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Relevance in Transition: Architects as Healthcare Providers

Architects are rediscovering the many ways their work affects the health of the public

By Kevin Sloan

Architects generally understand the relevance and relationship between health and the design of individual buildings. Ventilation systems, screen glare, mold, and material off-gassing are just a few of the environmental and health-related issues—but extending that intuition from the single building to the collective form of the city has the capacity to remap architecture as part of the nation’s health system. This could be accomplished easily enough by planning cities to be walkable places that promote health and social contact while lowering carbon emissions and air pollution through usable public transit. Presently such awareness largely eludes society and the profession.

Never, during the recent national healthcare debate, did an expert come forth to champion a longer and more strategic plan for healthcare that would eliminate or diminish the burden and/or diminish healthcare costs by making cities healthier places. The entire debate was about how to pay for chronic symptoms and illnesses and their costs, which are colossal.

Sources ranging from Forbes magazine, the National Bureau of Economic Research, and USA Today indicate that America’s obesity problem alone costs the health care system $168 billion a year. Type 2 diabetes, that is related to obesity, adds another $174 billion onto the problem. A modest 10 percent improvement—possible by reverse-engineering cities to be walkable—could save up to $35 billion a year.

“If architects don’t realize they are healthcare providers, then they don’t understand the power and authority of the discipline they are dealing with,” Dr. Richard Jackson, Hon. AIA, is fond of saying. Jackson, who has a PBS special on the relationship between architecture and health, was a keynote speaker at 2013 Texas Society of Architects conference in this month.

Linking health and architecture is not a new idea. According to De Architectura, a treatise on architecture written in the first century BC by the Roman architect Vitruvius, the single most important issue in orienting any building or any city is health.

Asthma is on the rise, signaling health problems that are mounting from another environmental segment. Thirty-five million Americans, or roughly one-tenth of the US population, have been diagnosed with asthma, adding $12 billion annually to health care costs. By 2025, predictions suggest that asthma could increase to over 100 million diagnosed cases.

Combined with the fact that 60 percent of those dying of lung cancer have never smoked, and that America is no longer a factory-based industrial nation, it is fair to intuit that most of the respiratory problems are coming from air pollution caused by sprawling cities and motorized vehicles.

Once again, the densification of cities is an architectural problem. Architects can improve the environment and boost the economy in the process through the design of new infrastructure and our urban fabric. It also opens the door to projects that rarely apply the benefits of architectural thinking. For example, the Philadelphia firm James Corner Field Operations transformed the world’s largest landfill (known as “Fresh Kills” in Staten Island) into a usable public space and a new kind of ecology. In Dallas, the transformation of an abused site into an enclave of Modernist housing at the Dallas Urban Reserve demonstrates the same kind of potential and vision.

Cities “make” or “unmake” themselves one building at a time, which is a powerful way for architects to impact the credibility and relevance of the profession by developing solutions that offer urban and environmental improvement.

This article is an excerpt from a feature in AIA Dallas’s fall 2013 issue of Columns.

Kevin Sloan is a principal at Kevin Sloan Studio in Dallas ( and he teaches architecture at the School of Architecture at UT-Arlington.

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Peter Zumthor’s Thermal Vals spa. Photo by Jennie West, Assoc. AIA.

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