Adapting to the health effects of climate change is one of the key challenges facing public health this century. Our knowledge of progress on adaptation, however, remains in its infancy. Using the Fifth National Communications of Annex I parties to the UNFCCC, 1912 initiatives are systematically identified and analyzed. 80% of the actions identified consist of groundwork (i.e. preparatory) action, with only 20% constituting tangible adaptations. No health vulnerability was recognized by all 38 Annex I countries. Furthermore, while all initiatives affect at least one health vulnerability, only 15% had an explicit human health component. Consideration for the special needs of vulnerable groups is uneven and underdeveloped. Climate change is directly motivating 71% of groundwork actions, and 61% of adaptation initiatives are being mainstreamed into existing institutions or programs. We conclude that the adaptation responses to the health risks of climate change remain piecemeal. Policymakers in the health sector must engage with stakeholders to implement adaptation that considers how climate change will impact the health of each segment of the population, particularly within those groups already considered most vulnerable to poor health outcomes.