At the 2014 Healthcare Design Conference in November, an American College of Healthcare Architects (ACHA) presentation by Dr. Richard Jackson of the UCLA Fielding School of Public Health really resonated.

Jackson, a co-author of “Making Healthy Places” and narrator of the 2011 PBS series “Designing Healthy Communities,” is a champion of promoting health through good design and reversing trends that adversely affect the health of Americans.

Citing a study, Jackson said that ”even under the most optimistic estimates, of the 30 years of increased life expectancy achieved between the 1890s and 1990s, only 5 years can be attributed to medical care.” Most of life expectancy improved because of public health measures, including better sanitation and nutrition and easing the spread of infectious diseases.

Despite these gains in longevity, the healthiness of the U.S. population is declining, largely due to sedentary lifestyles.

For example, highly sedentary habits are associated with increased risk of cancer, obesity, depression, heart disease, and Type 2 diabetes. “We lose two hours of life for every hour we sit,” writes Dr. James Levine, director of the Mayo Clinic-Arizona State University Obesity Solutions Initiative who is credited with coining the expression “sitting is the new smoking.”

As healthcare designers, our goal has traditionally been to “do no harm” by creating safe environments that promote healing. Over the past few years, though, some theorists have framed a new discussion, using such words as “regenerative space” or “salutogenic design” to describe environments that promote health.

However, these conversations have concentrated on aspects of the built environment that most designers are already familiar with: natural light, views of nature, and improved wayfinding.

So how can we rethink where care is delivered and proactively improve health?

In 2013, the Urban land Institute published “Ten Principles for Building Healthy Places”. Though these principles primarily related to design at the community level, there are plenty of takeaways for healthcare environments, too:

  • Put people first. Individuals are more likely to be active in healthcare settings that encourage use of stairs and pleasant internal destinations, such as courtyards and dining areas. Sites that are accessible by mass transit and biking encourage exercise, and walking paths allow staff and family to take active breaks.
  • Recognize economic value. Walkable, mixed-use communities have increased real estate value. Instead of locating new healthcare campuses on isolated greenfield sites, consider more compact and urban campuses that complement and spawn adjacent development.
  • Energize shared spaces. Incorporating public gathering spaces into healthcare settings can have a positive effect on health by providing space for wellness programming.
  • Make healthy choices easy. Improved wayfinding and communication within hospitals can allow caregivers and family to move about without anxiety, making visits safer and more active.
  • Ensure equitable access. Spaces should be designed for all ages and abilities, where anyone can be accommodated without a loss of quality of life. Collocating health facilities near schools and senior living facilities also improves access.
  • Mix it up. Mixed-use developments improve physical and social activity. Locating healthcare facilities in vibrant, walkable developments with retail and housing encourages utilization.
  • Make it active. Urban design can be employed to create an active healthcare site, including providing sidewalks and bike racks as well as playgrounds and gardens.

And these are just a few ideas. Healthcare facility paradigms are rapidly changing, and designers have an even broader opportunity to improve health and wellbeing beyond the walls of the hospital.