As we move further into the twenty-first century, there is growing realization that the relationship between humans and the wider environment is crucially important, and a recognition that unfettered globalization linked to an increasingly dominant consumer culture has wrought devastating impacts. Within this context, and catalyzed particularly by concerns about climate change, there has also been increased appreciation that public health and the health of the planet are closely interrelated. This article focuses on the opportunities and potential value of encouraging joined-up thinking and integrated action in the settings where people live their lives. Having set the broad context regarding health, equity and sustainability, we scope current activity in relation to ‘greening’ settings before honing in on two concerns: that few such initiatives reflect the holistic and ecological perspective that underpins a settings approach to health promotion, and that work on sustainability and work on health have largely been developed in parallel rather than in an integrated manner. Having discussed these concerns, we propose six principles for progressive practice as a means of grounding a healthy and sustainable settings approach, before concluding by looking to the future and highlighting the likely need and benefits of daring to make more radical changes to our individual, community and working lives.