Introduction

Cities have become increasingly important in shaping the economic and cultural life of our societies. As the number of older people living in cities continues to rise, so does the role cities play in their quality of life. Today’s cities, generally not designed with older people’s needs in mind, pose a number of unique challenges for older urban dwellers that appear set to only increase in the years ahead.

The World Health Organization’s (WHO) Age-friendly Cities program has created a dynamic, inclusive global movement to articulate the needs of older adults, and is an important tool in delivering healthy aging. To overcome the significant challenges of urban aging and realize the vision of truly age-friendly cities, the power and dynamism of private-sector innovators—particularly startups—needs to be harnessed. In this way ”innovation ecosystems” will be built that deliver better lives for older people, lower healthcare costs, and create jobs and economic growth.

Many of the ingredients are already in place to deliver these. What’s needed is a clear vision with bold leadership at the local level to engage in concrete actions, and a commitment to integrate the previously disconnected worlds of aging, senior care and startups.

The second coming of cities

With their ever-increasing populations—particularly of older people—cities are assuming the kind of power and importance they had in the days before nation states. They are the engines of growth, operating at the frontlines of economics and culture, with a mandate for change. Cities are also the first to feel the effects of societal stress, which present unique challenges to the older people living in them.

Increasing urban populations

As McKinsey recently put it, “The 21st century will not be dominated by America or China, Brazil or India, but by The City.” As of 2007, half the world’s population lives in cities (54.5 percent in 2016, according to Habitat III Conference), and according to the World Health Organization, that number will rise to 60 percent in 2030 (five billion people) and 70 percent by 2050. In fact, a number of cities today would be among the largest countries in the world (e.g., over 100 million people live in and around Mumbai and in the greater Tokyo region alone).

As cities grow and populations age, the proportion of older urban residents increases. According to the recent HelpAge report “Ageing and the city,” more than half a billion people over 65 live in towns and cities around the world, which accounts for 58 percent of all older people. And by the middle of this century, the number will be over one billion.

Urban aging is particularly pronounced in developing countries. According to the UNHabitat, the urban population growth rate in the developing world is 3.5 times higher than in developed countries. By 2050, older adults will comprise around one quarter of the population living in cities in developing countries (a sixteen fold rise from 56 million in 1998 to 908 million in 2050, according to the WHO).

Economic powerhouses and crucibles of culture

Cities are creating an urban consumer class that will exceed four billion people by 2025, up from one billion in 1990. In the US, the 51 cities with over a million people account for 168 million Americans and two thirds of the nation’s GDP. The story is similar abroad, with fully half of global economic growth over the next decade expected to take place in just 400 cities in the world’s emerging economies. National economic development and city dwelling are tightly linked, as countries generally only progress beyond GDP levels of $10,000/person after their urban populations reach more than 60 percent. Researchers have found that doubling the size of a city results in a per capita productivity increase of around 15 percent—in this respect, bigger certainly does seem to be better.

Driven and shaped by population size, density, and diversity, cities are often where culture gets formed. In turn, culture can be seen to drive economic growth, resulting in cities being major determinants of overall societal success.

”Cities are humanity’s real building blocks because of their economic size, population density, political dominance, and innovative edge. They are real ‘facts on the ground,’ almost immeasurably more meaningful to most people in the world than often invisible national borders.” – McKinsey, “When Cities Rule the World,” Feb 2011.

At a time of sclerotic national politics and political infighting, cities are a source of real-world dynamism. Mayors predominantly enjoy high approval ratings—generally between 70 and 80 percent (numbers national politicians would covet)—and are often first movers on emerging topics such as the sharing economy, gay marriage, and climate change (which is a topic for various international city networks such as C40 (and their new Blueprint 2020), the Compact of Mayors, the World Mayor’s Council on Climate Change, and The Covenant of Mayors).

Cities as resilient and adaptable social networks

Recent research shows that the largest cities have been the quickest and most able to adapt to societal changes, for example being the first to rebound after the recent recession. The Rockefeller Foundation’s Resilient Cities program helps cities “become more resilient to the physical, social, and economic challenges that are a growing part of the 21st century.” The program also aids cities in developing a strategy, learning from other like-minded cities, and even hiring their own chief resilience officer.

