How urban planners can promote health and wellness

The Baton Rouge Health District offers a holistic look at how to improve health care at all scales

Health care challenges are a hot topic in Louisiana’s capital. The United Health Care Foundation’s America’s Health Rankings 2015 report ranked the state in last place in population health, in part due to racial disparities and a high poverty rate. Most troublingly, Louisiana’s rate of residents with Type 2 diabetes ranks among the highest in the country. In 1998, roughly 6.5 percent of the state’s population had diabetes. Now, 13.9 percent of the state, or 520,000 people, have the adult-onset disease.

“In Louisiana, the need is urgent,” says urban planner Basak Alkan. “There’s a greater amount of obesity and diabetes in the community that needs to be addressed urgently, across sectors, by everyone.”

To help solve the problem, Louisiana’s capital, Baton Rouge, is turning to an increasingly common strategy—using urban planning, and the creation of the new Baton Rouge Health District, as part of a larger campaign focused on improving public health.

“Baton Rouge has very entrenched socio-economic problems that one approach can’t resolve,” says Suzy Sonnier, the director of the Health District. “The Health District is trying to approach it by not only looking at the built environment, but by taking a more holistic approach.”

A map of the current Health District boundaries.

Designing a district for health

Medical centers have been around for decades—large, campus-style developments that represent one facet of the “eds and meds” economic development strategy. But the Baton Rouge Health District aims to be different. Designed with input from a large coalition of community partners, including 15 local healthcare providers that will eventually have a presence on site, the Health District aims to show how urban planning can improve health care.

According to Alkan, an urban designer at Perkins+Will who helped shape the initial master plan, it’s a matter of incentives aligning. Changes in health care, including a shift away from the fee-for-service model and more of a focus on disease prevention and population health management, have given health care providers an incentive to invest in a healthier population, and a positive feedback loop.

When it comes to planning for wellness, the various pieces of the puzzle aren’t new. Whether it’s architecture that promotes daylighting and using less toxic building materials, urbanism with a focus on walkability and community green spaces, or development plans that promote workforce development and transit equity, myriad elements can help make a community healthier.

Projects like the Baton Rouge Health District want to pull together as many of these threads as possible, all tied together by a health care system with strong interest in promoting preventative care.

Perkins+Will

How the health district works

Through significant investments in pedestrian infrastructure, greenspace, transit, and jobs, the Baton Rouge plans seeks to improve health outcomes on multiple levels. Alkan has saidthat the neighborhood, a “food swamp” filled with unhealthy dining choices, lacks green space and connected walkways, leading to unhealthy habits.

”It may seem like there’s no way to design people out of poverty,” Alkan says. “But if you look at design broadly, and include a long-term strategic and facility plan, there is a lot we can do for these issues.”

Planners examined how hospitals could channel facility investment dollars to create a more healthy environment. Eventually, they hope this web of transit connections and healthcare facilities will become a new neighborhood, and perhaps even support new workforce housing.

A series of new roads, as well as a Health Loop trail lined with parks, will improve pedestrian access, add exercise paths, and promote outdoor activity and fitness. Streetscape, signage, bus stop, and sidewalk improvements, as well as landscaping and art installations along exits to Highway 10, will help give the district a unified look. Since the completion of the master plan in 2015, the Baton Rouge Health District has worked with state and local partners to add 4 miles of additional sidewalks and trails. Visitors will be able to access care, wellness classes, and visit a farmers market, all in one trip.

Amenities that create a healthy work environment and promote a culture of wellness—something nurses want to model for their patients—also decreases staff turnover, a big plus for health care institutions.

The plan has been slowly taking shape over the last few years, though especially dramatic flooding in late 2016 pushed back completion and led to changes to the overall layout. As the district evolves—road construction is underway, as well as string of health care facilities and commercial projects—it’s also seen as an increasingly important economic engine, with new development and transit options reflecting its importance to the local economy. A new hotel is coming to the area, and a proposal to locate a station for a new Baton Rouge-to-New Orleans rail line in the District reflects its growing importance. Ideally, it’ll become a hub in the city’s proposed new network of bike paths.

