Climate change is widely recognised as the greatest threat to public health this century, but ‘climate change and health’ often refers to a narrow and limited focus on emissions, and the impacts of the climate crisis, rather than a holistic assessment of economic structures and systems of oppression. This tunnel vision misses key aspects of the climate change and health intersection, such as the enforcers of planetary destruction such as the military, police, and trade, and can also lead down dangerous alleyways such as ‘net’ zero, overpopulation arguments and green extractivism. Tunnel vision also limits health to the absence of the disease at the individual level, rather than sickness or health within systems themselves. Conceptualising health as political, ecological, and collective is essential for tackling the root causes of health injustice. Alternative economic paradigms can offer possibilities for fairer ecological futures that prioritise health and wellbeing. Examples such as degrowth, doughnut economics and ecosocialism, and their relationship with health, are described. The importance of reparations in various forms, to repair previous and ongoing harm, are discussed. Breaking free from tunnel vision is not simply an intellectual endeavour, but a practice. Moving towards new paradigms requires movement building and cultivating radical imagination. The review highlights lessons which can be learnt from abolitionist movements and progressive political struggles across the world. This review provides ideas and examples of how to break free from tunnel vision for climate change and health by highlighting and analysing the work of multiple organisations who are working towards social and economic transformation. Key considerations for the health community are provided, including working in solidarity with others, prioritising community-led solutions, and using our voice, skills, and capacity to address the structural diagnosis—colonial capitalism.