Abstract To aid health adaptation decision-making, there are increasing efforts to provide climate projections at finer tem-poral and spatial scales. Relying solely on projected climate changes for longer-term decisions makes the implicit assump-tion that sources of vulnerability other than climate change will remain the same, which is not very probable. Over longer time horizons, this approach likely over estimates the extent to which climate change could alter themagnitude and pattern of health outcomes, introducing systematic bias into health man-agement decisions. To balance this potential bias, decision-makers also need projections of other drivers of health out-comes that are, like climate change, recognized determinants of some disease burdens. Incorporating projections via an it-erative process that allows for regular updates based on new knowledge and experience has the potential to improve the utility of fine-scale climate projections in health system adap-tation to climate change. KeywordsClimate change. Health risks.Adaptation.Risk management.Uncertainty