What do ‘development’ and governance’ mean for health? Health is a complex area, facing several simultaneous challenges and transitions: economic growth/crisis, demographic/epidemiological transition, privatization and pressure for democratic reform and universal coverage. Fundamental tensions exist between individual versus collective health priorities, market versus rights/entitlements and these play out in debates about governance, health and development. This paper focuses on the ‘publicness’ of health, drawing upon the theory of reflexive governance to explain the regulation and development of public health goods. It argues that governance can be better aligned with rights, with substantive rights, democratic procedures and public goods formation as development goals. A shift from technocratic to reflexive agency implies a shift in perspective, viewing health as a sphere where democracy and public health intertwine as public goods.