In the last decade or so, leaders in the field of architecture have begun to look at not just the aesthetics of building and community design, but also their own impact on the health of communities. In New York City, for example, the local chapter of the American Institute of Architecture’s New York chapter partnered with several agencies in New York City, including the departments of Health and Mental Hygiene, Design and Construction, Transportation, City Planning, and Office of Management and Budget, as well as research architects and city planners to create the city’s Active Design Guidelines. These provide architects and urban designers with a manual of strategies for creating healthier buildings, streets, and urban spaces, based on the latest academic research and best practices in the field. The Guidelines include:

• Urban design strategies for creating neighborhoods, streets, and outdoor spaces that encourage walking, bicycling, and active transportation and recreation.
• Building design strategies for promoting active living where we work and live and play, through the placement and design of stairs, elevators, and indoor and outdoor spaces.

NewPublicHealth recently spoke with Rick Bell, policy director of AIA New York, who was instrumental in the creation of the guidelines, about the burgeoning intersection between design and healthier communities.

>>Read more on architecture and design for a fit nation.

NewPublicHealth: How did AIA New York become involved in healthy design with the city of New York?

In the national conversation on the spreading epidemic of obesity and chronic diseases, and the ways in which public health initiatives can fight these issues, architecture and design are continuing to play a leading role in developing fit and healthy solutions. The way a community or a school or a store or a workplace is built can actually influence physical activity, access to healthier food and more to help create an overall fitter nation.

FitNation is an initiative that highlights innovative design strategies across the country to get people healthy and moving. These projects, which stretch across the realms of local and national policy and grassroots-driven action to urban improvements, are brought together in FitNation as inspired by New York City’s Active Design Guidelines and the annual Fit City Conference, which is a partnership between the American Institute of Architects New York and the New York City Department of Health and Mental Hygiene.

Here is a selection of some of the creative solutions featured in FitNation that were developed to help individuals and communities lead happier and healthier lives.

Red Swing Project
Design by Hatch Workshop and University of Texas at Austin Architecture Students
Worldwide

Starting in Austin, Texas, a group of architecture students seeking to make better use of public spaces started the Red Swing Project, an open source initiative to transform some unexpected places into playgrounds. The swings consist of a piece of scrap wood, painted red, and rock climbing rope and have popped up all over the world—transforming areas hit by natural disasters, lining a bicycle path from Paris to Barcelona, and below an interstate overpass. You can track the project online with a geo-tagged map or through #redswingproject on Instagram and Facebook.

Urban Farming Food Chain, Edible Wall
Design by Elmslie Osler, Architect
Los Angeles, CA

We all know that some of the healthiest foods grow on trees, but now in Los Angeles thanks to the Urban Farming Food Chain, they can grow on walls too. The Food Chain consists of “edible walls” that grow fresh fruits, vegetables, and herbs, intended to provide economically disadvantaged populations with healthier food options. The walls are installed on pre-existing structures and have storage for tools, seeds and soil. This project’s vertical angle on community gardens help provide social activities as well as the opportunity to share and develop skills and healthy habits.

In 2011, Sonoma County in California established the division of Health Policy, Planning and Evaluation (HPPE) in an effort to move the county up in the County Health Rankings, toward a goal of becoming the healthiest in the state by 2020. As the director of the division, Peter Rumble, MPA, has played a critical role in the development of numerous programs and policy efforts to help create opportunities for everyone in Sonoma County to be healthy. Rumble has worked on programs and policies that go beyond traditional public health activities and aim to address the root causes of poor health, including the local food system, education and poverty.

Following his presentation at the International Making Cities Livable Conference, NewPublicHealth was able to speak with Rumble about the ways in which his work with HPPE is pushing to achieve health equity in Sonoma County. Rumble will soon move into a position as Deputy County Administrator of Community and Government Affairs for the County of Sonoma, where he plans to continue his commitment to a vision of health and quality of life for the county.

NewPublicHealth: Sonoma is making a concerted effort to help address the root causes of poor health, like poverty and lack of education. Tell us about some of those efforts.

Peter Rumble: Health Action is our real heartbeat of addressing social determinants of health, and it’s a roadmap for our vision of being the healthiest county in California by 2020. Health Action is a community council that advises the Board of Supervisors. There are 45 seats on the council, including elected officials, individual community leaders, nonprofit leaders, and representative from the business, financial, labor, media, transportation and environmental sectors. If you pick a name out of the hat for all of the sectors in the community, we’ve got somebody who either directly or tangentially represents that sector. That group began talking about needing to do something around health in 2007. 

If we’re going to be the healthiest county in California by 2020, what do we need to do to achieve our ten goals based on the best evidence available? We certainly have goals associated with the health system, but predominantly, we’re focused on influencing the determinants of health. Our first goal is related to education. We want all of our children to graduate from high school on time and ready to either enter a thriving workforce or go into college or a technical career academy.

