Purpose: The purpose of this paper is to investigate whether students' perceptions of their school environment and their adjustment to school are associated with health outcomes across gender and age groups. Design/methodology/approach: Data from the cross-sectional international Health Behavior in School-aged Children Survey of the year 2002 (n=162 306) were analyzed. A structural equation model (LISREL) specified social school climate and school demands influencing, school adjustment (achievement and liking of school). The latter aspects were assumed to influence the health outcomes general health item, life satisfaction and multiple psychosomatic symptoms. Analyses were repeated across gender and age (11, 13 and 15 years). Findings: The specified LISREL model fitted the data well on the entire sample as well as for age and gender subgroups (RMSEA=0.043-0.054). Overall, girls' general perceived health and life satisfaction seemed to be more strongly affected by the school environment than boys'. Age affected the goodness of fit of the model and reduced the strength of the relationship between school pressure and school adjustment. In all subgroups, the relationship between better school perceptions and better subjective health and life satisfaction were supported by the analyses. Research limitations/implications: Reported findings are limited to the cross-sectional study design which precludes causal inferences. Further research using longitudinal data is warranted to confirm the findings. Practical implications: Relationships between school environment and school adjustment and health-related outcomes revealed the relative importance of school social climate and demands for school adjustment and through the latter in determining subjective health and life satisfaction. School social climate is a target for promoting health and well-being of children and adolescents. Originality/value: Complex statistical analyses employing structural equation modelling confirmed findings on the importance of school aspects for child and adolescents in a huge data set. (Contains 2 tables, 5 figures and 2 notes.)