This article describes the growing repository of evidence-informed climate-related health actions and builds a case for transformative adaptation strategies. The health impacts of climate change are far-reaching and diverse, affecting vulnerable populations disproportionately and at varying scales. While adaptation policies and plans are becoming increasingly intersectional, there is limited implementation of health-focused adaptation interventions. Securing finance at scale, for one, is a challenge. Funds are not being mobilized at the rate or scale required. Least developed countries and small island developing states are most at-risk and the least likely to recover, even under conservative global warming scenarios. Thus, this article spotlights opportunities for more resilient and equitable health systems across key dimensions of health surveillance, service delivery, infrastructure, finance, capacity development and policy coherence. Given limits to adaptation, co-benefits of mitigation and adaptation actions will need to be systematically assessed and prioritized to address the residual effects of climate disasters.