We are all public health professionals
American research suggests that access to clinical care may contribute as little as 10 per cent to determining health outcomes, with genetics responsible for 30 per cent, 20 per cent the environment and 40 per cent our health behaviours and choices. A focus on healthy environments and how they shape behaviours of people may therefore impact on up to 70 per cent of the “health pie” – we can harness the upstream benefits of health and wellness.
As we face spiralling costs of treating illness it is time to question why we allocate so little resource to making our environment healthy, and so much on treating the diseases to which our built environment contributes. For a long time we have known that the buildings we inhabit can make us sick, but why can’t they make us better?
Building Services Engineering and Passive Design in Architecture are both underpinned by a belief that “environmental design” can improve our wellbeing – sheltering occupants from the extremes of any climate whilst harvesting beneficial daylight, solar gains, fresh air and so on. Yet the depth of our engagement with health outcomes has been limited by how little contact there has been with health professionals.
The stark reality is that the costs of illness, absenteeism, reduced productivity, and staff retention, dramatically outweigh all the energy costs of operating a workplace. But without proven causal relationships between our interventions and health outcomes we are left with appeals to instinct rather than to evidence and hard data. Too easily decisions can be made from a low-carbon silo rather than a holistic view that also considers health impacts. These are decisions that will have lasting impacts on the health of our communities and generations to come.
The encouraging news is that today we are seeing a transformation brought about by deep and interdisciplinary collaboration between public health professionals and leaders within the green building movement. And progress is evident at all scales.
Take New York, where active design guidelines and PlanNYC are addressing healthy mobility, air quality, bringing nature back into the city and resilience to climate change. Or LA, where the Plan for a Healthy Los Angeles will embed health in all policies, supported by a Health Atlas that maps health inequalities to inform public health initiatives.
At a district scale in the USA we are seeing the emergence of Health Improvement Districts, where the impact of the Affordable Care Act (or Obamacare as it is better known) creates a financial incentive for hospitals to invest in improving their local environment. They can profit by reducing the costs of admissions for common conditions such as asthma by identifying clusters of cases and taking measures to address causal factors such as access to green space, or enhanced air quality. Meanwhile in England we see the emergence of Health and Wellbeing Boards to direct public health efforts at a local level based on an understanding of strategic local needs.
The end of September saw the welcome release of the World Green Building Council report on health, wellbeing and productivity within offices, to which many UK-GBC member organisations contributed. And in New Orleans in late October we were fortunate to be invited to attend the launch of the WELL Building Standard – an initiative that our organisation has been actively supporting through its work as peer reviewers and auditors for pilot projects.
With a robust evidence base linking health impacts and how we design, build and operate our workplaces we finally have access to a framework with which we can rigorously evaluate the wellness of workplaces and in the future schools, hospitals, homes and more. The challenge we have set ourselves is to apply this new knowledge to Elementa's own workplace and our projects. We’re committed to working collaboratively to create healthy environments within which everyone is able to make healthier choices.
By doing so we’re recognising – perhaps belatedly - that whilst we are designers we are unavoidably also public health professionals. With this responsibility in mind, we must be advocates for a built environment that is not only green and clean, but also healthy and happy.
Doug Kerr is Managing Director of Elementa Consulting – Member of Integral Group