Objectives: Human-generated climate change is causing adverse health effects through multiple direct pathways (e.g. heatwaves, sea-level rise, storm frequency and intensity) and indirect pathways (e.g. food and water insecurity, social instability). Although the health system has a key role to play in addressing these health effects, so too do those professions tasked with the development of the built environment (urban and regional planners, urban designers, landscapers and architects), through improvements to buildings, streets, neighbourhoods, suburbs and cities. This article reports on the ways in which urban planning and design, and architectural interventions, can address the health effects of climate change; and the scope of climate change adaptation and mitigation approaches being implemented by the built environment professions. Type of program or service: Built environment adaptations and mitigations and their connections to the ways in which urban planning, urban design and architectural practices are addressing the health effects of climate change. Methods: Our reflections draw on the findings of a recent review of existing health and planning literature. First, we explore the ways in which ‘adaptation’ and ‘mitigation’ relate to the notion of human and planetary health. We then outline the broad scope of adaptation and mitigation interventions being envisioned, and in some instances actioned, by built environment professionals. Results: Analysis of the review’s findings reveals that adaptations developed by built environment professions predominantly focus on protecting human health and wellbeing from the effects of climate change. In contrast, built environment mitigations address climate change by embracing a deeper understanding of the co-benefits inherent in the interconnectedness of human health and wellbeing and the health of the ecosystem on which it depends. In the final section, we highlight the ethical transition that these approaches demand of built environment professions. Lessons learnt: Built environment interventions must move beyond simple ecological sustainability to encouraging ways of life that are healthy for both humans and the planet. There are key challenges facing this new approach.