Abstract Background Climate health literacy (CHL), recommended and recognized as vital for the global response to climate change and impacts on health, lacks comprehensive studies on its integration into primary and secondary school curricula. In Kosovo, where numerous environmental issues already exist and are expected to worsen due to climate change, the resulting health outcomes pose significant challenges. Moreover, the low environmental knowledge among youth further adds to the complexity of addressing these issues. This study addresses this gap by focusing on understanding and enhancing the inclusion of climate change and health topics in pre-university education. Methods A content analysis was conducted on: (1) core curricula, (2) subject curricula, and (3) textbooks for pre-university education (grades 0-12) in Kosovo. The outcomes of the content analysis were then juxtaposed with the CHL framework to identify alignment and gaps. Results We found that curricula in Grades 0-5, contained one topic on climate change and health topic out of 638 (0.16%) topics documented; however, textbooks did not elucidate this focus. Grades 6-9 had 2 out of 701 (0.28%) and the relevant textbook revealed that various environmental and health topics are covered, but that they lack exploration of the interrelatedness between environmental pollution, climate change, and health. Grades 9-12 had the highest integration with 4 out of 745 (0.54%). Textbook analysis of these grades revealed a more in-depth coverage of climate change and health linkages. In total, seven topics out of a pool of over 2000 topics encompassed learning outcomes related to climate and health in Kosovo’s pre-university education. Conclusions The current efforts to integrate climate change and health into Kosovo’s curriculum fails to meet the recommendations for achieving CHL levels. Localized and context relevant additions are needed to fulfil CHL among students in Kosovo and other countries interested in improving CHL. Key messages • This case serves as a testing ground for a framework assessing climate health literacy within curricula. The results identify gaps and areas of improvement, which inform the implications to attain CHL. • Results reveal shortcomings in the incorporation of climate change and health topics in schools, underscoring the necessity for tailored strategies to foster CHL among students.