Washington has dedicated past global health initiatives to delivering food, drugs, and other health technologies to the world’s poor. In doing so, it has been able to achieve progress even in countries with dysfunctional governments. But it cannot enforce the regulations on smoke-free public places, food and drug safety, urban sanitation, and road traffic that are now needed in such settings. Accordingly, the fundamental challenge in this new area of global health is not necessarily new medicine but better governance.