The Infrastructure of Health

Life expectancy differential in urban areas - Washington, DC, Robert Wood Johnson Foundation

“We say, ‘You are what you eat.’ Well, we are what we build.”   Susan Piedmont-Palladino, Curator, National Building Museum

The built environment has a tremendous impact on health and wellness, and nowhere is this more evident than in our cities.  In a 2013 study released by the Robert Wood Johnson Foundation, it was found that being born (and living) just a few metro stops apart in Washington, DC can mean a difference in life expectancy of up to 7 years.  Where babies born to mothers in Northwest Washington DC, Arlington and Fairfax Counties in Virginia, and Montgomery County, Maryland can expect to live to be 83 or 84 on average, that average drops to just 77 or 78 years for residents of Southeast Washington DC, and parts of Prince Georges County Maryland.  For those familiar with the Washington, DC metropolitan area, these figures probably don’t come as much of a surprise - there is a very evident socio-economic gap between the communities of Northwest DC and those to the Southeast.  And Washington, DC is not unique in this sense.  All around the world, cities are divided by a complex and often entrenched set of factors relating to wealth, opportunity, and policy which, as the study above points out, can be a major detriment to the health of the cities inhabitants.  Increasingly, the built environment is being looked at as a key influence on community health, wellness, and prosperity.

In a recent panel discussion on ‘Creating Healthy Places’ sponsored by The Urban Land Institute, Scott Kratz, the Director of the 11^th Street Bridge Park in Anacostia, addressed this succinctly:  “Your zip code should never determine your life expectancy.”  In his view, place is the largest determinant of health.  As an architect and designer, this concept reinforces my own belief that the environments we create are never benign.  The buildings and public spaces we help build are more than just projects to place in a portfolio – they are real places with a very real impact on the lives of people who live in them.  At the most basic level, the built environment should promote and ensure both individual and community health.

"Creating Healthy Places - The 11th Street Bridge park and Beyond" Panel Discussion 

An Evolving View of Cities and Wellness

Today, the concept of health is better expressed by the word ‘wellness’ which describes a much broader view of personal prosperity.  In the past, being healthy was considered mostly a personal choice.  Do you eat well?  Do you exercise and stay active?  Do you practice good hygiene?  To a certain extent, this is still true of course, but we now know that there are many more external factors that influence health which exist outside the realm of personal choice.   And this is where the role of the built environment – and ourselves as designers– becomes critical.  This changing view on health acknowledges that the physical environment of cities and the inherent services they provide can impact the wellness of entire communities.  Numerous studies are beginning to quantify the benefits of cities designed with health and wellness in mind.  Living near parks and open space promotes happiness and mental health which correlates to a decrease in unemployment and increase in insurance status and income.  Food Deserts – areas without access to a full range of fresh and healthy food options – are linked to higher rates of obesity, heart disease, diabetes, and other long-term health issues.  And many jobs cannot be reached without access to comprehensive public transit options.  These are just a few examples, but the message seems clear – for healthy communities, we need to design cities with robust and inclusive access to open space, food health, transportation, safety, and education.

Housing and Full Spectrum Communities

In the same panel discussion, Maureen McAvey, a Senior Resident Fellow at The Urban Land Institute also touched on upward mobility and the idea of maintaining community as a contributor to wellness.  She noted that many residents in low-income neighborhoods are faced with a difficult choice upon moving up the economic scale.  In order to attain property or a lifestyle with increased access and benefits, the residents are forced to either leave their current community or stay and continue to struggle with the issues that exist in many low-income neighborhoods. Instead, McAvey argues that we need to design “full-spectrum” communities where all levels of housing and access to services are represented to allow for upward mobility within the community.  

New Generation, New Thinking

McAvey also sees potential for change being initiated by the younger generation of city-dwellers.  “The new generation thinks differently, so we have an opportunity to design our cities differently.”  Where decades past have seen movement out of urban centers and a heavy reliance on vehicles, the new generation is trending towards moving back into the city and leaving cars behind.  Many young people today are willing to trade-off large living spaces for a better location.  The sharing-economy is also helping to reinvent the idea of urbanity.  Car and bike-share systems are re-shaping the way residents and tourists get around the city.  Airbnb-style accommodation networks are revolutionizing the way people find housing without long-term lease or purchase commitments.  And companies like Uber are allowing people to use their own goods and services to become micro-entrepreneurs.  This collaborative consumption stresses sharing over ownership and empowerment over reliance. 

