A review of recent studies and initiatives on global health cooperation groups their findings into ten key reform issues.In addressing these issues, policy makers need to improve their understanding of what is meant by the shift from international to global health. Attention must also be paid to the fundamental question of what we want from a system of global health cooperation. Three main views currently exist on what priority activities such a system should pursue-traditionalist, essentialist, and social justice. Reconciliation of these views can then be followed by consideration of the structural features of a global health organisation for the 21st century. Achievement of the above will require a reform process that is more broadly participatory, well-informed, and coherent in purpose and direction.