Continuous, holistic, and equitable health communities

What Covid-19 revealed

The pandemic highlighted and underscored the multi-variate factors influencing personal and community health such as housing, nutrition, safety, education, and economic stability. With national conversations turning to examine the role of structural racism in our society, we’ve seen the role of race in health outcomes emerge as an important and integral topic. Your zip code should not affect how long you live. But in too many communities it does, and dramatically so. 

Our industry has taken note. In 2020, the Advisory Board focused on racism as a healthcare issue and offered resources to address racism in health care. 

In 2020, the AMA recognized racism as a public health threat. And in 2021, the AMA released a report and promised to pivot from ambivalence to urgent action on racial equity.

Health equity is not a new topic

We’ve been talking about health equity for years—in healthcare, in public policy, and in the design industry. But a quick reminder: Health equity means building a society where everyone has a fair opportunity to be as healthy as possible. Health equity means reducing and ultimately eliminating disparities in health, especially its determinants that affect marginalized groups.

So, promoting health means removing obstacles to health such as poverty, violent crime, lack of quality housing, discrimination, and lack of access to stable jobs. Health equity is not about settling for the current average. When there are disadvantaged populations who are unable to access health, the average is unacceptable. Now is the time to embrace these concepts and create a new standard of excellence. 

How do we get from where we are to a more equitable, wellness-oriented, holistic network for health? What is it going to take? Design has a role to play in realizing healthy and equitable community networks. Here are the key elements I believe will define that role.

Mode shift: Embrace a new way of thinking

Achieving our goal will require a dramatic and intentional shift in how we think and act regarding health.

The first step is recognizing that structural racism contributes to real health inequalities in our communities. Educating ourselves about structural racism and the practices that help dismantle it is an important aspect of advancing health equity. And likewise, in creating places for healthier communities to thrive, we expand opportunity.

Fundamentally, this mode shift redistributes our focus on the hub and spoke model of healthcare to an emphasis on networks of healthy living. It will feature a new emphasis on upstream approaches to wellness that prevent health issues and improve health disparities.

Vision: Lead by example

Remaking our environments to position health as a key priority requires designers and all stakeholders in the built environment to engage in robust placemaking across functions, destinations, infrastructure networks, and amenities. 

Today’s interventions, places that point toward this equitable version of healthcare in the community, can serve as powerful stepping stones. For example, a new women’s hospital that puts the patient experience first and promotes healing through sense of place is a step in the right direction.

Creating places within the healthcare continuum focused on preventative care is a start, but these interventions alone will not achieve the goal of a continuous and equitable health network. We should applaud places for leading the conversation and showing us what’s possible, but a deeper disruption is necessary.

Deeper disruption requires designing with the broader community in mind, considering both “well places” and “sick places,” connecting across communities for an integrated network, less isolated projects, and more contextual understanding of impacts on surroundings and people.

Our new mindset informs our design vision. We no longer see a hospital as simply a place for onsite treatment, but rather as part of a network that reaches out and engages the community. Taking an even wider view, we see how the health system network—where prevention and care takes place—is overlaid onto the community/city itself. Through this lens, we consider not just how the city design relates to the places where treatment takes place but how the urban plan impacts health and wellness every day.

We can lead by example and think holistically about design for health across the community.

Design can’t create healthy communities by itself. And it isn’t going to solve health equity on its own. Establishing truly healthy communities requires visionary effort from investors, developers, elected officials, policy makers, institutions, insurers, community leaders, healthcare providers, and others. It’s going to require forming new and integrated alliances and thinking outside of our areas of focus.

In our collaborations, we can offer a more holistic view of what development can do to knit together community needs. We should be ready to “catch” on the other side of the process when institutions, public entities, or providers make health equity a priority in their projects. We can speak a language of health equity in design—and fluently. Our design process, for example, must welcome input and look at outcomes for the most vulnerable populations.

Together, we can unite around a shared vision for our intention to create innately healthy built environments. 

What’s next?

What are the next steps we can take to manifest this reality? Listen, gather ideas, and make a commitment (see our commitment to equity and inclusion in the design process in Issue 12 of the Design Quarterly).

What actions can you commit to that contribute to a mode shift to an equitable, healthy community?