VTA Light Rail Santa Clara Street Station

How good urban design can make city residents healthier

With most of the world’s population living in cities, urban design has a responsibility to sustain health rather than harming it

What makes us healthy? It’s not just hospitals. The biggest influence on our health is our physical environment and behavior. With most of the world’s population living in cities, urban design has a responsibility to sustain health rather than harming it. As demand for healthy places to live and work rises, opportunities are created that can benefit local economies, the planet, and our physical and mental wellbeing.

The geography of health has inverted. A century ago, cities were home to open sewers, oppressive smog, and infectious diseases. Today, cities are cleaner, greener, and more productive than the suburbs that once sought to replace them. But we’re just getting started. Urban design can fight asthma, allergies, heart disease, cancer, diabetes, depression, and weight gain. “Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities” asks designers to increase physical activity by putting housing near stores, offices, transit, essential services, and schools with associated well-connected, safe, and attractive infrastructure such as sidewalks, lighting, landscaping, and bicycle networks. How are cities and designers responding?

Zoning that can drive actually down healthcare costs

Zoning regulations, roadway design, and building codes can improve communities and streets. In Fontana, California, I worked with the city to update their general plan to include an element on health and wellness. As a city with higher-than-average rates of asthma and obesity, Fontana emphasizes community health through its Healthy Fontana program. We’re helping them to make decisions and plans for transportation and land use to create communities and streets designed to support walking. I’m interested in finding more urban design solutions to deliver allergy-free zones, cleaner air, and opportunities for exercise.

I was on the design team for the world’s first WELL-Certified™ urban district in Tampa, Florida, a future roadmap for how design can support public health. The WELL Standard addresses seven categories of performance: air, water, nourishment, light, fitness, comfort, and mind. Responding to the standard, we designed the district, in collaboration with walkability advocate Jeff Speck, to feature strategies including ample walkability, handsome green spaces and streetscapes with low-pollen trees, access to healthy food, green rainwater infrastructure, and access to the amenities of an urban waterfront. The district will show that designers can create cities that are in harmony with the natural systems, while also pre-emptively eliminating risk factors for chronic disease.

Appointments at the healthy hub

Soon, we might be asking health providers to contribute resources to urban design. Insurers are waking up to the fact that most of what makes us healthy is not hospitals. The definition of health care is broadening to include our environment, rather than just clinical care and medicine. As an insurer and health service provider, Kaiser Permanente profits from services they don’t sell. The company is engineering a health system to keep patients healthy and out of the hospital. Their “health hubs” reimagine hospitals as indoor/outdoor public squares. Heath hubs invite patients to linger, receive nutrition and exercise information, and join a yoga or cooking class.

Innovations are happening within government, as well. To reduce costs, some states are redirecting Medicaid funding to support the construction of new housing for the homeless. These housing-first strategies create environments for positive health outcomes and keep people out of the emergency room. I expect urban design will continue dovetailing with health care. Hospitals rank as the largest employer in many towns, their role could expand to providing compact housing for employees and their families to live near work and to provide walkable, amenity-rich neighborhoods for their communities.

A prescription for urban design

What is the payoff of urban design? Life in walkable, compact, and connected neighborhoods allows us to enjoy better health, including lower levels of obesity, diabetes, chronic high blood pressure, and heart disease. Demand for healthy places is strong. There is an established positive correlation between a neighborhood’s Walk Score® and real estate value. A study by The Center for Real Estate and Urban Analysis found that Boston’s office, retail, hotel, and residential markets have higher values per square foot in walkable urban places than in drive-only locations. Healthy places are also sustainable places. There is a positive feedback loop between healthy transportation choices and air quality. Healthy places have the added benefit that denser, more walkable locations produce lower greenhouse gas emissions per person.

Thinking big about how urban design improves health can create environments that sustain us all.


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