BEYOND INFRASTRUCTURE (audio)
December 2, 2011 – As co-editor of Making Healthy Places, Andrew Dannenberg, M.D., MPH, has worked to promote the built environment as an infrastructure supportive of a broad definition of health, one which presents the healthy choice as the easy choice. His work nests health values in the very fabric of communities—in connected streets, complete sidewalks, and recreational facilities. In his interview for the AIA’s America’s Design and Health Initiative, Dannenberg suggests the conversation surrounding health and design can extend beyond not only the physical community-scale infrastructure, but the very systems architects and health professionals use to discuss well-being.
“One of the things that’s been interesting is how different some of the terminology is between the health world and the planning and architecture world,” Dannenberg says. The vision of health is the same, but the infrastructure—the framework upon which each profession communicates—inadvertently hinders the fluid conversation between health officials and architects. “When we have classes that use various terminology, we always have to stop and say, ‘Well, do the other people in the class know what the word means if you’re not coming from the field where the term is commonly used?” Dannenberg explains. The conversation about health and design depends on each expertise looking toward their shared vision, considering their shared infrastructure, and moving beyond that to a built environment that encourages wellness and many scales.
In the accompanying audio, Dannenberg shares how public campaigns, policy, and environment justice issues can engage architects in meaningful ways beyond traditional roles. Outcomes from the 7th World Congress on Design and Health provide a framework to consider methods for architects to apply health ideas beyond the macro-infrastructure into every nuance of their design projects.
There is a substantial overlap between health and sustainability. Not everything that is done for sustainability necessarily has an impact on health, and not everything you do for health necessarily has an impact for sustainability, but the overlap is continually expanding. As the AIA’s Stair Week and New York Active Design Guidelines have demonstrated, if you can encourage folks to take the stairs, you can reduce the energy demands on a facility’s elevator. While the electrical burden an individual may put on an elevator is relatively low, privileging the elevator has a higher environmental cost than exerting a little more human effort.
There’s a lesson there, says Dannenberg. Sometimes, the value exchange from health to sustainability, or sustainability to health emerges slowly and over long periods of time. “Efficient water use is good for sustainability,” Dannenberg explains. “But I wouldn’t expect a really big health impact.” Instead, owners and product manufacturers may become more sensitive to how people consume water, or how they clean their homes, and that conversation could engender subtle transformations in a community’s well-being, plumbing, or products.
EVIDENCE-BASED DESIGN: METRICS
The transformation of sustainable design and practice into a social decision gave rise to myriad tools for measuring performance. From cheese-puff packaging to multi-million dollar construction projects, sustainability is presented in terms of percentage of post-consumer waste used, pounds of carbon emissions and kilowatts of energy saved. Market-mandated metrics have validated sustainability as a social agenda; marketplace measures are increasingly presenting health-design in that direction.
Walk Score, an online map interface, algorithmically processes information from GoogleMaps and a variety of other online data sources to assign a walkability score for any given location. Points are weighted by distance to nine amenity categories: grocery, restaurants, shopping, coffee, banks, parks, schools, books and entertainment. Subsequently, the score for an address is displayed numerically on a scale of 100, qualitatively with a description (for example, 83 is “Very Walkable”), and comparative to the city. Popularity among Realtors and homebuyers suggest that quantified walkability has an economic value; according to one study, a one point increase in Walk Score with a $500 - $3,000 increase in home values!
Unobtrusive devices, such as FitBit and Jawbone Up, announced in November 2011, connect discrete physical devices to visually clear data platforms to track well-being. The small, clip-on FitBit—it’s about the size of a USB thumb drive—displays positive messages and data on a small LED display while uploading information to a graphic web platform; UP, a sleek wristband designed by Bluetooth developer Jawbone, communicates with the user through a series of gentle vibrations and a custom iOS app that encourages the user to eat healthier, sleep better and be more physically active. Beyond the pedometer of yesterday, these devices are able to document physical activity within the built environment: GPS can document the paths we walk, the neighborhoods we eat best in, and the stairs we take daily.
The power of technical interventions like pedometers or Up, is that they put health immediately in front of the user, even when yesterday’s architecture may not. “If you put the stairway where it’s attractive and in front of you,” says Dannenberg, “we can affect behavior just because people will do what’s easier and in front of them.”
Research conducted at the University of California San Diego’s Calit2 lab underscores Dannenberg’s statement. In her interview with the AIA’s America’s Design and Health Initiative, Dr. Esther Sternberg described the implications of the Calit2 research saying, it gives you a lot of information about how people are feeling […] when they’re able to orient themselves in a given space.” That is to say, research can monitor anxiety related stress against a user’s sense of navigation. Placing stairs in highly visible places, establishing well-connected sidewalks, or clearly denoting circulation in spaces like parking garages or public transit stops have the ability to make the healthiest option the lowest stress option.
Connecting research with intuition and practice is but one facet of design’s many values. Often, the value of these design decisions are visible at the urban scale, as seen in LA’s Model Design Manual for Living Streets or Making Healthy Places, co-edited by Dannenberg, Howard Frumkin and Richard Jackson. The value of these health decisions, however, extends beyond community infrastructure into all architectural spaces and the very way that people live their lives. To illustrate this point, Clark Manus, FAIA, 2011 President writes, "In suburban America, as well as within many cities, it’s almost impossible to buy a stamp, shop at a grocery store, or drop your kids at a basketball game without driving halfway to hell and back. This is a direct result of poor design." The lasting challenge for architects and those who design communities is to make effective design decisions that keep the healthy choice the easy choice.
In an accompanying podcast, Andrew Dannenberg, M.D., MPH, discusses how public campaigns, policy, and environment justice issues can engage architects in meaningful ways beyond infrastructure. The podcast is available here. Additional resources and articles can be found at www.aia.org/cvd/