Summary For a long time already, attempts have been made to bridge the gap between research and practice. In this respect, society demands that universities should have a bigger social impact. University and society/societal organizations should work together (co-create) during the entire research process, from the articulation of the research question until the implementation of the results. There is controversy about the question whether it is possible for universities to work together with practice and at the same time to retain the academic quality standards. First, this article deals with the question what characteristics are important for universities in order to be able to work together with practice. In this respect, the Dutch scientist Steinbuch came up with a tantalizing idea arguing that universities may take a next step and develop into ‘fourth generation universities’. Second, it is described how a process of co-creation between university and the health promotion practice has been developed, bottom up, at Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, the Netherlands. The ideas developed by Steinbuch and the results of the bottom up processes in Tilburg are combined. Consequences of the Tilburg experiences for the characteristics of a fourth-generation university are discussed as well as consequences for the role of universities in society.