Sea level rise, storm surges, heatwaves, and increases in dengue and other infectious diseases are projected to increasingly affect the health of populations in the Pacific with global climate change. The risks will vary over time and place, challenging the ability of communities and health systems to adequately prepare. Further, these hazards will interact with other social and environmental trends, with the potential for increasing or decreasing the extent of the challenges. Effective and timely adaptation can increase the resilience of individuals and communities to what climate change brings. Further, reducing greenhouse gases and pursuing sustainable development goals through cutting emissions of air pollutants, increasing biking and walking, and changing dietary patterns can benefit health in the short-term and reduce the projected health risks of climate change in the longer-term. The magnitude and pattern of health risks over the coming decades depends on the choices we make navigating the course ahead.