A new paradigm for cities in a longevity society
Authors:
Nic Palmarini and Lynne Corner.
Contributors and open feedback:
Yochai Zion Shavit, Elisabetta Donati, Tina Woods and Ingrid Liekens.
Artwork and design:
Polly Westergaard and Andrea Cavallazzi.
The inhabitants of our small planet are living longer than ever before.
Over the past thirty years we have increased awareness of demographic change and population ageing - a phenomenon which is too complex to be resolved by academic forums, television debates, or numerous government and local authority initiatives.
At first, we were surprised by the predictions made by demographers1. In Milan, for example, since 1951, the population of over 65’s has increased by 197%, and over 75’s by 496%2. This is a phenomenon which we foresaw, yet to which we have actually paid relatively little
attention to. We were in the middle of ‘the Population Boom’ and in a culture where ageing was seen as an inescapable destiny. Why worry if we couldn’t do anything?
Never before in the history of humanity, had five generations found themselves sharing the same coffee machines at the same time inside the offices of half the world. Dancing to the same songs played live by octogenarian rocker bands. Queuing together at airports and supermarkets. And yet discrimination of older age persists, nourished in cultural systems by a joyful and undisputed celebration of youth.
We have associated ageing with disease, despite the increasing evidence of the malleability of ageing. We’ve taken care of the visible illness, and ignored the invisible in everyday life, effectively the causes of those very diseases that we actively treat. Responses to ageing are still largely confined to health, a sector of industry rather than seeing ageing in a wider societal context with a focus on living, a life course perspective.
We then realised that much of what we had built in ‘the population boom’ and our vision of progress, was not exactly designed for an ageing population or considered for a society with many more older people, despite the predictions, despite the evidence. So much - handles, screens, directions, instructions, packaging, interfaces, surfaces - and indeed entire cities - were not and are not –‘tailored’ to what we already are and are increasingly becoming.
50%
Today more than 50% of people aged 60 live in an urban environment, and this percentage is expected to increase.3
We ‘waited for ageing’, with some disbelief as the trajectory of population growth raced towards eleven billion inhabitants4. And so we started this desperate race backwards, to retrofit, with ‘late interventions’, as Robine says, to patch up the disparate processes, models, policies, languages, architecture etc.
Innovation for ageing is still a disconnected choreography. Most of the initiatives dedicated to the ageing population focus on, ‘making inclusive’ (architectures, services), in ‘claiming’ (urban spaces, attention), in ‘redesigning’ (places, processes), in ‘recoding’ (languages), or in developing ‘agetech’ (technologies for a hypothetical and undefined age reached5). We could go on. It’s all about post intervention.
Instead of planning, imagining, and proactively creating and designing for the future - for what we knew was happening and had been so well documented, we continued as before and then were surprisingly ‘caught off guard’.
This is ‘dedicated to the first billion’. We have worked to develop ethics, aesthetics, and practices, to interpret, include, support, and serve, the first billion people over 60 who are inhabiting the planet today.
The time has come to start a new stage - one capable of getting us out of this reactive passivity and giving life to proactive innovations. One for the second billion people over 60 who will inhabit the planet by 2050 and of whom almost one and a half billion will live in cities6. Above all, to imagine how they and those who follow in the decades that lie ahead will be able to live with the normality of ageing in all it embraces -the physical, psychological, social, and economic health of a conscious society.
In 2008, for the first time in history, most of the population found themselves living in urban rather than rural contexts7
History has many examples where we were at a decisive crossroad in our history – the collapse of the Roman Empire, the Renaissance, the industrial revolutions and now the advent of the Fourth marked by the Interpenetration between the physical, digital and biological worlds. Of course we now have the tools to witness this in real time, simultaneously, globally and as actors rather than retrospective analysts.
This is a crucial stage of human development and experience. Ongoing demographic change is here to stay, generated by fewer births, and extensions of healthy life expectancy. Ageing populations and climate change - the other mega trend – are inextricably linked.
So much of this stage of our journey, and the challenges and opportunities for our future, concerns us. We as individuals, as citizens. We have entered the society of longevity.
For the first time in human history, in 2007, most of the world’s population were living in urban rather than rural contexts and rapid global urbanisation means cities are the dominant environment in which we will live not only as younger people but also into later life. Cities are the symbolic and physical representation of the intersection of our cognitive, affective
and behavioural components and the highest expression of the evolution of our intelligence and social systems we have created.
Cities are more exposed to the consequences of age-related social and demographic changes, the different stages of individual human experience and social interaction. With more complex social composition and variation in living standards, and the greater degree of human design and initiative that their functioning requires (for example, in terms of mobility, digital environment and built environment), they have the potential to help us accelerate the understanding of not only how we mitigate, adapt, or manage changes in society but also proactively influence it and transform from passive, adaptive, assisting containers, to being active tools for our through life well-being, health - our longevity. Cities have a fundamental role and clear opportunity to suggest forward proposals rather than reactive responses to living longer better lives, with better social circumstances and sustainable, economic growth.
Already today, more than 50% of people aged 60 live in an urban environment, with this percentage expected to increase significantly. The focus of government and civil society initiatives in cities has been mainly on supporting the contribution of young people9.
Although it would be wrong to generalise8, the focus of Rapid growth and development over the last six decades did not adequately account for the changing demographic curves already in progress – and the older population was all to frequently systematically excluded from urban and social planning scenarios, the usability and accessibility of services, and from other the decision-making processes.
The ARUP Report is an in-depth study on future scenarios of Europe’s cities. In the preface to the Italian edition “Città a misura di anziano: una guida”8 by Antonio Brenna, there is a focus on how existing reports do the untapped potential of older people .
“In Europe, many countries are already facing these problems. In fact, ageing is one of the greatest economic and social challenges facing OECD countries, representing a radical demographic change comparable to the industrial revolution. The change is dramatic, especially in Spain, Portugal, Italy, and Germany: the countries where the ten oldest major cities in Europe are located. Are we ready to respond to this social change? What are the problems, challenges, and opportunities that older people face on a daily basis in an urban context? What are the challenges and opportunities arising from the ageing of the urban population? How can cities respond to this demographic change and provide adequate solutions? 10
“Getting older doesn’t necessarily mean getting sick. The fraction of the population belonging to the “third age” that is not self-sufficient and, therefore, in need of continuous assistance and care in the European Union is less than 20%
The real problem then consists in asking what are the characteristics that the urban context must assume so that (older people) can preserve the economic freedom, authority and respect of those around them, the autonomy, dignity and social connections necessary, on the one hand for their well-being and on the other for their ability to contribute to the creation of wealth and individual and collective well-being.
The WHO Global age-friendly cities: a guide11 and the United Nations Sustainable Development Goals12, states to “leave no-one behind” and to “make cities and human settlements inclusive, safe, resilient, and sustainable”. Within the WHO report, is an inherent assumption that older adults are by definition fragile, or self sufficient and that the urban context must adapt to accommodate them. A series of reports promoting ‘active ageing’, ‘successful ageing’, inclusiveness, or more age friendly cities, have not been effective in translating from the relatively easy recommendation to the more complex implementation and application.
60%
60%
The vast majority of these recommendations are valid for all citizens, not just older adults. Would we not all want:
• Pleasant and clean environments
• More green spaces
• Places to rest
• Better pavements
• Safe pedestrian crossings
• Adequate public toilets
• Availability of public transport, with clarity on their routes and destinations
• Kindness of staff
• More connections with community and family
• Housing alternatives
• A decent living environment
Which makes us think: are we still lacking a fundamental culture of usability and accessibility in cities?
Why is the well-known concept of universal design still being discussed?
Why is it not now routinely applied?
Do we still have to establish, in 2023, courses in inclusive design or usability
of health is determined by individual behaviours (36%) & Social circumstances (24%)14
and accessibility to educate architects, urban planners, policymakers and designers?
Should that not now be the basis of design culture? Evidently not. And older adults have nothing to do with this gap. They pay the price like all of us.
On paper, all the good practices suggested have absolute sense and criteria. What seems to be missing are the tools to engage and stimulate the ‘willingness’ and understanding of people to make sense of what being part of it means. What behavioural techniques, logic, and policies –if not strategies – are needed in practice to reap the benefits of those recommendations that are so well outlined?
Recommendations are primarily drawn up involving senior citizens. However, we have learned that “asking and listening” is not enough. The historical case of New Coke’s market failure remains a reference in the literature13 on how engaging consumers (or citizens) should be cautiously considered. When we ask people, we must be aware that they will mostly make confident but often false predictions about their future behaviour. There is a big difference between imagining using something and using it, experiencing something, and living it. Especially when it comes to something that people have never
had direct prior experience with, other than through their loved ones: their future life. This does not mean that we should stop listening to people. On the contrary. Much more is needed than just listening. First, we need to know what to ask and how to interpret the answers. But above all, there is a need for involvement and active engagement, to exploit that intelligence that comes from life and experience. Instead of simply listening to it – we need to give it an active and systematic role not only in planning the future but how to actually put this future into practice and how to make it cyclical.
Curiously, in the ARUP report, the word ‘behaviour’ appears only three times. In the WHO report, ‘behaviour’ is associated with that towards older adults; that is, it refers to rudeness or little consideration. Only once is it mentioned as a factor that can influence health and wellbeing. In addition to a predominantly reactive approach, we are focused on drafting recommendations in the multiple areas of intervention (typically transportation, housing and buildings, public spaces, services, engagement, support to communities, inclusion, and accessibility), without worrying about how we measure their impact, or how to implement strategies to be able to achieve them.
• The venue is convenient for older people as it is in their vicinity, with sustainable and flexible transport.
• Older people can participate together with a friend or caregiver.
• Event times during the day are convenient for older people.
• Registration for the event is free (e.g. no membership is required), and admission, like paying an entrance fee, is a quick process, in one place, that does not require older people to queue for a long time.
• The accommodation is built with appropriate materials and are well structured.
• There is enough space to allow the movement of elderly people.
• The accommodation is properly equipped to meet the environmental conditions (e.g. appropriate air conditioning and heating).
• The accommodation is adapted for older people, with flat surfaces, passages wide enough for wheelchairs and properly designed bathrooms, toilets and kitchens.
Probably not. These are deeply sensible, well-structured, and articulated recommendations. Yet often utterly unaware of the importance and impact of technology on the lives of senior citizens16. We have learned, working for this first billion, that designing and planning cities with targeted actions which are primarily or even entirely concentrated on older people and age friendly actions, while important, is not enough. We need a new vision. We need a new vision.
• The cost of taxis is sustainable, with discounted or subsidised fares available to low-income older people.
• Taxis are comfortable and accessible, with space for wheelchairs and/or walking machines.
• Taxi drivers are courteous and ready to help.
Thanks to the initial stimulus of the reports on Age-Friendly Cities - the literature of the last fifteen years has been enriched with dozens of reports (and subsequent lists of recommendations).
In 2010, the WHO launched the “Global Network of Age-friendly Cities and Communities”, to stimulate the implementation of the policy recommendations in the 2007 report. Since its inception, the network has seen a rapid growth of its members, reaching more than 1100 cities, and communities in 44 countries, as well as 14 affiliates, including national or regional governments, civil society,
and research organisations from 11 countries. This plays a fundamental role in supporting the mission. Membership of the network is not a designation per-se, but reflects a member’s commitment to progress towards becoming more age-friendly.
Within the WHO database, there are 250 cities in different parts of the world that have given impetus to a series of virtuous behaviours and examples of positive actions, in different sectors, that stand out for effective cross-sectoral sharing of information, identification of service gaps, development of joint actions between the ageing population and municipal planning.
We have made great strides in realising the magnitude and importance of the impact of ageing in cities. We have rigorously identified the things we would like to be done, and we have taken tangible and promising actions. However, there are still few studies on the impact of age-friendly interventions. Just look at the projects and notice how many initiatives are more descriptive and programmatic rather than applied
in cities’ operations at an almost embryonic stage17.
In the face of some incredibly detailed plans (those of Japanese cities above all, for example), most current initiatives are often siloed and disjointed. Sometimes striking, but peculiar, with minimal impact or diffusion, yet sufficient enough to assign the ‘badges’ of Age Friendly. The title does not necessarily translate to the service offered to citizens. Despite many encouraging results at the global level, the framework for age-friendly cities has been criticised for the inadequacy of the development sectors of the United Nations, but mainly due to a real lack of evaluation of “age-friendliness” in the vast majority of cases relying on purely qualitative reporting.
There is a lack of strategic suggestions on coping with the impact of financial cuts on social programmes; the increasing and inevitable privatisation of urban space; how to overcome political barriers, on the prevalence of implicit and explicit attitudes and stereotypes about age in design.
