Risk assessments have traditionally focused on individual stressors and discrete endpoints, yet evidence shows that cumulative impacts arise from the interaction of chemical, physical, biological, ecological, and social stressors across the total environment. Because these stressors propagate through shared pathways, such as water quality, food webs, and ecosystem services, changes in ecosystem condition directly influence human exposure and susceptibility, and vice versa, highlighting the need to evaluate ecological and human health risks in an integrated manner. A multidisciplinary review of over 600 studies and regulatory frameworks was conducted, focusing on integration of stressors and risk factors across multiple domains. This work synthesized current approaches to cumulative impact assessment (CIA) to evaluate how diverse evidence streams can be combined to better visualize, characterize, and manage risks from a cumulative perspective. It was found that advances in chemical characterization and modeling have improved assessment of individual contaminants, but integration across stressors, media, and biological endpoints remains limited. Applications appeared to rely on broad indicators that do not capture local exposure dynamics, mixture effects, or causal linkages between ecological factors and human health, or human conditions and ecological health. Some of the more effective frameworks and applications from the study will be shared that include features that have the potential to advance more robust integration of ecosystem and human factors in risk assessments. Study results will be used to illustrate the need to explicitly link ecological condition and human health outcomes to provide a stronger and more complete scientific basis for assessing and managing cumulative impacts. Research needed to improve integration of ecological and human health risk assessment in the context of cumulative impact assessment will be summarized. SETAC provides an excellent forum to discuss and plan progress toward this goal.