Health Districts


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.

CDC's Healthy Community Design Checklist Toolkit and the CNU Charter for the New Urbanism 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 environments; and
  • Examples of existing health districts that seek to enhance the quality of the neighborhoods where they reside, and provide healthy living opportunities for employees, patients, visitors, and surrounding neighbors.

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:

  • Buffalo Niagara Medical Campus (BNMC) is dedicated to creating and maintaining sustainable environments for the greater community, as well as employees, patients, and visitors to the Medical Campus. BNMC addresses issues of common concern to their member institutions and neighbors, such as public safety, wayfinding, and transportation. Among the infrastructure projects currently under construction is the creation of a linear park which will provide a safe and walkable public space for all modes of transportation to be enjoyed by patients, visitors, students, neighbors, and employees.
  • Kaiser Permanente now hosts more than 30 farmers markets at their hospitals in 9 states. These markets help promote healthy eating habits and provide healthy food access to patients, visitors, staff and neighbors.
  • 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" on the Arkansas River Trail in downtown Little Rock. The 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 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:

  • 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.
  • LifeSci Village by Torti Gallas and Partners, Inc., is an example of a mixed-use 'Health District' infill project that will connect 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.




"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

Next Steps

The Health Districts Initiative Team will focus on where they can have the greatest impact on fostering the creation of health districts. These include:

  • Learning more about health officials who have jurisdiction over the design of health facilities (such as state departments of health)
  • Exploring the feasibility, usefulness and cost of of creating a planning tool for health systems that would incorporate health impact considerations for determine new facility sitings
  • Identifying health systems with facilities on a variety of scales who are willing to be pilot projects
  • Continuing to identify research on the health benefits of health districts and case studies as examples of viable health districts
  • Hosting webinars and speaking at CNU events on health districts

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,
CNU Program Manager, amckeag{at}
The Health Districts Initiative has been made possible by the generous support of the members of the Congress for the New Urbanism.