Purpose: To investigate the status of health education courses in elementary schools. Method: From September to December in 2003, 607 school nurses were surveyed by questionnaires. Results: 1) Of the schools, 32.1% had health education programs as part of the school health service. A higher proportion was found in schools in suburban and rural areas. Mass media in health education was used by 75% of school nurses. Regular classes were more frequently utilized in schools in rural areas, while the classes in health-related subjects were utilized in urban areas. For 20.6% of school nurses, there was a substitute person to provide health care while the nurse was in health education classed, but 94.2% of school nurses found they had to give up health education due to pressure from other health services. 2) Of the nurses, 97.0% felt the need to provide health education courses, but 60.6% insisted that their work load needed to be modified and supplemental personnel were necessary if health education courses were to be provided. 3) More than 30% school nurses responded that educational materials and media, and concern by teachers and administrators were insufficient. 4) School nurses suggested that the content for health education courses should include healthy life and dental health care for students in lower grades, dental health care, sex education and safety for students in middle grades, and sex education and drug abuse prevention for students in higher grades. Conclusion: There is an urgent need to provide health education courses in elementary schools but conditions in the schools are not satisfactory. For successful school health services, personnel supplement, modified work loads and sufficient educational materials and media should be in place before health education courses are provided.