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Issue addressed Globally and locally, environmental degradation (including climate change) and inequity pose major risks to health. While health promoters recognise the importance of both issues, they may be seen as separate agendas. This study investigated health promotion addressing both issues together. Methods The study was an investigation of health promotion practice addressing environmental sustainability and equity, conducted in 2013, as part of a community-based participatory action research project with three Primary Care Partnerships (PCPs) in Victoria, Australia, during 2009-2016. Results Thirty-two local health promotion projects addressing both environmental sustainability and equity were identified. Analysis showed clusters of environmental, equity and health themes, particularly around: (a) caring for local environment, food, access to nature and Indigenous participation; (b) sustainability of housing, thermal comfort and reducing energy costs; and (c) sustainable and active transport. The study also found a marked decline in the number of PCPs in Victoria identifying environmental sustainability as a priority in 2013, compared to 2009. Analysis of helpful factors and challenges to practice identified by research participants, suggests interrelated political, organisational and discursive factors contributed to this decline. Conclusions The study suggests local health promotion can contribute to the development of societies that are more ecologically sustainable and more equitable. However, the challenges suggest broader advocacy is required to support local action. So what? Environmental degradation and inequity are major threats to human and ecosystem health. This study shows local health promotion can address both issues concurrently, and provides important information about challenges to this work.