At last, climate change does appear to have entered mainstream consciousness. In the scientific community, the climate change debate has shifted from focusing on establishing the truth of the claim that climate change is a reality to warming public opinion to the cause and acknowledging that climate change will have far-reaching effects on how we build, organize and manage climate-responsive social systems including health care systems. There is particular urgency to the debate for health services and systems in low income countries where some of the worst effects of climate change will be felt and where health systems are already over-stretched due to long-term lack of investment, a double burden of disease (preventive and non-communicable), a crisis in human resources and governance deficiencies. Despite the urgency, the health care systems development community appears insular in its interests and actions, and a clear leader that could coordinate the activities of different researchers, research bodies, policy makers and international organizations across relevant sectors including disaster management, climate and health care systems, has yet to emerge. This essay considers the political landscape, possible leaders and why it is necessary for health systems' professionals to move beyond the health sector in order to secure support for health and health care systems development in a post-Millennium Development Goals development framework that is defined by climate change.