Music teachers face unique professional health and wellbeing challenges, including vocal stress (Brown, 2020), hearing health (Redman et al., 2022), music performance anxiety (Cui et al., 2024), professional isolation (Bautista et al., 2021), and additional extra-curricular workload (Robinson, 2022). However, teacher preparation for managing such challenges during initial teacher education remains under-researched. This international comparative policy review examines how music teacher health and wellbeing are addressed within initial teacher education accreditation frameworks and programs in the United States and Australia. The study employed a multi-method comparative policy analysis approach grounded in the PERMAH wellbeing framework (Positive Emotion, Engagement, Relationships, Meaning, Accomplishment, Health; Butler & Kern, 2016). Document analysis was conducted on accreditation standards from the Council for Accreditation of Educator Preparation (CAEP), National Association of Schools of Music (NASM), and state education authorities in the US. In Australia, documents were analyzed from the Australian Institute for Teaching and School Leadership (AITSL), state teacher registration bodies, and the Tertiary Education Quality and Standards Agency (TEQSA). Course handbooks, unit syllabi, and graduate outcomes from eighteen representative institutions (three research-intensive, three metropolitan, and three regional from each country) were systematically examined using a PERMAH-based coding framework to identify how each wellbeing domain is addressed in music teacher preparation. This enabled systematic comparison of which wellbeing elements are prioritized, absent, or implicit within policy documents and institutional curricula. Findings reveal significant gaps across multiple PERMAH dimensions in both systems. While accreditation standards emphasize pedagogical competence and subject knowledge, explicit requirements for holistic music teacher wellbeing education are largely absent. The Health dimension receives minimal attention despite music-specific occupational risks, while Positive Emotion (stress management, performance anxiety), Relationships (peer support, mentoring structures), and sustainable Accomplishment practices are rarely mandated. US accreditation through NASM and CAEP, and Australian AITSL standards, lack music-specific wellbeing competencies. Where wellbeing support exists, it operates through optional institutional services rather than integrated curriculum requirements, representing reactive rather than preventative approaches. This study argues for revised accreditation standards that explicitly require comprehensive health and wellbeing content within music teacher education curricula. Policy recommendations include mandating units addressing all six PERMAH elements, particularly music-specific health education (vocal and hearing health), emotional regulation strategies for performance contexts, relational support systems, and sustainable career practices. By comparing two distinct regulatory contexts, this research provides a theoretically grounded evidence base for international policy reform supporting music teachers’ holistic wellbeing and career sustainability.