The nature and character of cities is seen in the services, culture, and people as much as the physical buildings and infrastructure. Louis Bettencourt of the Santa Fe Institute makes a persuasive case that cities are social networks, and as such are malleable. Many American cities grew in the age of the automobile, and thus were optimized for parking and “flow” (highways, ideally uncongested) rather than pedestrians (with Los Angeles and Robert Moses’ era New York being prime examples). But objectives change, so a city being redesigned today to improve the quality of life for older people would look significantly different (see Age-friendly Cities below).

Challenges of urban aging

For older adults, four tensions in particular stand out: urban design being focused on the young and the wealthy; social isolation being exacerbated by digital disconnection; health and long-term care systems being overburdened and failing; and baby boomers delivering new expectations.

Urban planning is focused on the young and the wealthy

According to Ken Dychtwald, two thirds of all the people ever to reach age 65 are alive today. Historically, however, cities have not been designed for populations in which a quarter or more of the residents are elderly. The wishes of those with the loudest voices, deepest pockets, and best access to decision makers are often prioritized.

“The wealthy have a disproportionate ability to influence government and therefore urban design. Consequently, the shape and development of cities can often be the result of the needs of the elite, rather than the majority.” – The Future of Cities, Future Agenda 2017

For example, designing urban spaces around those who can’t or don’t want to drive seems to make sense on many levels. Citizen-centric urban planning—inclusive of the needs of all city dwellers and adaptive to their needs as they age—is now needed.

Social isolation exacerbated by digital disconnection

As multigenerational family living becomes rarer, and neighborhood support structures are less reliable, people are becoming increasingly isolated. Further, more and more day-to-day concerns, such as pensions, bill payments, and customer service, are being conducted exclusively online, thus creating challenges for those who are not. An important part of the rollout of “smart cities” will be to ensure they are inclusive of all ages and abilities, important social services are delivered across multiple channels, and social isolation and fraying social structures, particularly among older more vulnerable populations, are recognized.

Health and long-term care systems overburdened and failing

Healthcare costs in the US are among the highest in the world at almost 20 percent of GDP, while the quality of care ranks behind that of other Western countries. And while those other Western nations generally spend only 8 to 12 percent of GDP on healthcare, most of their systems are under significant stress, with populations that generally skew older than in the US. Most health systems were designed for hospital-based acute care rather than for the needs of today’s aging societies, such as with an emphasis on community-based, integrated chronic long-term care systems. In the US, Medicare is managed at the state level, which lets cities off the hook for the health costs of their older inhabitants, thus removing a potential incentive for cities to ensure their inhabitants stay in the best health possible.

Baby boomers change culture and expectations

Baby boomers have reimagined and reinvented culture as they move through society. And as they continue to turn 65 over the next 15 years, they will reimagine aging. The rejection of traditional societal barriers will manifest as “agelessness,” removing age as a determining factor in culture, social interactions, employment, housing, leisure, and other areas. This will bump up against deep-rooted and pervasive ageism (along with the semi-acceptable age discrimination—a particularly acute issue in Silicon Valley), resulting in increased cultural stresses. As Stanford professor Laura Carstensen points out, culture hasn’t had time to catch up with the new reality of longer lives and the need to keep older people productive and engaged.

The rise of the “Age-friendly” movement

Over the past decade or so, the WHO has led an “Age-friendly” Cities program, a growing movement that seeks to give voice to older people and ensure the cities and communities around them take their needs into account. A response to the twin trends of urbanization and longevity, it is grounded in asking older people what they want, and built on top of robust theoretical underpinnings.

The program has been embraced by hundreds of cities and implemented at the local level, bringing together stakeholders to address each community’s unique issues. Going forward, there is considerable potential to leverage the age-friendly cities network as a global platform for change at scale. And that’s where startups can come in.

