The relationships between our trusted healthcare institutions and the patterns of development that they follow have significant consequences for the health of the population they serve. 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 and to assist hospitals in their efforts to “do no harm” to their surrounding neighbors. 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 a team that includes representatives from federal agencies, architectural firms specializing in health planning, health systems, and schools of architecture, this initiative will work to advance urban design and planning criteria for Health Districts.
Building on the Momentum for Change in Health Design
The 2010 Patient Protection and Affordable Care Act (PPACA, or “The Affordable Care Act”) is changing the business model of healthcare, with potential long-term benefits for patients, health systems and the needs of the community they serve with greater focus on wellness, prevention and community health. 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 an excellent opportunity for health systems to improve public health by collaborating with their neighbors to build healthier, lifelong communities.
Leading institutions are already focusing on reducing healthcare costs by improving the health and wellbeing of their employees, patients, visitors and neighbors:
The CNU Health Districts initiative builds on this momentum to find solutions that remove the barriers between neighborhoods and health systems, and encourage collaboration among the professions of urban design and health planning and architecture. For example, a blind wall facing a neighborhood street 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 and parks, and are an economic driver for restaurants, and other public amenities - all providing opportunities for social interaction for patients and their families, employees and neighbors.
Good examples of health facilities, built to human-scale and in compact, walkable neighborhoods, can be found throughout the United States:
"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
The Health Districts Initiative Team will focus on where they can have the greatest impact on fostering the creation of health districts. These include:
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; the work of Lawrence D. Frank; thought leaders such as Henry G. Cisneros; Regional Planning Commissions; and hospital associations.
For more information, contact Alex McKeag,