This article proposes a shift toward the integrated governance of watersheds as a basis for fostering health, sustainability and social–ecological resilience. The authors suggest that integrated watershed governance is more likely when different perspectives, including health and well-being, are explicitly understood, communicated, and sought as co-benefits of watershed management. A new conceptual device – the watershed governance prism – is introduced in relation to the multiple facets of governance that characterize contemporary water resources management and examined as an integrative framework to link social and environmental concerns with the determinants of health in the watershed context. The authors assess the diagnostic and communicative potential of such a framework, discussing its utility as a concise depiction of multiple, interacting policy priorities and as a guide to integrate different research and policy domains into the governance of water, health and social–ecological systems.