The starting point: ask older adults what they want

Alexandre Kalache launched the idea of age-friendly cities at the 2005 IAGG conference in Rio de Janeiro. Over the following two years, at the WHO in Geneva, he and Louise Plouffe, the director of Research at the International Longevity Centre Canada, led global consultation and research into the concept. They asked older adults in 33 cities spanning 23 countries about the advantages or barriers they experienced in eight areas: outdoor spaces and buildings; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication; and community and health services. The age-friendly cities approach was developed, and a set of age-friendly city checklists was outlined in the WHO’s Global Age-friendly Cities: A Guide, which was published in 2007.

Functional ability driven by intrinsic health plus the environment

An important part of active aging is the “life course” approach, as explained by WHO Director General Margaret Chan in the preface of the 2016 WHO Global strategy and Action plan (referenced below):

As the evidence shows, the loss of ability typically associated with ageing is only loosely related to a person’s chronological age. There is no “typical” older person. The resulting diversity in the capacities and health needs of older people is not random, but rooted in events throughout the life course that can often be modified, underscoring the importance of a life-course approach. Though most older people will eventually experience multiple health problems, older age does not imply dependence.

WHO’s 2016 strategy is both comprehensive and specific, emphasizing chronic rather than just acute issues, and advocating for system-wide coordination, the development of long-term care capabilities, and a person-centric approach that emphasizes functional ability. It defines “healthy aging” as the process of developing and maintaining the functional ability that enables well-being in older age. Functional ability is formed from intrinsic capacity (“inside the skin”—the person’s physical and mental capacities) and the environment (the home, community, social life, work, and other structures the person interacts with). This is significant for innovators because it shows that health can be influenced by a range of non-clinical issues (e.g., diet, exercise) and the enabling environment, thus making up the “social determinants” of health.

An expanding global network of “healthy aging” cities

The WHO is in many ways the ultimate distribution network, with its 194 member states containing almost all the world’s population. There are currently 380 cities that have started the process for becoming age-friendly in nearly 40 countries worldwide, reaching approximately 130 million people. The process of becoming age-friendly requires the development of a comprehensive, tailored strategy and ensuring the buy-in from key stakeholders, such as mayors.

In 2010, WHO established the Global Network of Age-friendly Cities and Communities (GNAFCC), which is supported by the web-based platform Age-friendly World. Eleven “affiliates” to the global network support cities and communities on their journey to becoming more age-friendly. One such affiliate, AARP, supports 134 US cities covering over 40 million residents under their age-friendly communities program. There are 80 cities identified by the Dementia Friendly America program (although specific cities haven’t yet been made public), and 220 dementia friendly communities in the UK (most recently Purley, just outside London).

The European Union has many age-friendly cities, and has committed 70 billion Euros to innovation as part of the Horizon 2020 program, a large amount of which has been earmarked for healthy aging. In December 2016, it was announced that 74 European cities would be listed as reference sites of the European Innovation Partnership on Active and Healthy Ageing (Germany’s Ministry of Health Affairs was also recognized as a “National Reference for Excellence” based on their work at the national level).

In addition to the bottom-up movement of city adoption, age-friendly strategies have been adopted as intergovernmental goals. Fifteen of the seventeen goals set out in the 2030 Development Agenda (adopted in 2015) are relevant to aging. In particular, Goal 11 is focused on making cities inclusive, safe, resilient, and sustainable. The WHO’s 2016 Global strategy and action plan on ageing and health (GSAP) outlines five strategic objectives, including age-friendly environments, through the development of age-friendly cities and communities, a goal that was endorsed by the G7 Countries in June 2016.

Although it has been the work of a relatively small number of individuals, and has benefitted from enthusiastic adoption by a small number of countries, this movement now has a global scope. Canada in particular merits a mention both in terms of the scale and scope of its age-friendly city initiatives, its robust political and financial commitment to research (such as the Age-Well Network and Canadian Center for Aging and Brain Health Innovation), and its leadership and funding of the initial work to get the age-friendly program off the ground.

