At the AIA Conference, Public Health Emerges as a Powerful Tool for Architects
On several panels focused on cities, arguments connecting public health to architecture arose as new tools for empowering architects.
The world has countless ways of reminding architects of their powerlessness: Zoning rules straitjacket a project, a limited budget precludes quality finishes, the list goes on. So when architects look at cities and their challenges—which include looming “smart city” technologies, new resiliency imperatives, and evolving sustainability metrics like embodied energy—things can seem insurmountable. Coming into the conference, Metropolis anticipated that panel discussions would focus on these essential topics. While all these topics were cited during city-focused panels, a surprising common thread—one that promised to empower architects—quickly emerged: public health.
Public health is a broad topic, but the crux of the argument is this: architecture and urban design can deliver tangible, quantifiable solutions to public health challenges. This connection especially applies to certain building types, first and foremost affordable and supportive housing targeted at reducing homelessness. This is because placing the homeless in supportive housing (i.e. affordable housing paired with social and health services) reduces emergency room visits by homeless individuals, saving states, cities, and insurance companies enormous expenses.
Brenda Rosen, president and CEO of Breaking Ground, a New York supportive housing organization dedicated to fighting homelessness, explained to an audience of architects that, “We always say, ‘housing is healthcare.’” Similarly, affordable housing can lessen rent burden, freeing income for medical expenses, or ensure better access to primary care doctors. When faced with opposition to funding or locating affordable/supportive housing, architects can help “connect the dots” between their projects and public health (and public pocket books), said Karen Kubey, an urbanist specializing in housing an public health.
Sometimes the health benefits of better architecture and urban design are subtler, but no less factual. For example, in one panel, Dr. Bon Ku, a Philadelphia doctor and activist, said that vacant lots have a negative effect on health. He cited medical studies (similar to this one) which have demonstrated that greening decrepit lots has a real “physiological impact on people,” as evidenced by lowered heart rates (a good general proxy for overall health).
That observation was echoed by Claire Weisz, co-founder of architecture and urban design firm WXY. In a separate panel, she argued that these kinds of public health benefits could be broadly applied to the building environment. “Are streets a health system? I’d say so,” Weisz said as she highlighted her firm’s revamp of Astor Plaza, which introduced more green and pedestrian space to a formerly car-dominated Manhattan intersection.
In another panel, two representatives from the CDC—Liz York and Chris Kochtitzky—described how neighborhoods designed for walkability and outdoor recreation demonstrably reduce diabetes, cardiac illness, and injuries that could lead to opioid prescriptions and subsequent abuse.
If streets are a health system, then schools, offices, any building, could be part of health-focused infrastructure—one that Weisz said could be connected to health insurance, a national and tangible expense. This isn’t to say architecture can “solve” public health by itself—good design needs to be accompanied by nutritional foods, health education, and opioid treatment, just to name a few. Moreover, there’s always the risk that public health could be the next “greenwashing”—a flimsy, superficial claim applied to insubstantial efforts. But there are publicly-available tools, like the CDC’s Health Impact Assessment (HIA), that can help create credible claims.
And multiple panelists reminded architects that public health is an social equity challenge. “Zip code is the best predictor of how long you’ll live,” even better than DNA, said Dr. Ku.
Given the problems facing cities—from resiliency to sustainability—public health is clearly something architects can use to amplify their say. “The size of cities and the ability of cities to adapt is one of the biggest challenges architects and planners face,” said Metropolis Game Changer and architect Carol Ross Barney at one panel. As cities grow and densify, “our work for cities is going to be fixing cities.”
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