Climate change is the biggest threat to humanity through compounding ecological disasters. A focus on global averages tends to hide dramatic differences and mask health disparities that exist for Indigenous people. For 21 years, district health boards (DHBs) were responsible for providing or funding the provision of health services across Aotearoa. The introduction of the Pae Ora (Healthy Futures) Act 2022 disestablished DHBs and offered an opportunity to reshape health in ways that give serious consideration to climate change impacts. The need to give greater consideration to Indigenous people in climate change conversations is essential. The Waitangi Tribunal highlights areas where the Crown needs to work to improve Māori health outcomes. A clear deficit in existing policy process means a lack of preparedness for the intersecting health crises vulnerable Māori will experience in the face of climate change. Structural change is needed to strengthen health institution responsiveness to Māori health needs.