to 2015 that shows that 13 states have had policies that are stronger than or at least as strong as the federal government and other states have been much less protective. Cities, for example, San Francisco, Seattle, Portland (OR), and others with strong programs, are with rare exception found in the most innovative states. Our state typology is revisited throughout the case study chapters that follow.