Background: Interventions to promote health have been implemented in some urban settings. However, school-based health promotion interventions in at-risk urban schools have not been thoroughly investigated. Objective: This article investigates teachers' perceptions regarding health promotion interventions with the main goal of establishing social change in at-risk school communities. Design: The study used phenomenology as a theoretical lens supported by the use of a qualitative research approach. As a theoretical framework, the researchers utilised Vygotsky's sociocultural theory. Setting: The investigation used a descriptive case study design to select 17 teachers from 2 at-risk urban primary schools in Pretoria. Methods: Visual data including participatory reflection action posters and photographs, and field notes were part of the data collection techniques. Findings: Teachers' responses informed how school-based health promotion interventions can be developed in the foundation phase of education. Themes relevant to this included recognition of the importance of education in bringing about social change; involving the whole community in developing health promotion projects; working closely with parents; promoting physical activity; and advocating for nutritional literacy. Goals can best be achieved through a focus on nutritional needs, physical health and social needs of at-risk communities. Conclusion: Findings from this study can be used to inform at-risk communities about food consumption, optimum physical activities and positive socio-emotional actions. Beyond this, young professionals entering the field of education should be encouraged to develop awareness of how school-based health promotion programmes can benefit the health and well-being of children.