While some age-friendly initiatives recognise that their missions and goals of age-friendly cities should go beyond simply being “older-friendly”,
to being “friends of people of all ages”, there is only modest evidence that they do. This seemingly paradoxical trend is familiar to most age-friendly
initiatives. The actions and principles of the design of these initiatives, including the WHO guidelines, focus largely on older populations. More than 79% of actions in the WHO’s global database on age-friendly practices primarily target older adults18.
Although we have all contributed to the evolution of narratives, and feelings that recognise the value of ageing, and we have all recognised ageing as a fluid process that takes place throughout the life course, the focus of AgeFriendly cities is on creating accessible urban environments that respond predominantly to the needs of older people, with a reactive, passive, assisting approach. Healthy ageing – healthy longevity - is of course strongly influenced by numerous factors throughout life:
• Lifestyles, including diet and physical activity;
• Socio-economic determinants19 - education, financial status, and social support; the use of technologies;
• The characteristics of physical environments, such as green spaces, air quality, noise pollution.
Continuous interactions and cumulative exposures to the surrounding physical and social environment throughout our lives play a fundamental role in the subsequent healthy longevity outcomes. Therefore, designing and planning cities with targeted actions that focus primarily or even exclusively on older people, as is the case with most agefriendly actions, is just no longer enough. Even strategically wrong.
when a population becomes old.
The transition from the ageing society to the longevity society
2021-2030 is designated as the “Decade of Healthy Ageing” by WHO and UN20, perhaps missing the opportunity to make a decisive leap and introduce the prospect of longevity.
Professor Andrew Scott (2021) writes on “The Longevity Society” and the transition from an ageing society to the so-called longevity society, and
As the demographic transition enters a new stage of a longevity transition, focus needs to extend beyond an ageing society towards a longevity society. An ageing society focuses on changes in the age structure of the population, whereas a longevity society seeks to exploit the advantages of longer lives through changes in how we age. Achieving a longevity society requires substantial changes in the life course and social norms, and involves an epidemiological transition towards a focus on delaying the negative effects of ageing. The broad changes required to achieve healthy longevity include an increased focus on healthy life expectancy, a shift from intervention towards preventive health, a major public health agenda to avoid increases in health inequality, the establishment of longevity councils to ensure coordinated policy across government departments, and intergenerational assessment of policies, to ensure that in adapting to longer lives, policies are not skewed towards older people. A longevity society represents a new stage for humanity and requires deep-seated notions about age and ageing to be challenged if society is to make the best use of the additional time that longevity brings.22
therefore, from a vision of Healthy ageing, to one of Healthy longevity. The significance is fundamental because it summarises over twenty years of analysis and research and accurately frames the opportunity that this transition entails. A key component of a longevity society is attention to how we age, not only to the support of those who are older.
The longevity society must focus on promoting planned actions and interventions throughout the life course and not ‘waiting for ageing’. Similarly, while the challenges of an ageing society are often considered a problem only for high-income countries at an advanced stage of demographic transition, “the society of longevity implies that even those regions with currently very young populations, such as Africa and the Middle East, must ensure that today’s youth grow to become the healthiest older cohort ever”21.
The transition, suggested by Scott, necessarily generates a question: Why should we care about living healthier lives? This is important:
• For the individual - to achieve prosperity throughout human life and its various transitional phases in light of increased life expectancy.
• For families - the longevity trajectory is based primarily on a network of multi-generational and intergenerational supports.
• To leverage and recirculate the intrinsic heritage gained over the course of life: skills, abilities, competence, and experience, to solve complex problems, resolve conflicts, or strategically view priorities.
• To pass on and transfer those components of wisdom, emotional regulation of social decision-making, self-reflection, acceptance of uncertainty, decisiveness, and spirituality.
• For the socio-economic implications. To build a more robust and fairer economy. To build opportunities and optimism for young people beyond the horizon. To benefit and transfer the assets of older adults of yesteryear on a scale never achieved before.
In other words, for all our futures, all people on the planet.
The transition from an ageing society to that of longevity society implies radically reviewing the model of AgeFriendly cities on a global scale and developing a new sustainable model capable of interpreting and translating active and proactive, rather than just assisting programs.
Of course, just as there is no single action to reverse climate change, there is no magic button to achieving healthy longevity but adopting a progressive approach is essential.
The single most important intervention is to understand that there is no single intervention more important.23
Health is influenced by several factors in five key domains24:
These include behavioural patterns (40% influence on health), genetics (30% influence on health), social
circumstances (15% influence on health)25, environmental exposures (5% influence on health)26 and health care (10%). When it comes to reducing early deaths and helping us live longer and healthier lives, healthcare plays a relatively minor role. However, it consumes most of the attention of politicians, policy makers, businesses, and our budgets.
So, if we imagine ageing as a block of marble that, until a few years ago seemed un-scratchable, today we have the certainty that, if properly informed, supported and instructed, we ourselves can become the sculptors of our own life and transform that symbolic block of marble into a splendid sculpture, into a statue of which we are the subject. Healthy Longevity is, therefore, a journey, not a destination. It needs the proper companions to be appreciated and exploited and the suitable routes to make it pleasant, long and satisfying. Factors which improve the health of a community are similar to those that will improve the health of an individual.
This journey combines human
factors, experience, research, technologies, processes, and innovation of business models. There are extraordinary developments in the science of longevity, so why don’t more
people live longer and better? We know very well some key recommendations - physical activity, or a diet low in sugar, or sleeping well, helps us live better, so why don’t we do it?
The 15 minute city (and its different conjugations, from the 20 minutes of Larson and Da Silva to the T* of D’acci, where T stands for a reasonable time to reach the services) which suggests that a “citizenfriendly” city must be able to offer essential services at an ideal distance of 15 minutes.
The idea provides a simple and effective model to aid GIS-logical planning. By placing a non-permanent centre of gravity, you measure how many services are available within a short walk or bicycle ride and design the city accordingly. The model is attractive because it leverages the concept of micro-community, an idea of a poly-centric city able to deal more consciously with the issues that
concern it. It does not refer to ageing but focuses on density and proximity suggesting attention to the natural support networks that originate from villages and small towns. Something which is normal for most European citizens. Carlos Moreno, one of the leaders of the 15-minute movement, suggests that a chrono-urban model considers time as a value and not a cost.
All models centred on a fundamentalist idea of effect – the 15 minutes in this case – are left open to the doubt of the application. Fifteen minutes, but at what pace? Are there better services 25 minutes away? Are the fifteen minutes equally applicable to the centre of Paris, France compared to the centre of Paris, Texas?
The model proposed by the Blue Zones is different. The theme of places where people live better and longer has passed from university research centres to magazine covers. Initially targeting a reader base who are more sensitive to life issues, before moving into mainstream media. Undeniably, the definition of Blue Zones27 has
lit a beacon on the so-called places of longevity. Places where people live longer than others and where ‘centenarians’ are the controlling KPI.
It is a project born with the intent of “reverse engineering longevity”28, aiming to understand the reasons why, in some regions, people are more likely to live to a hundred years, and beyond. However, the mere fact that Barbagia is one of the only areas in Italy mentioned, and considered a Blue Zone, despite there being dozens of areas such as Cilento and the zone of Acciaroli, to name a few, where there are also high concentrations of centenarians. This lack of consistency has led us to doubt the soundness of the system.
The recommendations suggest drinking – in moderation – a red wine named Cannonau. But why not Barolo? Is this purely because Cannonau is produced in Sardinia? What started as a scientific project, has become a marketing platform, in which the intersection between science and common sense has been packaged with narratives of economic resources, and cultural matrices, for
the American middle/upper class. It has the merit of underlining how, somewhere else on the planet, people were living healthier and longer when compared to the average American (over 40 positions behind Japan and Italy for life expectancy, and further still for HALE29 which refers to Healthy life expectancy).
The Blue Zones have also taught us that we need a narrative to share and mutually support an idea. Marketing and storytelling are welcome, if it helps us evolve and engage. Every Italian, and most South Europeans, facing the Mediterranean Sea, are in contact with at least a dozen over-80s. They spend part of their time - when they are not living there, going on holiday, or visiting parents and relatives - in villages with a few thousand inhabitants, revolving around the café in the piazza and the seven o’clock aperitif. There is a support network which is well summed up by the recent Italian statistical Institute (Istat) data. This stated that, in Italy, 51% of those aged over 75 and over, live no further than one kilometre from their nearest child and 20% live with them30.
Other than Blue Zones and the city of 15 minutes, for many Europeans, the longevity factors are represented by the intersection of culture, climate, diet, proximity, lifestyles, community, affections, infrastructure and sharing. Characteristics demonstrated by cities like Genoa, Trieste31, Essen, Lisbon (Europe’s oldest capital city) or Toyama. In other words, the ‘what’
makes us feel good, and helps us live longer and are mostly shared and recognised. The recommendations, which we have written in black and white, in dozens of reports, have been covered by the Blue Zones. These have been packaged in an aspirational way, and thanks to the master of marketing, have become a global discussion platform.
The need for a key shift from Age Friendly Cities to Longevity Cities is, in some way, also enshrined in the mission of cities itself:
Local government is not an agency, responsible for providing a specific set of mandatory services. It is rather a unit of government, responsible for the well-being of a community and a place, independent of the wider system of government, but at the same time connected to it. 32
The commitment to improve health and well-being is at the heart of the work of all local administrations. Health improvement initially focused on the development of sanitation, living and working conditions, and the fight against infectious diseases. So, who, if not local government, was and is best placed to put it into practice?
“ The health and welfare of the people should be the highest law.
This city/citizen relationship has constantly evolved into the increasingly intricate network of services, data, relationships, and points of contact that the city carries out for us and with us. The city has always had and still has that decisive role in triggering and guiding the determinants that influence our health. However, a real risk is that these are delivered in siloed, disconnected departments, short term policies that change with administrations or competing initiatives.
In light of the transition to a society of longevity, the city, today more than ever, can and must amplify the role of ‘champion of prevention’. It can be the partner and facilitator of citizens in the path of their longevity. Communities can only be improved if we address all the wider determinants of health and work to ensure behavioural change and provide good quality education, housing, jobs and care. We have learnt that it is meaningless to merely treat people for a health condition if we do not address the causes of that condition and actively try to prevent them. The city is the avant-garde laboratory to implement this action.
So how do we evolve to bring cities to become an active partner in promoting longevity? Can these elements become exportable and systematised through different cultural backgrounds? Are they measurable beyond, or within, the axis of life expectancy trajectories? What techniques are necessary to involve the whole population? What role does technology have, and what role will it have, to maximise and accelerate the adoption of this context? How can we mitigate inequalities? Are only residents the beneficiaries of these policies? Can commuters or tourists be part of them? What of economic and climate sustainability? What would be included in a systematic and targeted programme, based on scientific evidence, implemented through culturally adaptive and dynamic action to change behaviours by exploiting social dynamics?
People in the poorest neighbourhoods, aged 55-74 are more than twice as likely to be physically inactive than people in the wealthiest.33
A static view of what it means to be older distorts our outlook on future longevity and our measure of actual costs and benefits. This does not consider the opportunities to change the trajectory of ageing and the associated costs. To start reimagining and redesigning institutions, practices, and norms to align with new realities rather than those of the last century.
The City of Longevity was born based on Antonio Brenna’s question:
Characteristics that the urban context must assume so that self-sufficient older adults and the people who progressively aim to become them can preserve economic freedom, authority and respect from those around them, autonomy, dignity and necessary social connections, on the one hand for their well-being and on the other for their ability to contribute to the creation of individual and collective wealth and well-being?
We have seen how we certainly do not lack reasons for living longer and healthier, nor a map of the actions necessary - suggested by the determinants of health, the evidence of age-friendly cities to those of longevity-ready ones, the Blue Zones and 15-minute districts. We have collectively pooled a vibrant heritage of knowledge and research. The evidence is solid and consolidated. So, acting the last step in the complicated process of improving healthy longevity, should be just a formality. Yet, this is not the case. How can we better implement what we know could change our lives? How can we instil a more accurate, applicable, adaptable, less patronising and contemporary concept?
The city is not an abstract entity or an administrative concept. The city is alive.
Beyond the dozens of administrations and agencies that manage it, the city has an identity essentially made by its communities. It is a daily interface that interprets and connects humans with the environment, with services, and as such, it is an entity to which the task is delegated of responding in a very tangible ‘physical’ way.
Which investments will produce the most significant returns for the most significant number of people over the next decades? The city is a translator, and it’s this translation that gives the possibility of changing the trajectory
People living in the wealthiest areas of England aged 65, have almost twice as many years of disability-free life ahead of them than those living in the poorest areas.35
of the life of people through everyday activities. Everyday life is represented by cities and their inhabitants and where daily choices must be put into practice. In doing so, we believe the city must be an active and discreet partner in supporting citizens of all generations and all social and economic backgrounds, to live longer and healthier lives.
