Improving Communities And Population Health Through Design
How can design make a difference in our communities and improve the health of our population at the same time? This sentiment isn’t something that we’ve all just been thinking about because of the worldwide pandemic, but rather, this has been an area of focus for decades. Nonetheless, as mentioned in the first installation of this blog series, COVID-19 is an accelerator and a catalyst for change. So, can we be the generation that makes a difference?
Looking at the overall conditions in our communities, we can see a wide variety of issues like food deserts resulting in poor nutrition, lack of affordable housing, and disproportionate access to care—alongside a rise in addictions, increase in behavioral health needs, and a sedentary lifestyle—driving unhealthy cohorts within a population. With 10 to 20 percent of a person’s health being driven by the quality of healthcare, as pointed out in several studies and highlighted in a 2017 paper “Social Determinants of Health 101 for Health Care: Five Plus Five,” in the National Academy of Medicine, we should be looking beyond the walls of the hospital to look to improve our health.
A lot of attention has been placed on COVID-19 over the last year, and rightfully so. However, the Centers for Disease Control and Prevention (CDC) report, “Provisional Mortality Data—United States, 2020,” states that of the total deaths in the U.S. last year 690,000 were from heart disease, 598,000 were from cancer, and 345,000 were COVID-19 related. According to research by Definitive Health, of the over 1.3 million claims of COVID-19, 76 percent of those cases were exacerbated by comorbidity. We could derive that a number less than 345,000 was directly a result of the COVID-19 virus. And yet, it has changed our lives forever. How much more of an impact could we as a society have to try and eliminate the other diseases and conditions that are driving up healthcare costs and have the U.S. far down on the list for quality health outcomes?
According to the CDC study, “Health and Economic Costs of Chronic Diseases,” the top chronic diseases impacting health in our communities include heart disease, diabetes, obesity, and even tooth decay. Of the top eight identified in the report, many are considered preventable. As a society, we have to make a shift to take accountability for our own health and focus resources to the places where the biggest impact can occur. As designers, we can have a positive impact by encouraging better healthy behaviors for those that use the buildings and places we design and guiding clients to make choices that will help them see the social benefit of investing in the health of the community.
Priority one is creating purposeful movement. As designers, we can encourage movement by placing programs and designing spaces to choreograph a physical response. A paper published in the American Epidemiology Journal cites that replacing sitting with 30 minutes of activity a day will help a person live a longer and healthier life by 17 percent. According to studies by the National Institute for Health, people in communities that encourage walking and biking within the normal course of their routine have better overall health compared to communities that require motorized transportation. The response from designers should be to do more to create solutions that encourage movement and connect spaces and programs in a way that users can experience health and well-being.
Taking it a step further, what if all our major needs could be met within 15 minutes of a walk, bicycle ride, or public transportation? Instead of segregating distinct neighborhoods or zones for activities, approaches that mix economic and social functions together in a more compact urban footprint would drive a more connected and vibrant community. For healthcare, this would resemble a broader, decentralized community health network versus a single hospital. In the article, “The 15-Minute City—No Cars Required—Is Urban Planning’s New Utopia, in Bloomberg, Carlos Moreno, special envoy to the mayor of Paris for smart cities development, says that the “15-minute city” idea was generated primarily to reduce carbon emissions, however he hopes to make Paris a “city of proximities,” where all aspects of life can come together in welcoming and safe streets and squares.
While a more sustainable community is good for the planet, it can also impact population health. The World Health Organization calculates that 24 percent of the world’s deaths are from environmental-related issues, such as climate change, which impacts a community’s ability to have clean air, safe drinking water, food, and shelter security. Finding strategies that showcase environmental stewardship, create regenerative and eco-responsive solutions that can clean the air, sequester carbon, or produce energy are ways to protect the environment, while at the same time making the community healthier.
The thing that’s clearer than ever is that we need to work together to help build stronger and healthier communities.
Jim Henry, AIA, NCARB, is senior vice president, director of health at CallisonRTKL. He can be reached at Jim.Henry@crtkl.com. In this series, he will explore how accelerated change is rapidly shaping our healthcare systems, built environments, and ways of thought when it comes to safe and healthy design.
Read past installments here:
