Rural health governance is an important part of low-carbon green life, which is also related to the sustainable development and population health project in rural areas. Based on the survey data of 2343 rural residents in China, this study adopted a binary logistic regression model to explore the effects of rural residents’ social network and cognition on their participation in rural health governance. The research results show that only less than 30% of the respondents participated in rural health governance, and the proportion of rural resident participating is not high. Both their social network and cognition have a significant impact on their participation in rural health governance. Introverted communication helps strengthen the connection between rural residents, form the network and structure of rural social communication, build emotional links and common interests, and form a common cultural understanding paradigm and action framework. The extraverted communication means that rural residents gradually break away from the social network of acquaintances, which is not conducive to building a rural community. Rural residents’ understanding of behavior begins to deviate from rural culture, customs and emotional values, and the binding force of traditional culture is reduced, making it difficult to motivate them to participate in rural public life. Policy cognition can improve rural residents’ recognition of the value and significance of health governance. Responsibility awareness is the internal driving force for rural residents to participate in health governance, which can also reduce the governance cost of rural managers. Based on this, increasing rural residents’ introverted communication and cultivating their sense of responsibility are key to promoting their participation in rural health governance.