The City of Longevity is an actor that actively promotes longevity, rather, like other models, adapting to it. It is not passive architecture but an active partner where each of its actions is tirelessly dedicated to identifying, evaluating, and promoting any practical activity where it can benefit citizens.34
1. Citizens are integral to creating and developing city policies and monitoring and evaluating their application.
2. Healthy lifestyles are systematically promoted through all channels of contact – private and public – between citizens and cities, according to different abilities, desires and life stages.
5.
The economic and social benefits generated by people living, working, volunteering, and engaging longer generates a measurable virtuous cycle.
6.
3. Education and training opportunities promote participation in lifelong learning and individual growth.
4. Local universities are routinely involved in generating evidence supporting strategies and policies to support the longevity of all citizens, accounting for local cultural traditions, habits and lifestyles.
Social cohesion, enhanced by intergenerational ties and the creation of opportunities for involvement and targeted engagement of older people at family, community and social levels, is the platform to build the city’s future layers.
7. Social protection and financial security mitigates the effects of financial vulnerability for all ages.
8. Integrated public health systems, social services, individualcentred health care and long-term care are built around intergenerational exchange and designed to prolong years of good health and support diverse needs throughout life.
9.
10.
Physical environments, mobility, transportation and communication infrastructure support engagement at life stages. Quality long-term care systems to ensure people receive the care they need in the environment they choose for a fulfilling life with meaning and dignity.
11.
Social infrastructure, institutions and business systems allow people to work safely and meaningfully engage in the community, at every stage of life.
12.
Free access to digital services is a right enshrined in the city statute.
13. Data and its transparent, graphical, accessible and comprehensive interpretation are the basis on which decisions are taken for the execution of city programmes.
The lack of a business model for prevention is a decisive factor that contributes to the poor health death of millions of people from diseases and conditions that could be prevented. Of course, the benefits accrue to other budgets and outwith the preferred timescales of investors and politicians.
Alternative complex actions are going to be needed while managing existing demands for immediate solutions. Further investments in cells, in current models for pharma and infrastructure are all fundamental. But, looking at how the world is progressing and how much GDP resource we currently devote to finding treatments and cures, this is unsustainable longer term. We need to implement alternatives. They are essential to build sustainable, credible, and therefore attractive prevention models for investors, businesses and politicians. Without these we will be unable to solve the underlying issue we hold dear: a fair, healthy, connected, productive, and empowered society and citizens.
The issue of prevention is the backbone of our future and is linked to a triple thread (see the New Map of Life on this issue). Not only saving the cost of care but with greater participation, better education and productive work, participation. The City of Longevity proposes a business model for prevention - helping cities to be greener, with better air as less pollution, more sustainable transport to keep us fitter.
Demonstrating City of Longevity sustainability will attract investors and ambassadors. We must get out of the stereotypes that have dominated until now and that have limited perspective, to a more realistic vision of what life is - and could be. As we said, the most critical intervention is understanding that there is no single most important intervention. It is only possible to improve the healthy life expectancy of communities and
cities if all determinants of health are addressed. We must move from reactive interventions to preventive health, through an interdisciplinary and coordinated agenda that avoids increasing inequalities, by aiming to ensure that in adapting to longer life spans, policies are balanced across generations and not targeted at a single one.
Of course this is complex - we already have so many models, templates, master plans of ideal neighbourhoods, wellness and health – and the intersections of different approaches.
We welcome them, but we believe that the real logic for the City of Longevity, is to become a global model and reach the ‘big’ population. Giving life to the virtuous circle it implies, is to introduce the paradigm of a holistic approach to life - work, transport, housing, environment, education, health, interaction, entertainment. In the intersections of everyday life, in the touchpoints that different generations share, elbow to elbow, every day, in the micro-behaviours and habits of each of us.
The evidence on which we suggest the model of the City of Longevity, is based on four catalysts:
1. The principles of rigorous evidence suggested by the New Map of Life (2018), developed by the Stanford Centre on Longevity36, who have synthesised a huge pool of research available. This evidence, logical flow and priorities is presented on a map that can guide us to identify, interpret, and above all, translate this complexity. This is a journey, enabling the benefits to accumulate over decades, while simultaneously allowing sufficient time to recover from any disadvantages and setbacks. The concept of the map is much more contemporary than the umpteenth report with recommendations. It allows us to see the ideal orography of the journey which we want to undertake, with all the possible deviations that will be necessary and clear of the territory which we move on, and of course, the destination.
2. The Global Roadmap for Healthy Longevity initiative, launched by the National Academy of Medicine (NAM)37, and supported by the Hevolution Foundation has a threefold value. First, for a purely chronological aspect, the roadmap is evolving. The latest iteration is from 2023. It is a developing observatory of the dynamics of Healthy Longevity. Secondly, although being a US-based and medical-led initiative, the scientific board and contributors include some of the most qualified global experts on the subject. Thirdly, the fact that one of the promoters, Hevolution Foundation, is an entity funded by the Saudi government, in partnership with the Gulf countries, puts, for the first time, the whole issue of longevity on a revolutionary level. It suggests an interpretation that is not only Western-centric, but an applied acceleration of models and their sustainability as we could never have imagined before.
3.
The model of an exposome vision of healthy longevity suggested by the blueprint of Quantum Healthy Longevity for healthy people, planet, and growth, published in the Lancet, November 2022.38
4.
The report, “Identifying the most promising population preventive interventions to add five years to healthy life expectancy by 2035, and reduce the gap between the rich and the poor in England”39 follows the ambitious mission of the UK Government when it established its Grand Challenges40. It tried to translate the mission of adding five years of healthy life to the British population by 2035, into action. The areas of intervention suggested by the report are traditionally born from an analysis of risk factors and therefore focus on how to mitigate those. If smoking remains one of the main reasons influencing a population’s healthy life expectancy, the City of Longevity will not ignore it. However, suggestions for how to address this and other risk factors (e.g. alcohol consumption, better nutrition, and physical inactivity) represent a logical platform on which to build a broader and more sustainable approach.
The City of Longevity, arises from the intersection of the dynamics of life where, for example, relationship, contact, exchange, and sharing, are factors that are at one with our life expectancy, and whose impact is as difficult to measure as widely validated. The task of the City of Longevity will be to suggest dimensions of intervention that will defeat in what the report codifies as
It will systematically promote intersecting synergies between some of the recommended interventions, so that their cumulative effect is more significant than their introduction as individual activities. Regarding transport, for example, the impact of fiscal and economic policies related to travel, will be more significant if combined with appropriate approaches to spatial planning, and the development of safe, and attractive infrastructure for walking and cycling. How can we not imagine, using machine learning techniques, to interpret data related to flows, behaviours, consumption, pollution, and walkability for those carrying around their dog, to develop the optimisation policies that the interaction between domains suggests?
For example, there is a growing literature on the impact of art, or the influence of companion animals on our long-term well-being. These two parameters have hardly found space in the recommendations of the past, and are aspects that the City of Longevity will have to consider.
The four sources mentioned contain vertical and horizontal axes. They are sufficiently precise and, simultaneously, adaptable and flexible to allow the world’s cities to set off on their journey of longevity with everything necessary to arrive at their destination.
Promising areas of intervention for which there is insufficient evidence, but are nevertheless well founded in theory and worthy of being considered in practice.
To title this last section, we borrowed from J.L. Austin’s beautiful book. Words generate actions. These actions can be what Austin called ‘speech acts’. It is a narrative ploy to underline our attempt to bypass the usual recommendations.
Instead, it suggests methodological elements to help generate, in a systematic form, not only other examples but structural policies. In this last section, we focus on indicating a first set of fundamental principles to implement the “how”, rather than listing again the “what”, which is already well defined and suggested by the many sources of evidence mentioned above. At the same time, the dimensions (smart-cities to name one) that, in the evolution of the last twenty years have taken hold and that were not part of the previous models.
The following are, therefore, some initial suggestions that we have traced, in order to give life to an open-source dynamic, both to co-involve the co-creation of what, to all intents and purposes, will be tools refined in a continuous
application-based improvement cycle. Whilst also helping administrators and policymakers, to not only plan yet another, intergenerational cohousing (who has not talked about it at least once in the last year?), or a neighbourhood with new green socialisation spaces, but to stimulate the hypothesis of the feasibility of the City of Longevity in its intrinsic multidisciplinary complexity.
The City of Longevity will intersect all dimensions of life over time and the first action is to embrace its interdisciplinary concept.
It is therefore not a sticker to be added to the ‘awards and affiliations’ web page of a city or municipality,
We need an orchestrator. And a inter disciplinary awareness.
but to action a strategic approach, where success is measured in healthy life expectancy of the population, in social participation and inclusion, in mental health, in reduction of health risk factors, in iterations between generations, in overall happiness.
To support the healthy longevity of the population, cities will therefore need the cross-departmental collaborative efforts of all councillors. Together. Healthy longevity will be the guiding principle and goal of all their actions. For example, the transport department should have as its main objectives supporting health (reducing transport-related air pollution, reducing accidents, increasing physical activity), in the same way that it has as its objectives reducing congestion and facilitating economic growth. The departments will therefore be asked to measure as the goal the impact of the actions on the axis of the city of longevity.
If this strategic and operational change is achieved throughout city government, significant improvements in the health longevity of the population can be achieved relatively quickly and with substantial social and
concomitant benefits. Cities of Longevity therefore must equip themselves with the vision, the culture and the necessary powers to implement this mission of healthy longevity. Let’s call it an “orchestrator of longevity” that will help both to identify and measure interventions and impacts. With a role of guidance and harmonization of its application capable to go beyond the current competences mostly framed within the area of social services. Open to interface and wisely and smartly connect environmental services, youth policies, green areas, workplace, mobility, construction, sport services and so on.
Cities must declare to their citizens the objective and meaning of the longevity initiative in a shared pact of agreement and exchange.
This is also the first step to sanction the end of a model dedicated to mono-generational interventions,
placing these interventions through the course of life and, therefore, facilitating intergenerational awareness and exchange that is inherent in the concept of longevity itself.
It makes little sense to propose the concept of de-carbonisation or reduction of traffic congestion if we do not explain the significant ‘return on our well-being’ versus an abstract
ideal of a ‘clean planet’ that we see in advertising. Without purpose it is difficult to involve citizens, especially with habits and behaviours which nudge healthy longevity, and if properly contextualized and narrated, can represent the meaning for citizens that is often missing today in planning the future of cities. Cities of the future must declare a mission of healthy longevity - for people and planet.
A hybrid approach to prevention: actions on the population and on the individual (starting from aggregating the existing under the heading of longevity)
Prevention of avoidable conditions is the burning platform. There are two complementary and interconnected approaches to prevention: targeting individuals at high risk or targeting the entire population. The City of Longevity will intersect the two models:
1.
Large-scale pervasive population actions – although interventions may have small effects at the individual level – are very broad in scope, meaning that the overall impact on the population and over time is substantial. For example, an apparently “small” average reduction of 13 kcal per person in energy intake among all young people (aged 16-29) would reduce the number of young people suffering from obesity in the UK by around 130,000 or 7%41. Populationlevel interventions, particularly those requiring few cognitive, social, material and financial resources, are better able to have equitable effects or reduce inequalities42 and interventions at the population level are also cost-effective or may even be able to save money43. The City of Longevity will therefore already take advantage of all the activities towards the population at large that the cities and municipalities carry out, putting actions and metrics into a system - an ideal dashboard of actions - to allow mid to long term measurement of results and to allow the transferability of good practices between different domains.
2. Population-level interventions not only offer an effective means of equitably achieving substantial gains at the population level but can also help ensure greater effectiveness of interventions targeting high-risk individuals. In the same way, therefore, the City of Longevity will integrate the actions dedicated to individuals at risk in order to build a shared culture of longevity where education, understanding and shared participation are the foundations on which to leverage the future of cities, and also to measure the effectiveness of timely action.
This is nothing new, but all too often citizens are only involved in one-off situations rather than in a systematic, participative model. This is certainly one of the reasons that led us to identify key areas where we could have proposed effective prevention solutions. This is linked to several factors including the lack of an embedded culture of ‘co’ (co-participation, codesign, co-innovation), a lack of tools, an objective negligence in using digital engagement systems, effective and meaningful re-use of existing data. The City of Longevity is based not so much on listening as on systematic co-design.
• Give a formal role to citizens of any generation through the development of modern, flexible, encouraged community engagement systems – and not only or not necessarily dedicated to the theme of the city. Recruiting citizens interested in contributing should be one of the first actions on the agenda.
• Use existing touch points creatively. Avoiding creating or adding infrastructure but rather leveraging and capitalising on existing is a key principle.
• Develop a visible, credible, digital engagement infrastructure to encourage participation.
• Develop a knowledge database that, thanks to machine learning techniques, allows us to interpret those data (qualitative feedback, statistical aggregations, sentiment) and provides a real flow to accelerate the dynamics of co-innovation and choice.