Articulating goals for healthy aging

According to the work of the WHO and their 2016 Global strategy and Action plan, there are five abilities essential for healthy aging in cities and communities:

• Meeting basic needs. Includes health and long-term care, personal and financial security, and adequate housing.
• Learning, growing, and making decisions. Includes learning and applying knowledge, engaging in problem solving, continuing personal development, and being able to make choices.
• Being mobile. Personal mobility (with or without an assistive device) or with a vehicle (private or public transport).
• Building and maintaining relationships. Includes family and social relationships, community relationships, and more formal, work relationships.
• Contributing. Informal contributions such as family and ad hoc community support, and more formal approaches such as working and volunteering.

Age-friendly cities + Startups = aging innovation ecosystems

Delivering better age-friendly cities in the face of considerable and growing challenges around urban aging will require bold vision and strategy together with the ability to deliver radical innovation in an accelerated timeframe. This is not business as usual. It will require a new approach based on public-private cooperation and attracting innovators, in particular technology startups. Tech startups are already making progress introducing innovative new services for older adults in cities, such as transportation, food delivery, social inclusion, and care coordination. However, rather than doing this in a piecemeal, ad hoc approach, we propose being intentional about building aging innovation ecosystems that connect the best practices of age-friendly cities (in particular, asking people what they want) with structured support for innovators.

We can define an aging innovation ecosystem as a locally based, multi-stakeholder system designed to bring about scalable impact to benefit older adults.

Startups as an antidote to the status quo

As technology becomes cheaper, startups proliferate. And while the internet enables more and more people to work from just about anywhere, certain locations attract startups in unusually high numbers—and in so doing, reap the benefits from the growth, diversity, and vibrancy these innovative companies bring.

Startups are high-risk, emergent ideas in the form of businesses. They are vehicles for relentless innovation, often launched in a crowded space with a new way of delivering products or services faster, better, and cheaper than their established competitors—or they create an entirely new market that didn’t exist before. Relatively few startups ultimately endure to enjoy great success, but those that do have the potential to radically remake the business and service landscape.

There are many definitions of a startup, but the startup’s Bible, TechCrunch, took a stab at it, suggesting the label be applied to companies with less than $50 million annual revenues, fewer than 100 employees, and net worth of less than $500 million. I would add two other important, more qualitative distinctions: they use technology to scale (hence the owner of a new corner shop is unlikely to be an avid TechCrunch reader) and are in search of a business model—meaning, they conceive of and test new ideas for ways to make their customers happy and willing to pay. Silicon Valley startup coach Steve Blank sums it up, borrowing a phrase from Winston Churchill: “Success consists of going from failure to failure without loss of enthusiasm.”

Startups as change agents and job creators

Why should aging innovators care about startups, especially when 90 percent of them seem to be run by people under 25 who are predominantly focused on stuff their mom won’t do for them anymore? Startups matter because they have the potential to deliver impact by doing something new and having the ability to scale it up. They’re also job-creating machines, which are the types of businesses cities should welcome. Startups tend to congregate in startup hubs, which creates a dynamic energy in the areas they are established.

The technology that drives tech startups is the key to reeling in investor dollars to scale quickly. For example, while local transportation services for seniors have existed for decades, Uber’s tech platform, started in 2009 and funded by over $10 billion in venture capital funding, has scaled to 450 cities in 70 countries, offers employment to almost 200,000 drivers, and has resulted in over two billion shared rides. Its recent well-publicized controversies are also in part due to an aggressive, “growth-above-all” mindset and lack of “big company” checks and balances.

There is little doubt technology is advancing automation and driving the creation of smaller, more efficient companies (today’s most successful tech companies have far fewer employees than their behemoth forebearers). According to data compiled by Azeem Azhar, today’s tech companies are way more productive. Whereas the previous generation of companies employed 25 people to produce $1 million of output, today’s startups require only six people to deliver that output. Despite that, startups and small companies are considered the job-creation engines of the economy. According to the Small Business Administration, since 1990, large companies have cut over four million jobs, while small companies have added upwards of eight million positions to the workforce.

Startups as tools for dialogue

Startups are creating dialogues with all sorts of people—most importantly, their customers—in order to understand what the needs are in their particular industry. On a personal note, over the past few years, I have organized many of these engagements. In fact, my first discussions about how to start Aging2.0 involved me taking coffee and muffins to an adult day center in Boca Raton, FL and asking the residents about their lives and what they needed. Since then, Aging2.0 has matched older people in senior living communities with startups in our network. The result has been a significant gain in useful information for the startups, and the reward of taking part in an engaging process for the older adults, in which they feel their opinions are being taken seriously.

