In 1986, the Ottawa Charter made a statement that continues to challenge our institutions to this day: health is not produced in hospitals. It is built where people live, work, learn, move and grow old. Health promotion, as defined in the charter, means healthy public policy, supportive environments, community action, personal skills and reoriented health services.
Forty years on, that agenda has naturally found its place. Around three-quarters of Europeans live in urban areas, and this proportion is constantly rising. Cities organise daily life: transport, food, housing, education, green space and local services. We are close enough to residents to spot problems early, test responses and scale up what works. And we hold the levers of prevention, still the most effective and least expensive health policy available.
Lyon has a particular history with this idea. For three and a half centuries, human medicine, veterinary medicine and public hygiene have met here, from the world’s first veterinary school to the International Agency for Research on Cancer and the World Health Organization Academy. When I took office during the Covid-19 pandemic in March 2020, that inheritance became an obligation: in February 2022, 25 cities signed the Lyon Declaration, Healthy Cities, Healthy Citizens, calling for One Health to become the compass of health policy.
One Health, to put it plainly, is the Ottawa Charter brought up to date. The charter told us to act on the determinants of health. We now know that those determinants include the state of our soils, our rivers, our air and the animals. Human, animal, plant and environmental health stand or fall together.
What this looks like in a city
Mobility first. We turned an urban motorway, Garibaldi, into a shaded, planted boulevard with cycle lanes and wide pavements. We introduced a limited traffic zone in the city centre, pedestrianised streets and built the Voies Lyonnaises cycle network. Between 2020 and 2025 we extended our cycle lanes by 40%, and 84% of our road space is now traffic-calmed. Since 2019, cycle and scooter journeys are up 58%, car traffic is down 12%, nitrogen dioxide in the city centre has fallen by a quarter and fine particles by 15%.
Then nature. Our parks and gardens are managed with the aim of cooling the environment and promoting the water cycle, with layered vegetation and locally grown, climate-resilient, pollinator-friendly species linked to green and blue corridors.
Then food. We serve some 30,000 meals a day in crèches and schools: fully organic in nurseries, 65% organic in school canteens, half as much meat as before, a vegetarian option always available, menus built with local farmers around the seasons. One lever, three health benefits.
None of this is exotic. It is ordinary municipal work, done with health as the filter.
Three political choices for cities of the Global North
First, make health the filter for every policy and every investment. Public authorities can and should require living-systems impact assessments for major urban projects. Anticipation always costs less than repair.
Second, consider inequality as a health determinant in its own right. A city that plants trees or promotes access to residents only in its comfortable neighbourhoods has not promoted health; it has redistributed it upwards. Universal ambition, targeted effort.
Third, fund cities directly. At a moment when multilateral health financing is under real strain, the answer cannot be ever more complex calls for projects. We need direct and flexible instruments: seed funding for local diagnostics, for pilot actions, from cutting exposure to pollutants to restoring urban biodiversity, and for the transition of public services. That is why nine European cities built the One Health for Cities network, why we took the call Empowering Cities to Lead the One Health Transition to the European Parliament last December, and why we took the opportunity of the One Health Summit hosted in Lyon in April to propose a One Health Cities Alliance: a North-South coalition, a modest budget, a large ambition.
This is not about cities replacing states. It is about recognising what cities know how to do, which is to coordinate, experiment, evaluate and replicate, and about making our powers work as one system.
Forty years after Ottawa, the promise of health promotion will be kept or broken in our streets, our canteens, our parks and our neighbourhoods. That is a political choice. In Lyon, we have made it.
