Purpose: The purpose of this paper is to critically examine school health education in the USA and present alternative approaches for more critical and comprehensive health education. Design/methodology/approach: An ecological model framework is used to identify the limitations and opportunities for improvement in school health education in the USA. An argument is made for school health education that embraces ecological approaches, political economy theory, and critical pedagogies. Findings: US schools have been tasked with providing health education that is primarily rooted in individualistic approaches. Often missing from this education is recognition of the social and structural determinants of health that greatly influence one's ability to practice the health behaviors promoted in schools. This raises pedagogical and ethical concerns, which can be addressed by teaching health education that is grounded in ecological and political economy understandings of health and in critical pedagogies that allow students to more comprehensively and accurately understand health, how their worlds influence health, and their agency within those worlds. Practical implications: This paper offers justification for a critical model of school health education and for the professional preparation of school health educators that is grounded in critical pedagogy and ecological approaches. Originality/value: This work complements other research on critical health education by adding explicit integration of the ecological model and the political economy theory within critical pedagogies.