Abstract Governance refers to the ongoing process in which governments, civil associations, markets and social networks mobilize resources and consolidate power relations and trust in order to achieve goals and legitimacy using different mechanisms and organizational perspectives. The objective of this article based on a critical review of the literature is to discuss the limits and scope of the governance arrangements oriented to health promotion and to reflect on the possible implications for the institutional and decision making profile in the area. The conclusion drawn is that effective governance in the health sector involves an incremental and dynamic process capable of bringing together multiple actors, enhancing inclusive deliberative spaces and expanding networking mechanisms.