This can only be done if we:
Examples such as Voice®44 can represent an example among many on which to build this systematic approach and embed this as an enjoyable (or even coveted and desired) civic duty, without appearing
as an obligation or with political constraint. Rather this is a lens through which people can give and share their ideas, suggestions, and contribute experience on the issues that matter to us.
Lifestyle choices are the basis of policies of prevention and at the root of healthy longevity. Even the most sensible recommendations are alone not enough to implement change. The City of Longevity uses nudging as its basic persuasion technique.
According to Thaler and Sunstein, ‘a nudge’ is an aspect in the architecture of the possible choices of an individual that aims to modify people’s behaviour in a predictable way, without prohibiting any option or significantly changing its economic consequences. Nudges are not mandatory, but optional. For example, placing fruit at eye level in a grocery store (to attract attention and thus increase the likelihood of choosing that fruit) counts as a Nudge. Banning junk food, does not45
If the techniques of promotion of products in supermarkets or suggestions for one click over another (digital nudging) work quite well for stimulating consumption, how can we apply them for the success of our mission? In other words, we have often failed to propose to citizens intervention policies to help them consider more healthy behaviours (towards ourselves and towards others), those little choices apparently less important over the global effects on the population, but that if added up along the life course are
between the foundations of our overall health.
The City of Longevity is a discreet and intelligent partner, not a legislator or inflexible guardian - it is an active actor in the daily journey towards our healthy longevity.
This partnership must be understood wherever it makes sense, at any time and place of the day and to be so it must be as invisible as it is accepted, sensible and patient. Therefore, for example, when citizens still have reluctance to understand the importance of physical exercise for themselves or why they should contribute to reducing their pollution footprint, it is necessary to think of alternative strategies that suggest the impacts not so much on themselves, but - for example – on those they care about the most: like their family members or even the pets to whom they place attention and expenses well above those dedicated to themselves46. Leverage the techniques of nudging It does not mean that the other interventions should not be considered, but nudging is one of the key methodological and narrative tools on which to leverage a practical “bottom up” application of the too many good recommendations ignored in these twenty years.
Nudging is most effective when it takes on an articulated and pervasive form - following a logical framework that is the sum of the determinants of health that defines the prevention scenario and a longevity trajectory.
Because if the city is a discreet partner, then it will try to be as discreet as possible and take advantage of existing infrastructure. Therefore, the City of Longevity will have to bring its influence and action to the touch points through which citizens live their life. The theme of touchpoints or “interaction channels” is crucial. This includes book shops, theatres, supermarkets, bars, schools, restaurants, cafes, cinemas, museums, airports, stations, meeting places, parks, public transport, offices and of course digital applications become the ‘places’ in which to suggest the in-visible influence that the city of longevity needs in order to achieve its goals .
An obvious point of reference would be pharmacies. In some countries they represent much more than a dispenser of products that act as a garrison of possible prevention. Yet they are under exploited (even if some initiatives are in progress, such as the one carried out by Solongevity, which is finally leveraging the pervasiveness and proximity of pharmacies). But beyond that, the City of Longevity must be able to suggest actions both in the form of messages and alternative choices wherever possible. If, let’s say, each bakery or restaurant offered even only one alternative in their menu attributable to healthy longevity, two effects could be leveraged:
• Over the individual who’s choosing a healthier diet (with a potential progressive impact on the population on a large scale );
• Over the population on a very large scale, by supporting a process of education about the “awareness of an alternative”, laying the foundations for a culture of longevity.
The multi-channel nature of longevity introduces interaction with the local economy in a non-ancillary,
but strategic way. Both because we certainly cannot revolutionize everything and open only macrobiotic restaurants or that offer specific diets as a menu. The pact with the local economy is a crucial key to the success of the City of Longevity and for the development of a sustainable prevention model.
We can already see dozens of interventions on multiple levels, from solar panels to supermarket’s lanes themed “wellness”. What is missing is how these can be put into a system, and what type of economic and financial incentives can be put into place to make it happen.
Supporting companies that sustain welldocumented longevity choices (and in the same way discouraging those who do not) can promote a first model of sustainability. Rather than continuing with the socalled ‘less labels’, there should be an encouragement and support of consumers’ new preferences, by47, offering labels – by strategic design – that are increasingly clearer, richer, and meaningful to help people take informed choices.
It is a business greenfield of which we are seeing only the surface today and which will have to be better regulated sooner or later. Paradoxically it is the food industry itself to suggest government to take action as it recently happened in UK with Danone48 where the food firm has said ministers should consider taxing products high in fat, sugar or salt to combat the obesity crisis. Doing it wisely could be a great victory for our tomorrow.
It would take too long to mention all the sectors that could benefit from such an approach (including the mega-brands present in local high streets), however, it is worth mentioning one above all. Where are the banks (insurance companies are timidly moving) in all this? Perhaps they have not yet noticed that payment systems, NFT, bitcoin and blockchain have a lot to do
with encouraging spending, investments, consumption, and – guess what, if properly incentivized - health. It is time for City Mayors interested in longevity to knock on the door of financial institutions to propose them to partner in innovations that - leveraging transactions, such as micro-paymentscould develop long-term longevity policies. The Civic Dollar example in Belfast is an embryonic system that suggests there is a pathway to be followed.
As we have said, if the city is a discreet partner, then it will try to get noticed as little as possible and will use the existing infrastructure as a daily interface to manifest itself. In the same way, instead of replicating what already exists, it will exploit the existing to put it into a system and maximize it.
Waste is not just related to food or natural resources. It is also that of our intelligence. Not exploiting the ongoing initiatives that objectively have given or are giving results would be a silly mistake. Reuse, leverage the existing, join up, coordinate.
One of the main reasons for the failure of the models discussed to date is the lack of cultural mediation of the principles and recommendations proposed.
The imposed models do not work for many reasons, even more so when the proposals are alien to the cultural heritage of a people in which they are proposed. For this reason, the City of Longevity places as a key prerequisite for its success the involvement of local actors able to understand how a good idea of great success in the Netherlands, can be adapted, shaped and become successful also in Portugal. Or not be at all. It is not enough to tell Americans to drink Cannonau wine and eat goat cheese to transform them, in a flash, into centenarian Sardinians.
principle of identifying the cultural characteristics of the population to which they are addressed, without being ashamed to leverage the stereotypes of character (and check Immanuel Kant on the matter if necessary)49, identifying behaviours, habits, peculiarities so deeply rooted that they are exploited instead of trying to change them. And so, the rituals such as the aperitivo in Venice bars or the pint in Newcastle’s pubs become the channels (physical or symbolic) to be exploited to introduce those nudging techniques we mentioned before.
Methodologically, the role of mediation will be up to local universities and partners that will have to be involved to systematically define “which” recommendations and above all “how” these recommendations can be effectively translated towards that population, in that community, in that neighbourhood. And therefore, what customs, meeting points, typical local dishes, vocation of the territory, times of day, social rituals to leverage .
The Cities of Longevity will have to base their activity on the founding
History has taught us that we do not need cake for people demanding
key to repeatability.
food50. We have learned that it is not very effective to offer baguettes to those who buy stotties (bread), or wine to those who drink beer, to suggest cricket to those who love basketball, to run to those who prefer to walk.
Anthropologists, sociologists, social and behavioural psychologists, experts in data visualization, linguists,
communicators, and data scientists are the professionals at the forefront of making the City of Longevity achievable. For all intents and purposes, they are the implementers of the program and the most effective tool for the City of Longevity to be replicable, the best allies alongside citizens who expect to potentially live 100 years and more in good health.
Unreasoned list of why we don’t do activities51:
• I don’t have enough time.
• I can’t afford it (especially low-income people and older adults).
• I’m bored.
• I have other priorities (especially working mothers and carers).
• It’s too competitive and not fun (especially for kids and young people).
• I don’t think I can do it (poor self-efficacy).
• I’m afraid of getting hurt or hurting myself (especially among older adults).
• No one follows me.
• There are no suitable places, or my workplace does not allow me.
• I’m afraid (of traffic, of crime, of appearing clumsy)
• I feel uncomfortable (litter, graffiti, air pollution, broken pavements, absence of parking spots or benches or shade, etc.), but I also feel uncomfortable with the fact that I can’t get out of the house.
• Ageism (I’m too old to put on overalls), sexism (not appropriate for girls or women), and cultural restrictions.
• Weather conditions such as extreme heat or cold and ice conditions (especially for older adults).
According to the theory of Nobel Prize winner Daniel Kahneman, humans are shaped by context, rely on habits (what we did last time), and are heavily influenced by rules of thumb – mental shortcuts to making decisions that may have little to do with the most “rational” or advantageous option. As Kahneman says,
It goes without saying that the issue of behaviour is decisive. Harmful behaviours should be avoided or modified, while virtuous behaviours dedicated to mitigating or eliminating risk factors should be suggested. It is important to understand which, while living in cities, should be leveraged to stimulate change.
We have already said that the success of the City of Longevity will be a discreet, present, and pervasive partner, visible when needed, but always well active in the background and we have therefore said how the nudging technique represents its lever of Archimedes. However, we understand its effect might need time to become a virtuous cycle. Hence, it is important to exploit other techniques that – combined with nudging - can be punctual and effective.
Humans are to thinking, what cats are to swimming. We can do it when it’s needed, but we’d much rather not do it.52
The evidence on which we suggest the model of the City of Longevity, is based on four catalysts:
1.
The fiscal and economic levers which have proven their effectiveness when it comes to tackling dramatic public health issues such as smoking. The increasing price of tobacco is making smoking more and more expensive. However, the most hardened smokers remain the lower-middle classes53. For cities, it is therefore important to understand when to use this lever properly without exacerbating existing issues. In another example, the limit of 20 miles per hour in city centres (a typical measure of the city of longevity), promises a flow of revenues for those municipalities for which this represent a bare novelty. After a long debate, Milan, Italy, will introduce this speed limit will be introduced in the near future , and it is already clear that the inevitable fines will lead to a change in behaviour and it will become a custom that will have an impact on the longevity of citizens (pollution reduction, reductions in deaths and injuries on the roads, “walkability” of the city). The funds generated through the fines might finance longevity.
2.
In the same way the availability of goods and services can have a radical impact. The ban of alcohol after a certain time can be terribly effective: for example, the data of collapse of episodes of violence downstream of the prohibition of the sale of alcohol in some areas of Australia are evident54. Another example is the development of policies regarding “availability” of cycle paths or pedestrian areas. They work. They work best when contextualized with a common sense, when we understand personal and social impacts, and that’s where marketing can help.
Typically, we can count on three “hows” to resort to.
3.
Different and broader is the discourse related to the techniques of Marketing.
Banning TV commercials of snacks full of polyunsaturated fats after 9 pm or forcing fast-food restaurants to label calories are reasonable actions, but controversial in terms of evidence55. Here the theme of identity becomes crucial (as in all initiatives that seek to influence behaviour).
The inhabitants of the United Kingdom are famous for their idiosyncrasy towards the “nanny” state, in the microcosm of the individual and intruding on their privacy, but in the same way able to mobilize when properly engaged. Dry January56 is an annual Alcohol Change UK campaign that encourages people to take a month-long break from alcohol. After eating and often drinking in excess during Christmas and New Year, the month of January is fictitiously associated by everyone with a balance of their health, the abandonment of unhealthy habits, the beginning of virtuous behaviour.
When Dry January was launched in 2013, an estimated 4,000 people attended. In 2018 the figure had grown to 40,000 and continued to grow. About 80,000 people signed up in 2019, over 100,000 in 2020 and 130,000 in 2021. Dry January is probably not suitable for people who are at the highest risk of suffering serious harm from alcohol and is certainly not intended as a substitute for addiction treatment. However, the data suggested by Alcohol Change UK are interesting for a Longevity City model: “a month without alcohol like Dry January teaches people that they don’t “need” alcohol for everything they thought they needed it for. They learn to relax, socialise, unwind, relax, and heal without drinking. This awareness is very strong. It means that for the rest of the year drinking can be a choice, not a habit” 57 .
Initiatives such as this and dozens of others exploit marketing techniques at their best, leaving us to understand how that of understanding the social context and translating it into values that are meaningful to the target population are the key to the success of initiatives that aim at prevention through behavioural change in a sustainable manner. Of one thing we are certain: that a “Longevity Week” is probably not needed. What we need is a long-term strategy and the full endorsement of all stakeholders.
We are already experiencing it.
