Design, Equity and Public Health Outcomes

Can good design improve the health of the public?

This is the question rattling the brains of architects and urban planners as they convene frequently at conferences to trade best practices on helping cities to recover from the sins of post-industrial buildings by leveraging design as a mitigating cure-all to detrimental health statistics plaguing communities around the world.

For Thomas Fisher, professor of architecture and dean of the University of Minnesota, design is capable of serving as a means through which we build healthier environments and influence healthy human behavior.

"It’s not just keeping people safe or meeting the building codes or fire codes, it is really a responsibility about keeping populations healthy," Fisher told Fast Company.

Fisher continues that battling rising trends in public health — namely obesity due to car-dependent communities and asthma attributed to inadequate ventilation and indoor chemical contamination in older buildings — presents tremendous design opportunities to broaden the craft and discipline of architecture to consider social constructs and impact through smarter building.

What I believe is lacking in Fisher’s argument, however, is a call for all-inclusive design and planning polices that would call for the equal participation of those communities typically missing from broader smart growth conversations.

Smart growth policy discussions have the power to support economic development, energy conservation and cost savings to cities, as well as produce cumulative impacts on urban form, travel, behavior and health.

If we seek to use design as a catalyst for improving the health of the public, we are also then charged with clearly defining measurable outcomes that benefit both resourced and under-resourced communities in three fundamental ways. First, we must guarantee greater social equity in our effort to create healthier and more inclusive communities. Second, we must define metrics by working with public health officials to assess and identify public health outcomes as a result of smarter, human-centered design. Lastly, and most importantly, we must require processes that include the communities in which we plan to re-design for the better.

Good design breeds opportunity for social equity

Kristen Jeffers, MPA and publisher of The Black Urbanist, argues in her essay that design alone cannot save communities, especially within the context of oversized and overpriced new urban projects that price people out of their neighborhoods. Jeffers shared with me that a lot of times firms just design.

“Just as we love compact urban development, we need to think about cooperative economics,” she proffered.

Smarter buildings retrofitted with innovative green technology, LEED frameworks and walkable environments that benefit only well-resourced members of society miss out on the opportunity to actively engage communities that are in the most need of this sort of growth and construct.

A study from the U.S. Green Buildings Council titled Understanding the Relationship Between Public Health and the Built Environment explicitly states that “buildings that displace existing communities, push out residents or businesses with lower incomes, eliminate jobs or replace good jobs with substandard ones, or expose people to unhealthy conditions cannot really be said to be sustainable from a triple bottom line perspective, even if they are 'high performance' in other ways.”

Jeffers calls for a comprehensive, all-inclusive list of design and planning practices that would remove voids from needy neighborhoods and encourage educational recourse, food access, physical activity and the like.

Defining public health metrics

The Department of Environmental Health at the Harvard School of Public Health released a study in partnership with the Boston Public Housing Authority measuring the impact of indoor air quality on low-income residents. Published in the Environmental Science and Technology journal, researchers concluded that green buildings have the potential to improve the health of low-income residents.

 Abstract: We observed significant decreases in multiple indoor exposures and improved health outcomes among participants who moved into green housing, suggesting multilevel housing interventions have the potential to improve long-term resident health.

“The thing I like most about this study, even if we can’t tweeze out exact causal agent we’re showing that comprehensive housing reform and smart rehabilitation of buildings and urban planning is important for low income neighborhoods as well and has the potential to kill a lot of birds with one stone. You can improve the environment and improve health at the same time,” Meryl Colton, lead author in the study, shared with me in an interview.

Drawing public health professionals into the architecture/public health conversation also adds tremendous benefits. Public health professionals come armed with data and the skills to design and conduct studies that can greatly influence and measure the intended impact of building for improved public health across communities.

Leveraging community engagement in the planning process

The gatekeepers to smarter, healthier design should not solely be policy makers, planners, architects, engineers or public health officials. Building all-inclusive communities calls for actively including the intended “community” in the planning, design and execution processes.

Successful community engagement solicits the perspectives, talents and skills of members of one or more communities to articulate their needs, concerns, visions and expectations in ways that result in better, healthier outcomes and more livable environments for residents. For example, advocacy groups can bridge the gap to engage residents and planners. Academic institutions, community health councils and other special interest groups are capable of sharing research to help planners and architects understand the acute problems of the community.

From these access points focus groups, community meetings, and public presentations can be birthed.

Re-thinking design as a solution to solving public health problems is a step in the right direction, especially in an industry that, as Fisher described in the article, has been “mystified”. But in order to be effective at reaching the desirable public health outcomes, architects and planners and those involved in the discussion of smart growth must attach themselves first to the work of peeling back the layers of all-inclusive design strategies that will serve the greater community—not just the all-too fortunate few.

Additional resources for further research and discussion:

Impact of the built environment on public health | CDC

Health Impact Assessment for Improved Community Design | CDC

Social Equity in the Built Environment | USGBC

The Built Environment and Its Relationship to the Public’s Health: The Legal Framework | National Institute of Health

Building Healthy Places with People and for People: Community Engagement for Healthy and Sustainable Communities | Prevention Institute

Image courtesy of BitHead Flickr

Sherrell Dorsey is a social impact branding and communications strategist, social entrepreneur and advocate for environmental, social and economic equity in underserved communities. Visit Sherrell at www.sherrelldosey.com and follow her on Twitter and Instagram @sherrell_dorsey.