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Q&A: Dr. Richard Jackson on Designing Healthy Communities
The connection between design and health is dangerous to forget
By Zach Mortice
Car-bound, sprawling, unwalkable, polluted, stripped of green space—poorly designed cities can kill you.
During the four-hour PBS documentary Designing Healthy Communities, series host Dr. Richard Jackson travels to neighborhoods where the simple organization of spaces nurtures and strengthens residents, and others where deficiencies conspire to lower the life expectancy of their people through obesity, diabetes, heart disease, and more.
The effect peoples’ environment has on their well-being has been a blind spot in the health industry for decades, but Jackson’s documentary (as well as his efforts with the AIA’s America’s Design and Health Initiative) strives to re-center this conversation, with the voice and expertise of architects leading the way. The list of ways to rehabilitate human well-being through the places they live and work are long: urban farming, retrofitting dead suburban malls, rails-to-trails, expanded public transit. But the list of ways to truly affect these changes on a broad scale is very short: The shape, form, and function of cities are the results of the policy framework that created them. “The built environment is social policy in concrete,” Jackson says.
Appropriately enough, Jackson, an author and public health expert, spoke about how to sculpt this concrete into a framework for building healthy cities at the at 2012 AIA Grassroots Leadership and Legislative Conference last week. But before his appearance in Washington, he sat down with AIArchitect to talk about the moral imperative of making communities healthier.
AIArchitect: Is good city design preventive medicine?
Dr. Jackson: Not only are you what you eat—you are what you build. We can build environments that help us to be healthy, or we can build them to make us overweight, unfit, and depressed. This works for populations, and it works for individuals.
Why have we divorced health from the design of physical built environment? Why is health so narrowly considered in terms of advances in medical technology and drugs?
Past prevention efforts have worked well. We don’t have polio or smallpox, and we rarely have waterborne illnesses. We still have plenty of air pollution-related diseases and an avalanche of obesity related ones. Instead of health, we think of disease treatment. But what I think we're confronting more and more is that health is a state of well-being. It’s not merely the absence of disease. I think this is one of the reasons architects are so important. You are about creating places that enhance, nurture, and develop human well-being.
What has been some of the most interesting research into the connections between design and health? What’s the empirical case for why this is important?
There are half a dozen studies that come out on this almost every week. If you live in a walkable community, you weigh about 7 pounds less than if you don’t. If you use public transit you weigh about 6–7 pounds less than if you’re a car driver. The worst air pollution levels are in places with the worst automotive vehicular emissions, and [there] you see higher rates of heart disease, lung cancer, and all the rest.
In your documentary series, you seem to be advocating for strong top-down leadership from the government to take charge of how communities are redeveloped in healthier ways. There’s the sense that this isn’t anything that the free market will shift to on its own. Why take this approach?
The changes we put in place must be both top-down and bottom-up. By top-down, I mean sooner or later infrastructure (transportation, housing, food, education) is almost always funded by the government. The government should not look for a three-month or two-year return on investment. It must look at a generational return. Today we live with the benefits of the infrastructure that government funded over the last century. Business and commerce will never support that kind of long-term investment because the return is far too slow.
At the same time, it absolutely has to be bottom-up. There has to be community engagement. If we’re going to redesign an inner city like downtown Detroit, which is filled with open spaces and many crumbled buildings, we’re going to have to cluster a lot of the isolated homes into urban nodes and turn the rest of it into agricultural land. Those decisions need to be made by the community, by the people with ground truth.
In the long run, this is in the best interests of industry. Industry’s got to sell their stuff to somebody, and having huge depressed and underemployed populations in the United States should be the last thing that industry wants.
In your documentary, you say “nothing ever comes back the way it was.” How do you think cities like Detroit grow back from the brink? Many times, when you talk to sustainable urbanism advocates, you get a pretty simple and idealized picture of Jane Jacobs’ Greenwich Village from the 1950s, which is a pretty picture but doesn’t really speak to the uniqueness and singular identity that every place has developed.
In my book, I meditate on the word “organic.” If you want to grow an organic garden, you have to pick plants that have native attributes, that work well with the soil mix, with those climatic conditions, and don’t need a lot of external inputs—and I think that dictating from the outside how places will grow is probably a mistake. Places, built environments, need to work for people—young, old, and in-between—not just for cars and investment.
How do you make the case for public-sector spending of this size and scale during a time of budget crisis and extreme wariness of any kind of public expenditure?
We spend nearly 99 percent of our time in built environments; even our parks are “artifacts.” What and how we build shapes how much we walk, exercise, socialize, smile, and relax. Persons of financial means, of course, build places that do this, but everyone should have this, and smart design can fill these needs. We should not have social policies that condemn the poor to unhealthy environments.
I think we have been guilty of generational child abuse. We owe to our children and grandchildren a world that is as beautiful, diverse, vital, and safe as the one that we were given. We are not doing it. We very much benefitted from prior generation’s investments in education and infrastructure. This is in the best tradition of the American people. In a way, this is a moral challenge as much as it is a physical and environmental challenge.
Dr. Richard Jackson. Image courtesy of Reed Hutchinson.
Visit the AIA’s Communities by Design website.
Visit the America’s Design and Health Initiative website.