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This study proposes and tests a model that explains the formation of health-related destination image and its influence on tourists' expectations for improving their health when going to a destination. The model incorporates grounded theories related to environmental psychology, public health, sociology and health geography. The data were obtained from international tourists from the United Kingdom, Germany and Spain, surveyed in their source countries and by evaluating two alternative tourism destinations. The results show that two cognitive dimensions influence the healthy destination affective image: (i) health-related environmental factors, and (ii) well-being resources and experiences. In addition, both cognitive factors and the affective destination image on health have a significant effect on the health improvement expectation of tourists planning to visit the destination. The results have implications for the management and positioning of those destinations focusing on health tourism. • Proposes a model of health destination image based on environment and well-being. • Factors related to public health are relevant to health destination image formation. • Destination well-being perception is influenced by human-made health environment. • Barriers for people with special needs influence health destination image. • Highlights the need for collaboration between all health and tourism stakeholders. [ABSTRACT FROM AUTHOR]