Purpose: Literature suggest that physical education and health (PEH) may contribute to the sustainable development (SD) agenda, yet little is known how PEH teachers relate SD to their teaching practices. This paper explores Swedish upper secondary PEH teachers' experiences and perceived competence regarding teaching SD as part of PEH. Method: An online questionnaire was used to examine SD competence. Data from 702 PEH teachers were analyzed descriptively and inferentially. Results: PEH teachers perceive higher competence regarding the social dimension of SD compared to the economic and environmental dimensions. Female teachers and those with more than 15 years teaching experiences reported the highest perceived competence. Seventy percent of the respondents perceived that they lacked competence to teach SD. Discussion/Conclusion: PEH teachers struggle to relate SD to PEH practice and call for support to increase their competence in terms of how to conceptualize and transform SD into PEH teaching practice.