The left and centre-left governments of the last decade in Uruguay have led to major societal changes involving tax, labour, health, high education and individual freedom, despite which several structural social problems remain. Advances in the environmental field have been, in contrast, more modest and often controversial. At the same time, significant changes in landscape have occurred over a very short time period. This has been a common trend in South America, where large international investments and land use transformations, driven by global demand of commodities, have been promoted to fund welfare policies by the mostly centre or left-leaning governments (a process called “(progressive) neo extractivism”). In Uruguay, such land use changes (in this case from grasslands to intensive agriculture and plantations of exotic trees) have led to a notorious deterioration of key watersheds, which increased public awareness and placed the environment in the public agenda. Contradictory national policies regarding the use of nature are now sparking growing scepticism among increasing sectors of the population, and even causing disputes within government sectors: New genetically modified organisms (GMOs), some designed to resist pests that are not a problem in the country, have been just approved despite a stand-off between the public health and environmental ministries and those of economics and agriculture. An irrigation law was recently passed by Parliament to facilitate large irrigation reservoirs so crops can be grown regardless of climate variability and exports of commodities can be maintained and increased, raising major concerns among environmental scientists. Right now, several grass roots organizations are organizing a national referendum to revoke this law, extending the current controversies across society. In this regional and national context, the paradigm of sustainable development has not been able to solve the tensions between environmental protection and current productive processes. Significant challenges remain in finding structural alternatives, where knowledge of local natural processes and technological advances can be enhanced and directed to incorporate sustainability while promoting the profound social advances that South America needs.