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The health impacts of climate change are distributed inequitably, with marginalized communities typically facing the direst consequences. However, the concerns of the marginalized remain comparatively invisible in research, policy and practice. Participatory action research (PAR) has the potential to centre these concerns, but due to unequal power relations among research participants, the approaches often fall short of their emancipatory ideals. To unpack how power influences the dynamics of representation in PAR, this paper presents an analytical framework using the metaphor of ‘puppeteering’. Puppeteering is a metaphor for how a researcher-activist resonates and catalyses both the voices (ventriloquism) and actions (marionetting) of a marginalized community. Two questions and continuums are central to the framework. First, who and where the puppeteer is (insider and outsider agents). Second, what puppeteering is (action and research; radical and managerial). Examples from climate change and health research provide illustrations and contextualizations throughout. A key complication for applying PAR to address the health impacts of climate change is that for marginalized communities, climate change typically remains a few layers removed from the determinants of health. The community’s priorities may be at odds with a research and action agenda framed in terms of climate change and health.