Climate change poses serious threats to human health and well-being. It exacerbates existing health inequities, impacts on the social determinants of health and disproportionately affects vulnerable populations. In the Australian region these include remote Aboriginal communities, Pacific Island countries and people with low incomes. Given health promotion's remit to protect and promote health, it should be well placed to respond to emerging climate-related health challenges. Yet, to date, there has been little evidence to demonstrate this. This paper draws on the findings of a qualitative study conducted in Victoria, Australia to highlight that; while there is clearly a role for health promotion in climate change mitigation and adaptation at the national and international levels, there is also a need for the engagement of health promoters at the community level. This raises several key issues for health promotion practice. To be better prepared to respond to climate change, health promotion practitioners first need to re-engage with the central tenets of the Ottawa Charter, namely the interconnectedness of humans and the natural environment and, secondly, the need to adopt ideas and frameworks from the sustainability field. The findings also open up a discussion for paradigmatic shifts in health promotion thinking and acting in the context of climate change.