Never before have five generations found themselves sharing the same coffee machines at the same time in offices around the world; never before have they found themselvesdancing to the same songs played by octogenarian rocker bands; never before have five generations met each och other in the halls of museums, in airport lounges, in public urban spaces. So how do we face “that evolutionary phase of life which is old age? As defined by Tracy Gendron, this in itself implies dynamic and simultaneous decline, as well as maintenance, adaptation, intellectual, socio-emotional, psychological, and spiritual growth, multidimensional and multi-directional processes”58
It is inevitable: the entire concept of generation will change. While we’re talking about Samara Joy, the first Gen Z to become a global star
at the recent Grammys, and while we’re already discussing the next generation called “Alpha,” perhaps we should completely revise our logic of generational segmentation. Instead we should start dealing with a phenomenon that we have never considered before, that of generational fluidity. This is needed, because if the 90-year-olds of tomorrow feel like the 30-year-olds of yesterday, and the 20-year-olds of today represent the future with that kind of inner wisdom that distinguished the ‘Silents’ along their trajectory of life, perhaps we are facing the birth of the first nongeneration. Call it ‘intergeneration’ if you’d rather: one and none, all and one in a single fluid exchange of experiences, visions and emotions, certainly facilitated by the technology of interactions and advances in longevity research, but also clamoured for by the Planet itself.
It is difficult to imagine how we can solve the important challenges that life presents us with if we do not share who we are, especially who we want to become, and how we intend to do it together. Since we will all live on this same small planet, and we
are coming from different histories, trajectories, and cultures, there is one factor that unites us: being human. It is no coincidence that two entire chapters of Stanford’s Map of Life are dedicated to children, their nutrition, their education, their role as influencers towards grandparents and parents and their own role as parents and grandparents of tomorrow. In an intergenerational society we will be obliged to review stages, expectations.
This means that some social norms will have to change accordingly. Why force children to start preparing for college as early as kindergarten? How can young people succeed over 100
years if they are forced to graduate at 18 or get a degree at 22? Why not make learning a lifelong activity that is just as likely to take place outside of a real or virtual classroom? At a time of labour shortages, why do we expect 65-year-old knowledge workers to leave the workforce, just when many reach the pinnacle of wisdom? Are we sure that a chronological number is the best way to define “age” when science offers new and more relevant tools for assessing vitality and health? There are issues – pensions, the school system – on which the city government has little power of influence, yet one cannot forget where those life events happen.
The City of Longevity represents an opportunity to offer a model of sustainability to cities according to four main dimensions:
The first is the most logical and – historically –the most deeply analysed, and it is based on the generation of indirect revenues. This relates to the effects of the savings that are being generated across the entire health system when putting in place a system for the prevention of chronic diseases. Such a plan would enable freeing up enormous resources which today are allocated to take care of what could be avoided. It would allow cities to design new policies that support a healthier, more cohesive, satisfied, empowered, and ultimately happy society. According to the Marmot report, the cornerstone of the concept’s evidence “health=wealth”, a year of healthy life would save £19B to the English health system59 (or $38T in United States60).
Even more interesting is the data that suggests how diseases generated by age-related discrimination, costs the entire American health
1.
The City of Longevity is a model of sustainability, it is a tourist attraction, and a business factor.
2.
system $63B (one dollar out of seven spent is for the 8 health conditions (15.4%)61. The Marmot report is from 2010 and the data referred to here are consolidated and shared data, but apparently utopian if after decades we are still talking about it, rather than to act on it. There are administrations and mayors (Giorgio Gori in Bergamo, for example, has made this policy one of his missions) who have given this commitment and attention. However, the articulated complexity that prevention and therefore longevity entail requires a common front, not just the commitment of the few. The combination of growing health emergencies, stereotypical thinking and current industrial convenience are a tough nut to crack unless we change the paradigm and introduce visions like the one the City of Longevity suggests. Sustainability is in the application of the model. Denying the evidence is anti-historical.
A second dimension of sustainability is suggested by the ILC’s Longevity Dividend report62 which illustrates what radical increases in GDP we could generate by reviewing the role of older people in society. The report
suffers from a still older person centric and non-intergenerational vision (what benefits to GDP of policies that suggest interaction and integration?) and is dated 2020. It does however note how “the social and economic impact of older people is already significant: in 2014, workers aged 50 and over earned one in three dollars in the G20 economy. By 2035, older workers are expected to generate nearly 40% of all G20 earnings. In 2015, spending by older G20 households averaged 22% of GDP, amounting to nearly $10 trillion, more than the combined GDP of Japan, Australia, Canada, and Brazil. The average unpaid contributions of older people in the EU and Turkey could be worth up to 1.4% of GDP. That’s more than these countries spend on defence.
But there is potential to increase it further. This is because some of the barriers to contribution they face are avoidable, the most important of which is poor health.
People who say they are healthy rather than in poor health are more than four times more likely to work between the ages of 50 and 65. Between the ages
of 65 and 74, that becomes more than 10 times more. Increasing spending on health prevention by just 0.1% can result in a 9% increase in annual spending for over-sixties and 10 more hours of volunteering”63.
All this, as mentioned, without taking into account the development of intergenerational policies. It is time to encourage businesses to respond, anticipating governments’ slowness: companies must act now to bridge the longevity dividend. Employers need to invest in their middle-aged and older workforce to ensure that they can attract and retain the best talent in an ageing society. They will then maximise the power of generational intersection with an uninterrupted exchange and development of knowledge and skills. Cities, necessarily in partnership with businesses, can represent the interface in which these policies and the services that will result from them can proliferate for the benefit of all.
Central governments? They are made up of people: and therefore in most countries and regions it is up to voters to choose those leaders capable of promising and maintaining support for this vision.
3.The third dimension is related to longevity as a tourist attraction, longevity as a destination. Let’s start with the most obvious dimensions, those related to travellers over 65. Data shows that the number of global travellers aged 65 and over will increase from 210 million prepandemic to 250 million by 2024. The UK, Europe and the US are huge
markets, but the biggest growth is in Asia. Of course, these represent a new demographic group: the new older consumers are different in needs, interests, and lifestyles. To say: 43% have made one to three international personal trips per year; 69% have walked or hiked to exercise at least once a week.
Opportunities for “relaxing” travel remain high in the rankings, but two of the fastest growing reasons for travel relate to well-being and education, especially for people from Asia and the US.
In addition to “health reasons”, “lack of motivation to travel” is the main obstacle for those over 65. What we have christened as “longevity destination” offers new motivation to support an evolving target. Travel to learn to live healthier and longer, to change behaviours through fun, personal commitment, and the discovery of other cultures. Unlike the Blue Zone or Chinese Longevity Villages in the Bama Region64destinations that attract visitors hoping to access the secrets of the centenarians who inhabit those places - and unlike the spa villages, the oases of dieticians, the retreat for meditators, the offer that the City of Longevity proposes is to integrate the proposals of longevity in the offer of the city’s heritage, not to distort or divert it, but rather to make it become an experiential added value in the fruition of the beauty of Venice, the style of Milan, the mood of
Amsterdam, the splendour of Dubai or the intelligence of Boston.
The cost of implementation is, all in all, low when the city has already embraced the strategy of longevity, yet the impact on visitors potentially incalculable. Artistic or shopping routes, foodies, cultural heritage: everything can be redesigned and enhanced of meaning for an offer oriented to support travellers interested in their well-being. Travellers can then plan their excursions knowing they can count on the alternative of longevity: even a walk that includes a climb can make the difference if corroborated by data. hat the City of Longevity suggests is to take this type of tourism out of the “wellness” destinations and make it an accelerator of economic growth for the sustainability of longevity cities.
If the global tourist expenditure related to wellness tourism, i.e. all tourism and not just the one related to citizens over 65, has exceeded 919 billion dollars (835 billion euros) in 2022, which is 18% of the global market, it is possible to see how cities could create and conquer a market
that we could define longevity tourism, still needing to defined and invented. This is without, of course, counting the benefit reflected in terms of dissemination, consolidation, and impact of longevity initiatives towards resident citizens.
Finally, the last dimension concerns the economy, seen through at least three different lenses:
We have already mentioned the importance of contact and interaction channels. The City of Longevity is an injection of value to the proposal of local economies, of any sector, because it is based on local economies. It cannot be ignored. Commodity activities are the permanent flywheel, the source of renewable energy that can make the city present in supporting citizens to choose logical alternatives, make it possible, supported by evidence, useful, not paternalistic, free not to be chosen. But present. They can harmonize with the many ongoing initiatives, such as the models for a circular economy of cities (where longevity is inherent in the 5Rs, Reduce, Reuse, Recycle, Recovery and Regeneration) or the aforementioned model of the City of 15 minutes which - by definition - requires a presence of services and proximity activities.
Not taking advantage of the opportunity to give common sense for the benefit of citizens to that
redundancy would be a mistake, also to try to mitigate the risk of gentrification that the phenomenon launched by Carlos Moreno could entail. The gentrification of urban areas once inhabited by less affluent classes is amplified by the 15-minute idea where, on the one hand, a spur is given to the creation of a proximity micro-economy, on the other, it opens the way for those new ‘quality standards’ that increasingly resemble those demanded by a class with higher incomes and willing to invest only where ‘those’ kind of services (coffee shops, gymnasiums, yoga clubs, nail shops, micro-breweries, qualified schools, etc.) can be found within the 15-minute time frame. Perhaps Moreno’s ideal model could be the village of 5 (rather than 15!) minutes - where distances are measured in Velosolex speed, where everything is automated by the second.
A movie forecast made 65 years ago that should make us reflect on the concept of time and city. The City of Longevity interprets time on its longitudinal and non-circular axis. In the City of Longevity, focus lies not on measuring minutes, but on measuring years. It is therefore important to be aware that those years are made up of the interactions that happen with systematic frequency during those small, recurring minutes. This realisation highlights the
importance of recognising the significant impact that small, minute by minute, everyday actions can have in achieving the desired outcomes. Therefore the models of development and sustainability (economic and environmental) should be seen in a radical and foundational way and are to be placed, involving the economies of territory and proximity. It is for their benefit; it is for the benefit of the City of Longevity, its citizens and visitors.
It is clear that cities will both benefit and drive the economy of longevity. This is a widely controversial topic both in terms of definition and market size. In April 2018, the term Silver Economy was coined by the European Commission to describe the economy linked to the population over 50.Its size was at that time estimated at 3.7 trillion euros. Perhaps you don’t feel old at 50 (or even 65), but it is a widely accepted fact that the business world, in the development and promotion of new or existing products, often has an imaginary stop at the age of 50. In this way, the EU underlined
the overlooked significance of an economically underserved target group. In this way, the EU followed the same reasoning as the AARP, which a few years earlier had published the first report65 on what has been defined as the economy of longevity (and not the “silver economy”). A concept brilliantly narrated by Professor Joe Coughlin in is “The Longevity Economy”66
According to a recent study67 the added value attributable to the economic sectors in which the Silver Economy has a direct impact is about 180 billion euros, a figure that rises up to 620 billion considering the indirect impact on the real economy. Private consumption statistics indicate that the sector that benefits most from silver spending is “housing”. At the European level, about a quarter of all Silver Economy spending is reserved for housing and utilities, worth €815 billion in 2015. The second sector of expenditure is food for a value, in Europe, of about € 445 billion. The third most important sector is Transport, with total expenditure at European level by “silver consumers” of € 401 billion. Not to mention the
health expenditure of this target group which is 6-7% per month of all their expenses. Let’s stop here with two considerations.
• Where do these expenditures and consumptions take place in the cities? Can we maximise them?
• Here we are talking about the spending of the “Silver economy”.
If – and not just for a semantic issue – we contextualise these consumptions in the perspective of longevity and therefore going to intercept an enormously wider spectrum of potential offers, what would be the value? Someone estimates the whole Longevity
Economy size of $27Trillions by 202668
The City of Longevity will need to implement a hybrid sustainability model, a partnership model oriented towards open-innovation together with the private sector and the non-profit sector, counting them as part of the same team rather than as impromptu financiers. An orchestrated longevity program needs a budget, and this budget comes from interactions with the channels mentioned above, where each entity plays its part in a concerted vision. And so if the third sector finances the dynamics of engagement of citizens, it also offers consulting services to companies to better reach those same citizens. It can then reinvest the proceeds of consultancy in policies for behavioural change that benefit the contact channels that will support “healthy” choices with discount and incentive policies that range in the round, including basic services: a free 5G network for access to longevity services provided by cities is not a socialist utopia, it is a prerequisite for the health of the population, it is an intelligent model to develop an economy where the volume of transactions, the well-being of society and the optimization of that “well-being through data” are part of the same business model.
To date, smart city initiatives have had little or no link with the Age Friendly Cities agenda and subsequent evolutions. The smart city is a solid and acquired concept that founds the principle of management and evolution of the city based on increasingly generated data that is widely available to administrators and subsequently to citizens. The city of longevity must intersect its agenda with that of smartcities on four axes.
