The Cook Islands is burdened with very high rates of noncommunicable disease (NCD) risk among adults and adolescents. Establishing health-promoting behaviours during adolescence may reduce the onset of NCD risk and incidence in adulthood for the individual and their future offspring. This is because many health-related behaviours that are established in adolescence are known to continue on into adulthood. Therefore, the promotion of healthful behaviours during this life stage is crucial to the health of future adults. Supporting healthy school environments through effective policies that actively engage students, parents, teachers and staff in the design and implementation process can enable adolescents to make positive lifestyle behaviours. This study will examine and document different styles of health-related policy development and implementation currently in use within secondary schools in the Cook Islands. This review will identify and test the potential of strategies that support active adolescent engagement of health policy-related processes.