A changing climate will exacerbate many of the problems currently faced by California's public health institutions. The public health impacts of climate change include: an increase in extreme heat events and associated increases in heat-related morbidity and mortality, increases in the frequency and severity of air pollution episodes, shifts in the range and incidence of vector-borne diseases, increases in the severity of wildfire, increased risks of drought and flooding, and other extreme events. This article assesses the readiness of California's public health institutions to cope with the changes that will accompany a changing climate and how they relate to strategies laid out in the state's Climate Adaptation Strategy. County-level health offices are the front line actors to preserve public health in the face of numerous threats, including climate change. Survey results show that local health officers in California believe that climate change is a serious threat to public health, but feel that they lack the funding and resources to reduce this risk. Local health agencies also have a number of tools in place that will be helpful for preparing for a changing climate.