AIM: With current health ministerial directives to prioritise actions on reducing health inequities and district health board (DHB) greenhouse gas (GHG) emissions, we argue that all climate change and environmental sustainability actions by DHBs must be pro-equity, and explore how the two priorities can be addressed concurrently. METHOD: Building on prior knowledge of climate change and environmental sustainability action in the health and disability sector, we undertook a visioning exercise to generate ideas for pro-equity GHG emissions reduction initiatives in the DHB context. Visioning was further informed by presentation and feedback discussion at an Annual Scientific Meeting of the New Zealand College of Public Health Medicine. RESULTS: Three scenarios were envisioned in the areas of DHB energy use, transport and procurement where GHG emissions could be reduced, and health determinants and outcomes for Maori and Pacific peoples improved. CONCLUSION: Current ministerial directives to address both health inequities and DHB greenhouse gas emissions present DHBs with the opportunity to ensure they systematically address both priorities at the same time. In doing so, Aotearoa/New Zealand has the potential to lead the world in demonstrating pro-equity climate change and sustainability action in health systems.