In many low- and middle-income countries, urbanisation and urban development are characterised by hazards that conspire with climatic risks and socio-economic vulnerability to influence population health inequality now and in the future. A large part of the epidemiological profile across countries in the �Global South�, has been influenced by a rapid rate of urbanisation and interlinked factors such as climate and ecology. This necessitates an integrated approach to governance for health and climate change. Through three case studies in Lagos, we explore real-life examples that demonstrate these interdependencies, noting approaches taken and missed opportunities. We conclude by reflecting on these experiences, as well as historical examples of comprehensive systems approaches to health, to propose a community-oriented model for integrated climate change and health action in rapidly growing cities.