Urbanization is a major public health challenge

Healthy urban planning has been a focus of organizations like the World Health Organization, which considers urbanization a “major public health challenge of the 21st century.” None of this is necessarily new. Numerous studies have shown the positive impact of better urban design on shaping community health. Perkins+Will research found that behavioral factors, such as diet and physical activity, accounts for 70 percent of overall health outcomes.

In Philadelphia, a recent study found that transforming vacant lots into green spaces can help curb depression. The recently founded Center for Urban Design and Mental Health has chronicled the links between good planning and emotional well-being, and the American Planning Association has promoted city plans that link health and other outcomes.

Many of the strategies and tools planners have at their disposal to improve wellness and health—more parks, plants, pedestrian infrastructure, and a push for sustainability—are already considered best practices by those advocating for better transportation options for greener cities.

But by integrating health outcomes, and health care professionals, in the planning process, as well as tapping into those resources when funding these kind of urban improvements, projects like Baton Rouge widen the pool of support, and funding, available to make important changes.

“Health and well-being are like the new sustainability,” Anthony Smith, a planner and advocate focused on health outcomes, told New City.

The interior of Bloomberg’s new London office space, a new project that meets the Fitwel standard for healthy buildings
 Bloomberg

Making health care a pillar of new projects

Wellness can also become a core component of larger architectural projects, with many architects and designers arguing that a more multidisciplinary approach can create healthier environments and multiply the impact of new health care facilities. This approach goes beyond current green building standards, including LEED, the Living Building Challenge, and the advocacy work of the Harvard Healthy Buildings project, as well as futuristic, data-driven designs such as The Edge in Amsterdam; more than building better, it’s about incorporating health care ideas into the design process.

In Dallas, the new Baylor Scott & White Sports Therapy & Research complex, just opened last month as part of The Star, a larger campus-style development. A collaborative health care and sports campus also designed by Perkins+Will, the Star hosts facilities for both the Dallas Cowboys as well as the new health care facility, a joint project between Baylor Scott & White Health, a large healthcare provider, the local Frisco Independent School District, and the Dallas Cowboys.

Ron Stelmarski, the project’s lead designer, says much of the design was predicated on deliberate, holistic strategies to help the health of an individual. It’s possible because the building itself is a fairly large public stage: using the branding power of the Cowboys and the reach of the healthcare network, the space can impact a considerable number of visitors, including members of the nearby community. The entire campus has been landscaped to encourage movement.

Stelmarksi calls it a “health care project turned inside out.” It’s not just about students and neighbors having access to superior sports facilities, it’s about promoting education and the “academic” side of healing.

While The Star clearly isn’t a ground-up, community led project in an underserved neighborhood, it is showcasing new way to create more holistic health care facilities. Other projects by Perkins+Will, including campus wellness centers at UCLA and Northwestern, also offer space to experiment with new ways to promote well-being as a part of the design process. The firm has been pushing the Fitwel standard for healthy building design, a new measuring stick for architects that promotes, among other things, buildings that increase physical activity, support social equity, and impact community health. Foster + Partner’s new London office for Bloomberg meets this criteria.

Stelmarksi says the biggest shift, as well as the common thread running between these projects, is a focus outward, and a desire to incorporate more community space. Encouraging ground-level connections to surrounding areas, and easier access, are foundational to helping people to get up, get out, and get fit.

“Lots of architects are seeing more opportunities to advocate for this sense of mental and physical well-being,” says Stelmarksi. “The real trick is how public can space become.”

A better lifestyle, and better life expectancy

Ideally, projects like the Baton Rouge Health District become the rule instead of the exception.

“We want to see these ideas move beyond Health District boundaries,” says Sonnier. “We want to see similar trails in the most underserved parts of our communities. But we need to demonstrate best practices in all that we’re doing.”

Stelmarski sees it as a question of acceptance. There are websites where typing in a zip code shows the average life expectancy. It underscores the importance of physical location to health and wellness, and more importantly, the power to make things better, he says.

“If we believe those numbers are accurate, there’s no way we can’t also conclude that the physical environment we control can’t be enhanced to improve that number.”

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