The Hill-Burton Act of 1946 funded many of our urban hospitals across the U.S., from the post-war period through the 1970s. American cities of that era presented a very different social, economic, and cultural landscape than they do now. Health campuses, in keeping with the urban planning ethos of the time, tended to be closed off and inward-looking, with little connection to the cities around them.

But things are changing. The 2020 Census shows that our cities and suburbs are becoming more ethnically and racially diverse, with white, non-Hispanic populations shrinking in many urban centers and becoming a minority in several. The new urbanism stresses inclusivity, diversity of uses, and sustainability.

In light of these shifts, our healthcare architecture is in danger of being left behind. But there’s hope: While implementing functionally necessary renovations and building replacements, our urban hospitals also can make themselves more welcoming, proactive, and connected to the communities they serve. Reimagined city hospitals would allow healthcare organizations to—literally and figuratively—break down the walls that have separated them from surrounding neighborhoods and contributed to persistent health inequities.

The following planning and design approaches can help hospitals weave health into urban life.

  • Wellness and holistic health. Hospitals can take a transformative role in integrative healthcare by providing indoor and outdoor spaces for activities that go beyond traditional medicine, such as spaces for fitness events like runs, bike tours, and walkathons; mindfulness practices like public yoga classes; healthy food options like farmers’ markets; and therapeutic and functional green spaces that offer recreation and respite to patients, staff, and the public alike.
  • Population health and preventive health. Hospitals can design public areas to host open and free fairs and clinics that highlight and provide a range of preventive care measures, diagnostic tests, and screenings. Public health heat maps and other data-driven criteria can help hospitals provide proactive health and prevention outreach.
  • Culture and education. Hospitals can bolster their unique role as community conduits by dedicating space for public learning, group meetings, and localized research and studies. Public art also can play an important part of this outreach as it can help forge bonds with the local population while also stimulating intellectual and spiritual wellness.
  • Contribute to sustainable cities. Hospitals can directly address urban sustainability by connecting their campuses to mass transit and active transportation routes (such as bike paths and greenways), introducing plantings and green roofs to reduce the urban heat island effect, implementing composting and recycling programs to manage waste, and designing sites to manage storm water and reclaim open space.

They say the only constant in life is change. The same rings true for cities. As they morph and evolve from generation to generation, our hospitals must respond with innovation. Not doing so risks jeopardizing the lives of residents and the very health and vitality of the cities we serve.

Nsenga Bansfield is a senior medical planner based in the New York City office of global design firm HOK. She can be reached at