The ecological environment in high-cold and high-altitude area is fragile and sensitive, which raise higher claim for municipal solid waste (MSW) management. In the high-cold and high-altitude area, there are problems, such as the mismatch between the actual amount of MSW generated and the scale of transportation and treatment facilities, and the inefficiency of MSW management. In terms of MSW forecasting methods, it is also difficult to forecast due to the lack of data. This study is the first to propose a system dynamics-based method for predicting the amount of MSW generated in high-cold and high-altitude area, and apply it to Lhasa. The research results show that the total amount of MSW generated in Lhasa is small, but the growth rate is fast. Through dynamic simulation, it is found that the synergistic consideration of gross domestic product (GDP) growth rate, urban construction policy and tourism development policy can significantly reduce the growth trend (14% emission reduction in 2030). In addition, strengthening supervision and restraint, publicity and education in high-cold and high-altitude area can produce better waste sorting effects, minimise the pressure on treatment facilities, and improve resource utilisation. Finally, the policy implications are suggested, for example, in the process of MSW management, the impact of economy, urbanisation, tourism and so on, should be taken into account and comprehensively adjusted. It is anticipated that this model and policy implications can be applied to other high-cold and high-altitude cities to provide data support and policy reference for the whole-process management of MSW.