Although officially dead due to US withdrawal from agreement, the Trans-Pacific Partnership agreement (TPP) is now in a ‘zombie’ state being resurrected in different ways by most of its remaining 11 member countries. This renders the analysis of its health implications both current and timely. This article, drawing on our own health impact assessment of the TPP and other analyses and commentaries, critically reviews some of the major ways in which the TPP, as a representative of so-called 21st-century regional trade agreements, poses a threat to global health equity. Four specific ways are identified and reviewed: (1) It increases restrictions on public health regulations (despite the tobacco partial carve-out) specifically through changes in the Technical barriers to Trade (TBT) and Sanitary and Phytosanitary Measures (SPS) chapters, and its new Regulatory Chapter. (2) Its flawed Investor–State Dispute Settlement (ISDS) system (with several cases affecting health services/insurance and indirectly health through cases challenging environmental protection) continues to benefit investor over public health and sustainability. (3) Its labour and environmental chapters are largely hortatory and concerned with ensuring increased trade by TPP rules, and not stronger labour rights or environmental protection per se. (4) There is little aggregate economic benefit, but disequalizing income distributions, and no accounting for public costs (e.g. trade adjustment compensation for negatively affected economic sectors, increased patent drug costs).The article concludes by locating the content and implementation of agreements as the TPP as a form of international law that entrenches a discredited neoliberal economic model of enormous benefit to capital and limited benefit to most of the world’s peoples.