This seemingly self-evident proposition conceals a greater subtlety, for the current regime of globalization has relied on the state and its capacity to effect purposeful public health policy. Indeed, political scientists will categorize states as weak or strong in part by their ability to create and maintain effective policy processes. Weak states can create, but not necessarily implement public policy (6) . Much of the world continues to live in "weak" states in which governments (central as well as regional and local) have difficulties ranging from grave to impossible to carry out policy intentions, particularly those regarding public health 2 . In these circumstances, maintaining good public health becomes impossible.