This paper addresses the issue of participatory learning about health from the perspective of the health promoting schools initiative. The democratic approach to the health promoting schools, characterised by the concepts of student participation and action competence, provides the conceptual framework for the discussion. Data is generated from a web-based international project "Young Minds exploring links between youth, culture and health". Young Minds is an educational development project in which students from elementary and secondary schools in several countries in Europe collaborate on health topics in participatory and action-oriented ways. The project has its roots in the European Network of Health Promoting Schools - a project resulting from the tripartite partnership involving the WHO Regional Office for Europe, The European Commission and the Council of Europe. The methodological framework for the study is constructed as theoretically based (i.e. instrumental) qualitative case study, using web contents and document analysis, observation and interviews. A model distinguishing between two different qualities of student participation - token and genuine - is used as an analytical tool in analysing the empirical data. In addition to the concepts embedded in the democratic health education discourse, the sociocultural theory of learning and development is suggested as a useful frame for understanding, problematising and theorising about the processes of teaching and learning about health. The two sets of concepts - democratic health education on the one hand and sociocultural perspective on learning on the other - help building a heuristic that views teaching and learning as mutually constitutive, establishing an integrated unit of analysis, and developing a social, sociocultural and constructive approach to understanding the processes of teaching and learning within the health promoting schools. The findings from the case study showed that, compared to traditional classroom based instruction about health, teaching-and-learning about health in participatory and action-oriented ways is more dialogical and empowering. Learning is characterised by transformation of participation in shared activities related to health issues that are tied to the wider cultural institutions. Through transformation, that is, intensification of participation in these activities students become increasingly competent members of their communities with regard to health. Further, the case study demonstrated that the open-ended processes of knowing by exploring, participating in joint productive activities, envisioning the future and acting to bring about change, in which students co-participated in genuine ways were conducive to creating dynamic, democratic communities of learners and to development of students' action competence in relation to health matters that concern them.