The City of Spokane is redeveloping the Division Street Gateway, a little over a mile of State Highway 2 that runs through the heart of downtown Spokane from its inception at Interstate 90 to its intersection with the Spokane River and north to the Gonzaga University neighborhood. This is essentially the city’s front door and living room, leading to the central business district, civic buildings, and Riverpoint Campus in the University District, home to five university branches. In addition to other safety and aesthetic deficits, this area experiences a relatively high level of bicycle and pedestrian accidents compared to other major streets in downtown Spokane. Together with the City of Spokane, other local organizations and city officials, the Spokane Regional Health District conducted an HIA to measure the potential health impact of the construction plan. The topics studied were transportation, safety, physical and mental health, social cohesion, economy, built environment, and natural environment. Data and recommendations were presented at informational meetings with the development consultant and city planners. The HIA is hoping to inform the final development plan and presented HIA findings at a City Council meeting in mid-2012. The findings are that the Division Street Gateway Project design will improve east-west connectivity for pedestrians and cyclists, enhance Spokane’s visual image, and provide safe and effective transportation for all modes.