The Public Dialogue

By Brad Leibin

Throughout history, one can find evidence that environment has a major role to play in improving public health outcomes. In the 19th Century, infectious diseases such as cholera and tuberculosis claimed millions of lives around the world before it was understood that environmental design measures such as aqueduct systems to supply cities clean drinking water, urban parks, revisions to building codes and zoning ordinances, and improved sewer systems (not medicine) were the most effective means to eliminate disease (i). Despite examples such as this, the importance of environment still too often goes overlooked by the healthcare industry as well as designers. Research done by the World Health Organization (WHO) has shown that many of the most pressing global public health issues of the 21st century are tied to environment. It is estimated that, currently, 24% of the global disease burden and 23% of all deaths can be attributed to environmental factors (ii). In its 2006 paper, “Preventing Disease Through Health Environments,” the WHO paints a picture of the negative impact that inadequate built environments, pollution, and climate are having on disease rates, particularly in the world’s poorest regions.

One might think healthcare facilities would be leaders in adopting sustainable building practices. But it appears, too often, that this is not the case. In United States the healthcare industry is the number one generator of waste (producing 3.4 million pounds, annually), the number two largest consumer of energy (spending $8.5 billion on energy, annually), and consistently ranked among the top 10 users of energy in any given community (ii, iii,iv). Not only does this wastefulness make healthcare more expensive and less accessible than it needs to be, it is makes healthcare a prime contributor to the environmental degradation that the WHO cites as a major causes of worldwide disease. In other words, the healthcare industry may actually be contributing to the spread of the illnesses it is trying to treat (iii).

Fortunately, there is an increasing number of examples of effective hospital design strategies, which point to a better way forward. One case-in-point is Meyer Children’s Hospital in Florence, Italy, which features a green roof as well as sophisticated daylighting, ventilation, and energy management strategies. Meyer consumes 35% less energy for heating and cooling and 36% less electricity than a standard, newly-built Italian hospital.  Interestingly, environmentally sustainable design strategies such as these can simultaneously have a positive effect on patient health outcomes. For instance, the Center for Health Design has shown that improving levels of natural light in healthcare facilities (which, generally, is a result of effective daylighting strategies) have been shown to expedite healing and reduce length of stay for patients, as well as reduce staff stress levels and generally improve quality of care (v).

Design has a role to play in improving public health beyond the walls of the healthcare facility, as well. In New York City, officials have recognized an “obesity epidemic,” in which the majority of adults and 43% of the elementary school children are either overweight or obese. This epidemic has been linked to cardiovascular diseases (which claim the lives of nearly 25,000 New Yorkers per year), as well as diabetes and cancer, among others. In fact, over $117 billion in healthcare costs in the United States were attributed to obesity in 2000. But rather than just telling people to eat better and go to the gym (which has limited effectiveness), officials in New York are literally attempting to retrofit the physical environment of the city to counter the epidemic. A major component of this effort is a publication called Active Design Guidelines, which was produced by the New York City Departments of Design and Construction, Health and Mental Hygiene, Transportation, and City Planning. Active Design Guidelines shares architectural and urban design strategies for increasing physical activity — such as more prominent and attractive stairs in buildings, more walk-able streets, and increased access parks and open space – with design professionals and others who are responsible for planning the construction of buildings, streets, and neighborhoods (i).  

The recent healthcare reform debate highlighted the massive scale of need for healthcare in the United States. But healthcare reform is actually only one piece of the public health puzzle. Though often overlooked, creating more equitable access to quality environment is also critically important. This raises some interesting questions and suggests a very important responsibility for architects and designers. If designers of the built environment don’t take this issue seriously and advocate for it, then who will? With projects such as International Planned Parenthood Federation/CIES Sustainability Framework and a new project for Alameda County Health Care Services Agency, Public Architecture has begun to address this question and the challenge of improving public heath through design, particularly for underserved communities. Healthcare and public health will continue to be major focus sectors of our design consultancy practice moving forward. Stay tuned for future posts about the aforementioned projects and others.