As our society starts to adapt to this new model of citizenship, we’ll see the physical nature of our cities start to change as well.  As designers, we need to acknowledge this evolution and recognize it’s potential for improving the overall wellness of our communities.  We should involve not just clients, but the community in our design process.  We should promote and insist on equal access to open space, transportation, and nutritional health as part of every project program and not just those that call specifically for it.  We should think like the new generation and help shift the paradigm of empowerment and ownership as integral to the health of our cities communities.  As Albert Einstein famously said, “We cannot solve our problems with the same method of thinking we used to create them.”

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Design Disrupted - The LDN LAB Experiment

This post was written as part of an ongoing research grant sponsored by RTKL Associates. The research is an attempt to understand and redefine how architecture and design firms operate traditionally and how they can evolve to function dynamically in a changing industry.

The LDN LAB Experiment - Redesign the London BikeShare Totem

I was more than a little nervous. I was nervous because I was about to present in front of some of the best and brightest colleagues I have at RTKL. I was nervous because the presentation included a handful of ideas that were critical of the way we operate as a design firm. I was nervous because I just drank too much coffee and I stayed up too late the night before. Oops. But I was most nervous because I didn’t have any answers. I had ideas, sure – but no real answers. I started my Kagan research because I wanted to challenge RTKL and prove that innovative design was not just the product of lone creative geniuses, but instead, how we collectively work, how we’re organized, and what our actions say as a firm. RTKL had just flown me halfway around the world to present my findings at the 2013 RTKL Design Conference in London; and now, I had the opportunity to wow everyone with my super-amazing, world-changing solutions. This was my chance. Only, that’s not the way it works and it was never really that simple to begin with.

Performance Driven Design is a great idea. A lot of people get hung up on the fact that it’s difficult to define, but that’s actually a major part of its strength and potential. I personally don’t believe that PDD is one definable method and we risk alienating people if we try to present it as such. To me, PDD is more of an ethos – more performance-based than prescriptive. Every studio within the firm works a little differently, and every project is unique. Performance Driven Design is simply the notion that every project, regardless of size, type, location or program should be treated as a unique design opportunity. The best possible solutions should be researched, tested, and implemented to produce the highest performing result possible. Sounds like that’s just good design, right?


It is. But again, it’s not that simple. Before any project even hits the desk, so many things happen that can hamper those efforts. Projects are preemptively categorized and funneled into singularly focused practice group buckets. Project teams are assembled and administered based on redundant, generalized expertise to achieve maximum efficiency. Most major project-defining decisions are made early on by a handful of senior-level employees and then handed down to production teams. All of these typical practices are great for efficiency, but they limit any chance at design innovation, which is the key to Performance Driven Design.

Much of the Kagan research I’ve done has led to three broad ideas meant to combat this conservative design process and allow for innovation to be an integral part of RTKL’s design identity – “Kill the Studio”, “Give It Away”, and “Flatten the Pyramid.” “Kill The Studio” is an attempt to move away from an overarching practice group-based structure so that every project is approached as a unique design challenge by teams layered with multiple types of design expertise. “Give It Away” is an effort to impart a deeper meaning to our work by assimilating research and development into the everyday design process as well as at a firmwide level through dedicated R+D teams, academic partnerships, pro-bono work and internal research-pursuit programs. “Flatten the Pyramid” is a move to enable and promote junior-level employees to decision-making stakeholders within the firm. This will balance out traditionally conservative senior leadership decisions and provide critical experience to create future leaders at RTKL. These are not groundbreaking ideas by any stretch, but they are necessary if we want to truly operate as an innovative design firm.

LDN LAB Design Activity

At the 2013 RTKL Design Conference, I was fortunate enough to have a chance to test these ideas. In a very well-crafted and ingeniously-supplied design exercise drawn up by Paul Anstatt, Carlos Alba, Sally Hart and personally curated by members of the London office, the design conference attendees were asked to go to three distinct locations around the city of London, using design to reinterpret the ubiquitous bike-share totem. In the true spirit of using the design exercise as a field experiment, I was given the ability to organize the three teams based on a few theories that roughly correlated to the ideas above.


To test out the “Kill the Studio” hypothesis, we put together a team of seven members, each one from a different practice group and with different areas of professional expertise. The idea here was to see if combining multiple types of expertise and experience would have any impact on design. To test “Give It Away,” the team was formed by attendees who all provided strong emotional responses to design as it related to them personally in a pre-conference survey. Here, we were looking to see if a distinct design outcome would emerge from team members who viewed design as something deeper than a formal exercise. Finally, to test “Flatten the Pyramid” we put together a team of all junior employees – associate level and below – to see if the result might differ from a typical top-down hierarchy-based team.

