Acting U.S. Surgeon General Rear Admiral Boris Lushniak told attendees of the AIA's Design + Health summit that architects are also public health workers.
Vincent Ricardel Acting U.S. Surgeon General Rear Admiral Boris Lushniak told attendees of the AIA's Design + Health summit that architects are also public health workers.

While no one intentionally wants to design and construct an unhealthy building, design and construction professionals who believe that health and design mostly intersect in traditional healthcare facilities are in need of a major paradigm shift. “There is no such thing as neutral spaces,” Tye Farrow, principal of Toronto-based Farrow Partnership told attendees during his opening keynote at the Apr. 23–24 Design and Health Summit at the AIA’s headquarters in Washington, D.C.. “The places we create either cause health or erode our ability to thrive.”

Consider this food for thought. There are the more than 8,000 known causes of disease in humans. Asthma rates continue to rise, affecting one in every 11 children, with indoor environments, some of which are two to five times more polluted than outdoor air, being a potential contributor to asthma. Childhood obesity rates have tripled in the last three years, and children living close to freeways are three times more likely than those living farther away to be diagnosed with autism spectrum disorder. Less than half of American adults meet the Department of the Surgeon General’s 2008 guidelines for physical activity, and only three in 10 high school students get the recommended 60 minutes of physical activity a day.

The challenge of the many health ailments in this country—obesity, diabetes, heart disease, arthritis, depression—should be seen as an opportunity for design, AIA president Helene Combs Dreiling said. “What if hospitals became a last resort and the focus wasn’t on fixing bodies that are broken, but was on keeping them sound instead? It’s a prescription for design,” she said, calling for spaces that provide ample access to nature, clean air and water, that encourage physical activity, and promote interactions among people.

To that point, over the course of the summit, public health professionals and design professionals offered up evidence for the power of uniting the science of medicine with the art of design. From research showing that daylit hospital rooms shorten patient stays to forthcoming research that link improved employee health with boosted productivity, engagement, and reduced absenteeism.

“As an architect, we’re charged with the responsibility of health and safety, and there is an inherent relationship between the two,” Farrow said. However, he said, the profession is stuck thinking about health either as a typology of hospitals and clinics or simply as disease mitigation and prevention. Instead, it should focus on creating spaces where health thrives. “How can we shift our perspective to a focus on thriving? It’s not just about doing no harm, which is the basis of medicine, but it is also the concept of being able to do our best work and thinking within the environments that we create.”

This paradigm shift of recognizing the health effects of every space and building and seeking to foster health is a critical next step for the building professions, said the Acting U.S. Surgeon General Rear Admiral Boris Lushniak, who gave a special keynote. “Architects are public health workers,” he said. “We have a partnership—public health professionals and architects and planners. Our minds have to talk because we have an influence on America’s public health that we’re only now beginning to grasp.”

Acting U.S. Surgeon General Rear Admiral Boris Lushniak with Elizabeth Chu Richter, FAIA, 2014 AIA first vice president/president-elect and 2015 AIA president; Helene Combs Dreiling, FAIA, 2014 AIA president; and Robert Ivy, FAIA, AIA CEO.
Vincent Recardel Acting U.S. Surgeon General Rear Admiral Boris Lushniak with Elizabeth Chu Richter, FAIA, 2014 AIA first vice president/president-elect and 2015 AIA president; Helene Combs Dreiling, FAIA, 2014 AIA president; and Robert Ivy, FAIA, AIA CEO.

In calling architects to take action in public health, the Surgeon General stressed the need to address health as defined in three facets by the World Health Organization: physical, mental, and social well-being. “Without these three features, we can’t achieve health for all people in this nation or this world,” he said. 

In an interview with following his speech, Lushniak expanded on what this may mean for architects, builders, and designers. Improving health must be seen as a long-term initiative, he said. “Health needs to be part of the design and planning language, and a natural aspect of the process so that in asking, ‘What are we building?’ we’re also asking, ‘What’s the impact on the community’s health?’ and ‘What’s the impact on individual’s health?’” From ensuring that spaces are safe and walkable to providing opportunities for physical activity and access to natural light, Lushniak said that designers need to be aware of their responsibility to design for health. “It is as simple as asking how to get people to use a stairwell,” he said. “If it’s the ugliest part of the building and thought of as an ancillary component, guess what: It’s not effective from an environmental viewpoint or as a physical component.” 

Building professionals hoping for a checklist to track progress will be waiting interminably. Success in design and health isn’t defined by a set group of metrics, Lushniak said. “The parameters of physical health are quite apparent, and we already have national initiatives out in this realm. Our Healthy People Initiative comes out every 10 years, and Healthy People 2020 includes 600 different parameters that outline what we’re shooting for in the next 10 years. Success is measurable by us actively collecting the data and asking how we’ve improved.” However, he continued, “When it comes to mental health, we remain in a mental health crisis in this country with issues of depression, psychological disorders, and substance abuse. We have some of those parameters built into Healthy People 2020, but the psychological health realm isn’t as evolved as the physical realm. And as for social wellbeing, it’s really tough to measure success. Part of social wellbeing is having a life with an income, so what is employment? What are the country’s income levels? What’s the national poverty level? There are so many aspects to the social realm.” Thus, he noted, success is measured in movement, not hard metrics. “Success,” he said, “is that we head in the right direction.”

Architects, Lushniak said, should ask their industry organizations such as AIA about how they can get involved. In turn, the associations as well as the professionals should advocate for progress on the local level. “It’s not just about a federal lead,” he said. “Look at smoking over the last 50 years. The federal government did something, but it was a small community in California that stopped allowing smoking in restaurants. To change social norms and behavior, all parties must be involved. Part of the job is that the local community has to turn to its authorities to being change. I can yell from Washington until I’m blue in the face, but how will I get to people in Peoria, Ill., unless the residents advocate for a walkable community?”

To help foster better collaboration between the architecture and health realms, throughout the conference attendees were tasked with adding to a working lexicon—a vocabulary taken from the book Making Healthy Places—in order to best allow representatives from both realms to speak in a common language. The summit concluded with a conversation between AIA CEO Robert Ivy, FAIA, and Howard Frumkin, dean of the school of public health at the University of Washington and co-author of Making Healthy Places, about the intersection of design and health, along with a recap from Frumkin that highlighted two key goals moving forward in further strengthening the connection between and collaboration among architects and public health professionals: be optimistic, and make an impact.