The 2011 high-level meeting of the United Nations General Assembly on non-communicable diseases (NCDs), and subsequent developments in global public policy on NCDs can be seen as a contemporary case study in global health governance. As the debate on what constitutes appropriate and desirable governance continues, highly contrasting models are being compared as starting points. We define these as the global health initiative model and the convention/strategy model. Each has a different strategy at its core and represents a different response to key normative challenges that are said to plague global health governance – participation, scope of action, balancing power, legitimacy and effectiveness. As the current structure of the Global Coordinating Mechanism for NCDs within the WHO emerges as a possible new model, we argue that these normative challenges need to be addressed to safeguard against potential policy ineffectiveness.