Despite synergies between action for air pollution and action for health, climate and social wellbeing in cities, siloed thinking and the “wicked” nature of urban air pollution limit optimal decision-making. Systems approaches offer opportunities to identify barriers and opportunities for action towards cleaner air, and to bolster solutions that optimize benefits and limit unintended consequences. Structured decision-making was adapted into participatory workshops as an engagement tool to develop systems insights into the barriers and opportunities for clean air action. 24 participants from 15 countries and a mix of non-governmental organizations, academia, public and private sectors partook in an online workshop. The aim was to understand the synergies and conflicts between stakeholders, and to identify the actions that stakeholders believe are feasible and provide co-benefits for climate, health and social wellbeing. Workshops identified “human health and wellbeing”, “equity” and “planetary health and climate” as shared objectives that drive stakeholders’ work. Participants developed over 100 actions to address these objectives. Highlights included the importance of transport and data related solutions, including air quality monitoring, modelling, and transparency. Stakeholders identified collaboration and integrated approaches as co-beneficial, yet they didn’t consider these particularly feasible. We identified a gap between the call for systems approaches and the evidence on how to implement systems thinking in decision-making practice. Structured decision-making enabled co-production and evaluation of objectives and actions, and promoted cross-sectoral networking between participants. It offers potential as a novel tool for engaging stakeholders and integrating systems insights and multisectoral perspectives into solutions to complex “wicked” problems.