Category Archives: Built environment
Most parents send their children off to school expecting they’ll have their minds enriched and expanded—they don’t expect that their kids’ health to be jeopardized.
But the reality is that the environmental conditions in aging or deteriorating school facilities can harm kids’ health and compromise their ability to learn. This is partly because children may be exposed to a variety of environmental hazards—such as lead, asbestos, molds, radon and volatile organic compounds—as well as toxic chemicals and pesticides at school. Half of U.S. schools have problems with indoor air quality, according to the Environmental Protection Agency (EPA), and research suggests that the poorest children in the poorest neighborhoods have schools that are in the worst condition.
Sixty percent of kids suffer health and learning problems that stem from the conditions of their schools, according to the Coalition for Healthier Schools’ Towards Healthy Schools 2015 report. Children are especially vulnerable because they’re smaller; their organs are still developing; they spend more time on the ground; and they breathe more air and drink more water per pound of body weight than do adults, according to the EPA. They also may not be able to identify obvious hazards and move away from them.
Reducing environmental risks in schools offers significant payoffs in multiple domains. Improving indoor air quality can reduce asthma attacks by nearly 40 percent and upper respiratory infections by more than 50 percent, according to the 2006 report Greening America’s Schools: Costs and Benefits. What’s more, a study weighing the costs and benefits of developing green schools for Washington State estimated a 15 percent reduction in absenteeism and a 5 percent increase in test scores, according to the Towards Healthy Schools 2015 report.
“A healthy school has a building that promotes health and learning—it will be clean, dry, and quiet. It will have good control of dust and particulate matter. It will provide good ventilation and good air quality,” said Claire Barnett, founder and executive director of the Healthy Schools Network Inc., a non-profit organization dedicated to children’s environmental health and safety in schools. “This also assumes there’s no lead in the pipes, no PCBs in lighting or other old building materials, and no routine spraying of pesticides indoors or out. It shouldn’t be hard to have a building that meets these standards but it is. Parents shouldn’t take it for granted that a school facility is healthy.”
In 2012, a new campus was constructed for the Buckingham K-5 public school in rural Dillwyn, Va., replacing the original middle and high school buildings that had stood since 1954 and 1962.
The Charlottesville, Va., architectural firm VMDO Inc., which constructed the campus, says the sites were transformed into a modern learning campus with the aim of addressing the growing concerns of student health and wellbeing. New facilities include a teaching kitchen; innovative food and nutritional displays; an open servery to promote demonstration cooking; a food lab; a small group learning lounge; scratch bakery; dehydrating food composter; ample natural daylight; flexible seating arrangements; and outdoor student gardens.
The firm took advantage of the school’s natural setting surrounding a pine and oak forest and wove them into the design and construction to showcase the “active landscape.” The school’s project committee and design team worked collaboratively to create a total learning environment in order to support learning both inside and outside the traditional classroom. Each grade level enjoys age-appropriate outdoor gardens and play terraces, which encourage children to re-connect and spend time in their natural surroundings. Inside the schools, in addition to core classrooms, each grade level has small group learning spaces that transform pathways into child-centric “learning streets” that have soft seating and fun colors that communicate both collaborative and shared learning experiences.
To study the impact of the healthy design features, VMDO teamed with Matthew Trowbridge, MD, MPH, an associate professor at the University of Virginia School of Medicine, with a special interest in the impact of the built environment on public health to study how health-promoting educational design strategies can support active communities and reduce incidence rates of childhood obesity.
NewPublicHealth recently spoke with Trowbridge about the project.
NewPublicHealth: How did the project come about?
Matthew Trowbridge: Through a collaboration between me and Terry Huang, who was a program officer at the National Institute of Child Health and Human Development and a leader in that institute’s childhood obesity research portfolio. [Editor’s note: He is now a Professor and Chair of the Department of Health Promotion, Social & Behavioral Health University of Nebraska Medical Center College of Public Health.] Back in 2007, Terry had been thinking about how architecture, and particularly school architecture, could be utilized as a tool for obesity prevention. The thinking behind that is that schools have always been a particularly interesting environment for child health very broadly, but also obesity prevention in particular, partly because children spend so much time at school and because the school day provides an important opportunity to help children develop healthy lifelong attitudes and behaviors.
