The review describes the evolution of the environmental policies in Italy underlying current delays and discords between the environment and its effects on human health. It also tries to define the major barriers to the introduction of the health impact assessment (HIA) in government policy-making process in Italy; the lack of regulations and the lack of methods to perform an HIA are the main reasons for its limited use. Epidemiology is a fundamental tool to produce effective health impact assessments along with a deep knowledge of medicine, environmental hygiene and risk communication. In conclusion, should the Italian scientific community agreed on a common and constructive approach avoiding possible exploitations and conflicts of interest, HIA could be a valuable method for helping to develop environmental policies and assisting policy-makers in important decisions.