I will admit that prior to the design exercise I was a little skeptical we would see any distinct results from a two-hour activity. However, the results were more clear than I could have ever asked for. During the activity, I was able to watch each team in action. Seeing that, in combination with the end results, clearly showed that we already have incredible talent and drive on our team and with just a few basic changes to the way we do things at RTKL, we can indeed be one of the best and most innovative design practices in the world.

The “Kill the Studio” team greeted me with a resounding “Which option?!” when I asked to see their design progress. As it turned out, rather than focusing on just one design solution, the team was cranking through multiple options. I asked them how they were undertaking the design and they described the design process as more of an improvisational jam session than a linear march to a singular solution. One person would suggest an idea, they would mock it up, and then someone would add onto it with a complimentary idea. They would eventually reach a point where the design felt “complete” or a brand new idea would emerge. The process would then start all over again, with each new iteration taking on an identity of it’s own. As I continued to question them on how they were making decisions and who was leading the design, it quickly became evident that a flat organization had emerged. Everyone had different skill sets, ranges of expertise and approached the design challenge through a different lens. If everyone on the team had the same background, then a general hierarchy based on experience would have most likely emerged and the potential for divergent ideas would have narrowed. Instead, the fact that everyone had unique perspectives based on varied backgrounds allowed a much more open and wide-ranging discussion on ideas and generated a hyperactive process that produced a diverse set of design options.

The site for the “Give It Away” team was situated in Shoreditch, a transitional neighborhood located just north of the downtown business district. It’s proximity to the business district and traditionally low rent make it an area ripe for development. The signs of that transition were evident. The team immediately took note of the diversity of people they met and the colorful street art that permeated the frenetic collision of old buildings, new buildings and construction sites. When asked about the neighborhood, one local citizen remarked that they ‘really liked the area, but we’re nervous about what it could become in a year.’ As the team continued to interview and interact with the local community, it became apparent that their design solution would have to be more about place and community engagement than just a new bike kiosk. Claire Bedat, from the Washington DC office, noted that “Talking with the people really got us started.” And Camilla Simas from Sao Paolo followed with “Whatever we do, the project has to be about interaction. It has to be open and allowed to mutate.” The major question they decided to answer: How will people engage with it and use it to make a statement about their place? Now, even though this might not be thought of as traditional research and development, the depth of their inquiry seemed to approach the true spirit of it. All of their observations – especially their interaction with the local population – led them to instill a deeper meaning to their design process and ideas. In other words, the ‘research’ they conducted allowed them to look beyond the activity as a straightforward task to redesign a bike kiosk, identify an underlying opportunity and approach it as a way to affect change.

At the very outset of the Design Activity, I walked with the “Flatten the Pyramid” team to their chosen site in Brick Lane – an eclectic neighborhood known for it’s delicious curry houses and an ever changing population of different ethnic groups. The excitement to be out designing in the streets was palpable. As we wandered through the crowded streets bursting with activity, bright colors, strange sounds and smells (both good and bad), and a sense of riotous adventure, it was difficult to keep the team together. There was just too much to see and too much excitement to avoid. In fact, by the time we reached the site, one team member had already wandered off to on their own to see more. The team quickly decided that in order to really immerse themselves in the design process they needed to separate into smaller teams and explore the area further before meeting back at the site to start designing. The group darted off in every conceivable direction to investigate, talk with the locals and drink in the new atmosphere. It was obvious that they were excited to have complete design freedom. All too often, young employees are only seen as tools for production, due to their limited experience. Ironically though, that limited experience is one of their greatest assets. Without their frame of reference narrowed by years of working on similar projects, young designers are often better suited to approach design from new and exciting points of view. Combine that with their inherent passion, energy and understanding of new social and technological trends, it seems more than plausible that giving young designers a voice at RTKL would be a critical step towards generating new ideas and promoting innovation. Freed from the typical hierarchy of the design process, this became all the more obvious to me when the team showed up with their solution after the design activity. It was by far the most whimsical, using big ideas and very ‘out of the box’ thinking to achieve their final design result.

LDN LAB - Design Activity Models

So now I was no longer nervous. Not because my presentation and the design activity were over. Not because the caffeine had worked it’s way out of my system. And not because I felt like I had any answers. I wasn’t nervous any more because I realized that we don’t need to start with answers and we probably shouldn’t ever start something thinking we have them. In the end, the design conference activity showed me that all we need to do is start the conversation, get our ideas out into the open and try them. Sometimes the results will amaze you. That’s Performance Driven Design.

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