Why Architects Should Care About Public Health

While architects have long recognized the importance of human health — including physical, mental, and social well-being — as part of their mission, implementation sometimes reflects a spirit of compliance more than of aspiration. Design that is limited to preventing harm by meeting building codes and standards forfeits the full range of design possibilities that could enhance the health and quality of life of a building’s occupants and visitors.

There are many major societal trends for which architects can contribute health-promoting improvements: obesity, housing and social inequities, an aging population, hazardous chemical exposures, urbanization, nature contact deficit, energy poverty, water shortages and excesses, natural disasters, and climate change.

For example, an architect can design an attractive stairway that invites use. Providing daylighting in a school or workplace offers mental health and productivity benefits as well as energy savings for lighting. Creating a transit-oriented development encourages its residents to walk and use transit more and to drive less, with benefits that include increased physical activity, improved air quality, and fewer motor vehicle injuries.

On the flip side, we know what poor design can do. Poor-quality housing, which disproportionately impacts people with low incomes, is not only dispiriting, but is associated with poor outcomes ranging from decreased academic performance to depression to asthma and other respiratory diseases. Healthy architectural design can yield affordable health-promoting housing, featuring fresh air circulation and safe and attractive interior and exterior components.

In each of these cases, the evidence supports healthy design strategies.

So why don’t all architects incorporate health into their design now? There are several challenges. First, few architects learn about the health implications of design in their initial training or in continuing education courses — or they only hear about how design can be used in healthcare facilities. Those who do learn enough to incorporate health into their designs can encounter resistance from clients who may see positive interventions as too costly in the short term, even if the long-term benefits are well-defined.

Another barrier to adoption is the fact that — unlike more traditional aspects of sustainable design where benefits such as water and energy use reductions can be measured and reported — there is a relative lack of empirical metrics to fully quantify the health benefits of good design.

The good news is that there is movement in the field to change this. For example, the Bullitt Center in Seattle — the first office building to be certified as a “Living Building” — was the subject of a study to assess its influence on human health. The research considered environmental and behavioral data collected through measurement, monitoring, and dust sample collection, along with surveys of occupant perceptions of these factors.

The findings demonstrated how quantitative and qualitative methods may be complementary when it comes to building design and health. For instance, the study found that building users are achieving healthy levels of physical activity throughout the day. This conclusion was drawn from a combination of objective measurement and self-reported behaviors that combine to create a fuller portrait of occupants’ daily use of the design features that promote activity.

On a national scale, the American Institute of Architects and the Association of Collegiate Schools of Architecture have partnered to translate the latest public health research into architectural practice through the Design and Health Research Consortium. This unique collection of 19 universities that includes faculty from both schools of architecture and schools of public health is working to conduct and disseminate peer-reviewed research, develop evidence-based tools, and build understanding of the important link between our built environment and our health among policymakers and the general public.

We are just beginning to understand the pivotal role architects can play in enhancing human wellness and wellbeing, but clearly the potential is enormous and the time is now for all architects to begin designing health and wellness into their work. They can accomplish this in numerous ways and at any scale.

Education is a great place to start. The AIA has a growing body of coursework available online and through in-person workshops. Meanwhile, at Consortium universities and others, more and more schools of architecture are teaming with schools of medicine and public health to create interdisciplinary classes and even joint degrees. At the practice level, there are standards such as WELL and Fitwell that offer clear guidelines for incorporating evidence-based health strategies into building design, along with the incentive of certification.

Whatever the specific route, by focusing on the health-promoting aspects of design, architects can be significant solutions drivers to the major societal challenges of the 21st century — including obesity, housing and social inequities, an aging population, climate change, and urbanization — and substantially improve our quality of life. Let’s commit today to building on what we’ve already started, and see the benefits ripple out for generations to come.

Professor Thomas Fisher, B.Arch, MA, Assoc. AIA, is the Director of the Minnesota Design Center, at the College of Design, University of Minnesota, Twin Cities. Andrew L. Dannenberg, MD, MPH, is an Affiliate Professor at the School of Public Health and the College of Built Environments, University of Washington, Seattle. The authors are co-chairs of the Design and Health Committee of the American Institute of Architects

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