ABSTRACT
This chapter provides a commentary on major shifts in global political economy and geopolitics since the 1970s which have brought together processes of governance and liberalization in often uncomfortable ways. These processes have important manifestations in society, including the generation of structural constraints on policies that would improve health. Geopolitical realignments and neoliberal policy ascendancy can be observed in a series of several dozen moments in which key events refl ect important power shifts. The context has been a series of durable economic problems: stagnation, fi nancial volatility, and uneven development. Political alignments have followed and remain in an adverse balance of power from the standpoint of redistributive socioeconomic reforms essential to improving global health equity. Any expectation that global governance offers solutions, at least within prevailing political-economic and geopolitical processes, structures, and trends, requires careful and critical evaluation.
