Introduction Asian policy-makers are in the process of redefi ning their relationship to a system of global health governance (GHG) shaped principally by actors outside of the region, most notably Western governments. The way in which Asian policymakers defi ne this relationship – by choosing lukewarm or wholehearted support, passive or active resistance, pressure for change from within or the creation of alternative institutions – will be a key determinant of how GHG will evolve over the next decades. Whatever their choices, they will have a major impact on human health and well-being in Asia and beyond.