Already in 2011 Michele Vianello, at the time Deputy Mayor of Venice, argued that “building a WIFI network in a municipality is not dissimilar to building a nursery or kindergarten”69. Access to the broadband, compared by Vianello as a universal right of citizenship, explains well on which axes it can and should evolve, and it is not very different from the right to healthy nutrition for public school children. If the city increasingly moves its services to digital ones, it means that more data will become available. This data can then be the basis for measures and effectiveness of our interventions.
Providing access to broadband will be strategic and will be socially essential not to just provide access to services, but also to receive feedback from citizens. Tel Aviv, Barcelona, Perth, Wellington, Osaka, Tallin, Helsinki, Milan, or Leeds, Bradford, Oxford, Manchester, Salford, York, Edinburgh, Cardiff and Newport, all cities which
Network access is a pre-requisite of the City of Longevity.
have been equipped with free public Wi-Fi, are excellent examples for the foundations of the city of longevity. However, a lot more can be done both from an infrastructural point of view (diffusion, and – moreover, speed and signal reliability), sharing with the public (information about access) and usability (ease of access).
Since the risk is what Citizens Advice in UK found: during the first lockdown, certain groups, including people with children, disabled people, people from Black, Asian or ethnic minority backgrounds, those who were shielding and young people were particularly struggling with their broadband bill. Towards the end of2022, an estimated 2.3 million people had fallen behind on their broadband bill, according to the charity70. How can we suggest better behaviours and access to education, information and data if we can’t grant the bare access?
There is no City of Longevity without its measurement. What would be the point of proposing interventions for our well-being if we cannot understand their impact over time? Below we have listed a first series of key performance indicators (KPIs). More and more personal and social contexts, in fact, are measurable thanks to both devices and the ability of software to analyse the growing flow of data.
Three considerations above all:
• The first is the need to constantly scout new technologies and techniques to help measure the city. Just to mention a few: the resolution of satellite images, the ability to “see” augmented data in addition to pure orography, data derived from generative neural networks models, data-driven modelling of what-if scenarios, data from the wide spectrum of the Internet of Things, open up possibilities of data collection and interpretation that could only be guessed a few years ago and that today are in the public domain (and more and more involving the individual as a proactively engaged source of these data).
The city of longevity is measurable (and therefore evolves on data)
• The second concerns data visualization: this will be a mandatory rule of the City of Longevity because we should use data to engage citizens to be part of the city mission. There is no better way to see for believing and, above all, understanding how and where our contribution matters to us, to others and to the city itself.
• The third: if the city of longevity is made of data, then it will also be necessary to systematise the skills to interpret and maximise them. The powerful data-viz software, advanced algorithms, causal inference techniques, the possibilities offered both by augmented and virtual reality, just to name four of the dozens of technological enablers, require a new class of experts to exploit them and will be at the core of the success of the City of Longevity.
• Healthy life expectancy: It is the mother of all metrics. Healthy life expectancy71 is similar to life expectancy72 but with a crucial difference: it adds a quality dimension to the quantity of life. It offers a concise measure of how many years we can expect to live in good health, without illness or disability. Whether life expectancy without disability increases in proportion to total life expectancy is still a debated question that the City of Longevity will likely help address.
• Access to healthcare: this is another rather traditional KPI that measures the availability and quality of health services in the city. It can be measured by tracking the number of hospitals, clinics and healthcare professionals per capita, as well as patient satisfaction ratings. The variable “distance” from the individual (the infamous “15 minutes”) will have to be considered. To this will be added the measures of the availability of services and technologies both for ageing in place and for assistance at home.
• Physical activity levels: This KPI measures the percentage of citizens who engage in physical activity. It can be monitored both by conducting surveys and collecting data on citizens’ physical activity levels, using, for example, street cameras, or by involving citizens to share their performance collected using personal wearables. Initiatives like Stepn’s73 demonstrate both the feasibility and good acceptance (and involvement) of the population.
• Connectivity: Monitor both availability of broadband, usage and network access and cost.
• Access to healthy nutrition: This KPI measures the availability of food options in the city. It can be detected by involving distribution channels and both by monitoring the offer by grocery stores, agricultural markets, restaurants, etc., and consumer demand by appropriately tagging products.
• Environmental quality: this KPI measures environmental parameters and the factors that influence their impact.
• And therefore, the quality of air in open spaces in its different forms (pollutants, particulates, etc.) all the typical values of the weather related to air quality with a particular relevance of heat, water polluting factors, air quality in public indoor spaces, noise. And conversely, traffic in all its dimensions, emissions related to heating and cooling systems.
• Green spaces: This KPI measures the number of green spaces. It can be inferred by monitoring the number of public parks, community gardens and green areas per capita, localization, distribution and accessibility using GIS and drone or satellite reconnaissance.
• Social connection and engagement: This KPI measures the social connection and the community “sense” in the city. It can be measured by monitoring both the number of community events, volunteering opportunities and social organisations available to citizens, both through the engagement of digital platforms as suggested above, and through the social proximity of individuals
(using the same techniques to measure social distancing - as done in Newcastle during the Pandemic)74, and the active participation of employees through employers (when adopting policies that the City of Longevity can suggest and facilitated by organizations such as onHand75).
• Happiness, well-being, sentiment: there are multiple indicators to indicate a level, albeit empirical, of happiness76. In addition to the existing ones, such as the annual measurements of the “best place to live” it is possible – if properly designed and digitally enabled –to build a punctual and recurring survey model of these factors. Moreover, the growing capacity of affective computing Interpreting the feelings of people opens the door to novel, more sophisticated and punctual logics of investigation and analysis, on what interests, stimulates, involves, empassions or disgusts people.
• Personalised health data: By combining data analysis and machine learning techniques, it is possible to suggest personalised
health plans for residential areas and for each individual by measuring any return on their wellbeing and health. By involving pharmacies, a whole series of individual KPIs can be introduced, including salivary epigenetic or glycan tests that allow an assessment of metabolic changes within a very short time frame. If developed on a sample model of the population by geographical areas and then interpreted with machine learning techniques, it could provide indications of effectiveness of intervention allowing continuous micro adjustments and improvements of policies.
• Mapping and measuring current activities: web scraping and data mining techniques, combined with NLP, make it easier to find, categorise, qualify what already exists, capture its effectiveness, and share it for common use. Instead of tables collected by someone, existing data can be sourced and made actionable for policy makers as well as citizens.
• Macro and micro-behaviours: the
development of a dynamic bank of behaviours (“who” does “what”, “when”) will allow to design intervention strategies based on real flows rather than assumptions. Models based on causal inference will show us correlations between behaviours and outcomes that we have never been able to identify before.
• Intergenerational interactions: the intersection of demographic data with touchpoints (participation in events, composition of the office workforce, etc.) or the measurement of ad-hoc designed events (participation, appreciation, outcomes), could allow to map where and how an intergenerational dynamic develops and, therefore, suggest how to maximize it.
• Smart infrastructure: Smart infrastructure, including smart buildings and transport systems, are a crucial source of data at the City of Longevity. The data from these sources are already widely available and used, they just need to be contextualised along the longevity scope.
As noted above, future planning and implementation of research projects should consider existing digital skills and literacy levels of all end-users in society.
“It is impossible not to notice that many of the questions that guide today’s research on the use of technology by older adults are the same ones that 20 years ago were at the forefront of ageing and accessibility research. Back then, computers were mostly large desktops, social media was just a speck on the horizon, and mobile phones were big and not (yet) smart. Older people were scarcely present on the Internet. Today, devices have changed, and older people are of course increasingly online. Of course there are differences – some groups continue to lag behind in their use of broadband, in the breadth of applications used and, in the time spent online. According to the most common data, there is for some groups little interest in social media (other than to stay in touch with family and the pandemic has shown us how and why) and are sceptical of online financial transactions.”77
It is clear that the problem of older adults and the use of technology has not disappeared, despite an increasing flow of technology-wise users entering into the “ageing
The sense of non-use: beyond accessibility, education, services, and participation.
group” frame given demographic dynamics. According to some research78 predictions of an imminent wave of retired workershave not yet come true. These workers are a cohort accustomed to dealing with digital and technology thanks to their working background and digitally enabled working life. They are able to take full advantage of the services offered via the Web. Indeed, the prevailing perception remains that older generations are unable or otherwise resistant to the use of technology.
Crucially, this “digital divide” is potentially more disabling today than it was 20 years ago, given the push towards an increasingly digital society. Today, digital technologies have become essential to life in cities. Just think of the plethora of mobility services that are strictly bound to geo-localization and on-line booking. It is reasonable to ask whether the inability of older adults to interact with technologies can be included among the main triggers of the transfer of elderly people to assisted residences. While there is a call for a more holistic view of design for older adults, as was the case 20 years ago, most interventions to bring older adults online commonly focus on age-related declines (such as vision, hearing, cognition, or dexterity) as major barriers to technology adoption.
These interventions typically come in the form of alternative variants tailored to the older adults or adaptations to make technology more accessible. However, older people are much less likely than younger users with disabilities to adopt aiding tools designed specifically for them, which suggests that they may either not view the conditions of ageing as disabling (we get used to it, we learn to manage it), or (in addition) that their resistance to technology adoption is not exclusively or even primarily rooted in issues of Usability/accessibility on which we continue to invest the vast majority of our energies. Our interactions with older communities through the Voice® community reveal that people are often unwilling to acknowledge that their lives would be enriched by digital technologies (made accessible or not). It is this attitude towards technology that the City of Longevity must leverage to enable the citizens of today and tomorrow.
there more general problems related to the “digital society” that lead older people to reject certain technologies? If so, are these issues likely to continue to be relevant when future generations grow older? In other words, is this cyclic? While growing old, are we all facing a rejection towards those technologies that progressed at such an unsustainable pace (and an unsustainable need of version updates) to push us to avoid understanding and therefore using them? If today older adults are struggling with cloud-based services and touch screens, will the older adults of tomorrow refuse large language models and generative AI? As we said earlier, it is masochistic to treat people and then send them back to the conditions that made them sick, in the same way it is self-defeating to insist on developing services according to logics that prevent the perception of usefulness – what is it for? what’s in it for me? - even before use.
Given that the types of technologies and applications to which older adults are receptive or adverse vary from individual to individual, older users do not appear to identify inherent design flaws of specific tools. So, are
The City of Longevity represents an opportunity of mitigating digital divide by promoting services and technologies that accompany citizens throughout their lives with the clear purpose of helping citizens to live
a better life. Services such as city accessibility maps, pick Seattle79 between the thousand cities who have developed one, are designed to allow persons with disabilities to identify accessible paths or avoid troubles areas. But why don’t we extend the purpose? Aren’t the steepest uphill and downhill sidewalks, or those
crossings furrowed by tram tracks and intersected by uneven cobblestones an issue for parents with baby strollers too? For someone who temporarily wears ankle cast or has put on 12 inch heels for a gala evening? Can we integrate data on walkability? Suggest less polluted or capable routes to help us relax the mind while we cross the
city? Can we profile who we are, in what status of life we are and evolve it accordingly to situations and contexts? Of course, we can. The data is already available, as well as the technologies.
We need to review the design logic in a longitudinal - and not a vertical – sense. We need to get used to sharing aspects of the city and services in a fluid and integrated way. By doing so, the process of awareness of who we are and what we need helps to automatically interface the other “we” that we will be or could be or that we care about, simply by suggesting the presence of functions whose usefulness interests our other “self” along its trajectory of life, projecting it throughout life and therefore exploit the experience as an educational lever too. Similarly, the City of Longevity must be able to consider the non-use of its services, not so much from the point of view of lacking, i.e. a simple “not doing something”, and embrace the knowledge that “non-use of services or products” can be instead “active, meaningful, motivated, considered, structured, specific, nuanced, direct and productive.”80 Therefore, we need to understand what alternative meaning is assigned when individuals selectively choose “not to use” something. The City of Longevity needs to reflect on the implicit meaning represented by the technologies that these non-users are rejecting. It will increasingly need more non-usability experts (read behavioural scientists) rather than just usability designers.
The digital soul, powered by data, of the City of Longevity must also be understood as an opportunity to build a pact with citizens that we have never actually experienced or applied. research projects should consider existing digital skills and literacy levels of all end-users in society.
We are all aware of the rules we must abide by for data processing, but here we are going far beyond the EULA notes to be accepted in the face of a service or compliance with the GDPR. We are going to develop a partnership with citizens that will last, theoretically forever, we are building a platform of values and ethical principles that will help establish the trust necessary to believe that the suggestions of the city are credible, that the
The trust between the Cities of Longevity is based on the sharing of ethical values, well beyond those of data processing.
data we decide to make available are used to develop policies of which we should see a tangible (and measurable) benefit not only for our health, but for that of our children and our parents. Not an easy task, given speed and complexity of tech evolution.
The theme is also fascinating and complex because, in addition to the purely moral or legal aspects around one rule that often confuses us on its truemeaning , involvement has to do with behaviour. For instance, lowering cars’ speed limits or banning junk food advertising, will most likely be judged based on the impact it has on our life, routine, cultural heritage, education, etc.
