Friday, May 2, 2014

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 11th 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.”