Startups making in-roads on aging issues

In the 10+ years since the age-friendly cities project was launched, technology has changed significantly. In particular, the barriers to creating startups have come tumbling down, with new startups proliferating in every walk of life. Many entrepreneurs are now focusing their attention on building on-demand services, many of which are relevant to the older adult demographic. But given the logistical complexities and the need for a critical mass of customers and efficient delivery options, many of these services are only available in larger cities.

My Aging2.0 co-founder Katy Fike gave a talk recently in San Diego where she pointed out a variety of mobile apps and services that can be used by city residents to stay connected and engaged, highlighting how many of the concerns facing older people in age-friendly cities can be addressed with technology. Transportation and mobility is one area in particular where we see a high level of interest. Centennial, Colorado (the latest city to join the Aging2.0 Alliance program) also considers this a high priority. In August, the city launched Go Centennial, a public-private partnership with Lyft and Xerox to supply free Lyft Line rides within a three-square-mile service area of the city’s Dry Creek Light Rail Station. Throughout the six-month pilot program, Centennial has been collecting data to understand commuter trends and how best to supply residents and people who work in the city with effective transportation options.

Centennial is now focusing on enhancing the experience of aging for residents within the community, and looks forward to understanding the pain points seniors face, and working with partners to introduce a high-impact solution to the city.

Based on the eight topic areas and associated features highlighted in the original WHO report, below is a selection of startups and tech companies that are addressing the needs of older adults living in cities (updated online version can be found here):

Source: Global Age-friendly Cities: A Guide (WHO, 2007), Stephen Johnston, Aging2.0

Entrepreneurs are motivated by solving problems, and the experience of older people in cities is a rich source of such problems to solve. A useful next exercise would be to have a critical look at the essential capabilities for older people to experience well-being and see how that maps to startups and how startups can collaborate with other services providers to deliver “joined-up experiences” ie. shift the focus away from being startup-centric to being person-centric. In turn, this can be looked at at the individual level or at the scale of the city.

The chief architect of the WHO Age-friendly Cities program mentioned above, Alexandre Kalache, recently published a report, “Towards Age-friendly Design” agrees with the concept of connecting these two worlds. “We certainly need to bring aging to startups,” he asserts. “The young person typically involved in startups needs to become mindful of his/her own life-course trajectory, and that aging is a process, not a condition—that everyone has a stake in. But we also need to bring startups to the aged. The design and technology capabilities of gerontolescents (late middle-agers) in particular, who are unlike any cohort that has gone before them, should not be underestimated.” In conversations, Dr Kalache also stresses the importance of a further often overlooked challenge – building inclusive systems that allow the increasing number of immigrants in our cities to grow old successfully. These multi-faceted problems require both novel solutions as well as engagement by the affected population and commitment for change by the established status quo – just the kind of challenge that needs to be solved with an ecosystem approach.

If we combine age-friendly approaches with the rise of startups, we have the potential for the best of both worlds: a focus and clarity on the needs of older adults combined with the tech savvy and scalability that is the hallmark of startups.

Conclusion: the need for connection

Combining the two trends of age-friendly cities and startups holds the potential to deliver scalable impact to meet the needs of older people. An aging innovation ecosystem brings together all the necessary players to make change happen in aging and senior care—the startups, industry, investors, older adults, governments, and academia—with the tools and ability to make change happen and get things done at scale.

At its most basic level, this is about connecting previously disconnected worlds, with their own sets of experts, protagonists and world views about what works: aging populations, cities and startup technologies. There haven’t been many good examples of cities doing this at scale – taking the challenges faced by older people and mapping them against the variety of solutions out there – and then taking things to scale. However, it is only a matter of time before we can point to examples of local aging innovation ecosystems.

