Climate change and economic growth are having a profound influence on the integrity of socio-economics and ecology of coastal Bangladesh. In the extreme, there are widespread expectations of inundation and coastal abandonment. However, results from our integrated assessment model (IAM) show that over the next 30 years, development choices might have a stronger influence on livelihoods and economic wellbeing than climate driven environmental change. The IAM simulates the economic development of rural areas by coupling physical models (driven by expectations of climate change) with economic models (informed by a series of policy decisions). This is done using substantial primary, secondary and stakeholder-derived biophysical and socio-economic datasets, together with shocks such as cyclones. The study analyses the future socio-ecological sensitivity to climate change and policy decisions and finds that well managed development is as important as adaptation to mitigate risks, reduce poverty and raise aggregate well-being. This analysis enables decision makers to identify appropriate development pathways that address current social-ecological vulnerability and develop a more resilient future to 2050 and beyond. These policy actions are complementary to climate adaptation and mitigation. Our IAM framework provides a valuable evidence-based tool to support sustainable coastal development and is transferable to other vulnerable delta regions and other coastal lowlands around the world.