The Millennium Development Goals (MDGs) were criticised for failing to address the issue of governance, and the associated notions of responsibility and accountability. The Sustainable Development Goals, we argue, need to recognise the structural constraints facing poor countries – the power imbalances in the global economic system that limit their ability to promote the prosperity and well-being of their people, as was clearly brought out by the Commission on Global Governance for Health, of which we were both members [Ottersen, O. P., J. Dasgupta, C. Blouin, Paulo Buss, Virasakdi Chongsuvivatwong, Julio Frenk, Sakiko Fukuda-Parr, et al. 2014. “The Political Origins of Health Inequality: Prospects for Change.” Lancet 383: 630–667]. This article is divided into three parts. We begin by making the case for a global justice perspective which emphasises the responsibility – and hence also accountability – of international organisations and rule-making bodies. We next demonstrate the limitations of accountabi...