Creating healthier cities and finding a shared language to move forward

Sonja Kahlmeier reflects on her research, overcoming challenges, and learning from different people’s realities

Sonja Kahlmeier is an independent expert on physical activity, sustainable transport and healthy cities. Before, she headed the health department at Fernfachhochschule Schweiz with teaching programmes on nutrition, health promotion, and osteopathy.

She also led the health research, focusing on the topic of physical activity and health, where she specialised in policies and strategies as well as transport-related and economic approaches. She is particularly interested in upstream determinants of health and environmental health promotion.

Sonja has also worked for the World Health Organization and the Universities of Zurich and Basel. She holds a master's degree in environmental sciences from ETH Zurich, a doctorate in epidemiology from the University of Basel, a habilitation in public health from the University of Zurich and, until 2024, a professorship at SUPSI. Sonja is a member of Sciana’s sixth cohort.

This interview has been edited for brevity and clarity.

Sciana Network: Can you tell us more about your work in the field of physical activity?

Sonja Kahlmeier: One theme that’s kind of going through my career is the contribution that active mobility—so cycling, walking, and everyday forms of physical activity—can make to reaching the physical activity guidelines […]

Cycling and walking are forms of physical activity that are more equitable, but they require infrastructure. So, it requires us to work more intersectoral[ly] and to learn to speak the language of other sectors and to get into their agendas […]

I work very translationally. I don’t do basic research on the physiology of physical activity, but a lot on how do we get the support of other sectors to change transport systems, for example, or how cities are built.

SN: Was there something in particular that inspired you to work in this field?

SK: When I did my PhD, it was an evaluation concept of a political programme in Switzerland, which was the National Environment and Health Action Plan, which really brought together these topics of environment and health. I found that really inspiring: this intersectoral approach to promoting physical activity and health.

That was really new to me. It was a new approach. The thing that really prompted me on going to active transport was much of the Finnish work [in this area]. They were way ahead of everyone else with the health-in-all-policies approach, promoting active transport as a form of physical activity and having cycling as a keyword around physical activity. I found that really inspiring.

SN: What have been some of the main challenges you’ve encountered while trying to change policies, and how have you tried to overcome them?

SK: Language and terminology [are] a big challenge, so we have to learn to speak [other sectors’] language[s]. For example, an issue in transport is relieving congestion. They are not interested in promoting health. They’re interested in improving the air quality and relieving congestion.

That was really a process at the beginning: to understand how we can get onto [other sectors’] agendas. [This is] not by asking them to promote health—because this where we will lose them—but really using their issues and problems to get our interests onto their agenda more in a subtle way. That was a challenge. I’ve been working in this area—for example, the Health Economic Assessment [Tool] for walking and cycling—for 15 years now, so it’s something that we’ve become a lot better in […]

The other challenge is that as scientists, it's often frustrating that scientific evidence is only a tiny part in political decisions. We’ve seen it with COVID as well. We think, “But we have all the evidence, and we have the science. Why don’t you listen to us? Because we know the truth, so to speak.” But that’s not how political processes work.

It takes a lot of patience, humility, and understanding of the priorities of politicians, and talking about money and economic approaches is actually a door opener. Now that we’re able to quantify in economic ways the benefits of active mobility and physical activity, through that, it can be very helpful.

SN: In your bio, you mention your work and focus on the upstream determinants of health. Can you tell us more about this and how you think policies can work to address them?

SK: For a long time [in physical activity], the focus was on leisure time physical activity and—in a way—taking a bit of a paternalistic approach to people saying, ‘You know, you should move, just move more’ […] It’s not really a fair way because there are these upstream determinants of their health behaviour: constraints in time, resources, but also in knowledge about health […]

That’s in a way what prompted me to try to work, for example, on the transport system […] Because the transport system and how cities are built has a huge influence on how people behave and their abilities to move […] these things are very low barrier ways of allowing people to move rather than appealing to them as individuals […]

SN: You’ve worked with the WHO. Working within a big organisation like the WHO can be full of challenges as well as opportunities. Would you mind reflecting on some of these, how you approached them, and how they have influenced your current work?

I still work for the WHO, but not within the organisation. I’m a freelancer now. [The main challenge I perceive] is that it’s a very political environment. You work with member states, so there is always a political component. You have to be very diplomatic in bringing your things across. [It involves] intergovernmental processes, so there are very different interests, and there is always a negotiation.

While sometimes one would like to move faster or be more ambitious, it’s always a very diverse group of countries that has to come to a consensus in the end […] I guess that was the most challenging thing, but it taught me a lot about negotiation and going where the other people are rather than trying to push my point in a very aggressive way […]

The other thing I found extremely enriching—and also humbling very often—[was] to learn about other people’s realities […] It’s enlarging my horizon, steering [me] away from my reality and realising [how] other people’s living circumstances are […] We cannot expect that the same solutions work for them. We really have to understand what their realities are. 

That’s the reason also why I applied for Sciana. There are three different countries, and I find that incredibly enriching to learn [about] the diversity of realities in a way.

SN: How would you reflect on your experience in the Sciana Network so far? Has it had a noticeable impact on your health expertise?

SK: My Sciana journey has lifted my understanding of what systems change for prevention and public health really means, and how we could make it happen to a completely new level.

The unique combination of direct access to outstanding experts and high-level stakeholders, co-creation and constant exchange with my Sciana Fellows and learning from experiences from three different countries has been a game changer.

My learnings will directly impact on my work and roles in my own country. One message I will carry with me is: there is no one else to do the job. It’s us!