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For one week, representatives from approximately 1,700 cities and the international scientific community gathered in Donostia/San Sebastián, Spain, for the World Health Organization’s third “World Congress of Age-Friendly Cities and Communities.” Following conferences in Dublin and Quebec City, this was the third congress of its kind.
Creating age-friendly environments is one of the four priority areas of action for the UN Decade of Healthy Aging 2021–2030. This conference focused on the key question of how to achieve this transition in practical terms.
Dr. Alexia Zurkuhlen, Chair of the Board of the Kuratorium Deutsche Altershilfe (KDA), talks with us about the moments that have moved her the most—from Arctic neighborhood groups in Norway to French city networks, and the realization that often the simplest ideas make the biggest difference.
SBC: Dr. Zurkuhlen, you attended the WHO “Age-Friendly Cities” conference in San Sebastián. What was the most important insight you gained from this international exchange?
Zurkuhlen: This year’s WHO Congress was only the third of its kind overall and took place for the first time in 13 years. During this time, social scientists have gained many insights into how people can live together more harmoniously in cities and communities undergoing demographic change.
This includes a significant improvement in quality of life when caring communities are actively practiced and supported. My most important insight came from a discussion with a Norwegian and an American researcher: Participation is the key to improved security of care and strengthened democratic cohesion.
SBC: “Age-Friendly Cities and Communities”: What does that actually mean—beyond accessibility and benches in public spaces?
Zurkuhlen: Age-friendliness is indeed so much more than just benches! Age-friendly means that life is conceived and designed with all generations in mind. This means that social participation—which includes, for example, travel for people in need of care, digital inclusion, accessibility, sustainability, and combating loneliness—must be considered from a society-wide perspective.
Of course, care and support services must also be accessible and available; this must be taken into account when designing more age-friendly neighborhoods.
“Age-Friendly Cities” in the WHO Network: Germany and Austria
Worldwide, the WHO Global Network for Age-friendly Cities and Communities includes approximately 1,740 cities and municipalities in 57 countries (as of the end of 2025).
In Germany, these include, among others: Radevormwald (the first German municipality, since 2016), Münster and Stuttgart (both since 2022), Hamburg (since 2025, the first German city with a population of over one million), Düsseldorf (since January 2026), as well as Heidelberg and Gelsenkirchen.
Vienna represents Austria —it is the first and, to date, only Austrian city to be admitted, in October 2023. Membership is coordinated by the city’s Senior Citizens’ Representative and the “Vienna for Senior Citizens” team at the Vienna Social Fund.
SBC: Why has this issue become so urgent right now?
Zurkuhlen: I had the opportunity to learn about a French network of cities called “Friends of the Elderly” (Réseau Francophone des Villes Amies des Aînés). To become part of the network and receive certification, a city must submit a proper application, demonstrate compliance with a set of criteria, and work continuously to meet the requirements.
There are currently 114 municipalities that have been certified, and another 89 are in the process of certification. This momentum underscores the urgency of the situation: cities and municipalities—not only in France—are facing the challenges posed by age structures that are, in some cases, highly disparate. Fewer and fewer working-age professionals are living in communities with an ever-increasing number of people of retirement age. These groups do not communicate with one another enough. Supporting cities and municipalities in this regard—by facilitating the exchange of information on best practices—is very helpful and encouraging.
What Norway Achieves with Simple Means
SBC: Which examples from countries or municipalities particularly impressed you at the conference—and why?
Zurkuhlen: Onepresentation in particular has stuck with me: Siri Arntzen-Ratnarajan spoke about the unique challenges of Norway’s Arctic regions—the long, cold months in sparsely populated areas—and, at the same time, about the surprisingly simple solutions that have been implemented there.
Mobility concepts were developed collaboratively during co-creation workshops. Not only did the method itself help combat loneliness, but it also led to the formation of outreach neighborhood groups that conduct exercises with people who have difficulty leaving their homes due to icy conditions.
SBC: What are these cities doing differently or better—what can we learn from them?
Zurkuhlen: Looking at examples from Europe, it often seems that there could be more courage to undertake “outside-the-box” pilot projects. “Just do it” seems to be the motto here. However, I believe that what is quickly portrayed as a reluctance to innovate in Germany is, in reality, partly just a lack of a coordinated presentation of the various initiatives.
