Health in All Design

Note: the following is a summary annotated slide deck from a talk given in London, UK in the Summer of 2019 which can be seen here.

1 / What if everything we build & design was done with Health as a Priority? Much like policy makers adopted, “Health in All Policies” , what if architecture systematically committed to “Health in All Design?” #HealthInAllDesign

2 / Architecture in fact has a long history of incorporating health into design. The earliest writing of architecture come from Marcus Vitruvious (1st Century BC) where he explicitly advocated medicine as a core competency.

3 / Vitruvius also advocated for a close connection of medicine and design by insisting that our design reflect the same proportions of the human body. The Vitruvian Man (popularized by Da Vinci) was in fact a 1st Century idea.

4 / Avicenna, the 9th century physician and polymath made seminal contributions to medicine. Among them? That disease had a geographic location and where you live mattered to your health.

5 / Of course this would be a similar frame work that would allow John Snow, in 19th century, to understand the outbreak of cholera by literally locating it onto city maps.

6 / Architecture has always had a strong connection to our health. But is that still true? When you think of the most pressing problems in our health, who do you think of to solve them? Clinicians? Scientists? Policy Makers?

What about architects? We don't, but we should...

7 / Let’s step back and think where we are as a society now. Healthcare is the most expensive and uncoordinated its even been. In fact, life expectancy in the US & UK has actually gone *down*.

8 / How is that possible? For all our advances in modern healthcare and technology, are we somehow getting worse? I don’t think so. There are just too many examples of great discoveries and advances. For example here via @Atul_Gawande.

9 / But it’s worth asking, are those specialized services available to most people? And is that what most people need? At its best, healthcare explains ~10% of our health. What’s more? Environment and our day to day behavior accounts for ~60%.

10 / In other words, if we want to make meaningful improvements in our health, having a great healthcare system is necessary, but not sufficient. We must also address the way we build and design the places we live, work and play everyday.

There are some promising examples...

11 / Example 1 of Design & Health: 541 Vacant City Lots in Philadelphia were randomized to either stating vacant vs landscaped. The result? People living near landscaped lots reported 42% lower rates of depression.

12 / Example 2 of Design & Health: In Ontario, Canada researchers found those living in the most walkable neighborhoods – places with walkable services & destinations, higher connectivity to other people—experienced lower rates of obesity & diabetes.

13 / Example 3 of Design & Health: What about a healthy building? Based on >3,000 publications, the @CDCgov @USGSA established “FitWel” criteria to help create healthier workplace environments. To date, >790 buildings have FitWel certification https://fitwel.org/ 

14 / Is there demand for #HealthInAllDesign? A recent survey by @AIA_national of prospective clients in the US planning large capital projects in the next 3 years; 84% said they would want the design to explicitly address health as a priority.

15 / But why are healthcare stakeholders taking interest in the built environment now? With post #ACA mergers and consolidations, many have monopolized large geographic regions. As such, investing in the actual physical space has potential return and capture.

16 / Nearly every health insurer in the US now has a regional housing portfolio. Compelling Op-Ed from @PatrickConwayMD on why that (and addressing food deserts) makes sense.

17 / So let’s assume we all committed to the #HealthInAllDesign today, how would we know a decade from now it worked? Architecture will need to embrace Ernest Codman’s “End Results” idea and begin tracking the impact of our design on health.

18 / It won’t be enough to simply come up with designs that we find meaningful to health, but we should also be able to measure (at least part of most of it) so that we can continually test and improve the quality of our design.

19 / If done right, Architecture can reclaim a central in improving health. It would not only be timely given the challenges of healthcare today, but also be true to the earliest roots and foundations of architecture.

20 / Think back to today, and all the spaces you spent time – home, office, subway, mall, stadium—and ask yourself, “What that space designed with health as a priority?” What you do differently to make the space healthier?

21 / Enjoyed the conversation in person this week – look forward to continuing it here.

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Andrew M. Ibrahim MD, MSc is the Chief Medical Officer at HOK, a global design and architecture firm. More information about his work can be found here: www.SurgeryRedesign.com