Well-being on the college campus has been a top identified area of priority for college presidents over the past decade, further heightened by the COVID-19 pandemic. The Okanagan Charter was created in 2015 as a framework for Health Promoting Universities and Colleges to embed health and well-being into all aspects of campus life and operations and describes the college campus as a unique setting for addressing these rising needs. The purpose of this study was to explore the emerging phenomenon of the designation of a Health Promoting University or College through the adoption and implementation of the "Okanagan Charter: An International Charter for Health Promoting Universities and Colleges (2015)." A qualitative, comparative case study was designed including data collected through committee observations, relevant document review and open-ended interviews with 15 higher education leaders across three early adopting United States higher education institutions. Data were analyzed within each case and then compared across cases to provide relevant patterns, similarities and differences with aim to better understand and guide further leadership practice with adoption and implementation of the Okanagan Charter's action framework. Conclusions drawn from findings include shared beliefs among higher education leaders with regard to a holistic view of health connected to the environment as well as beliefs in a shared responsibility and need for systems-based leadership. Two action principles from the Charter emerged as strengths in driving this initiative forward in alignment with building a strong foundation for change (Kotter, 2012). Findings further indicated processes emerging to revise strategic plans to include health promotion language with an identified need to create a more systemic assessment tool to track and monitor health promotion change efforts related to the implementation of the Charter. A theory of action was developed from the conclusions to represent relevant recommendations for practice in growing a health promoting campus. These steps include formation of a collaborative committee including partnerships across Student and Academic Affairs. Next, resource allocation should be considered to sustain the change, including development of a position to lead this change effort forward. Initial action should focus on educating all stakeholders in multiple forums across campus and development of a process to systematically scan and organize current supports that could fall under the Charter's framework. Finally, a system wide assessment tool needs to be created to measure and monitor outcomes to track growth. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]