This article presents an overview of the conceptual development of school health promotion over the last twenty years. It also reflects on the changing inter-reaction between education and the health sector. It will show that the approach to school health promotion has become more setting-oriented, more complex in its intervention, more salutogenetic in its direction and more evidence based. The Health Promoting School as a setting approach has emerged and been recognised by several reviews as the most successful and therefore most recommended. In reality however, everyday school-life health-intervention of this type occurs rarely. It will be shown that after more than 10 years of piloting school health promotion, a paradigm shift has evolved in reaction to such disappointing developments...