Climate change in the Caribbean is characterised by rising temperatures, changes in precipitation patterns, sea level rise and more powerful hurricanes. This chapter presents a conceptual framework to understand these as “climate drivers” that affect “exposure pathways” towards health outcomes. Exposure pathways include extreme heat, water and food availability and quality, air quality, changes in infectious agents, and damage to infrastructure and livelihoods. Using Caribbean evidence, effects of these on health outcomes are shown, including heat-related illness, injuries, mental health, water-borne, food-borne, nutritional, respiratory and vector-borne diseases. Ways that the effects of climate change on health are mediated by environmental, institutional, social and behavioural factors are presented. Environmental factors include local ecosystems and geographical characteristics, implying the need for tailored adaptation strategies. Institutional factors include government policies and the resilience of health and other infrastructure. Policies and options for health systems strengthening are presented. Social factors such as gender, income distribution and access to health services influence the health outcomes of climate change. Behavioural factors such as waste management practices mediate effects on specific communities and populations. Upstream factors must therefore be addressed to assure equitable responses to climate change and health. Multisectoral collaboration is critical.