In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

MacKenzie Kusler is a designer at Ryan Architecture + Engineering (Minneapolis). Here, she shares her thoughts on designing for health equity and the importance of understanding site analysis, historic research, and community context before establishing a design.

  1. Understanding social determinants of health

Health equity is based on the idea that everyone has access to the basics that support positive health, but the reality is that it’s highly limited by social determinants of health, such as access to food and education, economic stability, and neighborhood environment. If health outcomes are rooted in where you live, then designing for health equity must begin outside of the healthcare facility and in the community context. To understand and design for conditions that are determining patient outcomes before they even step foot in a healthcare setting, designers need to evaluate site, community, and historic context.

  1. Site evaluation and historic analysis 

Traditional architectural site analysis revolves around surface-level inquiries such as sun, shade, and wind studies. To start reflecting and designing for health equity, site evaluation must also include in-depth site analytics and historic research, which can shed light on essential facts of a site and how it’s informed by or informs its surroundings. Discoveries may include a historic lack of investment or the elevated use of racially restrictive vocabulary in property deeds that denied ownership to people of color. For example, an in-depth site analysis may uncover an area where there was a lack of investment in public transportation. As a result, the residents of that area cannot easily access care beyond their neighborhood. A proposed solution would be a site design that is highly approachable and accessible by pedestrian traffic.

  1. Community context research

After achieving a comprehensive understanding of the site, it becomes essential to understand how it connects to the community at-large. This involves researching how the social determinants of health are manifesting and influencing the health of those in the surrounding neighborhoods. For example, it’s become apparent how some communities may be more susceptible to poor health outcomes when COVID-19 mortality rates are mapped, with rates twice as high within populations of Black, indigenous and people of color. In turn, it becomes important to reflect on the social determinants of health that have been manifested through systemic causes such as housing and infrastructure policy, how those may be perpetuated within the built environment, and the corresponding impacts on health and access to resources. To appropriately design for health equity, designers must obtain a deeper understanding of the individuals who are being impacted.

  1. Community research reflection

Design is often seen as tangible, but it can also be based on relationship and system designs. For example, research may point to high, local childhood obesity rates and potential solutions could be a healthy foods initiative or nutrition education. Not only can this support long-term health and wellness, but it can continue to evolve with the changing community. This research also can guide site selection and development, spatially informed design, and community-tied construction.

  1. Facility design

For health equity, the design must be highly reflective of what was learned during site analysis, historic research, and community context. If that broader understanding isn’t achieved prior to establishing a design, then there will be missed opportunities of community connection and support. Architecture needs to expand beyond the physical building and consider the people and the community they live in.

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