This article extends the thesis presented in the paper by Tingle, Gibson and Ferrante (2011) that the patient safety agenda needs to operate within a new paradigm. We will introduce the social determinants of health (SDH) as an emerging discourse in global public health. The SDH advocate social and health equity among nations and individuals, and within countries and communities. It has become a key driver for policy makers, health researchers and public health professionals (Raphael, 2011). This article will demonstrate that the paradigmatic lens of SDH offers the opportunity to develop a more upstream analysis of the patient safety agenda based on health systems.