German “Age-Friendly Cities,” including Oldenburg—which has been part of the WHO network since 2026—have established close partnerships with research institutions to better monitor the cities’ age-friendly initiatives. Düsseldorf has been implementing the action plan “Aging in Düsseldorf” since 2025. Under the motto “Our Stuttgart—at Every Age,” the capital of Baden-Württemberg is prioritizing intergenerational thinking. Overall, German cities have already implemented many initiatives and set their priorities for the coming years.
SBC: Are there any factors that positively influence implementation—for example, better structures, greater political commitment, different budgets, or greater participation by older adults?
Zurkuhlen: German municipalities have no financial leeway; the pressure on their finances is too high. At the conference, several presentations explicitly highlighted the macroeconomic benefits of age-friendly municipal policies. If we consider the example of fall prevention, it can—beyond the ethical and social perspectives—in fact quickly pay off to invest more in age-specific preventive measures.
Participation is also beneficial in this regard: not only does it ensure success in the eventual implementation, but it also combats loneliness and increases efficiency at the same time.
Fall Prevention Pays Off
A recent analysis by the U.S. National Council on Aging (NCOA, 2026) shows how effective structured fall prevention programs are for older adults. Data from over 275,000 participants (2014–2024) were analyzed.
After participation, falls decreased by 52%, injury-causing falls by 56%, and fall-related emergency room visits by 18%. The economic impact is also significant: on average, approximately $3,900 in follow-up costs were avoided per participant. For every dollar invested, the study calculates a projected return of between $8 and $38.
Source: National Council on Aging (NCOA), “Return on Investment of Evidence-Based Falls Prevention Programs,” 2026. The cost savings are projected based on the number of falls prevented.
SBC: What advice would you give to a municipality that wants to become more age-friendly: Where should it start?
Zurkuhlen: Network! The WHO network offers the opportunity to engage in dialogue with cities that have already been working toward becoming age-friendly for some time. Sometimes it’s simple recommendations that can make a difference. And you realize that small things can sometimes have a big impact.
SBC: Based on your experience, what are the first three questions a city or municipality should ask itself?
Zurkuhlen: Am I an attractive city for people over 60? Am I an attractive city for people over 30? Are my efforts to appeal to these age groups being noticed, and if not, why?
SBC: What are your hopes for the future?
Zurkuhlen: I hope people will stop thinking in such convoluted terms: Age-friendly cities are friendlier cities for everyone. Inclusion measures benefit not only people aged 60 and older, but all citizens—for example, when it comes to digital access to social services.
I would like to see an integrated health, social, and elder care policy that rewards (social) innovation and encourages people to get involved. I hope that the necessary data will soon be available to support better planning and enable tailored solutions at the regional level.
SBC: What does a city look like where you would like to grow old?
Zurkuhlen: I grew up on the coast in southern France, in a region that has long been attractive to many older people, partly because of the weather conditions. That’s changing: the heat waves, which are occurring in rapid succession, are difficult for many to endure and can even pose a health risk.
Age-friendly cities must work with their citizens to design and implement measures to address the impacts of climate change. This means both creating more green spaces and climate-neutralizing areas, as well as adapting emergency services to climate-related challenges. And if this city still has those iconic wooden chairs that look out at the Mediterranean from the shade of the palm trees and invite you to linger, I’m happy.
Thank you very much for the interview!
The Kuratorium Deutsche Altershilfe – Wilhelmine-Lübke-Stiftung e. V. (KDA) was founded in 1962 by the German Federal President Heinrich Lübke and his wife Wilhelmine Lübke, and remains under the patronage of the incumbent Federal President to this day. The KDA sees itself as an independent, nonpartisan catalyst at the intersection of academia and practice: It develops new approaches to promoting a long, self-determined life and explicitly views demographic change as an opportunity.
Dr. Alexia Zurkuhlen has been a member of the KDA Executive Board and Managing Director of KDA gGmbH since September 2024. Prior to that, she was an executive board member of the Cologne-Bonn Health Region Association and headed the gewi Institute for Health Economics. She studied political science in France, Ireland, and Germany. Learn more at kda.de
The French network “Friends of the Elderly” (Réseau Francophone des Villes Amies des Aînés)
National Council on Aging (NCOA), Study “Return on Investment of Evidence-Based Falls Prevention Programs,” 2026
Author: Anja Herberth
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