No education system is effective unless it promotes the health and well-being of its students, staff and community. These strong links have never been more visible and compelling than in the context of the COVID-19 pandemic. A health-promoting school (HPS) approach was introduced over 25 years ago and has been promoted globally since; however, the aspiration of a fully embedded, sustainable HPS system has not yet been achieved, and very few countries have implemented and sustained the approach at scale. This publication is based on an extensive review of global evidence on the barriers to and enablers of implementation, maintenance and scaling-up of the health-promoting school approach. Its aim is to guide adaptation and implementation of the global standards for HPS.