There is a danger that we might lose the citizen’s support, trust and complicity if there are continuous requests from them by the city. All of these are the basis for the model we are defining. This opens a wide debate. Too little has been done to resolve it and we certainly cannot do it here. For now, we will not talk about the opportunities that this model allows to advance in order to have a “gym of innovation” that we referred to before. However, in order to identify the “hows” in addition to the “what” of this series of notes on the City of Longevity, we have identified five main areas of attention.
Too often older people are seen as a homogeneous group, without an assessment of individual aspirations, capacities, vulnerabilities, and contributions within different communities. Objectively, this is one of the main obstacles both to mutual understanding and the development of intergenerational relationships, and to the development of the City of Longevity. In the last decade there have been important national and international contributions that have explored the human rights of older people and identified possible gaps and ways to address them (e.g. the International Index on the Human Rights of Older Persons - IOPHRI81). Incredibly, (in 2023) the actual relationship between a formalization of human rights of older people, ethics ( such as values and standards that suggest what we should do) and the real world is complex and not yet fully explored.
The City of Longevity offers the opportunity to face the reality of the longevity society and develop an understanding of the opportunities and challenges of an ageing population. This is not only geared towards the current older population, but keeps in mind those who will be older in the next 10, 20, 30, 40, 50 years. It - explores how and which ethical values need to be reformulated, enunciated and above all practised when referring to human experience and the daily life in the office, on public transport, in a restaurant inhabited by a population that fluctuates simultaneously between five or six different generations.
Because ageing creates so many interconnected challenges and opportunities, an equally comprehensive and, in its own way, innovative range of responses is needed. The ethical approach that the city of longevity will be called to define takes place, at least, on these domains82
• Truth, disinformation and propaganda.
• Dopamine addiction and economics
• Economic and patrimonial inequalities
• Machine ethics and algorithmic biases
• Surveillance status
• Data control and monetisation
• Implicit trust and understanding of users
• Heinous actors and criminals
The ethical dimensions of the city of longevity are manifold.
It would be wrong not to give the importance that machine learning techniques deserve when it comes to re- imagining our relationship with reality through data and allowing us to accelerate the journey to the City of Longevity. For this same reason, artificial intelligence puts us in front of a series of questions that we will be called upon to answer. We have summarised them like this.
• Bias in data or models: Is AI fair in its decisions?
• Alignment of values: Does AI understand our intentions?
• Explain ability and transparency: How do you make decisions? How can I be sure that there are no manipulation deceptions? Can these explanations be understood by everyone?
• Robustness and security: Can we make AI robust when challenged and safe from attacks?
• Data management: How and for what purpose is my data used?
• Design transparency: How can I evaluate the properties of the AI models I use?
• Impact on the environment: how much does AI pollute? How much energy does it consume?
• Protection of personal data: Will my personal data be protected?
• Privacy: Should we abandon online digital privacy to get better AI services? If yes, how?
• Responsibility: Who is accountable if something goes wrong?
• Impact on jobs: How to relocate and retrain people who have lost their jobs due to automation?
When we suggested the need to ensure free access to online services and when we suggested digital platforms to engage citizens, we were thinking of this: to establish systems of co-participation that are not extemporaneous but systematic and well embedded in the flow of our everyday lives. A kind of daily routine. We believe that only by building this infrastructural background is it possible to develop a proactive debate on the construction of a new ethical platform that is valid today and capable of adapting to the natural evolutions of life.
The ethical debate is public, traceable and broadened.
4.
The techniques to build the trust we were talking about will have to adapt in addition to legal rules and exploit a new logic of data, managed “at the source” by citizens. These solutions are already well available under the domain of distributed ledgers, allowing citizens to choose from time to time or accordingly to a sort of personal, political, ethical pre-set “master rule” which data can be shared with whom and for what purpose. So instead of being a passive provider of data, often regulated by obscure contracts, we can become managers of our digital alter-ego, tracing exactly what our contribution through our data is and has been. This control of our own data, managed, for example, through an encrypted pod on our mobile device, can be easily extended to our profile too:
applications that concern us can be – once for all - customized for our own profile instead of generic interfaces and therefore solve the accessibility problem at the source.
On top of this personal-centric approach, synthetic data, i.e. data that is statistically consistent like the originals, but synthetic, i.e. decoupled from their real entities, can represent the other side of the coin. It is such a promising and already solid technique that it could become the ethical database on which cities will not only develop their analysis for policy design, but can monetize to private entities to support the City of Longevity. The time horizon of the City of Longevity is in an indefinite future that has as its start date “today” and end date “never”. There will be no technology that the City of Longevity will not consider to optimize its processes and offer a better service to citizens.
It seems obvious to state that inclusion is one of the founding values of the society in which we live andin perspective - the one in which we are about to live. Yet, social tensions are all around us, in the very cities in which we live, and they tell a story of a reality that is anything but cohesive.
The most recent example of that are riots in France, which quickly spread to Belgium and Switzerland. It shows an image that is far from that ideal of communion and welcome which, perhaps naively, we had envisioned as the guiding principle of our future. As we have been saying throughout this document, once again cities find themselves at the forefront of social tensions stemming from national policies. It is true that France or the United States ‘burn’, but it is the streets of Paris, Nanterre, Marseille, Minneapolis, Los Angeles that
are ablaze, along with their surrounding banlieues and suburbs. Even in the city centers, where luxurious and fast-fashion brands present an illusion of a meticulously crafted and harmonious world, destruction has arrived right on schedule in response to the call.
Cities have become aware of their political role. They have become increasingly strong actors in the (certainly European) debate on migration and have created national and transnational networks for cooperation and knowledge exchange, regardless of the recommendations of their host governments. Across Europe, for example, city representatives and administrations are taking a stand against the highly restrictive migration policies of the EU and its member states. Many cities have declared themselves places of refuge and safe havens for people on the move. Cities in Spain, France, the Netherlands, Germany and Italy have taken action, especially in relation to the blocking of civil rescue operations at sea. With their different progressive approaches, many European cities have become a testing ground for new policies of inclusion and participation, paving the way for the democratisation of urban society.
Being at the front has its advantages. Politicians, local authorities, and civil society organisations in cities not only have concrete experience with the coexistence of long-term residents and newcomers, but have also created a place
for social experiments, creative bottom-up processes and fruitful collaborations between civil society and city authorities. Cities have a long history of proposing solutions for the healthy life of its citizen so that they can support, learn, adapt and create policies of inclusion. For the City of Longevity, this must be at the forefront of its mission. There is an the imperative need for bare survival: we are acutely aware that while life expectancy is on the rise, birth rates are declining. Countries – and by extension cities – are therefore compelled to seek solutions beyond the traditional ones based on familiy incentives. The aim of the City of Longevity is to help residents, citizens and those who have yet to acquire this right live as long as possible in good health. The goal is to reduce, in perspective, the cost of the health service itself, while at the same time building a social support mechanism where:
• Those in good health can help those less healthy,
• Where skills can flow,
• Where exchange is between generations, backgrounds, cultures.
A multicultural society is in the order of history that has brought us this far and it is the future that awaits us on an increasingly smaller and more connected planet. It is also the natural source of that innovation that we so much desire and that can only arise from encounter rather than clash. Urban diversity is an asset. Society, and by reflection the urban one, is becoming more diverse every day: the number of new identities is growing, and these identities are becoming progressively more complex, fluid and connected than ever before.
We are (still) struggling to recognise that people do not have a single identity: they manifest their belonging to categories as diverse as gender, ethnicity, class, ability, sexual orientation, and other multiple micro-identity axes, which flourish continuously and interact on multiple levels, often simultaneously. This hyper-diversity translates into patterns of behaviour, lifestyles, and attitudes over the course of years. It is on this crucial axis of inclusion, represented by our diversity, that the City of Longevity is founded. It is an immense opportunity, and it seems
almost incredible that we are still only at the stages of discussion about this. Similarly, we believe it is utopian to respond to the needs of increasingly complex and diverse urban societies with standardised policies and policy instruments. Doing so only increases the risks of exacerbating social and spatial inequalities.
Citing an individual’s ethnic or cultural background as the primary reason for his or her failure or success is now rather unrealistic. Considering instead the complexity and dynamism of urban life, the layers and points of contact that the City of Longevity suggests, an individual’s success or failure is part of the orchestration
that the City proposes. It is part of the possibilities that a city (or better, a neighbourhood) must develop to stimulate relationships, businesses, lifestyles, interactions, exchange, knowledge, value. It is time to recognise urban diversity as a positive aspect of contemporary urban environments and to increase interaction and communication between groups in a diverse urban society, time to increase participation to meet community needs.
Probably, this is the only way we can imagine the future.
Is there a concept of architectural longevity? And not in the static sense of a building handed down through the centuries (European cities would have a couple of things to say on the subject) but more in the sense of its evolution over the course of life.
Although it may now be normalized – and perhaps we cannot be surprised enough – we are the lucky witnesses of the evolution of a building, the Sagrada Família84, which, like a man, a woman along her
life path, is the tangible physical testimony, of the concept of longevity that we are suggesting. It is testimony to the practicability and applicability of a project idea “in the long term”. It is architecture not aligned, like it or not, with the style of the time. It is an expression of diversity and a a permanent vision in the making. It is resilience to the cycles of politics, to the vagaries of time, to turncoat budgets.
The Sagrada Família is a living stone that reminds us how we can evolve and change even in a permanent geographical immobility. One can object to a thousand things, whether there is the hand of God, of an immortal genius (proving that a kind of immortality is far from unattainable), or that all the churches of the past took decades to be completed. Which brings us to the Fabbrica del Duomo85. It is the concept of “factory” that we consider central in this discourse. The Duomo, in its finiteness, is alive thanks to the daily work in the marble quarries, in the symbolic care of one’s health so apparently “lapidary”, and instead ... It is the metaphor of the same factory of longevity that requires first to define the need to set up - precisely - a “factory” and then follow the daily unfolding of that path made of work, care, small actions, sharing, participation, respect for the values of identity and innovation that has been tirelessly renewed since the Middle Ages. We all enjoy the result. We will all enjoy it along the longevity of the cities.
We must solve an extraordinarily complex problem, which can be expressed with disarming simplicity: now that science suggested we can live healthier for longer, how can we live better? We need a profound change of mentality. Because the answer lies in understanding the processes of ageing itself and how to influence them to our advantage. To do this, we must go beyond our traditional domains of knowledge so vertical and unwilling to dialogue with others, so jealous of their centrality.
We must embrace an articulate, multidimensional, and simultaneous vision of what that “better living” means and what it implies. Life happens to us all together, not one piece at a time. After all, we don’t ask for much: spend time with family or friends, sleep well, have a decent salary, maybe feel fit. It is enough for us to be respected for
who we are. It is enough for us to be considered according to those values of dignity that hold high, just like we do for our parents , our children, their children. Yet, all this simplicity is terribly complex to achieve because it has to do with those tiny, huge things that life implies, including the fear we have of becoming what we never imagined to be.
Growing old is one of the few things for which we have some certainty and for which we do nothing to prepare. Terrified of a culture of contempt. Immersed in our own unconscious rejection against those we will become. Cities have the burden and honour of hosting us to build a future that is already present. They can become the best possible companion along this journey that – in some way – implies a new social pact so evident that it can no longer be ignored: that between generations. And they can do more than just host us. They can inspire us to build that model so articulated that only those who are in the depths of our lives twenty-four hours a day can afford.
The time for recommendations is now marked by the time of implementing them. To live better, not necessarily longer. We know that our longevity is not only regulated by us or by a particularly inspired or visionary mayor. But helping them to help us may be the right thing to do today.
1 Leaving No One Behind In An Ageing World, World Social Report 2023, https:// desapublications.un.org/publications/ world-social-report-2023-leaving-no-onebehind-ageing-world
2 SiSI, Municipality of Milan
3 https://population.un.org/wup/
4 https://www.un.org/en/desa/worldpopulation-projected-reach-98-billion2050-and-112-billion-2100 SiSI, Municipality of Milan
5 Over the years, different age groups have been used to define the “elderly”. The fact is that ageing is a process. Governments set an age for pensions and social security, and several services offer agebased rates for seniors. From an individual point of view, however, age is largely a state of mind. A person who is 60 years old may feel old, while another who is 80 may not feel old. Research on older adults’ use of technology varies in terms of benchmarks for age categorisation. Often an age over 50 was used, although a less controversial limit would be 60 or 65. A person does not suddenly wake up one day and find himself “old”, nor does he wake up discovering that
he is no longer able to use a technology unless a sudden disability, even the banal fracture of a finger, which can happen at any age. So, although some general statements can be made about older adults versus younger adults, it is always important to maintain awareness of the stages and contexts of life, and of the consideration that older or older adults are individuals.
