Demographic change is one of the key societal challenges that cities are facing. The number of elderly citizens is increasing continuously, but cities are struggling to adapt to their needs. The city of Badalona (ES) acknowledged this mandate for change and demonstrated that it is possible to redesign the local health and social services to improve the quality of life of elderly people.
Through several initiatives and projects launched since 2012, Badalona aims at putting the citizen at the centre of the continuum of care, including vertical integration (between different levels of care) and horizontal integration (between different local services, e.g. social services, employment and housing). The results are an improved quality of care, and more stable interconnections between different public services.

The good practice in Badalona is formed by a set of interrelated solutions that conform a holistic approach towards active and healthy ageing, while including all the relevant stakeholders within an innovation ecosystem. The practice is completely aligned with the policy level, service provision, industry level, academia, R&D activities and the civil society throughout a participatory process that enables a common design, and redesign of the overall strategy. The practice is represented mainly by four different solutions: • Badalona Towards a Healthy City: a city project that fosters and promotes healthy habits within citizenship, and helps to prevent disease with a clear participatory vision and networking view; • R&D Chair between Badalona Serveis Assistencials (BSA) and the Open University of Catalonia UOC): with the objective to foster the research and innovation actions based on the use of ICT in the fields of health and social care; • Badalona Reference Site on Active and Healthy Ageing: where 24 actors, covering the Quadruple Helix of Innovation within the city of Badalona, have obtained the recognition of the European Commission, and operate in a coordinated manner towards the common goal of building an age-friendly city; • Badalona Health Observatory: merging environmental, demographic, social and clinical data towards identifying patterns and determinants of healthy living within the urban context.

Active and healthy ageing should be understood as the way of optimising the health opportunities, participation and security of the people as they age. We are moving from a conceptual healthcare model that deals individually with each citizen and that considers him/her a passive actor of the system towards a model that fosters the rights of old people, their autonomy and the establishment of social relations. They are appraised as change actors, recognising the values and competencies that they bring into the community and the main objective is the improvement of their quality of life. Tackling ageing from this new vision requires taking into account the following concepts: autonomy and dependency, participation, the vital course of life, cultural aspects, inequalities (in terms of poverty and social exclusion) and environmental factors. The project deployed in Badalona is fully built on the top of the sustainable and integrated approach in all of the dimensions as defined in the URBACT values. A full ecosystem of partners covering the Quadruple Helix of Innovation work together (vertical integration) towards converting the city into an urban age-friendly innovation ecosystem. This is greatly improved through the regional and international cooperation. The interventions deployed through the Reference Site network combine physical, economic, social and the environmental dimensions (horizontal integration).

The target of this practice mainly comprises the Northern Barcelona healthcare region, where the assigned population reaches 545,000 inhabitants. Even though the city of Badalona is the coordinator of the initiative, there are other municipalities that are also benefiting from the holistic strategy: Santa Coloma de Gramenet, Sant Adrià de Besòs, Montgat, Tiana, Alella, Teià and Masnou. This shows a participatory design not only at a local level, but also at metropolitan area level. The leading ecosystem of the practice has been collaborating for many years through the so-called Healthcare Boards, managed by Badalona Serveis Assistencials, to engage all the relevant stakeholders at local level in order to contribute to shaping the health and care model deployed. In 2016, this consortium presented the city's application to become a Reference Site within the European Innovation Partnership on Active and Healthy Ageing. Its members bring full coverage to the Quadruple Helix of Innovation: a) Government health and social care provision, b) Industry, c) Academia and research and d) civil society. Coming from this application, the city's reference site was validated and rewarded with 2 stars out of 4.

In Badalona, the whole care model puts the person at the centre of the continuum of care, including vertical and horizontal integration. The internal assessment conducted shows that there has been a reduction in the average length of hospital stay, in the average number of bed days, and in emergency visits. Furthermore, the clinical pathways developed have facilitated an improvement in the process outcomes, including compliance and adherence to the guidelines. These processes have improved the functional status and health outcomes of the elderly, and have led to a reduction in the operating cost of clinical services, while increasing the quality of life of older people living in an urban context. Another example are the economic opportunities that emerged from the inclusion of the private sector through collaboration agreements, meaning to bring new ideas into the market, first through a piloting phase, and later implemented. Three good examples of such strategies are: • ITHACA project (BSA - Novartis - Indra): monitoring hypertensive patients at home, and including an educational programme; • Caring.me project (BSA - Arvato/Bertelsmann): tracking patients impaired by depression through an Internet Cognitive Behavioural Therapy Intervention; • AsmaProcare project (BSA - IN2): a mobile application that manages patients in acute stage of asthma and avoids as much as possible income visits.

Interest in how things are done by the Badalona municipality has been widely demonstrated. The partners involved in the ecosystem of Badalona are actively contributing to European co-operation and consequently, to transferability through their participation in relevant EU strategies. The experience of BSA in EU-funded projects dates back to 2003, when, following the recommendations from the strategic plan, the organisation started its R&D specialisation strategy towards ICT solutions, to improve the care provided to its target population. Following such an approach, BSA started looking for networking opportunities, both at national and international level. Since then, BSA has participated in many EU projects and different funding programmes such as AAL JP, FP7, CIP, DG SANCO Health Programme, and more recently in H2020. The role in different partnerships has mainly included piloting leadership, evaluation modelling and evidence generation, care pathway design and co-design processes. Two good examples, which show that emerging learning and experiences are being shared with other regions at international level, are: • The case study from the SIMPHS3, conducted by the Joint Research Centre of the EC; • The ACT Cookbook.

