People living in low-income countries require protection from the economic and social impacts of global economic competition, yet, historically, the International Monetary Fund's (IMF) fiscal austerity programs have weakened the potential for redistribution both within poor countries and between rich and poor countries. The current development paradigm's focus on "sustainability" is an obstacle to developing systems of global social protection and an impediment to future progress. Reforming IMF policy conditionality and democratizing the IMF's decision-making processes will be necessary for offsetting growing inequalities in health financing among poor nations.