Current debates concerning the rise of health diplomacy are polarized between competing international relations theories of realism, based on power politics, and constructivist approaches, which emphasize the norms, values, and identities shaping foreign policies. A case study of Brazil's health diplomacy over the past 10 years, focusing on issues related to pharmaceuticals, seeks to provide data to assess these theories. The country's intellectual property disputes, multilateral lobbying efforts, and foreign assistance programs are contrasted with those of the United States, Mexico, and other countries. Instead of viewing Brazilian efforts as a form of soft power, the evidence suggests that the origins of Brazil's involvement and continued efforts in this arena stem more from values based on human rights and social democratic principles. A close examination of domestic political considerations leads to a more nuanced understanding of the drivers behind a country's health diplomacy.