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Building the Case for Design and Health

In eight cities, a joint AIA and MIT research project begins to untangle the connection between urbanism and health

By Brooks Rainwater
Director of AIA Public Policy

The AIA’s Decade of Design commitment to action with the Clinton Global Initiative seeks to effect positive change through design in the global urban environment. To address the urgent need to create far-reaching solutions, the AIA has partnered with the Massachusetts Institute of Technology Center for Advanced Urbanism. The Health and Urbanism project is focused on leveraging the power of design to serve as a catalyst for improving urban health.

Decade of Design: Health and Urbanism will use cities as a laboratory for research, analysis, speculation, invention, and ultimately the design and development of sustainable models of urbanism centered on health metrics. The first piece in this decade-long program is the MIT course, Advanced Research Workshop in Landscape + Urbanism. The goal of this course was to establish the research foundation for further exploration in the metropolitan regions selected for analysis.

MIT graduate students from architecture, landscape architecture, and urban planning took part in this course, taught by professors from MIT’s Center for Advanced Urbanism in the School of Architecture + Planning. The students fanned out throughout the country to study eight metropolitan regions—Atlanta, Houston, Los Angeles, San Francisco, Chicago, Minneapolis, Boston, and New York—taking into consideration geographic, climatic, and population diversity. The research included fieldwork, novel forms of geographic and environmental analysis, social factors, and the development of indexed priorities detailing where design may influence urban health the most. Each metropolitan area was comparatively studied at the county scale for health indicators. More detailed studies were conducted in health hot spots, where health indicators already suggest a negative impact that can be tied to urban design.

At the end of the semester, the students presented their results, with some exciting and at times unexpected outcomes. The final results for all of the cities will be available in a published report to be released this fall, but two cities are worth examining now.

Los Angeles

With 10 million people living in Los Angeles County, this metro region can be a trendsetter for innovative health and design policy solutions. While a variety of data was analyzed and presented, some of the key findings centered on neighborhood form, location, and Los Angeles’ omnipresent highway corridors.

Throughout the region, high-income residents tend to reside in more urban areas along the coast and suburban areas in the mountains, while low-income residents live in urban basins and suburban desert areas. This bifurcation in settlement patterns has important impacts on health and has exacerbated the effects of ongoing air pollution, stretching back almost 100 years. Five of the 10 worst-congested roadways in the U.S. are found here. The impact of freeways on health, and the current location of new development patterns, was consistently raised throughout the analysis.

On the bright side, 87 percent of new residential construction from 2011–2013 has been multifamily, and much of this building has taken place near transit lines. Transit-oriented development typically provides communities with myriad benefits, but, in this instance, one big drawback is that the majority of the Los Angeles transit lines straddle congested freeway corridors. As a result, much of the construction has taken place in areas with high levels of particulate matter polluting the air, some of the worst in the U.S. MIT students found that out of the $1.50 billion in construction put in place during this period, $1.28 billion of it has been built in dangerous particulate matter zones that may result in severe asthma-related illness.

The good news is that Los Angeles is in the midst of an infrastructural investment renaissance, with the passage of the 30/10 Plan that is slated to spend $40 billion on infrastructure improvements by 2020, rather than by the original 2040 time frame. With this high level of investment and strong focus on transforming Los Angeles into a walkable, transit-accessible city, the analysis posited that there may be a need to reexamine different commonly accepted urban models for the city.

For example, in Los Angeles transit stations are often located along transit corridors that belch out high levels of pollution and particulate matter. Instead of building as densely as possible around these transit hubs (as is typical in any urban transit-oriented development), might public health be better served by inverting the traditional patterns of density seen radiating outward from public transit stations so that fewer residents live and work near these locations, and they’re spared the worst effects of airborne pollution? These and other questions will need to be further explored as the project progresses.


The Atlanta metropolitan region has changed dramatically since 1970, when growth was concentrated around the center of the city. While the city has in recent years introduced many positive initiatives to focus development back toward the center, the development pattern over the last 40 years has seen the population radiate outward toward the northern parts of Fulton and DeKalb counties.

MIT’s research showed that health indicators tended to be best in the inner suburbs, rather than in the city itself or outer suburbs. This was also a consistent theme throughout the broader research, with inner suburbs generally exhibiting the best health indicators. As in Los Angeles, Atlanta’s freeways and high congestion areas tend to spatially align with high asthma rates and poor health indicators. This was also found in areas with higher levels of industrial development.

The data showed that higher diabetes rates did not necessarily correlate with areas with larger numbers of fast food restaurants, nor was there a quantitative “food desert” problem exhibited in the mapping exercise performed on Atlanta. When the researchers focused in, it was found that in some of the more transit-rich areas higher levels of diabetes existed, although other factors such as income and education would need to be included for a fuller analysis on causation.

The initial recommendation of the Health and Urbanism research focused on the need for transit to be better distributed, rather than just located downtown, so that it could better help those with higher vulnerability and risk factors. The Atlanta BeltLine, 22 miles of historic railroad corridors that connect dozens of neighborhoods with trails and park spaces, could be further developed and continue to function as an opportunity for mitigating health risks, particularly since much of it transects with high health-risk areas. Also, many industrial and brownfield areas are sporadically located throughout the region; a concerted effort to relocate these to lower-risk areas further from population centers could help provide healthier outcomes.

Next steps

Professor Alan Berger, who taught the MIT course, says it’s important to pay attention to examples of this research that confound typically assumed notions of how design and health interact. “The exciting results from our first workshop reveal unexpected and significant results that question conventional wisdom when it comes to urban transportation and density. Some of the densest areas in our studies of metro areas have the worst health, while many suburban densities show the best health comparatively. This is true in many cases, and suggests that we need to examine the qualities of suburban environments that lead to better health signatures, and vice versa. What we have proven is that understanding urban health must go beyond stereotypes of ‘one type of density being better than another,’ and should be embedded in specific locations with real infrastructures, populations, social dynamics, and climatic differences.”

Indeed, the focus of the AIA and MIT’s collaboration will become narrower and narrower as the research develops, controlling for socioeconomic, demographic, and geographic factors, to eventually focus on a single metropolitan region, using it as a laboratory for improved health through the power of design.


LA Live, Los Angeles. Architect, Nokia Plaza at LA Live: Rios Clementi Hale Studios. Architect, Nokia Theater: ELS Architects. Architect, Ritz-Carlton Hotel & Residences and JW Marriott: Gensler. Photo by Ryan Gobuty at Gensler.


Recent Related:

Design as Preventative Medicine

Q&A: Dr. Richard Jackson on Designing Healthy Communities

Building Healthier New Yorkers: Urban Design—Part I

Designing Healthier New Yorkers: Building Design—Part II


Visit the AIA’s Decade of Design website.

Visit the Clinton Global Initiative website.

Visit the MIT Center for Advanced Urbanism website.


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