Note, although there is a focus on older adults here, we don’t want to fall into the trap of making aging be about “the other”. Innovation ecosystems won’t exist in a vacuum, but rather more likely within a thriving ecosystem that is delivering innovative products for people of all ages. So, while the focus here is on aging innovation, the solutions are likely to benefit everyone. We see this as cities and companies put aging-friendly strategies in place – benefits accrue more widely. The focus on aging is needed because the converse is true – the default model evolved by cities and communities has not been inclusive and age-friendly.

This is a conversation that is just getting started. Aging2.0 was established in 2012 with the goal of building global innovation ecosystems to improve the lives of older people, and our network of 50+ chapters around the world (a number that is growing at one a week) is starting to deepen these connections between startups and older adults, industry executives, investors, academia and governments. At Annex is an emerging framework that goes through in more detail the steps described above to build diverse and thriving innovation ecosystems. Going forward, we would welcome a dialogue with other city and community leaders who have their own experience and expertise around building systems so that we can collaboratively take on the unique and important challenges and opportunities in aging and senior care.

Annex: Five steps to building local innovation ecosystems

Aging2.0 is a different type of global organization. A bootstrapped global network run as a for-profit social enterprise, its mission to support innovators taking on the biggest challenges and opportunities in aging. It has built a global social movement of over 15,000 innovators spread across 50 volunteer-run Aging2.0 city chapters in 20 countries. (Note: this sheet lists the Aging2.0 Chapters as well as the WHO Age-friendly cities.)

A five-step process

Building an aging innovation ecosystem can be broken down into a five-stage process. Adapted from the design thinking playbook, this approach can help cities and communities gather input from older people and engage the innovation community, and then scale up solutions that will improve the lives of older people, lower costs, and create jobs.

Fig1. Building local aging innovation ecosystems

Dialogue

The first step to creating new solutions for people is to engage them in conversations about what needs to change and why—not just assume that we already know the answers. The WHO Age-friendly Cities program did this with a multi-year study involving on-the-ground research with groups of older people in 33 cities. HelpAge conducts research on a regular basis on the topic. Another group working on global innovation topics is the Future Agenda, which every five years engages in a global program organizing over 100 in-person workshops with stakeholders from around the world in which participants meet face-to-face to discuss and prioritize emerging trends in an effort to arrive at consensus on insights and recommendations.

While in-person focus groups involving people from all walks of life are the gold standard, by their nature they’re a lot of work to organize, expensive to put on, and will generally only capture input from a small number of people at a moment in time. As awareness of technology grows and the cost and usability barriers to getting online continue to come down (including easy-to-use interfaces to the internet such as Amazon’s voice-based Echo) new modes of interacting with older people on an ongoing basis becomes possible. In a sense, this is part of the broader movement that all democratic countries need to undertake to ensure they are engaged with their citizens’ priorities. Specifically for seniors living in cities, a new kind of dialogue that engages them around the issues they care about most would have the twin advantages of ensuring accurate and specific priorities and benefitting those engaged in the process, allowing them to be heard and potentially get more engaged in their local social life, which has many benefits of its own. Emerging online communities being developed at the local level hold some promise here, such as the Linkages program in Palo Alto, CA and Iris in Orange County, CA. There are also multiple other online platforms for engaging in conversations about topics (such as OpenIDE, IdeaScale, and Skilld, among others), which seek input and ideas around innovation.

Develop

With a clear sense of the kinds of issues that need to be addressed and an ongoing communication channel with the people who will benefit from innovation, innovators can engage to develop different solutions. As June Fisher, Aging2.0’s chief elder officer often points out, it’s about designing with—not for—older adults. It requires constructing opportunities to connect designers and developers with the customers themselves. Where possible, the input from the dialogue should be both qualitative and quantitative: stories, case studies, and real-world examples that paint a picture, in addition to data that can be used to discern patterns and gaps.

One example is the travel hackathon Aging2.0 organized last year at Google’s London campus that brought together 10 senior advisors and around 50 technology developers and designers. The older adults discussed their experiences and challenges with travel, for example outlining their difficulties with walking long distances in airports, finding bathrooms, or getting affordable travel insurance, while the developers created solutions during the weekend to address their needs. The developers also had access to research and data about the space, and to technology platforms and tools to help build their products.

