Design Matters

The causes of our high mortality rates are telling. Heart disease and cancer lead the list. Lung disease and stroke are important contributors. The United States tops high-income countries in motor vehicle deaths with 10.3 per 10,000 people each year. Much of this burden is preventable.

Turning from mortality to morbidity, the details aren’t pleasant either. Despite progress on some fronts, obesity, hypertension, diabetes and asthma have risen steadily over recent decades. Anxiety, depression and substance abuse are disturbingly common; so is the use of prescription drugs. We are a prosperous country, but many Americans are unhappy and overwhelmed, giving credence to the phrase, “Money doesn’t buy happiness.”

People’s habitats—their buildings, neighborhoods and metro areas—play a role in their health and well-being. Accordingly, design professionals are health professionals. How do we design places that optimize human health and well-being?

A Healthy Habitat

The ingredients of healthy habitat aren’t a mystery. They include regular physical activity; clean air and water; a comfortable temperature and humidity range; plenty of daylight; safety from toxic chemicals, mold, injuries, and other dangers; opportunities for social connections balanced with adequate privacy; contact with nature; and more. Moreover, environmental sustainability—a prerequisite to sustainable human health and well-being—needs to be factored in. The challenge is to incorporate these elements, intrinsically and consistently, into design.

The sprawling communities that typified American development since World War II subverted many of these design goals. Driving became the normal way of getting from place to place, and active transportation—walking and cycling—was marginalized. The vehicular traffic reduced air quality and drove up injury and fatality rates. “Third places” such as town squares were omitted. Vast amounts of energy, land and other resources were consumed, in an unsustainable fashion. The millennial generation’s renewed interest in urbanism promises some correction of these blunders.

Healthy design elements don’t just operate on the community scale. They also need to be incorporated at the scale of buildings, where Americans spend about 90 percent of our time. Health threats in buildings are all too common, and too many opportunities to promote health are bypassed.

• Noise can reach very high levels in buildings, not uncommonly approaching 90 decibels. Controlling noise reduces stress and improves overall health and well-being.

• The temperature and humidity of a building directly impact comfort and performance. They also affect health, through such pathways as mold growth.

• Harmful chemicals are commonly found in buildings. Some are legacy chemicals such as lead (which targets the nervous system) and asbestos (causing cancer and lung disease). Others are routinely brought into commercial buildings, schools and homes, whether they are found under sinks, in janitors’ closets, in art classrooms or in chemistry labs.  Pesticides and fungicides are often used in situations where design and building management could prevent infestations. Flame retardants, paints and solvents, carpet adhesives and other potential toxins are used in building components and furnishings.

• We’ve all seen buildings with iconic elevators in the lobby, and with a stark, utilitarian staircase hidden behind cinder block walls. What if irresistible staircases seduced people into routine physical activity, and elevators were hard to find?

Regular contact with nature also has a wide range of benefits, including reduced stress, anxiety and depression, improved sleep and greater overall levels of happiness. Contact with nature is associated with lower blood pressure, smoother recovery from surgery, and better pregnancy outcomes. Children with attention deficit disorder can often focus better in nature, and people engage in more pro-social behavior such as introducing themselves to each other, helping others and deepening their social networks in greener settings.

In the 1970s, an environmental psychologist named Roger Ulrich found an opportunity to study the impact of exposure to nature at a Pennsylvania hospital. On the post-surgical ward, half the rooms looked out at a tree canopy while the other half had a view of a brick wall. Patients were assigned to their postoperative rooms randomly, based only on which room happened to be empty. Ulrich studied ten years of post-surgical records and compared outcomes in the two types of rooms. The patients in the rooms with the view of trees had shorter hospitalizations, less need for pain medications, and fewer negative nursing notes. The health benefits of exposure to nature are substantial, and should be incorporated into design as much as possible.

A Research Opportunity

A central question, when we intervene in hopes of improving lives, is “Does it work?” A crucial companion question is “Is it safe?” Any potential medication is interrogated accordingly, through empirical research—ideally the well-known clinical trial.

But this tradition of empirical research—of rigorously evaluating our actions, in terms of their impacts on people—is less well established in the design professions than in the health professions. If we’re serious about creating great places for people, we need to embrace that empirical perspective. Health professionals and designers need to work together on needed research. Every design project is a research opportunity that can be studied to inform our knowledge of what promotes health and what doesn’t. Why shouldn’t research be woven into the training of design professionals?

There are several ways the design industry can achieve market transformation and increase the demand for healthy buildings. One is social marketing to persuade consumers to demand healthy places. Another is accumulating evidence supporting the impact of the built environment on health and making it accessible in the hope that it will change how designers think about their projects. Rating systems such as LEED can also provide some assistance—and several are emerging that specifically focus on health—although opinions vary as to whether such systems have had an impact on the market.

Every zookeeper knows that animals need healthy habitats, and that these must be created with care, caution and intentionality. Every zookeeper also knows what success looks like: the animals thrive. Surely humans deserve the same consideration and accountability. Designers, in partnership with healthcare professionals, should empower themselves and their projects with knowledge of what makes places healthy, and put their considerable talent and training to work to usher in a healthier, happier future for Americans.

Howard Frumkin, a physician and epidemiologist, is dean of the University of Washington School of Public Health. His research focuses on human health aspects of the built environment, climate change, energy policy and nature contact.