School can be an effective environment for achieving a more equal health among children and adolescents, since many individuals can be reached by the health promoting work in the school. In the year of 2000 a project in Skåne was started for the development of health promoting schools. The health promoting projects however, have shown to be of short duration. So, as an alternative, the integration of the health in school ought to be tried. The aim of this study is to give examples how health promoting schools can strengthen their profile. Seven principals on health promoting schools were interviewed. The barriers against the integration were the lack of plans and goals for the health promoting work, few engaged staff, weak parent involvement and lack of resources. Possibilities for integration of health in schools on the other hand, appeared when a new principal entered the school, earlier health thinking existed among the staff, engaged staff, existing discussions, education and resources. The conclusion of this study is that it takes comprehension and knowledge about the importance of the health promoting school, if a health culture is to be accomplished.