Health Beyond Health Care: Q&A with Matthew Trowbridge, MD, MPH

Jul 18, 2014, 1:32 PM


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. 

file (Image courtesy: Tom Daly)

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.

An important inspiration for the Healthy Eating Design Guidelines and the Buckingham School project was the Active Design guidelines, developed by the New York City Department of Health and Mental Hygiene and the New York City chapter of the American Institute of Architecture, which were released around the same time. The Active Design Guidelines were a major step forward for the field of built environment and health because they provided a tangible, useable tool for designers to public health research into practice.

So an architect can decide that he or she has a client and a building and a project that may be amenable to targeting physical activity—in other words active design—and you now have a tool that they can utilize and it goes through in detail critical features such as how to design stairs.

NPH: How did you connect with the Buckingham School project?

Trowbridge: I live in Charlottesville, Va., and we happen to have a world-class architecture firm here in town, VMDO Architects, that specializes in educational facilities. One of their staff members invited me to come speak at their firm. I talked about how the intersection of health and design was emerging as a field within public health and ended my presentation with an open-ended hope that it was time to start piloting these ideas in real-world projects. VMDO came back to me and told me they had a client, Buckingham County, that had expressed an interest in thinking about health as a part of what they want to do with their school design. And the project went from there.

NPH: How long did it take from design to completion?

Trowbridge: Well, it’s important to think about this project as one that happened in different phases. In many ways, we feel like the real project was building a framework for collaboration between VMDO Architects and our public health research team which developed the healthy eating design guidelines for the Buckingham School architecture.

What was really cool actually was that they didn’t jump right in to designing a school. We got the designated staff members of the firm to sit down with us and over a course of several weeks we developed the guidelines.

We went through all the spaces of the school and its grounds and brought as much available research and theory as we could to the table, and then the architects helped us translate that into actionable design decisions. The healthy eating design guidelines were then utilized by VMDO to inform the design of the Buckingham School project. So Buckingham really represents the first field test of the design guidelines.

NPH: Did Buckingham have all the money it needed for both the structural changes and the guidelines changes?

Trowbridge: One of the really important aspects of this story to emphasize is that Buckingham County is in a rural, ethnically diverse school district in central Virginia where resources for large-scale building projects are limited. The community saw the redesign and renovation of Buckingham, which is the main elementary school for the entire district, as an important opportunity that only happens once every few decades.

This was an important insight for our research team. A major school building project is not just a chance to create a cool building and it’s not just limited to the school. It’s really not overstating it to say that it’s a critical opportunity to engage the community and put a Culture of Health at the center of the discussion. It’s one of the largest community investments that is made. It’s an amazingly powerful opportunity to change the discussion about public health in this community and surrounding district.

It’s also important to note that while the architectural firm had been not been hired initially to consider concepts like health promotion, adding the healthy design features did not change the overall budget of the school.

That said, for VMDO this was a completely new project. They had never been as deeply engaged with the community. It did take a big investment on VMDO’s part. Developing a business model with attractive incentives and recognition for cutting-edge architectural firms willing to engage in public health research will be critical to expanding understanding and implementation of this type of work going forward.

NPH: What’s next for you in terms of the design principles that promote healthy activity and wellness for young students?

Trowbridge: We need more opportunities for public health researchers to engage directly with design firms to keep learning how to improve access to healthy environments for all.

Development of the Healthy Eating Design Guidelines and the opportunity to collaborate on the design of Buckingham Elementary with VMDO occurred as the result of a series of serendipitous events. Going forward, as we work to make this type of collaboration more deliberate and routine, we need to engage the community as fully as possible and early in the process. Each community needs maximum opportunity to determine and target health promotion priorities it wants to address through design projects such as a school redesign. In addition, we need to develop ways to ensure input from each stakeholder in a school throughout the design process.

NPH: How are you sharing this information?

Trowbridge: The Robert Wood Johnson Foundation funded a video about the project, and we have been presenting at design conferences such as the America Institute of Architects. We’ve also published about the design guidelines and school project in both public health journals and architectural and design publications.

Looking longer-term, our team also hopes that the health eating design guidelines—informed by our experience in Buckingham—could be used as the basis for credit within green building certification, such as the LEED rating system developed by the U.S. Green Building Council. Green building certification has revolutionized the building industry by driving adoption of sustainable building strategies. And now we’re just beginning to see health-focused credits becoming available as options within these systems. This is a huge potential opportunity to drive health-focused design at scale given the tremendous market position and demonstrated return on investment of green building certification.

Toward this end, we’re concentrating on making tools that are available at a broad scale and sharing what we’ve learned from the process so that design firms and other public health teams can form their own collaborations. We need more architecture firms to work with public health researchers the way in which VMDO did. Ultimately, we want every school being developed and designed to have health promotion as a central consideration and motivation.

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This commentary originally appeared on the RWJF New Public Health blog.