||This chapter assesses 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 to improved health policy. Geopolitical realignments and neo-liberal policy ascendancy can be observed in a series of several dozen moments in which key events reflect important power shifts. The context has been a series of durable economic problems: stagnation, financial volatility and uneven development. Political alignments have followed, and remain in an adverse balance of power, from the standpoint of redistributive socio-economic reform. Any expectation that global governance offers solutions, given the prevailing political-economic and geopolitical processes, structures and trends, should be carefully reevaluated.