6 It is expected that in 2050 almost 7 billion people will live in urban areas. https://population.un.org/wup/
7 https://population.un.org/wup/
8 https://apps.who.int/iris/bitstream/ handle/10665/43755/9789241547307_ ita.pdf?sequence=2&isAllowed=y
9 For example,: European cities have responded to population ageing with a wide range of responses, from mitigation and impact management to adaptation. A comparison of trends and patterns of 10 European cities in the ARUP report cited below suggests that at first glance, there is an inverse relationship between the growth of the total population of cities and the proportion of elderly people living there. Looking at percentage changes, between 1991 and 2011, London, Brussels, Amsterdam and Copenhagen grew, attracting new residents and/or thanks to a positive birth rate, while
their elderly population declined. Shrinking or low-growth cities, such as Milan, Lisbon, Madrid and Berlin, are generally aged.
10 Excerpt from the beautiful report “Shaping Ageing Cities - 10 European case studies”, Arup, 2015.
11 https://apps.who.int/iris/handle/10665/43755. The term Age Friendly City was coined by Alexandre Kalache, then Director of the WHO Lifecourse and Ageing Department.
12 https://sdgs.un.org/topics/sustainable-cities-and-human-settlements
13 https://www.cbsnews.com/news/30years-ago-today-coca-cola-new-coke-failure/
14 https://www.goinvo.com/vision/determinants-of-health/?utm_source=determinantsofhealth.org&utm_medium=redirect
15 Excerpt from “City Suitable for the Elderly, a guide”.https:// apps.who.int/iris/bitstream/handle/10665/43755/9789241547307_ita. pdf?sequence=2&isAllowed=y
16 Despite many corresponding goals, the technology was largely ignored in the WHO’s original checklist. This, however,
does not mean that the WHO has not made progress on its agenda in the years after 2007. In 2015, it published a set of key indicators to measure the compatibility of cities with age. This report included a number of additional indicators, including Internet access. Although, these additional indicators were not included in the final list. The WHO stated in a subsequent report (2019) that, in practical terms, age-friendly environments are also supported by technologies.
17 The methodology follows a 5-year cycle that begins with the participation of older people in assessing the “age compatibility” of a city or urban community, developing a shared action plan and identifying appropriate success indicators.
18 https://extranet.who.int/agefriendlyworld/network/ W
19 https://www.who.int/health-topics/ social-determinants-of-health#tab=tab_1
20 A decade in which to promote strategies, based on solid evidence, that support the well-being of older people, support the development and maintenance of functional capacities, recognizing that these depend on the intrinsic capacities of each individual, the surrounding environment and the interactions between the two.The Decade builds
on the Madrid International Plan of Action on Ageing and aligns with the time line of the UN’s Sustainable Development Goals, https://www.decadeofhealthyageing.org/
21 Ibid.
22 Excerpt from the introduction by The Longevity Society https://www.thelancet.com/pdfs/journals/lanhl/PIIS26667568(21)00247-6.pdf
23 https://researchportal.bath.ac.uk/en/ persons/harry-rutter
24 https://www.who.int/news-room/ questions-and-answers/item/determinants-of-health
25 In the discourse on cities, it is inevitableto deepen the definition of social determinants. The WHO offers this definition: “The social determinants of health are the conditions in which people are born, grow, live, work and age. These conditions affect a person’s opportunity to be healthy, disease risk, and life expectancy. Social inequalities in health – the unjust and avoidable differences in health status between groups in society – are those that result from an uneven distribution of social determinants. Social determinants of health and inequalities in health can be changed through policy and governance interventions. The condi-
tions that make up the social determinants of health are far-reaching and include the following elements: income level, educational opportunities, employment, employment status, workplace safety, gender inequality, ethnic inequality, food insecurity and inaccessibility to nutritional choices, access to housing and utilities, early childhood experiences and development, social support and community inclusiveness, crime rates and exposure to violent behaviour, availability of transport, neighbourhood conditions and physical environment, access to clean water, clean air and toxin-free environments, recreational and leisure opportunities.In addition to each individual factor, these influences obviously interact with each other in a complex way. For example, poor health or lack of education can impact job opportunities, which in turn limits income. Health is certainly influenced by behaviours, smoking, alcohol consumption, unhealthy diet and physical inactivity are the most important among disease-related behaviours. However, these behaviours are largely influenced by social determinants of health, including income, employment, and access to healthy environments. https://www.who. int/europe/health-topics/social-determinants-of-health#tab=tab_1
26 Percentages are a processing of https://www.goinvo.com/vision/determinants-of-health/?utm_source=determinantsofhealth.org&utm_medium=redirect
27 https://www.bluezones.com
28 https://www.ncbi.nlm.nih.gov/books/ NBK298903/
29 https://www.who.int/data/gho/data/ themes/topics/indicator-groups/indicator-group-details/GHO/healthy-life-expectancy-(hale)
30 https://www.istat.it/it/files/2020/04/ statisticatoday_ANZIANI.pdf
31 Italy, compared to the EU average of 33% for the elderly, is above with its average 38% of people over 65, but there are 58 cities among the 83 surveyed by Eurostat above this average.At the top, as mentioned, there is Savona with a percentage of 51.7%, followed by Genoa (50.7%) and Trieste (49.9%).
34 Our adaptation to the 2050 goals of NAM’s Global Roadmap for Healthy Longevity. https://nam.edu/initiatives/grand-challenge-healthy-longevity/
35 ONS (2020) Health state life expectancies by Index of Multiple Deprivation (IMD 2015 and IMD 2019), England, at birth and age 65 years. Available at: https:// www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/datasets/healthstatelifeexpectanciesbyindexofmultipledeprevationengland
36 https://longevity.stanford.edu/ wp-content/uploads/2022/04/Short-Report-2.pdf
37 https://nap.nationalacademies. org/catalog/26144/global-roadmap-for-healthy-longevity
38 https://www.thelancet.com/journals/ lanhl/article/PIIS2666-7568(22)00267-7/ fulltext
32
“What makes people healthy and what makes them ill?” Durham University
33 Sport England (2020),Active Lives Survey, 2018-2019. [data collection]. UK Data Service. SN:8652. Available at: http:// doi.org/10.5255/UKDA-SN-8652-1
39 https://www.repository.cam.ac.uk/ bitstream/handle/1810/294711/Short%20 Report%20Increasing%20Healthy%20 Life%20Exepctancy%20Equitably%20
20%20April%202019%20.pdf?sequence=1&isAllowed=y
40 https://www.gov.uk/government/publications/industrial-strategy-the-grand-challenges/industrial-strategy-the-grand-challenges
41 Briggs AD, Mytton OT, Kehlbacher A, et al. Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK: econometric and comparative risk assessment modelling study. BMJ Published Online First: 2013. doi:10.1136/bmj.f6189
42 Adams J, Mytton O, White M, et al. Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual Agency. PLoS Med 2016;13:e1001990 doi:10.1371/journal.pmed.1001990
43 Webber L, Chalkidou K, Morrow S, et al. What are the best societal investments for improving people’s health? BMJ 2018;362:k3377. doi:10.1136/bmj.k3377
44 www.voice-global.org
45 Thaler, R., & Sunstein C. (2008). Nudge: Improving Decisions about Health, Wealth, and Happiness. USA: Penguin Books.
46 According to SkyQuest’s recent study of the global pet tech market, more
than 52% of American adults own a smart device for their pet. In Europe, the percentage is even higher: 67%. Technology has also been used to improve relationships with pets. For example, 83% of owners use mobile apps to track their pets’ movements and 74% use mobile apps to play with their pets. In addition, 68% of owners use mobile apps to provide medical alerts to their pets in an emergency.
47 The data on impulse purchases of “less” products – sugar-less, fat-less, antibiotics-less, GMOs-less, etc. compared to “non-less” counterparts are emblematic as well supported by the research of Professor Graffigna’s team and suggest that much more can be done than simply claim an often not well documented “less” of some substance or ingredient.
48 https://www.theguardian.com/ food/2023/jun/11/uk-food-giant-calls-forhigher-fat-sugar-and-salt-taxes
49 https://arts.units.it/retrieve/handle/11368/2980474/358803/FUP.pdf
50 From Wikipedia: “Let them eat cake” is the traditional translation of the French phrase “Qu’ils mangent de la brioche”, said to have been spoken in the 18th century by “a great princess” upon being told that the peasants had no bread. The French phrase
mentions brioche, a bread enriched with butter and eggs, considered a luxury food. The quote is taken to reflect either the princess’s frivolous disregard for the starving peasants or her poor understanding of their plight. While the phrase is commonly attributed to Marie Antoinette, there are references to it prior to the French Revolution, and historians do not agree that she is likely to have said it.
51 Free interpretation from the WHO report on Healthy Cities.
52 https://www.theguardian.com/media-network/media-network-blog/2014/ apr/07/thinking-fast-slow-marketers-consumers
53 https://www.sigmagazine. it/2020/07/sorveglianza-passi/
54 In Australia, laws were introduced in 2014 to restrict the sale of alcohol in Sydney’s popular Kings Cross after 3am. This measure was associated with a 49% reduction in non-domestic aggression in the area. Donnelly N, Poynton, Suzanne Weatherburn
D. The effect of lockout and last drinks laws on non-domestic assaults in Sydney: An update to September 2016. 2016.
https://www.bocsar.nsw.gov.au/Documents/ CJB/Report-2017-Effect-of-lockout-and-
last-drinks-laws-on-non-domestic-assaults-cjb201.pdf
55 After New York City introduced mandatory calorie labelling in fast food restaurants in 2008, studies of this natural experiment found that it had no effect on the number of calories purchased by children and adults. Field experiments also found no effect of labelling food outside the home.
56 https://alcoholchange.org.uk/helpand-support/managing-your-drinking/ dry-january
57 https://www.addiction-ssa.org/ research-analysis-measuring-the-impact-of-dry-january/
58 https://www.penguinrandomhouse.com/books/700435/ageism-unmasked-by-tracey-gendron/
59 https://www.local.gov.uk/marmot-review-report-fair-society-healthy-lives
60 Scott AJ, Ellison M, Sinclair DA. The economic value of targeting ageing. Nat Aging 2021; 1: 616–523
61 https://pubmed.ncbi.nlm.nih. gov/30423119/
62 https://ilcuk.org.uk/ healthequalswealth/
63 Ibid.
64 https://www.nationalgeographic. com/magazine/article/explore-wellness-china-longevity-village-traditional-medicine
65 https://www.aarp.org/research/topics/economics/info-2019/longevity-economy-outlook.html
66 https://www.amazon.co.uk/Longevity-Economy-Inside-Fastest-Growing-Misunderstood/dp/1610396634
67 https://romebusinessschool.com/ wp-content/uploads/2022/12/RBS-Report-Silver-Economy-e-invecchiamento-demografico-in-Italia.pdf
68 https://www.forbes.com/ sites/cognitiveworld/2019/12/07/ ai-will-drive-the-multi-trillion-dollar-longevity-economy/
69 https://www.michelevianello.net/ wifi-gratuito-diritto-universale-cittadinanza/
70 https://www.citizensadvice.org.uk/ about-us/about-us1/media/press-releases/ more-than-one-in-six-struggling-to-affordbroadband/
71 ttps://www.who.int/data/gho/data/
indicators/indicator-details/GHO/gho-ghehale-healthy-life-expectancy-at-birth
72 https://www.who.int/data/gho/data/ indicators/indicator-details/GHO/life-expectancy-at-birth-(years)
73 https://www.stepn.com/
74 https://www.ncl.ac.uk/who-we-are/ coronavirus/research/smart-cities/
75 https://www.beonhand.co.uk/
76 https://worldhappiness.report/
77 The Wisdom of Older Technology (Non-)Users Knowles, Bran; Hanson, Vicki Published in: Communications of the ACM DOI: 10.1145/3179995
78 12. Ofcom. Adults’ media use and attitudes: Report 2016. (2016). Available: https://www.ofcom.org.uk/__data/assets/ pdf_file/0026/80828/2016-adults-mediause-and-attitudes.pdf.
79 https://www.accessmap.io/?region=wa.seattle&lon=-122.338&lat=47.607 &z=14.5
80 Satchell, C., & Dourish, P. (2009, November). Beyond the user: use and non-use
NICA National Innovation Centre for Ageing
in HCI. In Proceedings of the 21st Annual Conference of the Australian Computer-Human Interaction Special Interest Group: Design: Open 24/7 (pp. 9-16). ACM.
81 https://social.un.org/ageing-working-group/
82 Taken from the Ethical IoS.
83 Taken from the Ethical IoS.
84 https://sagradafamilia.org/en/
85 https://en.wikipedia.org/wiki/Veneranda_Fabbrica_ del_Duomo_di_Milano