Quirky.com was a site that helped surface product concepts from anyone with a good idea, facilitated co-creation into products, and then produced them, sharing revenues with the original developer. Although the site has shut down, the essential concept of a platform on which to build products based on an identified need remains a compelling idea. As such, a platform developed for facilitating dialogue could feasibly extend to enabling people to participate in the development of product ideas and then share in the revenue upside should the products become successful.

Deploy

In most cases, a critical phase of innovation is real-world testing and feedback of the ideas with pilots. Pilots allow the solution creator to test its effectiveness in real-world settings, and the customer to test the solution before deciding whether to make a significant purchase investment. Aging2.0 has spent a great deal of time helping innovators develop pilots, and produced a number of guidelines for innovators, such as 10 Tips for Partnering With Startups. While many innovators get excited about having landed a pilot, care is needed to avoid ending up in “pilot purgatory,” wherein precious time and resources are wasted chasing a large deal that never comes.

Pilots are good opportunities to ensure the proposed solution works in a real-world environment with others services. Products and services that work seamlessly in the lab can still break down when required to work as part of an integrated solution that requires data sharing and an integrated user experience.

The most useful pilots are those designed to prove specific business hypotheses and generate data that can help bolster the business case for other providers. As outlined above, today’s health and long-term care systems are struggling to cope with budget shortfalls and an ever-growing aging population—and increasingly require robust demonstrations of impact and ROI calculations.

Distribute

Conversations with 3,000+ startups over the past five years have shown that one of the biggest obstacles to innovation in the aging and senior care space is a lack of distribution. There are few high street outlets for ‘healthy aging’ products or online portals. Cities in theory have the potential to be the ultimate distribution channels for new products and services – IF there can be collaboration among providers and vendors. The WHO Age-friendly Cities network in turn has the potential to be a channel for innovators to reach millions of older people either directly or via intermediary organizations.

In the same way that Quirky was both a development platform and a tool for distribution, so too could cities use an online platform to leverage their scale and allow innovators into an aging market. Within cities, a more joined up approach that allows products to get to end users more effectively is needed. Customer-friendly portals such as Unforgettable.org (based in the UK) are emerging from the private sector to educate and connect people looking for support and products for dementia, and some health plans and insurance companies are starting to become channels for new technologies (such as insurance companies recommending the use of wearable devices to monitor health). The Village to Village model has also been discussed in the context of a distribution channel, and some Villages (such as Ashby Village in Berkeley, CA) are exploring the more active use of technology. Many of the existing platforms used in the public sector to reach large numbers of older adults – e.g. Medicaid programs, local area agencies on aging – don’t seem close to opening themselves up as platforms for innovators, so there is still a long way to go.

Scale

Getting to scale requires not only access to a distribution channel, but also a scalable business model and (potentially) external capital from investors (unless growth capital comes from customer revenues, which is often hard for technology businesses).

The impressive size of city budgets is an obvious place to start, however risks and rewards are not well aligned so far. At the recent Sorensen impact investing conference, a panel of mayors talked about the issues that impact them the most. At no point was there any discussion of older adults, so after the event, I broached the subject with a few of the panelists. It quickly became clear to me that most cities are not on the hook for the health outcomes of older adults – their funding and costs were only loosely related to the health outcomes of their residents. Going forward, connecting the massive public health procurement budgets, and those of the cities, holds promise. Citymart has been developing a platform to connect public procurement activities (not just health) with city budgets – introducing the concept of challenges to spark private sector innovators. And new efforts underway by the European Commission to identify leading public health use cases and pool public procurement dollars seems promising.

The situation regarding capital is somewhat similar – there have been a few efforts and isolated private sector support for new technologies, such as caregiving platforms, though these have found it hard to scale without support of the health systems. As a result the healthy aging space is still underfunded compared to its potential impact. The use of regional and infrastructure funds to invest in private sector projects, along with private sector venture investors to ensure high quality due diligence, is one model, and the use of new innovative financing mechanisms that tie investment funding with value delivered, such as social impact bonds, could also be explored here. Either way, there are rich opportunities for impact-minded investors and entrepreneurs to help promising ideas get to scale.