5 Ways architectural epidemiology redefines design impact

Too often, a community’s first glimpse of a project comes at a public meeting after plans and renderings are already drawn. By then, changes are expensive, frustrating, and sometimes impossible. The conversation starts with conflict instead of collaboration. 

Now picture a different process: Programming begins with the community at the table. The project team reviews local public health data, environmental conditions, and the municipality’s plans before making any design moves. Decisions about the mix of uses, amenities, and site features reflect site-specific evidence and community input, not just market assumptions. The project sails through the entitlements process because the neighborhood supports it.

In this model, architects aren’t solely executing developers’ visions. They’re helping bridge private goals with public benefit. This is powerful because it returns architects to the role of protecting health, safety, and welfare. Architects are city builders, community creators, and stewards of the built environment.

Architectural epidemiology is a new method for kicking off the design process by focusing on impact in all areas of design. Outlined in Adele Houghton, FAIA, and Carlos Castillo-Salgado’s new book Architectural Epidemiology and rooted in public health methodology, the framework uses place-based data to guide architects toward design strategies tailored to their location. The payoff: buildings that work better, gain approvals faster, make progress towards climate goals, and deliver benefits that people want.

From Points to Impact

To architects, this may sound familiar: going through a certification checklist and marking the box for bike racks. There’s nothing wrong with that—unless it misses the bigger need. Too often, teams choose strategies because they’re easy or inexpensive, not because they deliver the greatest benefit.

Installing bike racks might earn the same credit as upgrading ventilation. But if an area’s childhood asthma rates are double the national average, HVAC improvements to a local school will have a far greater impact on student health, translating to higher test scores. On the other hand, in a community where chronic disease rates are high, bike racks and a connection to nearby bike paths might be exactly the right call to encourage physical activity.

Architectural epidemiology puts site-specific data in front of the team early, so each point they earn delivers tangible value by addressing real challenges. Limited resources mean every design choice counts. The method helps teams aim for the strategies that make the most meaningful difference.

For example, High Point, a 120-acre mixed-use redevelopment of a public housing complex in Seattle, placed indoor air quality and healthy living amenities—like walkability, access to nature, and community gardens—at the core of its design. The team responded both to residents’ concerns about safety, opportunities to exercise, and high childhood asthma rates as well as to data showing that industrial pollution persisted in the area despite a 96% citywide reduction in toxic air emissions.

Post-occupancy studies found that children with asthma at High Point had more symptom-free days and fewer ER visits compared to peers in other public housing. The project’s safe green spaces and walking groups also boosted weekly physical activity and improved self-reported physical and mental health. Importantly, these benefits emerged while the neighborhood sustained its mixed-income character, a credit to the work of the project’s architecture firm, Mithun.

Turning tradeoffs into treasure 

Knowing that the goal is meaningful impact, how do you identify the issues that matter? Local community members bring on-the-ground expertise to proposed developments. Local officials have often already done the homework, such as making climate action plans, conducting housing and community health assessments, and more. Yet most projects focus exclusively inside the property line, only engaging with prescriptive requirements coming out of these studies.

Architectural epidemiology flips that approach by linking neighborhood data with local goals for the environment, economic development, and public health. When your design reflects priorities that local officials are already tracking, your project becomes a partnership rather than another generic proposal. Think back to that opening story: Instead of springing a design on the community at a public meeting, you’re showing them a project they’ve already helped shape. They see their fingerprints on it. The tone of the room shifts from “Why are you doing this to us?” to “How soon can we get it built?” Alignment builds trust. Trust speeds approvals. And faster approvals keep projects moving.

In rural Dillwyn, Va., VMDO Architecture’s design for the Buckingham County primary and elementary schools, which are next to each other, was shaped by high rates of obesity and physical inactivity. Every element reinforces healthy living for students and families—from edible gardens, walking paths, and playfields to a central open kitchen and furniture that encourages movement. The same lessons echo in the curriculum.

