The Kentucky Environmental Foundation conducted an HIA of coal and clean energy options in the state of Kentucky. The HIA provided a health-based screening of the life cycle of coal from point of extraction to disposal of byproducts. These impacts are compared to those associated with energy efficiency and renewable energy options proposed in the Clean Energy Opportunity Act as introduced in the 2011 and 2012 Kentucky legislative sessions. Development of this HIA included input from health professionals, health affected citizens, individuals working within the energy sector and professional researchers. The HIA found that public health is affected throughout the coal cycle, from air pollution and water contamination during mountaintop mining to greenhouse gas release during coal extraction and burning. The HIA made several recommendations, including that Kentucky legislators support diversification of the state’s energy portfolio and provide incentives for residents to use energy more efficiently.