Preventing negative health outcomes requires understanding change as well as its direct and indirect health effects. To assess climate change impacts on public health, the Alaska Native Tribal Health Consortium (ANTHC) worked with partners to complete Climate Change Health Assessments (CCHAs) for Bering Strait Communities, Upper Nushagak River, Atqasuk, Nuiqsut, Wainwright, Bristol Bay Communities, Levelock, Nondalton, Pilot Point, Selawick, Kiana, Noatak, Kivilina and Point Hope. The CCHAs are driven by local observation and traditional seasonal time scales, which are synthesized with available climate, environmental and health data. A survey tool, the Climate and Health Measure (CAHM), was developed and used for recording observations, assessing potential health effects, identifying data gaps and exploring adaptation pathways. Through the CCHA process, priorities are identified and stakeholders empowered to address specific problems, consider strategies, develop partnerships and implement adaptive measures. Because the process relies upon local observations, the Alaska Tribal Health system has been able to act quickly and support local efforts to develop appropriate responses.