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This chapter describes the “global health system” as the organized social response to cross-border health risks. The global health system is comprised of actors whose primary intent is to improve health, along with the rules and norms governing their interactions. The system should perform four essential functions: producing global public goods, managing externalities, mobilizing solidarity and providing stewardship. However, the ability of the system to do so is impeded by three types of governance challenges – the sovereignty, sectoral and accountability challenges. This chapter calls for stronger global health governance.