The schools’ location also anchors community life, hosting farmers markets and yoga classes on weekends. Within a year of opening, researchers found that students were less sedentary and more physically active than peers in traditional schools. 

Solving for complexity

Buildings do more than keep out the rain; they can knit communities together and increase resilience in the face of health risks or climate disasters. But if project teams don’t include public health officials, environmental advocates, or policy experts at the beginning, important risks and opportunities remain hidden until later in the process.

Architectural epidemiology brings these voices in early. A health professional can flag conditions that erode air quality or exacerbate asthma. An emergency manager can outline potential evacuation challenges during flood events. A community leader can describe the kinds of amenities residents use and love.

As the Buckingham County schools illustrate, this isn’t just box-checking. It leads to stronger, more creative solutions that create co-benefits for occupants, communities, and investors. And it positions you, the architect, as someone who’s designing alongside the community to address multifaceted challenges. More perspectives up front mean fewer blind spots, a more relevant design, and fewer costly redesigns later.

Future-proofing by design

Most design teams visit a site on a clear day for a couple of hours and use that experience to guide decisions that will last decades. Even if they note flood risks or weather patterns, many projects meet minimum code requirements without anticipating future conditions or unintended consequences.

Architectural epidemiology helps teams layer today’s requirements with long-term resilience measures by analyzing health, climate, and population trends together. Discovering that a neighborhood has a growing elderly population might change how you design entrances and circulation. Including models of future flood risk as design parameters could shift the placement of vital building equipment or housing for vulnerable residents.

Santa Monica, Calif., used the design of its city hall annex—the first municipal building certified under the Living Building Challenge—to help future-proof the entire community. After reviewing climate projections showing heightened risks of drought, wildfire, and extreme heat, the city adopted net-zero energy, net-zero water, and climate resilience requirements for all new projects.

But public health and plumbing codes had no pathway for net-zero water. The city and design team rose to the challenge, creating new compliance strategies for capturing, filtering, purifying, storing, and reusing rainwater on-site. They also worked with regulators to establish compliance pathways for composting toilets.

The annex—designed as a 100-year building and disaster hub—shows that future-proofing isn’t extra credit; it’s essential. By taking the long view, the design team expanded the local definition of emergency management to include building community resilience through architectural design. (Frederick Fisher and Partners headed this design project.)

Measuring what matters

As much as architects encourage post-occupancy evaluations to see how a design performs over time, rarely do architects measure how a project changes a community. Architectural epidemiology sets you up with clear metrics that can be revisited over time. The process outlines indicators like air quality, park access, and flood risk within a framework that teams can use to evaluate progress and inform future projects. As these three projects demonstrate, evaluation is key to turning architectural design into a science-based approach to public health and preparedness. 

By establishing a measuring stick, architectural epidemiology clearly shows the co-benefits that thoughtful architectural design can create for owners, occupants, and communities. Architects’ mandate to protect health, safety, and welfare hasn’t changed—but architects need new tools. With architectural epidemiology, you can design with more relevance, more collaboration, and more visible value.

Want to get started? Here are some methods and resources for implementing architectural epidemiology. 

Uncover the site’s full story: Look beyond the site visit. Use health and environmental data to identify patterns you can’t always see—like high asthma rates, urban heat islands, or flood-prone streets. A helpful resource is CDC PLACES: Local Data for Better Health.

Engage the right people first: Bring in community members, public health experts, environmental voices, and policy leaders before the site plan is set. Early engagement builds trust and minimizes costly redesigns. For engagement strategies, check out the USGBC LEED page on social equity and stakeholder engagement.

Define success together: Agree on a few meaningful metrics from the start—such as air quality, walkable green space, or lower utility bills—that keep the design focused and make impact easier to prove. For guidance, take a look at the AIA Framework for Design Excellence and the AIA Climate Justice in Architecture Case Studies.

Liz York, FAIA, is the principal of Healthy Design Collaborative in Atlanta and a former chief sustainability officer at the Centers for Disease Control and Prevention.