The destructive consequences for sub-Saharan Africa of multiple health challenges, including infectious diseases, non-communicable diseases and injuries (the double, or even triple burden of disease) are now well recognized. Less well studied in a systematic way are the connections between these challenges and key policy choices made by the industrialized world. Building on our earlier research, we argue that the G7/G8 group of countries have a special obligation to support health improvements in the region, based (a) on an ethic of meeting basic human needs as a priority and (b) on some of their own commitments, made at their annual Summits and as nations that have declared their support for the Millennium Development Goals (MDGs). We then demonstrate (a) that the financial commitments of the G7/G8, measured against the resources needed to attain their own stated goals, fall short by an order of magnitude and (b) that the historical record and contemporary research show that macroeconomic policies promoted by the G7/G8, directly and through their dominance of the World Bank, International Monetary Fund and World Trade Organization, actively undermine potential improvements in health. Above and beyond these concerns the apparent inability of the G7/G8 to constrain emerging US unilateralism, as manifested e.g. in its trade policies and its management of the President’s Emergency Program for AIDS Relief (PEPFAR), deserves special attention. We conclude that more systematic, transdisciplinary research on the linkages between the macro-scale policy choices at the national and international level and health outcomes at the household and community scale will be valuable. Meanwhile, more than enough is already known to provide a basis for immediate action to redress past indifference toward health in the region, and to organize future research around the potential to support advocacy.