One of the insights that Terry had was that while public health had done a lot to develop programming for school-based obesity prevention, the actual school building itself had really not been looked at in terms of opportunities to help make school-based obesity prevention programs work most effectively. In 2007, Terry actually wrote a journal article outlining ideas for ways in which architecture could be used to augment school-based childhood obesity prevention programs that was published in one of the top obesity journals. When I met Terry at NIH, we realized we both shared an interest in moving beyond studying the association between built environment and health toward real world translation. In other words, providing tangible tools and guidelines to foster collaboration between public health and the design community to bring these ideas into action.
Earlier this year, when a federal task force convened to look at how to help Detroit pull out of bankruptcy and regain resident and business confidence, one of the first recommendations was to assess the many blighted areas of the city—typically created when residents leave an area in droves, or when a business moves out of a building and isn’t replaced by another—and begin restoring them for residential, business or green space use.
Blight matters. Beyond making a city ugly, abandoned areas become a haven for trash, toxic elements, drug sales and prostitution. In Dorchester, outside Boston, a space sold by the city for a parking lot was left vacant for years and became a trash dump with mounds of cigarettes, and cars and tires—all leaching toxins.
A growing number of communities are starting to clean up those lots. In Baltimore, flight from the city has left close to a million homes and apartment buildings vacant over the last few decades, leaving in their place empty, dirty spaces that invite crime and trash. Bon Secours Community Works—the foundation of the Bon Secours Health System with hospitals in Baltimore and other cities—supports initiatives aimed at creating stable housing, including a program called Clean and Green, which is a part of Bon Secours' Housing and Neighborhood Revitalization Department.
Clean and Green is a landscaping training program that has transformed more than 85 vacant lots into green spaces, and has also begun to initiate community arts projects such as large public murals and community gardens. The program is designed to teach green job development skills, as well as provide free cleanup and beautification services to Baltimore neighborhoods.
Each program team is hired for six months of on-the-job training in green landscaping, during which they learn how to use landscaping and gardening tools and then go out into the field to clean lots, plant trees, pick up trash and do weeding. As part of their training, each individual gives at least three presentations about some aspect of green landscaping that they’ve learned, further preparing them for job interviews and jobs in the field. Each summer, youth employees also join the Clean and Green team for six weeks, working alongside the adults to learn about green landscaping and giving back to a community.
Planners, public health experts, community development leaders, architects and many others have come together over the past decade to focus on housing as a framework for a healthy life. A report released earlier this year by the Robert Wood Johnson Foundation’s (RWJF) Commission to Build a Healthier America made the link between health and housing clear:
“Living in unhealthy homes and communities can severely limit choices and resources. Healthy environments—including safe, well-kept housing and neighborhoods with sidewalks, playgrounds and full-service supermarkets—encourage healthy behaviors and make it easier to adopt and maintain them.”
Housing also impacts health when people spend so much on their rent or mortgage that they don’t have enough left over to pay for critical expenses such as food and medicine. According to the MacArthur Foundation—which released its second annual “Housing Matters” survey last month—during the past three years more than half of all U.S. adults have had to make at least one sacrifice in order to cover their rent or mortgage, including:
- Getting an additional job
- Deferring saving for retirement
- Cutting back on health care and healthy foods
- Running up credit card debt
- Moving to a less-safe neighborhood or one with worse schools
Ianna Kachoris, a MacArthur Foundation program officer who oversees its How Housing Matters to Families and Communities research initiative, said that the quality and safety of a home make a significant impact on a person’s overall quality of life. Among the housing specifics that can impact health are lead or mold; the need to move frequently; having to live with many other people to make housing affordable; and concern over being able to afford the rent, the mortgage or needed housing repairs. The survey also found that accessing affordable quality housing in their communities is difficult for many people, including families with average income, young people just getting started in the labor force and families who want to live in quality school districts.
