This paper explores the role of consumer activism in the context of complex global health system reforms. It might be said that globalization has a complex effect, and we might even speak of ‘globalizations of health’. In Asia, there are significant moves towards privatization, commoditization of health and health services and the emergence of novel and complex hybrid public-private forms (Chan 2010; Readings 2010). At the same time, there are countervailing moves towards health systems approaches and reforms towards universal and equitable healthcare (Tangcharoensathien et al 2011).What does consumer advocacy have for public health and health rights, given the current nexus of development transitions, which include economic growth and crisis, demographic and epidemiological changes with the rise of non-communicable and lifestyle diseases, as well as democratic transition, which bring even more to the fore equality, access and quality concerns?(see Khoo 2012a; Hilton 2009). The arguments converge around efficiency and choice on the one hand, and equity, rights and public health on the other hand. Consumer activism has proved to be a leading force shaping global health governance since the 1960s. Asian consumer activism has played a significant role in governing mixed health systems, for example through quality and price surveillance and advocacy for regulation, as well as campaigns for rational, affordable and quality health provision. At crucial junctures, consumer activism has provided an important counterbalance to private interests seeking to commodify health and healthcare for profit (Khoo 2012a, 2012b). For example, Malaysia is a key Asian country example that could be justifiably proud of having developed healthcare systems capable of delivering high quality and relatively accessible care at medium cost. Such strategies formed the basis for good human development performance and represented significant public investment in human development. However, the increasing cost and complexity of health systems and reforms towards privatization and corporatization pose new challenges for health consumers. This paper connects research on consumer activism to health system reforms and questions of public health and health rights. Asian consumer activism is at a crossroads, given the transition from a distinctive model of ‘Southern’ consumer activism to a new global health transition with equity and health systems reform at its centre.