Population Health Blog

Population Health Blog

Why It Matters

Design + Health + Sustainability = Place making

By Sarah Lewis
In September, the American Institute of Architects Michigan Chapter sponsored the Green Health Summit http://www.aiami.com/GreenHealthSummit, a multi-sectoral conference, including architecture, ergonomics, urban design, city planning, healthy food access, public health, and environmental health, featured discussions on building design and urban design, as well as keynotes addressing how active design impacts health.

What is active design? According to summit co-chair Joyce Lee, former chief architect and planner for the New York City Office of Management and Budget, “We put health front and center in every design decision we make because we have learned the immense impact we make.” In other words, urban and building environments play key roles in addressing health epidemics. Lee co-authored New York’s Active Design Guidelines http://activelivingresearch.org/new-york-city%E2%80%99s-active-design-guidelines, a list of evidence-based and best practice strategies for increasing the healthiness of our buildings, streets and neighborhoods. They aim to increase physical activity supports in everyday places: where we live, work, go to school and play; and create neighborhoods, buildings and public places that encourage walking, biking, active transportation and recreation.

“Diseases of energy” such as obesity result from too many calories in and not enough calories out – and design is one solution. Active Design Guidelines co-author Dr. Karen Lee describes the impact of increasing stair use: “If the average American adult climbed the stairs an extra two minutes a day, the average increase in weight gain would be eliminated.” Even in many modern buildings where stairwells are locked away in a corner with escalators and elevators out front and center, stair use can even be promoted in tall buildings: “skip-stop” elevators only stop at every 3rd or 4th floor and have shown to greatly increase stair climbing.

While concepts such as “green design” may sound cutting edge, the very practice of public health is rooted in environmental factors and urban design. Karen Lee points out that most public health successes in combating infectious diseases like cholera and tuberculosis in the 19th and early 20th centuries stemmed from implementing city codes, plans and infrastructure. “High population densities and crowded living conditions coupled with poor sanitation, insufficient garbage removal, dark and dank streets, little air or light penetration, the presence of mosquito breeding puddles…” were addressed through urban planning measures such as reforms to tenement housing construction. “Essentially, architects and urban reformers helped to defeat disease by designing better buildings, streets, neighborhoods, clean water systems, and parks.”

In contrast, chronic diseases are the leading killer in the 21st century. Americans have been designing environments and buildings that are not conducive to physical activity, which is one of the most significant risk factors leading to premature death. Jim Tischler, Michigan State Housing Development Authority community development manager says that our “car-oriented society” severely limits opportunities for physical activity. “We don’t think of livability, mixed use, mixed income, dense forms. What are the elements of neighborhood design that promote health?” He cites the Walk Score https://www.redfin.com/how-walk-score-works as one measure of potential access to physical activity making it a surrogate measure of neighborhood form.

Dr. Mouhanad Hammami, Wayne County Public Health Department Health Officer and Chief of Health Operations, discussed the county’s Place Matters http://wayneplacematters.com/ program, projecting images of a cul-de-sac neighborhood clearly not designed for anything but driving, and showing the correlation between determinants and their outcomes, e.g., vehicle miles driven per capita and obesity rates increasing together over decades.

Moderator Dr. Richard Jackson, Environmental Health Sciences Professor at the University of California Los Angeles and Designing Healthy Communities http://designinghealthycommunities.org/, summarized: “It is every citizen’s right to live in a clean, healthy environment… a non-polluted, health promoting area.” In a way, we seem to have come full circle in public/population health. As the guidelines underscore, “in the 21st century designers can again play a crucial role in combating the most rapidly growing public health epidemics of our time.”

Sarah Lewis is the Kellogg Population Health Fellow at the Detroit Wayne County Health Authority.