This chapter explores the complex population-environment dynamics underpinning three major and interconnected environmental challenges in Ghana, with a critical focus on unsustainable urban land use in Kumasi and the Odaw River Basin in Accra and illegal small-scale gold mining (Galamsey) in the Offin River Basin. Through a Driver-Pressure-State-Impact-Response (DPSIR) lens, the chapter identifies and analyses multifaceted drivers, environmental pressures, their resulting states and associated impacts, and the responses to these stresses. The main drivers include demographic dynamics such as rapid population growth and concomitant youth unemployment, weak institutional and legislative frameworks, socio-economic inequalities, policy fragmentation, and technological limitations. Pressures manifest through unregulated urban sprawl, poor waste management, and destructive mining practices, leading to altered ecosystem characterised by deforestation, soil erosion, water pollution, urban sprawl and declining biodiversity. These degraded states exacerbate flood disaster risks and biodiversity loss and reduce long-term socio-ecological benefits, often sacrificed for short-term socio-economic gains. The impacts are severe, affecting human health, livelihoods, infrastructure, access to and cost of potable water and ecological integrity across urban and river basin landscapes. Evidence-based management responses have been fragmented and often reactive, with limited integration across governance scales and sectors. The chapter recommends a sustainable policy and management responses informed by a holistic, systems-based understanding of contemporary population-environment linkages. Such responses should be participatory and transboundary in nature and recognise the emerging population dynamics underlying multiple developmental pathways to ensure resilience and equity.