Background: This article reports on an international collaborative study which compared school-based health care in the United States of America, Canada and Australia.

Method: Tri-nation school-based health care was compared and contrasted through the utilisation of a series of interpretive case studies. Grounded theory approaches informed the data analysis and reporting processes.

Findings: Unlike the US, Canadian and Australian school students rarely have access to school-based health care on site. All three nations face structural, cultural and societal barriers, often related to limited resources which limit the effectiveness of school-based health care.

Discussion: The benefits of school-based health care and providing comprehensive services through schools can include healthier children, better learning, healthier parents, and healthier communities. Unfortunately, based on our research, comprehensive school health services have not been adequately implemented in the US, Canada or Australia.

Implications for practice: Given the findings of this study, increased comprehensive school-based health services are urgently needed in the US, Canada and Australia.