The present chapter follows the evolution of global governance in the health realm starting in the mid-nineteenth century. It begins by noting the first important actions taken by governments and nongovernmental groups to deal with health issues on a national scale. It then shows that activism in the domestic health realm quickly “spilled over” into global governance due to the increased physical interactions that came with a rise in international travel.

The following narrative then highlights the very many changes in the main global governors in the health realm across time as well as numerous changes in the intergovernmental or nongovernmental nature of these organizations. By doing so, it addresses the first main question for this chapter, regarding the types of changes taking place in the intergovernmental–nongovernmental nature of global governance. Additionally, I will identify the main states that supported or opposed each attempt to shift global governance across the intergovernmental–nongovernmental continuum (whether successful or not) and determine whether such states embraced activist or passive domestic approaches to health.