Despite the evidence of increasing climate change, and thus the importance of proactive development and deployment of public health interventions, it is unclear to what extent public health professionals in general view climate change as a public health issue. Although many of the anticipated health threats of climate change are within the current focus areas of public health departments, public health professionals may not be associating these problems with climate change, and hence may not be adequately preparing for future needs. This report is intended to highlight the gaps between the likely challenges to public health posed by climate change and the U.S. public health systems current state of preparedness. Information comes from existing literature and the results of a recent survey conducted by the authors. Understanding and addressing gaps in preparedness is critical to protecting the U.S. population against the health risks of climate change. This survey, which was given to a representative sample of local health departments from around the country, asked respondents to discuss their perception of climate-related health risks and the status and adequacy of their departments programmatic activities in response to these risks. It also asked respondents to identify the regulatory roles they perform, the programs in place that address policies and activities to reduce greenhouse gas emissions, and the additional resources needed to allow their departments to more effectively deal with climate change as a public health issue.