Do we have ethical obligations to promote global health equity? If so, what prioritised values should represent the satisfaction of those moral duties? These are not easy questions to answer and despite a general agreement that current inequalities in global health provision exist, as well as some agreement that a response is required, there is little consensus about what ethical foundations apply when responding to these inequalities. In an effort to provide some response to this lacuna, the purpose of this chapter is to explore three diverse normative arguments about why we might have global health responsibilities and to examine their relationship with distributive principles for the alleviation of global health inequalities. Through this examination it will be argued that current theorising about global health rests on opposing ontological worldviews about what global health should prioritise and that these pre-suppositions result in distinctively antagonistic normative demands about how we should calculate the distribution of global health. Moreover, by examining these ethical positions together (assuming that some movement toward the elevation of global health inequality is important) the philosophical attractiveness of a cosmopolitan approach to global health will be stressed.