Allison Larr, 25, graduated from Columbia University’s Mailman School of Public Health a few weeks ago as a member of the 2014 Master’s in Public Health class and will soon start working at Citigroup in New York City as an analyst in the bank’s public finance division, which finances infrastructure projects.
“Infrastructure is central to maintaining a healthy population,” according to Larr. “If you don’t have a sewer system, public transportation and roads, you won’t have a healthy population.”
NewPublicHealth recently spoke with Larr about the path she took to her new career.
NewPublicHealth: How did you end up at Citigroup?
Allison Larr: As an undergraduate I studied neuroscience, and I was considering pursuing a career in academia or medicine. After my college graduation, I worked for a psychiatric research organization where I realized that I didn’t want to perform the traditional academic roles of creating and distributing knowledge or devote my life to being a physician, but I still wanted to work in a field related to health. By that time, I had developed quite an interest in the environment and in climate change, and so I thought why not connect these two by studying environmental health sciences and figuring out some sort of way that I could work in that field on large-scale problems related to health from upstream processes.
When I started my Master’s in Public Health at Mailman, I didn’t really have a clear vision of exactly what I wanted to do after graduation. I did know that I wanted to work on some bigger-picture environmental issues related to health, so I chose environmental health policy. I worked on a funding opportunity for electric vehicle infrastructure, and that was really the first time that I considered anything related to finance as related to health, because electric vehicle infrastructure would certainly increase electric vehicle uptake, which would have a positive impact on public health through reduced emissions. And in order to make that happen, you need to be able to pay for it.
That’s when the seed was planted that finance could be health related. Following that I worked at the New York City Department of Environmental Protection in the energy office, and when we were evaluating potential projects, part of my role was to evaluate how much greenhouse gas savings the projects would produce, as well as the payback period—investigating really whether it was a worthwhile investment from a financial point of view.
At this week’s Spotlight: Health conference at the Aspen Ideas Festival, Michael Murphy of the MASS Design Group will be part of a panel called “Buildings that Heal.” Murphy is a recent recipient of a grant from the Robert Wood Johnson Foundation (RWJF) for a two-year year research initiative to investigate effective and innovative models of health care facilities in Rwanda and other Sub-Saharan African countries. The goal is to gauge the implications for community health and economic development and then disseminate the findings in order to help improve facilities in the United States.
NewPublicHealth spoke with Murphy ahead of the Spotlight: Health conference.
NewPublicHealth: Tell us about the scope of your work.
Michael Murphy: I’m an architect and designer by training, and I launched MASS Design with my partner, Alan Ricks, around designing built environments to improve health outcomes. We have been working with a number of NGOs in the global south, thinking about the way that hospitals are designed and the built environment, and seeing very specific and direct links between our built environment and the health of our individual selves and our communities. We were struck by the direct links between the two, and how un-designed those environments are when they could be so easily shifted to improve people’s health.
NPH: Where have you done your work?
Murphy: We have an office in Rwanda where we built the Butaro Hospital in Northern Rwanda, together with the healthcare nonprofit Partners in Health. That first opportunity came about after meeting with the group and seeing that they were doing a lot of their work without the help of designers and architects. We were given the opportunity to assist their infrastructure team to help them rethink hospitals. We finished Butaro Hospital in 2011 and since then have brought this model to other countries, eight of which are in Africa: Tanzania, Uganda, Gabon, Liberia, Zambia, Malawi, the Democratic Republic of the Congo, Burundi and Haiti.
So, we have quite a bit of experience thinking about the health care environments that are affecting some of the more vulnerable communities in the world, and we encountered some real insights that could actually vastly improve the way in which we think about our health care environments back at home in the United States.
