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If meeting basic survival needs can truly make a difference for the world’s population, and if this solution is preferable to other paths, then how can international law play a constructive role? Extant legal solutions have deep structural faults. The most glaring problem, widely debated by scholars, is whether international legal instruments and global institutions can effectively govern the diverse State and non-State actors that influence health outcomes. Setting normative standards and assuring follow-through are particular problems in health—more so than in other fields of international law. But even this governance debate does not address the hardest problem in global health. International law seems ineffective in creating incentives, let alone binding obligations, to provide funding, services, or protection for the world’s poorest people. But this is exactly what is required to solve the most intractable problems in global health.