 Given the tight connection between global health justice and global distributive justice, it is no surprise that approaches to the former piggy-back on approaches to the latter. Briefly, cosmopolitans start from the premise that all humans are moral equals and argue on this basis that high-income states have robust distributive obligations to people regardless of their nationality or relation to them. Some cosmopolitans defend a sufficientarian position (Brock 2009), while others argue that global justice demands equality since national membership is a morally arbitrary factor on the basis of which people should not be disadvantaged (Caney 2005). Institutionalists do not reject the claim that all humans are moral equals but argue that robust distributive obligations—as opposed to a duty of assistance—are contingent on the existence of certain types of institutions, whether a coercive legal system (Nagel 2005; Blake 2001) or institutions establishing substantial economic interdependence (Sangiovanni 2007; J. Cohen &amp; Sabel 2006).