The visibility of public health in world politics has increased due to epidemics such as HIV/AIDS, and tensions between public health and international trade, including those related to patents and access to essential medicines. Advocacy for raising the profile of public health on diplomatic agendas raises fundamental theoretical questions about public health: why should public health be higher on global diplomatic agendas? How should the pursuit of better public health globally be structured and implemented? This article explores answers to these questions provided by traditional theory on public health and analyzes the problems the anarchical context of international relations poses for such answers. A major part of this analysis utilizes theories from the discipline of international relations – using realism, institutionalism, liberalism, and social constructivism to illuminate theoretical challenges global health advocacy faces in making public health more important in world politics. These theories help identify a theoretical conundrum faced by public health, and the article considers various ways in which to handle this in light of the desire to increase the role public health plays in international relations.