Environmental Quality has always been a keystone of the green building movement. The concept has evolved from "Indoor Air Quality", for example, in the first version of LEED seven years ago to a much broader and enriched concept - a concept that fully embraces Acoustics - today. This paper explores the evolution of Environmental Quality in both general and health care environments, and demonstrates the emerging role of Acoustics as an equal partner with Air Quality and Lighting as determinants of both health and productivity in the built environment. Specific references will be made to LEED rating systems and to emerging acoustical design requirements within LEED.