Health inequalities, deeply connected to broader social determinants such as unemployment, inadequate housing, and limited access to healthcare and essential services, remain a global concern. These factors disproportionately impact socioeconomically underserved communities, even in high-income countries. In Ireland, similar disparities are evident within urban areas. Although policy and practice increasingly promote community participation, there is limited evidence on how communities perceive and articulate their challenges and priorities. This study, conducted in collaboration with Healthy Communities Local Development Officers across three underserved Dublin communities, employed an interpretive qualitative approach grounded in a community-based participatory research framework. Data collection involved guided interactive walks with residents and workers, structured group activities to define and prioritize needs, and focus group discussions. Braun and Clarke's thematic analysis method was used, followed by relevant parties' engagement workshop to review findings and discuss next steps. Six interrelated themes were generated: challenging environmental conditions, substance use and drug-related harm, gaps in healthcare access, social isolation and inadequate amenities, diminished safety and support, and fragmented family structures. These were underpinned by recurring latent themes of community disempowerment, lack of involvement in decision-making, misaligned interventions, and mistrust in statutory bodies. The findings highlight the importance of amplifying community voices to better understand local needs and priorities. Addressing these issues requires integrated, multi-sectoral approaches that combine local government action on place-based determinants with systemic and national-level policy reforms. This study lays the foundation for more meaningful community engagement and co-creation of locally tailored, community-led solutions to tackle entrenched inequities.