Public health became a significant multilateral concern on the eve of the 21st century, as reflected in the Millennium Development Goals (MDGs). However, the struggle for this central place in the international agenda should be understood within the global geopolitical context. This paper provides an analysis of globalisation by historically defining four different forms of globalisation which each entail a new vision on both multilateralism and health diplomacy. This analysis focuses on four successive waves of globalisation: the globalisation associated with European hegemony through its trade, industrialisation and education (16th-18th centuries); the globalisation at the outset of multilateralism and the absolute power of the West; the revival of multilateralism after the fall of communism; and the globalisation at the beginning of the 21st century, marked by the emergence of a multipolar world. Understanding the history of globalisation and multilateral relations allows for a better grasp of the context in which health diplomacy has developed. Most importantly, this allows for a wider look at the global system, thus allowing for a broader perspective and better integration of all the social, economic and political parameters related to health in the analysis of the global processes of decision-making.