Architecture and Public Health: A NewPublicHealth Q&A with Brooks Rainwater
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.
NewPublicHealth: And what is MIT’s role?
We see MIT as a critical partner with AIA on Decade of Design, with a core focus on health and urbanism. The Center for Advanced Urbanism's expertise focuses on integrating separate disciplines in architecture, landscape, ecology, transportation engineering, political philosophy, politics, technology and real estate. And that’s really just great to be able to pull all of those things together so we can look at this problem holistically and work at scales ranging from complex regional systems to local communities and at the neighborhood level.
We want to develop evidence-based guidelines and design solutions. So over the next decade, the project will develop these solutions through research, prototypes and demonstration projects, and the ultimate goal is to transform cities for concerted participatory action supporting human economic and environmental health improvements, by using designs as the key nexus point between them all.
NPH: How does the project build on previous efforts by the AIA to improve community health?
Rainwater: The AIA has been focused on improving community health in a number of ways over the years. Two specific programs are our local leaders report and our design assistance program. Our latest report, Local Leaders Healthier Communities through Design, sought to demonstrate the power of architecture to improve public health, with policies that promote active living, accessibility, transit options and better indoor air quality. The U.S. Centers for Disease Control and Prevention reports that chronic diseases are now the leading cause of death and disability in the United States and that it's imperative to focus on community-level solutions, and we think that design is a big part of that solution.
We put together a number of case studies that showcase policies and initiatives for designing buildings that promote physical activity and reduce respiratory illness. They also covered living streets, promoting access to fresh foods and building livable neighborhoods for all ages with accessible high quality housing.
We also have a program called the Sustainable Design Assessment Team which is focused on community development. It is a community assistance program that focuses on the principles of sustainability and brings together teams of volunteer professionals including architects, urban designers, landscape architects, planners, hydrologists, economists, attorneys and many others to work with community decision makers and stakeholders to help them develop a vision and framework for a sustainable future.
The RUDAT program, which is our longer-standing community assistance program, focuses on regional scale urban design assessment. Communities across the country constantly change and they face many challenges. Some of these challenges they encounter include the loss of major employers, new bypass roads, gridlock, unfocused suburban growth, loss of urban space, unaffordable housing, and many others, and so what happens with the RUDAT is they can help communities respond to these kinds of issues, develop that vision for a better future for the community and implement a strategy that will produce results. Because the process is also highly flexible, it is effective in communities as small as villages and as large as full metropolitan regions.
NPH: What are the chief goals of the MIT course and what have the findings been so far on Los Angeles and Atlanta?
Rainwater: The chief goals of the course have been to create the foundation for further research and to be an in-depth workshop on health and urbanism. The students conducted research at the intersection of design, urban planning and public health to develop those contemporary insights about future urban form and structural adaptation. They did in-depth research at MIT, and also went out to eight cities throughout the country that were chosen to be “ laboratories” of research analysis, invention and ultimately the development of health metrics for new design proposals.
What is really exciting about this is that it tied in with the Center for Advanced Urbanism's teaching strategy, which is learning by doing. Multidisciplinary students were able to come together, from architecture, landscape architecture, urban planning and urban design. And they drilled down not only at the full county health metrics level but also studied them at the neighborhood level.
In Los Angeles you have a city with 10 million people which is a trendsetter for the rest of California and for the nation. Some of the key findings centered on neighborhood form, location and—of course—Los Angeles' omnipresent highway corridors.
A key finding by the students was that throughout the region, high-income residents tended to live in more urban areas along the coast and within the suburban areas in the mountains, while low income residents lived in the urban basin and suburban desert areas. So this type of settlement pattern had really important impacts on public health. At the same time, having five of the ten worst-congested roadways in the United States also greatly impacted public health. We also saw that 87 percent of new residential construction has been multifamily, which is just amazing to see in Los Angeles, and much of it is in transit-oriented development. But much of it straddles congested highway corridors, so you have the benefits of transit oriented development, but a lot of the construction is being built in areas with dangerous particulate matter zones. That could result in increases in asthma-related illnesses.
What the MIT students found is that the city may want to look at different potential models of development surrounding transit. One of the questions that they posed is perhaps there might be a different way to develop so that there isn’t so much high-density development right next to the transit corridors.
When we looked at Atlanta, the research showed that health indicators tended to be best in the inner suburbs of Atlanta rather than the city itself or the outer suburbs. And this is interesting; too, because it was a consistent theme that they found throughout all eight of the cities that they looked at, inner suburbs generally exhibited the best health indicators. And similar to Los Angeles, the freeways and high congestion areas tended to have high asthma and some poor health indicators.
The students came up with a number of initial recommendations focused on the need for transit to be better distributed. They also thought that the Atlanta beltline was a very exciting and well-meaning project, but that it could be further developed and continue to function as an opportunity for mitigating health risk, particularly since much of it transects with high health risk areas. And then they looked at whether there was a way to relocate some brownfields—properties that may have hazardous materials—to lower-risk areas and create healthier outcomes.
NPH: What happens after the course report is released in the fall?
Rainwater: We’ll narrow our focus on which of the eight cities the AIA will focus on. And the MIT course will begin again in the fall though we’re discussing now whether it will look at a smaller set of cities.
NPH: How will you help implement some of these ideas the students have suggested?
Rainwater: We'll work together with MIT on reaching out to community leaders, working within the political and business environment in the community. We have our members on the ground with very strong chapters in all of these cities that already have those connections. We'll work with local public health officials as well. It’s going to be a joint effort with the research side led primarily by MIT. We’re still building that basis for the research and actual activation of the program.
The plan will be to work directly with the community. Over the first few years we're focused on planning the design and policy ideas, and then we'll move to the demonstration phase and that’s when we will partner with developers and other local people to actually demonstrate these policies in place. And so it will be a mixture of researchers working at MIT as well as on the ground in the community that we're working with.
NPH: And what other initiatives are ongoing at AIA to improve community health?
Rainwater: Design and health is one of the key initiatives of the AIA. It's grown out of a number of programs including having Dr. Richard Jackson, Professor and Chair of Environmental Health Sciences at the UCLA School of Public Health, on our board, and we've worked with him over the years on these issues. He was able to help communicate the importance of how design can positively affect public health and so from that, we formed a group called America’s Design and Health Initiative, which brought together professionals from public health and architecture to start that conversation.
And over two years we convened a number of meetings with that group, put out recommendations on how professions could work better together, and grown from that into a program whose advisors include Dr. Jackson and a number of other high-level officials from public health as well as architecture, help guide our ongoing efforts within this realm. We've also formed an internal steering group focused on design and health to talk about how we can bring this conversation into our advocacy and policy efforts and ingrain this idea that architects can play a big role in improving community health at the building level, the neighborhood level and the city level itself.
NPH: What is the one thing you would want someone working in public health to know about how Design in Architecture can impact this world?
Rainwater: That design makes a big impact on health because the way that individuals interact with their building, with the neighborhood, with how they walk from one building to the next can really increase the level of activity that people have. Creating the community where people have the ability to live, work and play where they are rather than having to always rely on automobiles to get around as well as using building materials that are the safest choices, will also impact health.
So much of what designing for health is is providing people options so that they can interact with their environment in different ways and make those choices that can really improve their health.