Healthy ageing touches every part of a city, from housing and transport to culture and social life, and no single department or project can address it all. Julia Moser, who works on healthy ageing and health promotion at the Public Health Department of the State Capital Stuttgart, asks what a local public health professional can do about that. She explains how returning to the Ottawa Charter helped her see her role differently, and how a free neighbourhood film festival brought together more than 30 partner organisations.
In university, I loved analysing public health problems, looking at them from every angle and tracing every social determinant — the conditions in which people are born, grow, live, work and age, and people’s access to power, money and resources — that might be linked to them. It was as if my mind followed these connections almost on its own. Now that I work in the local public health service in Stuttgart, I also have to think about solutions. And that is where things get tricky.
Stuttgart, like many larger European cities, faces challenges such as an ageing population, loneliness, and increasing poverty in old age. Although Stuttgart is relatively wealthy, significant social inequalities persist. A recent local survey highlighted considerable health inequalities, particularly in relation to poverty and migration history.
There, determinants of health touch on the responsibilities of different city departments, each with its own priorities and requirements, which do not always include health or healthy ageing. So much of what shapes our health sits outside the health system, and that's not a new challenge. Health in All Policies is one approach to addressing this issue; it asks decision-makers in every sector, not just health, to consider how their policies affect people’s health and health equity.
But knowing what needs to change at a city-wide level does not automatically tell me where to start in my own work. I need to find ways to contribute to a more health-promoting and age-friendly city without trying to change everything at once. So, where do you start?
The challenge of healthy ageing
This is especially challenging when working on healthy ageing. When it comes to ageing, there is no single setting where you can reach the target group, as you can with children at school. Ageing is living, and living happens across all the different spaces in a city. It also looks so different for everybody, which makes it even harder to find ways to sustainably promote older people’s health.
Most projects I oversaw somehow felt too small. What could they really change? How were they helping to make Stuttgart a place to grow old in good health? And above all, how are they helping socially disadvantaged older people?
I could not always tell whether my projects were reaching those facing the greatest disadvantages. And even when they did, I knew most projects couldn’t address the structural disadvantages shaping their health. This underlined the problem I was struggling with: how could I make a meaningful contribution to healthy ageing when I could neither reach everyone who needed support nor change the underlying conditions affecting their health?
Back to the basics: the Ottawa Charter
One way to deal with this feeling of being overwhelmed was to return to the basics. I came back to the Ottawa Charter and its call to advocate, enable, and mediate. For me, advocating means speaking up for health-promoting environments and living conditions wherever I can. Enabling means supporting older people to reach their best possible health by helping build supportive environments. And mediating means bringing different sectors together to work toward the common goal of making Stuttgart a good place to grow old.
The Charter helped me understand that my role in health promotion is not simply to run successful projects or measure whether individual activities work. It is also to bring a health perspective to other departments, make the relevance of health and healthy ageing visible, and create opportunities for different actors to work towards shared goals.
This also changed how I looked at my own projects. I began to recognise how they could create opportunities for participation and build partnerships, and so become part of a broader effort to make Stuttgart a healthier and more equitable place to grow old in.
The Film Festival of Generations: bringing the bigger picture to life
The Film Festival of Generations is a great example of what this can look like in practice. It brings cinema to neighbourhoods and places where regular cinema is not easily accessible. All screenings are free, removing a potential financial barrier to cultural participation. Although I know cultural and social participation is extremely important for healthy ageing, the project initially seemed a bit removed from the bigger picture of what I wanted to address.
But I have come to see that contributing to healthy ageing does not always mean addressing its underlying determinants directly. Sometimes, it can mean bringing different actors together around a shared goal. The festival offers 60 film screenings across more than 30 partner organisations, including nursing homes, neighbourhood centres and youth centres. None of these organisations works in public health, but each contributes to this shared goal in its own way, and together they create opportunities for cultural and social participation and contribute to a more age-friendly city.
So, where do you start?
I am learning to start with what is possible in my role while continuing to work toward the bigger changes healthy ageing requires. I can bring the right people together around shared goals and look for ways to connect individual projects to the bigger picture.
Small projects can be more than isolated activities. When they build partnerships, create opportunities for participation, and bring health into different settings across the city, they can become part of a broader effort towards structural change. They cannot, on their own, remove the structural causes of health inequalities or reach everyone who could benefit. But that does not make them meaningless.
For me, it starts with recognising what I can contribute, bringing the pieces together, and using my role to advocate for health, enable participation, and mediate between different actors and perspectives.
Keep on reading
The Stuttgart Film Festival of Generations is a community-focused film event that brings cinema directly into Stuttgart's local neighbourhoods and districts. It screens German and international films that tackle cross-generational and future-oriented issues, such as demographic change, ageing, migration, inclusion, social cohesion, and climate change. The festival travels into local community spaces, town halls, multi-generation houses, and neighbourhoods to make film culture accessible to all age groups.
Julia Moser
Julia Moser is a Public Health Officer for Healthy Ageing at the Public Health Department of the City of Stuttgart, Germany. She holds a bachelor's degree in Health Promotion and a master's degree in Public Health. Before joining the department, she worked as an advisor on health equity at the Baden-Württemberg Ministry of Social Affairs, Health and Integration. Her work focuses on health equity and reducing health inequalities in older age, with a particular interest in how local public health can help create the conditions for healthy, self-determined, and socially connected lives in older age.