The “exposome” concept looks at environmental and socioeconomic factors surrounding individuals throughout life that can impact their biology and health. These exposures include air quality, noise and light pollution, housing stability, access to transportation, and strength of social networks—all of which can either provide or deplete a person’s pool of resources to cope with the opportunities and obstacles they encounter in life.

During the 2023 Healthcare Design Conference + Expo educational session, “The Exposome – Going From Ideals to Implementation of Health Equity,” speakers Angela Mazzi, partner and senior medical planner at GBBN Architects (Cincinnati); Tiffany Broyles Yost, associate principal and director of sustainability and resilience at GBBN Architects (Louisville); and Greg Coni, architect at GBBN Architects (Pittsburgh), discussed ways healthcare facilities can offset negative exposome impacts and the stress they cause through planning and design strategies.

“Health equity is where everyone has an opportunity to achieve optimal health. To achieve this, we need to remove obstacles, including poverty and lack of education, and the consequences of these issues,” Mazzi said.

Explaining the exposome

“Because the exposome is linked to the amount of negative stress we encounter, it impacts internal bodily processes—which in turn can lead to physical and mental illnesses,” Mazzi said. “These stressors also decrease likelihood of seeking preventative care or complying with treatment, which increases health disparities. We can intervene by providing environmental resources in our buildings and cities that cue the parasympathetic nervous system which increases one’s resiliency.”

The speakers said resiliency is an equity issue because certain populations, including minorities, elderly, LGBTQIA+ individuals, and those with mental illness, often have fewer resources due to experiencing a higher proportion of negative exposome conditions.

For example, Mazzi said, while a lot of the people sitting in the conference session room would have resources available to handle their car breaking down on the way to work, for others, it might create a variety of problems.

“Think of the single mother who drives an unreliable, old car she can’t afford to maintain. If her kids get sick or the car breaks down, she could lose her job. The stress of getting through each day can lead to bouts of depression and anxiety,” she said.

Supportive facility environments

To help decrease these stressors and better support equality, the speakers noted that there are a variety of planning and design strategies that can be implemented on the design and community levels to support patients, staff, and neighborhoods.

“At the scale of buildings, health systems can consider opportunities to employ and purchase locally, become a transportation hub, and include program elements that are health or lifestyle resources,” Coni said.

Furthermore, within the built environment, the speakers encouraged project teams to look at design strategies, including intuitive wayfinding, to lower the stress response and think about better ways to meet the needs of patients, families, and staff.

For example, creating a welcoming entry at a hospital or medical office and providing access to daylight can help reduce stress as patients visit for a procedure or appointment.

Turning to the topic of staff wellness, the speakers said designers and healthcare leadership can also collaborate to create respite spaces for staff to decompress from the daily stresses of caring for vulnerable patients.

Ideas included prioritizing a connection to nature through daylighting and views and using natural, non-toxic materials to create indoor comfort and enhance staff well-being, Yost said.

Generating positive health outcomes in communities

At the community scale, the speakers suggested that health systems can leverage partnerships with other businesses or community resources to create health districts where social services, education/training facilities, public spaces, and healthy food are accessible near health services.

Wrapping up, the speakers noted that humans spend on average about 90 percent of their time in buildings—sleeping, sitting at desks, eating meals, and watching movies.

“So there is a significant opportunity for architects and others in the building industry to help generate positive health outcomes, equitability, through design excellence,” Yost said.

For more session reviews from the 2023 HCD Conference + Expo in New Orleans, visit