We started with some grassroots initiatives. Being a real strong agricultural community, iGROW was a good place to start. It was a movement to develop community gardens—for people to tear up their front lawns and plant a garden there, and increasing access to healthy food. That was a huge hit. We set a goal of a few hundred community gardens, and we’re up to a thousand now—it’s just caught fire.  

That was all great, but a community garden is not going to make us the healthiest county in California, right? You can see the beautiful posters out on shop windows, you can see your neighbor tore up their front lawn and is growing this beautiful zucchini and has an edible lawn now and all that’s wonderful, but we only have a graduation rate of 70 percent. We’ve got nearly one in four kids living in poverty by the federal poverty standards and if you look at what actually it takes to raise a family in Sonoma County, about half of all families can’t make ends meet. 

NPH: Does that surprise people to hear about Sonoma?

In 2012, the American Institute of Architects (AIA) established the Decade of Design initiative to research and develop architectural design approaches for urban infrastructure and to implement solutions to ensure the effective use of natural, economic and human resources that promote public health.

NewPublicHealth recently spoke with Brooks Rainwater, the AIA’s director of public policy, about the initiative and the impact it can have on public health.

NewPublicHealth: How did the Decade of Design project come about and what are the goals?

Brooks Rainwater: The Decade of Design global urban solutions challenge is our Clinton Global Initiative commitment to action. CGI convenes global leaders to create and implement innovative solutions to the world's most pressing challenges. We put together a 10-year AIA pledge with a focus on documenting, envisioning and implementing solutions related to the design of the urban built environment in the interest of public health, and effective use of natural economic and human resources. In order to do this, the AIA is working with partner organizations—including the Association of Collegiate Schools of Architecture and the MIT Center for Advanced Urbanism—to leverage design thinking in order to effect meaningful change in urban environment through research, community participation, design frameworks and active implementation of innovative solutions.

We started in 2012 by giving research grants to three architecture programs at Texas A&M University, the University of Arkansas and the University of New Mexico.

At Texas A&M, they focused on evaluating the health benefits of livable communities and creating a toolkit for measuring the health impacts of walkable communities as they’re being developed in Texas.

Researchers at the University of Arkansas have a plan called Fayetteville 2030. The city is slated to double in population in the next two decades, so they have brought together community leaders to develop a long-range plan to focus on local food production, including urban farming to help prepare for the large population growth.

At the University of New Mexico, they're establishing an interdisciplinary public health and architecture curriculum. Over the next three years they want to create joint courses on some of the translation issues that come up between the professions, making sure that architects can speak the public health language and public health professionals can also understand the built environment in a new and different way.

"We have medicalized what is in fact an environmental-driven set of diseases," said Richard Jackson, MD, MPH, professor and chair of environmental health science at the UCLA School of Public Health, in a keynote presentation that energized and galvanized discussion among the diverse audience of city planners, architects and public officials at this week’s International Making Cities Livable Conference. This year’s conference focuses on bringing together a vision— across sectors—of how to shape healthy suburban communities.

Jackson, a prominent pediatrician and host of the “Designing Healthy Communities” series that aired on PBS, told an all-too-familiar story of a child who comes into a doctor’s office overweight and with alarming cholesterol and blood pressure results even at a young age. So the doctor prescribes behavior change: No soft drinks in the house. No screens in the bedroom. Exercise, do more, and come back in two months. In two months, what’s changed? Nothing. The food at school is still unhealthy, the neighborhood is still unsafe to play in and the family still uses the car to get absolutely everywhere because there is no other choice. The likely outcome for that child and so many others, said Jackson, is to end up on costly cholesterol medication just two months later when the child’s vital statistics continue to spiral out of control.

"It’s a 20th century idea that our minds are separated from our bodies, and our communities are separated from ourselves,” he Jackson, who reminded the crowd that the most critical health advancements in the last century took place because of changes in infrastructure, not medicine—primarily new sanitary standards to curb out-of-control infectious disease.

Now, said Jackson, “We’ve built America around the car” and we need a whole new set of infrastructure changes to re-build communities that offer better opportunities for health as part of everyday life. “The built environment is social policy in concrete.”

Municipal mixed-use zoning is a public health strategy to create more walkable neighborhoods by creating integrated, un-siloed access to daily activities—such as going grocery shopping and traveling to school and work. A recent study in a special issue of the Journal of Health, Politics, Policy and Law funded by Public Health Law Research, a program of the Robert Wood Johnson Foundation, evaluated municipal zoning ordinances in 22 California cities to see whether the ordinances improved walkability in those communities. NewPublicHealth spoke with the study’s two authors, Sue Thomas, PhD, senior research scientist at the Pacific Institute for Research and Evaluation-Santa Cruz (PIRE) and Carol Cannon, PhD, formerly with PIRE and current associate research scientist at the CDM Group, Inc, a consulting firm in Bethesda, Md.

>>Read the full study.

NewPublicHealth: What was the scope of your study? 

