Sub-Saharan Africa (SSA) has contributed the least of any world region to the global accumulation of greenhouse gas emissions; however, this region will probably be more vulnerable to the impacts of climate change than any other . Less than 7% of the world’s total emissions of greenhouse gases emanate from the African continent ; thus the continent contributes very little overall to climate change. Yet the highest regional burden of climate change is likely to be borne by SSA, with 34% of the global disability adjusted life years (DALYs) attributable to the effects of climate change in the region . The impacts of climate change are likely to be concentrated in low-income countries where poor populations already have compromised heath prospects, health systems are weak, and where the capacity to adapt and address vulnerabilities is limited. However, to mount a proper response there are some fundamental constraints that need to be addressed, which we further discuss in this Essay.