This document presents the first joint report by Canadian and United States agencies on a number of environmental stresses affecting the binational Georgia Basin - Puget Sound ecosystem. The underlying message is the challenge that we regionally share of maintaining the long-term environmental, social, and economic sustainability of the region in the face of continued population growth and current, resource-intensive consumption levels. The high air quality that is basic to healthy lives and important aspects of economic well being, for example, will be affected by choices about transportation technologies and strategies, settlement patterns, energy use and individual consumption practices. Also, critical wildlife habitats, species, and related economic resources will be significantly influenced by development patterns and land-use decisions.