Abstract: Objective To investigate the current status of the ecological environment and health literacy of residents in Lanzhou, China and their influencing factors, and to provide a scientific basis for surveillance and evaluation of the ecological environment and health literacy, as well as the identification of goals and priorities for literacy improvement. Methods A questionnaire survey on ecological environment and health literacy was conducted among the residents in Lanzhou from July to August 2024. A multi-stage stratified sampling method was used, and a total of 2 582 respondents were included. Multivariate logistic regression was used for influencing factors analysis of ecological environment and health literacy. Results The overall literacy level of ecological environment and health among residents in Lanzhou in 2024 was 20.37%. Among the primary classification, the literacy levels of basic skills, basic concepts, and basic knowledge were 25.21%, 20.33%, and 20.10%, respectively. Among the secondary classification, the literacy levels of scientific knowledge (13.98%) and basic attitudes (13.87%) were relatively low. The results of multivariate logistic regression analysis showed that the overall ecological environment and health literacy of residents in Lanzhou were primarily affected by sex, age, and degree of education, with the degree of education being a significant factor influencing the two indices (P<0.05). Compared with females, males were likely to have a higher level of overall literacy, with an odds ratio (OR) (95% confidence interval CI) of 1.253 (1.017, 1.544); compared with residents aged 50 to 69 years, residents aged 15 to 34 years and 35 to 49 years were more likely to have a higher level of overall literacy, with an OR (95% CI) of 1.697 (1.192, 2.415) and 1.655 (1.185, 2.312); Compared with individuals whose educational attainment was primary school or below, the overall literacy levels of those with senior high school/vocational high school/technical secondary school, junior college, and bachelor's degree or above were significantly higher, with OR (95% CI) values of 3.322 (1.777,6.209), 7.053 (3.679,13.521), and 10.722 (5.440,21.132), respectively. Conclusion In 2024, the overall level of ecological environment and health literacy of Lanzhou residents is low, and the literacy level of scientific knowledge and basic attitude needs to be improved. In the future, differentiated improvement strategies should be formulated for different ages, and degrees of education groups, focusing on residents aged 50 to 69 years, residents with a lower degree of education.