Carol Cannon: We looked at ordinances that create municipal mixed use zoning, and whether these laws seem to have an impact on the potential for walking to destinations. 

NPH: In what ways were the study and findings innovative?

NewPublicHealth is in Kansas City this week for the 2013 New Partners for Smart Growth conference, which brings together partners for smart and sustainable living from across diverse sectors. Over 1,000 attendees are expected including elected officials, government agency leaders, developers, builders, bankers, realtors, and advocates and professionals in planning, transportation, public health, landscape architecture, architecture, housing, parks and recreation, public works, crime prevention, education and the environment.

Just what is smart growth? “Smart growth means building urban, suburban and rural communities with housing and transportation choices near jobs, shops and schools. This approach supports local economies and protects the environment,” according to Smart Growth America.

Ahead of the conference, NewPublicHealth spoke with Paul Zykofsky, associate executive director at the Local Government Commission, which assists local governments in establishing and developing the key elements of livable communities, and organizes the conference. He will be leading a session at the meeting called Smart Growth 101.

NewPublicHealth: What is Smart Growth 101?

NewPublicHealth continues a series of conversations with local public health directors on the issues that impact their work and the health of their communities. Recently, we spoke with David Fleming, MD, MPH, public health director of Seattle and King County in Washington State. Dr. Fleming talked with us about how transportation innovation can impact the health and prosperity of a community.

>>Check out an INFOGRAPHIC on the connection between transportation and health.

>>Hear from Secretary of Transportation Ray LaHood on how transportation impacts public health.

NewPublicHealth: How is transportation innovation making a difference in the health of communities in Seattle/King County?

Dr. Fleming: We’ve started with transit-oriented development such as increasing bike and walking paths, which provides opportunities for physical exercise for many folks that want to do it, but haven’t been able to. It draws a larger number of people into activities and helps them exercise routinely. And in addition to increasing physical activity, you’re also increasing safety, reducing injuries, increasing the social capital in the community, getting better connections between community residents and from an economic development standpoint, you’re creating jobs and increasing property values, and therefore, improving one of the underlying social determinants of health.

NPH: What other examples of transit-oriented housing and community development can you tell us about in Seattle/ King County and what have you learned from them?

Marissa Sheldon, MPH, a Public Health Prevention Service Fellow at the Centers for Disease Control and Prevention who is temporarily working at the Manatee County Health Department in Bradenton, Fla., spoke at a session today during the APHA annual meeting on working with non-traditional partners to improve community health. Sheldon heads the county’s APHA Power of Policy Complete Streets Work Group. The health department is developing guidelines for a complete streets policy with implementation planned for 2013. Such a policy ensures that transportation planners and engineers consistently design and operate the entire roadway with all users in mind – including bicyclists, public transportation vehicles and riders, and pedestrians of all ages and abilities.

>>View a related infographic on the connection between transportation and health.

NewPublicHealth spoke with Marissa Sheldon just before the meeting.

NewPublicHealth: Who were the partners on the complete streets project?

Marissa Sheldon: There are so many different benefits to the project that it is important to include multiple people with multiple interests. From the health department perspective we are interested in obesity prevention, getting people out walking and biking, and injury prevention. Then you have people from the planning department or public works who are more interested in making sure that the traffic flow is going well and there isn’t a lot of congestion and that there aren’t a lot of accidents. The school board is concerned about kids who are walking to school. We have people who are bicyclists and pedestrians themselves who just want to make sure that they are safe when they are out on the roads and we also have been in contact with fire and rescue and the sheriff’s department who are the people who are responding to accidents on the roadways. So, it’s really a big effort of several different groups of people who are all interested in the same project, but for different reasons. 

NPH: How close are you to completion? 

The health upside to a new casino can be the increased quality of life and life expectancy associated with new jobs. But, it can bring health downsides too, including the fallout associated with gambling addiction. Those are some of the key findings in a new health impact assessment (HIA) from the Kansas Health Institute (KHI), released this week. The HIA was funded by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, and conducted by KHI together with the University of Kansas School of Medicine-Wichita.

“Our first HIA intended to inform the discussion of potential casino development…” says Robert F. St. Peter, MD, who is KHI’s chief executive officer. “In many cases,” says St. Peter, issues like these may not seem to have direct connections to health, making them a good fit for [a] health impact assessment.”

The results of the new HIA suggest that there may be positive impacts of casino development related to new jobs; the negative impacts would be related to increases in pathological gambling, which is also associated with nicotine dependence, substance abuse, depression, insomnia, and domestic violence. The HIA offered recommendations including:

• Train physicians to screen for problem gambling behaviors
• Eliminate smoking within and around casino buildings
• Strengthen local services to treat and prevent gambling addictions and related conditions
• Operate a “safe ride” program for patrons and residents
• Use a “loss limit” strategy to prevent substantial financial losses among casino visitors

Read a recent NewPublicHealth interview with Tatiana Lin, KIH senior analyst and strategy team leader, who was the director of the Casino HIA.