The article provides a rationale for a comprehensive analysis of major investment projects and their impact on natural and social environment of the Baikal Region. The investment projects currently under way in the region have been characterized; most of them deal with resource development and raw material processing. Their impact on the environment largely controlled by their proximity to major zones of displacement of population has been determined. The Baikal Region is remarkable for a combination of abundant natural resources and its unique natural landscapes. This requires a balance between the economic value of a project and its negative impact on the environment. The government must act as an arbiter, providing legislational regulation for any contractual relationships between the production activity, environment and regional community. However, the decline in investment activity and reduced fiscal opportunities could provoke implementation of a project by compromising requirements for the environmental attributes to production activities. Therefore, a critical criterion for evaluating a specific project’s feasibility is to be the impact on public health, which will be assessed in public expenditures for its recovery. This may be benefited by an integrated approach to the assessment of the impact by means of involving medical research institutes in the solution of this common issue. Promoting green economy principles should become the main direction in economic the development of the territories like the Baikal Region, which makes it possible to preserve the unique ecosystems in conjunction with the industries modernization for the benefit of people living here.Keywords: large-scale investment projects, environmental impact, ecosystems, public health, environmental assessment.