A network of medium-sized cities in Catalonia (ES) has been working since 1988 on a collaborative, integrated and continuous Research and Development programme to get indicators to measure Quality of Life and Sustainability (QofL&S) at the local scale. This is useful for benchmarking and positioning, and for decision-making processes. The network developed a common methodology to select and discuss indicators, and manage how to use them in decision-making processes related to indicators from public policies management. The participants believe that the creation of a common resources system is useful for every agent involved in urban development processes, helping to value and measure the key elements influencing the quality of life in medium-sized cities. The Profile of the City contributes to the existing body of knowledge on the definition of public policies designed to improve the quality of life of medium-sized cities.

The project developed a methodological tool, which we will call tableau de bord, that will ease and inform policy decision-making, as well as offering an instrument to link and commit citizens to the assessment of the QofL&S in their own environments. The project will unfold in several work packages that will involve different timing and partners. The action plan is divided in two different work lines: the first line of action, the core activity of the project refers to the measurement of the QofL&S, as defined, of European medium-sized cities based on the construction of a set of indicators relevant to policy making. The other line of action includes the complementary activities that refer to the reinforcement of the skills needed for managing quality of life and sustainability, and all the communication and diffusion activities well beyond the network. Work packages included in the core action line are the following: • Definition (permanent) of the tableau de bord; • Establishment of a socio-economic observatory in each locality; • Information collection; • Analysis of the information; • Review of the cities profiles and review of the decision supporting tool; • And communication of the profiles (currently by a yearly report and a blog posted on its web site: http://www.perfilciutat.net). The tool will be built on the conceptual development of a methodology to tackle issues related to QofL&S from a local point of view and focusing on its usefulness for city planning.

The practice is directly related to urban policy development, focusing on the core of economic and social matters. Measuring QofL is a way to obtain the very essential base to start an evaluation of those policies, as in fact these measures (the indicators) have been used for policy-makers, even in a confrontation with opinions or perceptions of citizens, especially during the deepest moments of crisis. The actions of The Profile of the City have as their most visible result the construction of models of quantifiable profiles of the quality of life of a city, based on measures or calculations from official statistics and the local government’s management data (and also now in databases of private companies, on which the network is currently working, connected with smart-city processes and impact analyses of public policies).

The network is providing an annual report about the quality of life indicators, through which indicators city partners are compared, also thinking about the historical series to not lose evolutive dimension, divided into eight chapters (demography, labour market, housing, economic and business activity, enterprises fabric, social cohesion and sustainability, and finally a special part on synthetic diagrams of local information, related to evolution benchmarking). Also, an open blog is provided to express and debate several contributions on experiences on data use and new statistics and methodologies, and also for expressing opinions on the results of public policies, as a way of evaluation of those policies. The net also organises training sessions or conferences and meetings in order to communicate, argue and discuss the results of its reports. All the activities of this network are published through its web site (www.perfilciutat.net). The report is reviewed through deep working sessions, very participative, taking into account the significance and pertinence of indicators, their very lateness and also their usability. Members are also committed to taking part in the composition and writing of the final report and also about contributions to the experiences blog.

Profile of the City aims at improving the knowledge on structural changes in an urban environment and measures the impacts of those transformations on the QofL. It will do so by producing a conceptual and methodological tool to promote a framework of sustainable development in medium-sized cities, assess the QofL and inform urban policy decision-making. Special attention will be given to overcoming the sectoral approach to urban policy development and ensuring stakeholders participation in the definition of this decision-supporting tool. The proposal seeks a holistic view of living conditions and a multidimensional definition of sustainability and QofL. That is why this project intends to develop a common place where local authorities, economic agents, interest groups and citizens can share their notions of quality of life and sustainability and improve their measurement through agreement, sharing and the process-line “reflection/initiative/action”. The main difference is focusing on the link between the evolution of social or territorial indicators and the evolution of management ones, which leads decision-makers to ask some critical questions about the continuity and pertinence of several public programmes. The annual report is a basis for a constructive discussion on local development policies and also the treatment of sustainability matters, especially related to urban environment and the contribution on heat islands and on climate change process.

The initiative can be useful for other cities, as we have already said (see sections 1 and 2). But for a double motivation: (1) To implement progress in territorial cooperation (technically, horizontally) of cities and wider territories, on their own competencies and responsibilities, and (2) The permanent evaluation of implementation and impulse of public policies for each city from its own indicators and also in a comparative way with other cities, to get enough reference to know what position was gotten. It is from a temporary and comparative serial of quantitative indicators. In fact, this practice was shared with other partners (local authorities) in Europe in several methodological meetings. Also is related with statistic aims of Eurostat and Eurocities in actions providing indicators for territories/administrations smaller than states or regions, in a similar way than that done by EU Urban Audit for bigger (capital) cities. It was extremely interesting to compare methodologies and to learn about other experiences developed by other possible partners in other countries. Ours is rather a learning organisation.