The U.S. Surgeon General urged land use professionals to partner with him in his nationwide campaign to curb the rise of chronic diseases and obesity and to encourage a physically active lifestyle, in a talk earlier this month at the National Institutes of Health (NIH) outside of Washington, D.C.
Acting U.S. Surgeon General Rear Admiral Boris Lushniak said that he cannot achieve his office’s mission to “protect, promote, and enhance the health and safety of our nation” without the help of architects, planners, and real estate professionals in designing and building communities that prioritize the physical, mental, and social health and well-being of all Americans.
Lushniak’s remarks introduced a panel of experts gathered to discuss the role that the built environment and community planning can play in advancing the National Prevention Strategy, the Surgeon General’s plan for disease prevention and health promotion.
Moderated by Melissa Lim Brodowski, acting senior advisor for policy and outreach at the Office of the Surgeon General, the panel was part of NIH’s “Mind the Gap” discussion series focused on bridging the gap between clinical research, public policy, and real-world habits, practices, and behaviors.
Rachel MacCleery, ULI’s senior vice president for content, served on the panel, as did Gwen Wright, planning director at the Montgomery County (Maryland) Planning Department, and Allen Glicksman, director of research and evaluation at the Philadelphia Corporation for Aging.
The National Prevention Strategy is just one initiative from the Office of the Surgeon General whose success will depend highly on how communities are planned, designed, and built as much as on changes in individual behavior. The Every Body Walk! Initiative elevates the role of walking and walkable communities in improving public health.
But Lushniak said that his goal of “putting America back into its walking shoes” to get the recommended 30 minutes of daily exercise will be unattainable without adequate sidewalks, walking paths, and crosswalks on busy streets.
“I can’t expect people to go and walk if it’s unsafe,” he added.
Healthy and safe community environments is one of the pillars of the National Prevention Strategy. Just as the “green” and sustainability movements took decades to move from the fringe to the mainstream, Lushniak predicted that the building-for-health movement will gain momentum in the years ahead: “We have to build structures that, in fact, take health into consideration. . . we need to take health as part of our mission in the building of things.”
Designing and Building for Health
The panel shared examples of approaches that have the potential to improve health outcomes and reduce health care spending on chronic disease management.
MacCleery explained to an audience largely unfamiliar with ULI’s Building Healthy Places Initiative its objective: to leverage the power of the Institute’s global networks — its members and partnerships — to shape projects and places in ways that improve the health of people and communities.
She cited the work of Susan Powers, a ULI member whose company, Urban Ventures LLC, is codeveloper of Aria Denver, a new health-focused, mixed-income, 17.5-acre (7 ha) master-planned community in downtown Denver with walkable access to parks, transit, shopping, and other amenities. The development offers market-rate townhouses, affordable apartments, and an intergenerational cohousing option with 24 units and several communal gathering spaces.
Partnering with Regis University, a Jesuit university adjacent to the development, Aria Denver will offer residents a variety of health- and wellness-focused programming: cooking and nutrition classes, community gardens, bike-repair/maintenance clinics, and wayfinding signage to connect Aria Denver with surrounding neighborhoods and trails. Regis’s Rueckert-Hartman College for Health Professions will also offer primary and preventative health care services.
“We all have a responsibility to make the healthy choice the easy choice,” MacCleery said.
This goal is exactly what planners in Montgomery County, Maryland, a 507-square-mile (1,300 sq km) county just outside of Washington, D.C., which is home to more than 1 million people across urban, suburban, and rural communities—have in mind as they transform “old, unhealthy suburbs” into healthy ones, said Wright, a ULI member.
Guided in part by ULI’s Ten Principles for Building Healthy Places, the county’s planners are attempting to turn low-density, disconnected, auto-dependent communities where residential, retail, and office uses are separate into transit-oriented, mixed-use, and walkable ones with compact downtown centers and plenty of sidewalks, walking trails, and bike paths.
“I like to call it ‘ten-minute living,’ where within ten minutes you can get to anything you need, easily and accessibly,” Wright said, including schools, jobs, shopping, and public amenities like libraries and civic centers.
Wright shared two examples of legacy developments in Montgomery County that are undergoing massive retrofits geared toward walkability: the White Flint shopping center, currently home to 400 acres (162 ha) of paved parking lots that will be transformed into a mixed-use development clustered around a Metro Rail station; and Lyttonsville, a historically African American residential community that in the future will be served by the Purple Line, a new Metro Rail route that will connect the county’s east- and west-side neighborhoods.
Challenges Ahead: Measuring Success and Consumer Engagement
A major challenge for developers interested in building communities around health is proving that their interventions actually make a difference, MacCleery said, calling it the “holy grail of metrics.”
Lushniak reminded the audience that establishing a link between health-focused design of the built environment, behavioral changes, and improved health outcomes can be made “only with data” and “evidence-based” approaches.
Going beyond anecdotal examples to larger consumer studies will require “nontraditional partnerships,” MacCleery said, citing a joint project between Catellus, the developer of Mueller, a master-planned community in Austin, Texas, and University of Texas and Texas A&M University. Researchers are studying the activity levels of Mueller’s residents to determine their relation to Mueller’s vast network of parks, walking trails, and bike paths.
Another metric that ULI members are keen to know is the market performance of health-oriented projects, detailed in Building for Wellness: The Business Case, produced by the Building Healthy Places Initiative and ULI’s Center for Capital Markets and Real Estate. Ultimately, there needs to be strong financial returns on health-oriented investments in physical infrastructure and design.
In addition, using the built environment as a tool to reduce chronic disease and obesity rates requires going beyond a “build it and they will come” mind-set. Successful projects have created year-round programming for people of all ages and creative marketing campaigns to engage consumers, MacCleery said, adding: “It actually takes a lot of soft programming and infrastructure [like] ongoing classes, clubs, events, and festivities to get people to come out and take advantage of the . . . asset that is there.”