Purpose: The purpose of this paper is to report the formative evaluation results from the Association for Supervision and Curriculum Development Healthy School Communities (HSC) pilot project. Design/methodology/approach: This study utilized 11 HSC pilot sites in the USA (eight sites) and Canada (three sites). The evaluation question was "What are the levers of change in a school community that allow for the initiation and implementation of best practice and policy for improving school health?" Pre- and post-site visits along with in-depth interviews with school teams, teachers, students, administrators, community stakeholders and other involved individuals, school site report reviews, Healthy School Report Card results and school improvement plans were used for evaluation purposes. Findings: This study identified nine levers of change: principal as leader of the HSC efforts; active and engaged leadership; distributive team leadership; effective use of data for continuous school improvement; integration of the HSC process with the school improvement process; ongoing and embedded professional development; authentic and mutually beneficial community collaborations; stakeholder support of the local HSC effort; and creation or modification of school policy related to HSC that increased the likelihood that school improvement via health promotion would be pursued and sustained. Research limitations/implications: Owing to the qualitative methods used in this study and the number of schools in the pilot project, the research results may lack generalizability. Therefore, researchers are encouraged to test the proposed evaluation question further. Practical implications: This study has implications for schools seeking to create sustainable, systemic integration of health and education for effective health-promoting schools and continuous school improvement. Originality/value: This study provides evidence that integration of health and education can become a sustainable and integral part of a school's culture.