The 28th Conference of the Parties (COP28) to the United Nations Framework Convention on Climate Change marked a step-change forward in integrating health into the global climate change agenda..

This perspective explores the public health achievements and the imperatives from COP28, warning that there are a number of loopholes in the conference outcomes regarding the continued use of fossil fuels. To protect global health, urgent action is needed to phase out fossil fuels and transition to renewable energy, ensuring no communities are left behind. Investment is needed to increase the resilience of communities and health services to address innumerable challenges, including those associated with climate change, the authors argue. They also suggest that the health sector needs to become an enabler of action across sectors, as well as managing the health consequences of climate change on communities and health services.