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The health dimension of sustainable development and its limits in optimizing health protection has led to a rethinking of the management of shared water resources in international environmental law. This paper discusses human health in the sustainable development of shared waters and its limits using a case study of the sustainable management of the Lake Victoria Basin. It links the public health challenges to the strengths and limitations of the global, East African, and domestic legal regimes for sustainability and environmental governance. The quest to integrate health concerns in the sustainable management of Lake Victoria faces challenges. The substantive legal regimes for tackling health issues and governance mechanisms are weak, fragmented, and ineffective in a framework of adaptive governance. This paper calls for enhanced collaboration among the actors and the reinvigoration of regional and domestic governance mechanisms to promote human health and the environment in the basin. [ABSTRACT FROM AUTHOR]