"As a medic working with returning Vietnam veterans, I would take vets on a walk down the street into the neighborhood. This was one of the best things we could do during their rehabilitation. And the same was true for my father when he returned from World War II. Daily walks just down the street to the church, park, or pool hall reconnected him to life after war." - John Norquist
As the true health impacts of our auto-oriented communities emerge, the relationship between our trusted healthcare institutions and the patterns of development that they follow have significant consequence. Concerned with requirements for safety, efficiency and security, health facilities have grown in size and scale throughout the twentieth century, often at the expense of walkability and livability and a connection to the surrounding neighborhoods. The Health Districts initiative aims to address these issues at this critical juncture in our national healthcare debate. The focus is shifting to disease prevention and much of this can be accomplished through better planning.
Livable, walkable neighborhoods are a critical component of healthy neighborhoods and of Health Districts - districts that contain one or multiple health facilities. With assistance from the Centers for Disease Control and Prevention (CDC). David Green, Basak Alkan and colleagues from Perkins+Will, Joanna Lombard from University of Miami and CNU leadership, this initiative will work to advance urban design and planning criteria for Health Districts and, in particular, for Veterans Health Administration (VHA) facilities. These criteria will focus on promoting a healthy built environment that benefits patients, patients’ families, health care staff and neighbors. CDC's Healthy Community Design Checklist and the CNU Charter will be the springboards for this investigation. In addition, our efforts will be guided by the latest research in Evidence-Based Design (EBD), an emergent interdisciplinary field of research that investigates aspects of physical environments that influence well-being and promote healing.
The Promise of VA Health Districts
Our focus on VA Health Districts as a case study is not accidental. We see, above all else, an imperative to improve the health outcomes of U.S. military personnel who are returning home from Iraq and Afghanistan. These returning veterans, often needing the long-term health care offered at VA Medical Centers, should benefit from facilities that are designed to help them transition into civilian life. This includes integrating facilities into their community surroundings. The provision of excellent healthcare within the hospital also should extend to areas around the hospital. Many VA campuses are isolated from the networks of neighborhood and communities. In fact, given their regional reach, VA facilities tend to be located near a major arterial or highway and the hospital itself is surrounded by parking lots. This challenge presents an important opportunity to maximize mental and physical health outcomes for veterans through the implementation of Evidence-Based Design, while also addressing safety and security needs.
As a federal agency, the VHA also has great potential to serve as a leader in the ongoing transformation of the larger for-profit and non-profit healthcare industry. Such transformative thinking is already taking place among related agencies. For instance, the Government Services Administration (GSA) recently set new procurement criteria that require Federal courthouse buildings to be integrated into community neighborhoods. And further, HUD, DOT and EPA, through their Partnership for Sustainable Communities program, have invested in hundreds of projects around the nation that meet six Livability Principles in implementing transportation and affordable housing projects that promote healthy communities.
A current example of the need for new criteria for VHA facilities procurement is in New Orleans, where a new VA hospital is scheduled to replace an older facility damaged by flooding after Hurricane Katrina. The older facility was housed in a compact set of buildings seamlessly integrated into the traditional medical district within the city’s Central Business District. However, due to constraints posed by current federal facilities regulations, the new medical center—while only a half-mile away—will be built as a sprawling, auto-oriented campus that covers twelve urban blocks occupied by historic homes and buildings in the lower Mid-City neighborhood. The older facility provided walkable access to neighborhood life and amenities, to hotels and New Orleans destinations. Vast parking lots, an elevated highway and security barriers will cordon off the new facility. Instead of giving veterans and families a sense of community and easy access to parks, services, restaurants and public spaces, the new health facility surroundings will be dominated by parking and freeway connections.
Building on the Momentum for Change in Health Design
The Great Recession of 2007 and the 2010 Patient Protection and Affordable Care Act (PPACA, or “The Affordable Care Act”) have set in motion the transformation of healthcare, with potential long-term benefits for patients and for health systems. The Affordable Care Act has mandated that tax-exempt hospitals produce Community Health Needs Assessments (CHNA) every three years. These assessments, among other requirements, describe communities served and methods for receiving input on community interests. (See Notice 2011-52). This requirement is a strategic opportunity for health systems to build healthier, lifelong communities in their neighborhoods.
Other leading institutions are focusing on reducing healthcare costs by improving the health and wellbeing of their communities. Kaiser Permanente now hosts more than 30 farmers markets at KP hospitals in nine states. These markets are organized to promote healthy eating habits among patients, staff and community members. In 2003, physicians at the Heart Clinic of Arkansas committed to support the Arkansas River Trail. In partnership with the National Park Service Rivers Trails and Conservation Assistance Program, and Little Rock Parks and Recreation, the Heart Clinic Arkansas raised funds to create “The Medical Mile,” of the Arkansas River Trail in downtown Little Rock, a venture which quickly engaged other physicians and practices, as well as local hospitals and the Arkansas Department of Health.
The CNU Health Districts initiative builds on this momentum to formulate implementable solutions that remove the barriers between neighborhoods and health systems, and encourage collaboration among the professions of urban design and healthcare planning and architecture. A blind wall facing a neighborhood street, for example, can be transformed into a ground-floor use, such as a pharmacy, that benefits the community as well as the institution. The street face of a parking deck can be shielded with a liner building that provides housing for patients’ families. Security buffer zones can be turned into public parks that promote healing and wellbeing. Most importantly, new facilities can be sited in locations that are accessible by transit and that provide connections to walkable neighborhoods, parks, restaurants, and other public amenities, all providing opportunities for social interaction for patients and their families.
Good examples of health facilities, built to human-scale and in compact, walkable neighborhoods, can be found throughout the United States. For instance, the Fort Belvoir Community Hospital in Virginia is one of the first military treatment facilities to use evidence-based design principles to increase patient health outcomes, decrease recovery times and maximize provider and patient safety. There are also built precedents in educational and research districts that provide potential solutions for Health Districts. An example of a mixed-use 'Health District' infill project is LifeSci Village by Torti Gallas and Partners, Inc., to be connected to the National Headquarters for the US Food and Drug Administration and adjacent to the newly planned Washington Adventist Hospital. LifeSci Village is a 300-acre infill development demonstrates connecting health, life sciences research and continuing education in a live/work/play environment. Considering evidence-based design when building or renovating health facilities will help create healing environments that offer better outcomes for patients, families, staff and community members.
Health Districts integrates community based planning strategies for health care facilities with special attention to seniors and veterans, and senior housing and design. The initiative will draw on the CDC Sustainability Planning Guide for Healthy Communities, university research prepared by the University of Miami and the Columbia University Mailman School of Public Health, and thought leaders such as Henry G. Cisneros, Regional Planning Commissions, and State Veterans Affairs Offices. To identify demonstration projects, the initiative team will reach out through CNU Chapters, CNU members and allied organizations such as: AARP, The Prince's Trust for Building Community, Macauley & Schmidt, The Integral Group LLC, and Warrior Transition Units (WTU) and other new urbanist projects by Torti Gallas and Partners, Inc. in Washington DC and internationally.
Join the discussion on the Health Districts Tumblr Forum. Discuss the latest news, updates and projects for the initiative.
For more information, contact Caitlin Ghoshal,
The Health Districts Initiative has been made possible by the generous support of the members of the Congress for the New Urbanism.