Although global health researchers and practitioners routinely interact with state agencies, the research literature contains little theorizing or critical reflection on the role of the state. This chapter addresses this neglect on two dimensions: states’ policies within their borders and states’ involvement with global health politics and other areas of international interaction that influence health. Examples are drawn from both rich and poor countries. The chapter concludes by examining three lines of argument related to the declining relevance of the nation-state, organized around pressures for economic policy convergence; the proliferation of non-state actors in global health; and the emergence of a nascent transnational state. While each has merit, each likewise risks overstating the case for a ‘post-Westphalian’ global order.