BACKGROUND:
Health inequalities among women and youth in rural Uganda are driven by interconnected social, economic, and environmental determinants, including poverty, lack of productive assets, and reliance on environmentally harmful livelihoods. Evidence linking economic exclusion to health access and climate-related behaviors at community level remains limited.

METHODS:
A baseline cross-sectional study was conducted in Luwero, Kiboga, and Nakasongola districts. Structured interviews were administered to 200 women and 50 youth, complemented by four focus group discussions and three key informant interviews. The study assessed associations between poverty, knowledge of government programs, health service utilization, livelihood practices, and environmentally harmful behaviors. Descriptive and thematic analyses were performed.

RESULTS:
Findings revealed marked structural vulnerability. Only one woman reported independent land ownership, and most relied on male partners for healthcare access. Awareness of government livelihood programs was low, and informal women’s groups lacked meaningful economic impact. Approximately 90% of women reported mental stress from repeated livelihood failure; over 95% expressed readiness to engage in income-generating work if guided and assured of markets. Youth identified lack of capital and collateral as key barriers. These conditions correlated with continued reliance on biomass fuels, limited healthcare utilization, and environmentally destructive practices.

CONCLUSIONS:
Baseline evidence indicates that health inequality and environmental degradation are strongly linked to economic exclusion. Findings informed the introduction of supervised common user hubs as a systemic public health intervention. Early implementation suggests structured economic empowerment models can simultaneously improve equitable health access, climate restoration, and community safety, offering a replicable approach for low-resource settings.