Continuous, holistic, and equitable health communities
September 28, 2021
What is design’s role in realizing health and wellness for everyone?
Picture wellness as a?series of?interconnected?destinations, pulsing centers?of activity?across?the community where sensory and experiential design, biophilia,?and nature-informed?environments?come together?seamlessly.?Sustainable, walkable, and active?places invite contemplation and human connection. A holistic network woven into community life reaches out and meets the population where it lives.???
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It’s high time that those of us who shape the built environment, and particularly those of us who?focus on the health sector,?reach beyond?conventional?acute care?models and the edges of outpatient care to fully?embrace a new paradigm. We need?a new?approach that promotes healthy communities and?takes?on?the?unhealthy lifestyles, chronic conditions,?and health disparities?that we see today.?The future is a?holistic network for health.?
Swamp Rabbit Trail Extension Master Plan, Greenville, SC
What?Covid-19?revealed
The pandemic highlighted and underscored the multi-variate factors?influencing?personal and community health?such as housing, nutrition, safety, education, and economic stability.?With national conversations?turning to examine the role of structural racism in our society,?we’ve seen?the role of race in health outcomes?emerge?as an important and?integral?topic.?Your zip code should not affect how long you?live. But in too many communities it does, and dramatically so.?
Our industry has taken note.?In 2020,?the?Advisory Board?focused on? and offered in health?care.?
In 2020, the AMA .?And in 2021, the AMA released a and promised to pivot from ambivalence to urgent action on racial equity.
New York Presbyterian - Uptown Hub, New York, NY
Health equity is not a new topic
We’ve been talking about health equity for years—in healthcare, in public policy, and in the design industry. But a quick reminder: Health equity means?building?a society where everyone has a fair opportunity to be as healthy as possible. Health equity means reducing and ultimately eliminating disparities in health,?especially?its?determinants that affect marginalized groups.
So, promoting health means removing obstacles to health such as poverty, violent crime, lack of?quality housing, discrimination, and lack of access to?stable?jobs.?Health equity is not about settling for the?current?average. When there are disadvantaged populations who are unable to access health, the average is unacceptable.?Now is the time to embrace these concepts and create a new standard of excellence.?
How do we get from where we are to a more equitable, wellness-oriented,?holistic network for health??What is it going to take? Design has a role to play in realizing healthy and equitable community networks. Here are the key elements I believe will define that role.
Mode shift: Embrace a new way of thinking
Achieving our goal will require a dramatic and intentional shift in how we think and act regarding health.
The first step is recognizing that structural racism?contributes?to real health inequalities in our communities.?Educating ourselves?about?structural racism and the practices?that help dismantle it?is an important?aspect?of advancing health?equity.?And likewise,?in?creating places for healthier communities to thrive, we expand opportunity.
Fundamentally, this mode shift redistributes our focus on the hub and spoke model of healthcare to an emphasis on networks of healthy living. It will feature a new emphasis on upstream approaches to wellness that prevent health issues and improve health disparities.
Re-imagine Main Street, Complete Streets Project, Hartford, CT
Vision: Lead by example
Remaking our environments to position health as a key priority?requires designers and all stakeholders in the built environment to engage in?robust placemaking across functions, destinations, infrastructure networks, and amenities.?
Today’s interventions, places that point toward this equitable version of healthcare in the community, can serve as powerful stepping stones. For example, a new women’s hospital that puts the patient experience first and promotes healing through sense of place is a step in the right direction.
Creating places within the healthcare continuum focused on preventative care is a start, but these interventions alone will not achieve the goal of a continuous and equitable health network.?We?should?applaud?places for leading the conversation?and showing us what’s possible,?but?a?deeper disruption?is necessary.
Deeper disruption requires designing with the broader community in mind, considering both “well places” and “sick places,” connecting across communities for an integrated network, less isolated projects, and more contextual understanding of impacts on surroundings and people.
Our new mindset informs our design vision. We no longer see a hospital as simply a place for onsite treatment, but rather as part of a network that reaches out and engages the community. Taking an even wider view, we see how the health system network—where prevention and care takes place—is overlaid onto the community/city itself. Through this lens, we consider not just how the city design relates to the places where treatment takes place but how the urban plan impacts health and wellness every day.
We can lead by example and think holistically about design for health across the community.
Educating ourselves about structural racism and the practices that help dismantle it is an important aspect of advancing health equity.
Design?can’t create healthy communities by itself. And it?isn’t going to solve health equity on its own.?Establishing?truly?healthy communities?requires?visionary?effort from?investors,?developers,?elected officials,?policy?makers, institutions,?insurers,?community?leaders, healthcare providers, and others. It’s going to require forming new?and integrated?alliances and?thinking outside of our?areas of focus.
In our collaborations, we can offer a?more holistic view of what development can do to knit together community needs. We should be ready to “catch” on the other side of the process when institutions, public entities, or providers make health equity a priority in their projects. We can speak a language of health equity in design—and fluently.?Our?design?process, for example, must welcome input and look at outcomes for the most vulnerable populations.
Together, we can?unite?around?a?shared vision?for our intention to?create?innately?healthy?built?environments.?
New York Presbyterian - Uptown Hub, New York, NY
What’s next?
What?are?the next steps?we can take to manifest this reality??Listen, gather ideas,?and?make?a commitment (see our commitment to equity and inclusion in the design process in Issue 12 of the Design Quarterly).
What?actions can you commit to that contribute to a mode shift to?an equitable,?healthy community??