One of the key lessons of Hurricane Sandy—which caused massive destruction in New York and New Jersey, two states that don’t usually see that kind of weather devastation—is that disasters can strike anywhere. That’s the thinking behind a new exhibit at the National Building Museum in Washington, D.C., Designing for Disaster, which brings together objects, video, photos and interactive components to show that policies, plans and designs can result in safer, more disaster-resilient communities.
A key goal of the exhibit is to share ideas for building and rebuilding. In a recent interview posted on the museum’s website, the exhibit’s curator, Chrysanthe Broikos, asks “as we face an increasing number of destructive and deadly natural disasters...should we have the right to build exactly what we want, where we want, no matter the risks? Should we give more thought to the long-term viability and protection of the structures and communities we build?”
Those are policy discussions underway right now, and some suggestions are being shared in a “disaster mitigation” blog launched to complement the exhibit. The blog invites building and disaster experts to post their ideas and thoughts on how to make us all more disaster-resilient.
The exhibit highlights current work by planners, engineers, designers, emergency managers, scientists, environmentalists, business leaders and community leaders, some viewable in a short video on the exhibit. For example, constructed just for the exhibit is a Federal Emergency Management Agency (FEMA) “safe room” that would be highly protective if a tornado struck. But the exhibit asks the necessary questions, as well. For example: What if requiring safer construction makes housing unaffordable for many?
While many of the exhibit designs are experimental, the museum’s website also offers resources to learn about steps individuals can take in their own homes and communities to prepare for disasters, remain safe and prevent damage. FloodSmart, for example, is a FEMA resource which lets users see how much damage flooding can cause, assess flood risk and learn about flood insurance.
>>Bonus Link: On June 24, the National Building Museum will hold a competition, Rebuild by Design, that challenges contestants to envision rebuilding designs for communities devastated by Hurricane Sandy.
Although the overall traffic death rate is dropping, the number of pedestrians and bicyclists killed by distracted drivers in the United States is climbing, according to a new study in Public Health Reports.
Researchers utilized the Fatality Analysis Reporting System to find crashes on public roads from 2005 to 2010 that led to at least one death, finding that pedestrian deaths jumped to 500 from 347. The number of bicyclist deaths rose to 73 from 56, with a peak of 77 in 2008. They also found that distracted drivers were three times more likely to hit pedestrians on road shoulders and 1.6 times more likely to hit them in marked crosswalks.
“The problem is that pedestrians and cyclists have little protection on the roadways,” said study author Fernando Wilson, PhD, associate professor in the College of Public Health at the University of Nebraska Medical Center, adding, “Evidence suggests that separating non-motorized travel from motorized travel, through bike lanes or other redevelopment efforts, could greatly reduce deaths.”
The study’s authors concluded that new and better policies are needed to stop this growing public health problem. They hope that the findings—particularly the demographic findings—can help advocates and policymakers determine exactly what these policies should be.
For example, the pedestrian victims are more likely to be:
- Older than 65
- Physically impaired
- On the road shoulder
- Hit during the day
Bicyclist victims are more likely to be:
- Riding in the morning
- On the road shoulder
- In a rural area
The study was funded by the Robert Wood Johnson Foundation’s Public Health Law Research program.
A story on the urbanwonk blog of The Atlantic Cities website finds that in Vienna, Austria, pilot projects are taking women’s home, work and elder care responsibilities into account in design planning. For example, surveys found that women—often with strollers in in tow—were more likely than men to use public transportation and needed some accommodating. They also found that after age nine boys were more likely than girls to use park space, perhaps because the girls felt fearful or outnumbered. A reengineering soon followed that brought girls into the parks. Austrian city planners have worked a lot of that data into other city construction, including a pilot apartment complex that includes onsite parks, doctor’s office, a pharmacy and a preschool.
A key concept? Assess needs first…and then plan the design.
>>Read the full article at The Atlantic Cities
>>Bonus Link: Read a NewPublicHealth post on creating safer urban biking opportunities for women
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?