Want To Design Better Hospitals? Put Them in Walkable Communities

The 20th Congress for the New Urbanism (CNU) concluded this spring with a rousing speech by Dr. Richard Jackson, a pediatrician and chair of Environmental Health Sciences at the UCLA School of Public Health. You may have seen him hosting the four-part documentary Designing Healthy Communities on PBS, which previewed the Institute of Medicine’s (IOM) just released report Weight of the Nation about the epidemic of obesity in America. The report notes that two thirds of adults and one third of children in the U.S. are overweight or obese. How can this be? Where have we gone off the rails?

Dr. Jackson said that the design of the built environment is killing us and threatening the very viability of our society. We are now almost entirely dependent on cars, with fewer and fewer of us walking to work or school (or anywhere for that matter). The statistics in the IOM report are sobering. But what was most interesting to me is the report’s number one strategy for combatting the obesity epidemic in our society: change the design of our built environment to increase physical activity. Not simply changing our eating habits, not exercising more, not drinking less sugary soda. Yes, these things are important but they pale in comparison to the impact that the design of the built environment is having on our bodies.

As an architect and planner of healthcare environments, I’ve been watching with great interest the mushrooming awareness of the impact of the built environment on public health. The Fit City movement is a hot topic in urban design circles. Now, with Dr. Jackson leading the charge, many designers are using the newly available data (including the IOM report) as ammunition in their push towards new models of healthier urban and architectural design.

In our practice, the link between the choices we make in the design of healthcare facilities and the potential impact they have on public health, is leading us to push for sustainability strategies. These include specification of materials for our projects that have the least possible environmental impact. Our next step is to create better connections to the urban fabric in the hospitals we design.

There is, however, a wide disconnect between the Fit City movement and how hospitals and healthcare facilities are designed.

Many hospitals are accessible only by car. The buildings and complexes are like fortresses, surrounded by a wide moat of surface parking and busy roadways. They typically turn their back on the surrounding community, showing little concern for how they relate to their neighbors.

I believe that the change now under way in the business model of healthcare will lead to a radical change in the perspective of healthcare providers who are increasingly concerned with wellness, prevention, and the health of the communities they serve.

As our unhealthy lifestyles lead to skyrocketing chronic diseases, many healthcare providers are looking for ways to mitigate the related epidemics of obesity, diabetes, heart disease, and hypertension, as well as certain types of cancer. All these diseases are known to cause a precipitous rise in our healthcare costs, to unsustainable levels. The best way to treat this epidemic, if we follow Dr. Jackson’s thinking, will not be through fancy new drugs or expensive new medical technology. It will be by building old-fashioned walkable communities like the ones we used to build in America before we let the transportation engineers take over.

Why did I go to CNU 20? I have been hearing more and more about how urban design can be a force to improve public health. But this message has not yet gained traction in the way hospitals are designed and built, despite architects like me trying to get the word out about the disconnect and to bring some of the healthy city thinking into healthcare planning.

I was at CNU to be a part of a new initiative called Health Districts. The goal is to develop a framework for the design of hospitals that would encourage a better interface with their surrounding communities. The Health District workshops presented some diverse and promising perspectives from architects and urban designers, as well as representatives of the health systems themselves and NGO advocates. All of us are seeking ways to collaborate and to change the status quo. It was great to be involved in changing the way hospitals could be designed.

Jason Harper is an architect and associate principal in the New York office of Perkins+Will. He is an expert in the design and planning of hospitals and healthcare facilities with over 20 years experience.

See Metropolis related content in Design + Policy = Fit Cities and Design + Pedagogy = Fit Cities.