INTRODUCTION:
Health inequalities in the context of global health are deeply intertwined with power asymmetries that structure contemporary global governance. The international order established after World War II, shaped by colonial legacies and the dominance of international financial institutions, consolidated a political and economic architecture that positioned post-colonial countries in a subordinate role. From the 1980s onward, the global diffusion of neoliberalism intensified these asymmetries through austerity policies, public sector retrenchment, and market-oriented reforms, directly affecting health systems and constraining the realization of human rights, particularly the right to health.

METHODS:
This study adopts a theoretical and conceptual approach based on a critical review of the literature and interpretative analysis grounded in political economy, sociological institutionalism, and human rights frameworks applied to health. The analysis considers multiple levels of power (macro, meso, and micro) and examines the role of traditional and emerging actors in global health governance.

RESULTS:
The findings indicate that global power asymmetries operate as root causes of health inequities by shaping norms, policies, and priorities within governance structures. International financial institutions and neoliberal policy frameworks reinforce structural inequalities by imposing fiscal constraints that limit social protection and universal health coverage. Furthermore, the expansion of new actors such as philanthropic foundations, public–private partnerships, and multinational corporations has contributed to fragmentation in global health governance. This process often reframes human rights through technocratic and targeted approaches based on “vulnerability,” weakening their collective, political, and emancipatory potential.

CONCLUSIONS:
Addressing global health inequalities requires confronting power asymmetries in global governance and re-centering health policies on human rights, equity, and social justice. Health must be reaffirmed as a public good and fundamental right, supported by democratic institutions. Human rights based institutional arrangements are essential to reduce health inequities and counter neoliberal logics that prioritize economic rationality over human life.