Abstract Climate change is one of the biggest threats to global health in the 21st century and is likely to impact on health through a range of factors (societal, economic or environmental). The need to take action on climate and nature emergencies in order to protect population health and well-being and prevent negative impacts are becoming more urgent. Public Health Wales carried out a comprehensive mixed-method Health Impact Assessment (HIA) of climate change in Wales. HIA is a systematic process which considers the impact of a policy on the health and well-being of a population. It appraised the potential impacts of climate change on health and inequalities in Wales. This involved participatory workshops, engagement with stakeholders, statistical data, systematic literature reviews and case studies. The HIA findings indicate significant potential impacts across the determinants of health and mental well-being. For example, air quality, flooding, economic productivity, working conditions, access to services and community resilience. Impacts were identified across population groups, settings, and areas including urban and rural contexts, outdoor workers, children and young people, older people, schools, hospitals and workplaces. These findings have been beneficial to inform decision-makers to prepare for climate change plans and policies using a preventative evidence-informed approach. The work has demonstrated the value of HIA for significant, complex policies by mobilising a range of evidence through a transparent process, resulting in government and organizational action and transferrable learning for others. Key messages • HIA is a beneficial tool to identify at a granular level the health impacts of climate change. • The HIA has been used by the government of Wales and organisations to respond to and plan for climate change.