BACKGROUND:
Ecologically fragile regions such as the Sundarbans in the Bay of Bengal face intersecting challenges of climate change, biodiversity loss, emerging zoonotic risks, and socio-economic vulnerability. Conventional health systems policies—largely focused on financing, governance, and service delivery—often overlook the wider social, ecological, and environmental determinants of health. This fragmentation limits effective pandemic prevention, climate resilience, and sustainable development, particularly in vulnerable deltaic ecosystems.

METHODS:
This paper draws on findings from a pilot study conducted in the Sundarbans to examine human–animal–ecosystem interfaces and their implications for health, livelihoods, and environmental sustainability. Using a One Health analytical framework, the study maps ecological vulnerabilities, livelihood dependencies, and disease risk pathways, alongside a gap analysis of existing health systems and development policies. The analysis integrates ecological, social, and economic dimensions to assess pathways for climate-resilient and inclusive development.

RESULTS:
The study reveals that current health and development approaches remain poorly aligned with the causal drivers of disease production rooted in environmental degradation, climate stressors, and socio-economic precarity. This misalignment fosters reliance on costly techno-managerial health solutions while neglecting preventive, ecosystem-based interventions. Applying a One Health lens highlights the potential of integrated eco-social interventions to simultaneously enhance human well-being, strengthen pandemic security, protect biodiversity, and support sustainable livelihoods. Such approaches also align with green economy transitions by linking health outcomes with environmental stewardship and climate adaptation.

CONCLUSIONS:
A One Health-based, eco-social intervention model offers a viable pathway for climate-resilient development in ecologically fragile regions such as the Sundarbans. By integrating health, environment, and livelihoods, this approach repositions public health as a driver of green economy transitions, pandemic prevention, and social equity. Embedding One Health principles into development and health policy is essential for addressing Asia’s converging climate, health, and inequality challenges.