This strategic foresight report assesses the interaction between demographics, economic development, climate change and social protection in six countries in East Africa between now and 2065: Ethiopia, Kenya, Mozambique, Tanzania, Uganda and Zambia. The report combines population projections with trends in health, urbanisation, migration and climate change and identifies the implications for economic development and poverty. It concludes by identifying policies to address seven grand challenges for social protection planners in national governments and donor agencies which emerge from the projections. These include: eliminating extreme poverty; extending social insurance in a context of high informality; the rapid growth of the working-age population, in particular the youth; adapting social protection to urban settings; protecting the poor from the effects of climate change; harnessing a demographic dividend; and substantially increasing funding for social protection.