The mayor of Sao Paulo, Paulo Maluf, has a bullish approach to arguing and is not renowned for his subtlety. Despite this he has been a key campaigner and instigator of various public health policies that form part of an international “healthy city” initiative. The most successful of these has been the introduction of a law making the use of car seat belts compulsory, which has led to a massive reduction in the number of fatal road traffic accidents. An attempt to prohibit cigarette smoking in restaurants has been less successful owing to a number of legal challenges that have left the legislation in a consitutional and legal limbo – but the fight goes on.