Background: Few studies have been conducted in Canada to investigate the roles, actions and beliefs of health teachers in school health programs. Purpose: The purpose of this study was to explore health education teaching and assess related needs among pre-service and in-service teachers in a British Columbia K-12 school system, and to elicit conclusions regarding how to improve health through schools. Methods: K-12 teachers from the participating school district (N = 16) and pre-service teachers from the participating university (N = 14) participated in four focus groups. Results: Guided by the ecological model, seven themes were identified and categorized: (1) Intrapersonal Level (teaching strategies; knowledge/skills; comfort); (2) Interpersonal Level (teaching barriers); and (3) Community Level (health curricula; health programs; role of school). Discussion: Seven themes highlight the issues of school health programs from practitioners' perspectives, which also correspond with five sources of problems of school health programs classified by the WHO Expert Committee. This study reinforced the need for initial development of health educator roles and competencies to guide actions in school health improvement. Translation to Health Education Practice: The identified sources of problems illustrate the potential role that a health-promoting school approach plays to build school-community connectedness. (Contains 2 tables and 2 figures.)