ARTICLE

Landscape Design Influences Health Care Outcome

November 27, 2018 – Gregory Bair

The availability of quality health care is an important resource for community well-being.

According to Maslow’s hierarchy of needs from his 1943 paper “A Theory of Human Motivation,” physiological needs are at the very base of the pyramid hierarchy and are what Maslow calls ‘basic needs.’ Basic needs form the foundation of motivation, according to Maslow. While there have been legitimate critiques of his theory, the importance of physical and physiological well-being is hardly a controversial position.

There are many ways to improve public health. The primary method is usually by investing in health care services. The higher the quality of healthcare, and the lower its cost, the greater the prospect of a healthier citizenry. However, many communities lack the funds or control over the availability of significant health care services.

Thankfully, there are other ways to improve public health. According to research, thoughtful urban and suburban landscape design positively impacts healthcare outcomes. This means that communities can achieve a better healthcare outcome apart from just investing in or attracting more health services.

It is not uncommon to view urban design as divorced from community healthcare outcomes. But non-genetic healthcare factors account for 60% of health outcomes. Which means that urban design can have a positive (or negative) impact on well-being, depending on the design factors that create healthier spaces.

More and more physicians are beginning to understand the impact of design on healthcare outcomes. Dr. Bon Ku of Thomas Jefferson University Hospital in Philadelphia, Pennsylvania created one initiative to promote the linkage between the two fields. Dr. Ku co-founded JeffDESIGN, a hybrid program that combines traditional medical training with design classes. Dr. Ku, a second-generation Korean immigrant, grew up in New Jersey without access to healthcare, an experience that led to him to becoming a doctor and co-founding JeffDESIGN.

Bill Bradley writes in a profile about Dr. Ku and JeffDESIGN on Next City:

“The built environment itself can influence both physical and mental health. Whether it’s blighted blocks or a lack of trees, the way cities are designed is as much a public health concern as food deserts or access to healthcare facilities.”

There are many ways in which urban design specifically impact healthcare outcome independent of healthcare service availability. Smart urban design can provide easy and better access to existing healthcare facilities for community members. Also, certain activities and lifestyles are simply healthier than others. Urban design ‘hacks’ into healthcare by promoting space for, and access to those healthy lifestyles. Urban design creates the appropriate environment and influencing factors that make possible the pursuit of healthy lifestyles.

As an example, thoughtful urban design ensure parks and green spaces along with vehicle-free zones that encourage walking and biking. Good urban design also facilitates access to these spaces. The physical effect of green, vehicle-free spaces is undeniable. According to a study published in the journal Environmental Health Perspectives, individuals with high access to green spaces around their home actually had lower mortality rates than those with a dearth of green access.

Access to parks and other green spaces may seem trivial, but again and again this benefit rings true. Those with close proximity to safe parks engage in more exercise and are less frequently obese. Furthermore, those with close access to green spaces are at less risk for heart attack, stroke, and other common chronic diseases.

Parks do not just encourage more exercise. They also help alleviate stress. Tree shaded streets with intermittently spaced benches contribute to promoting walking among all age groups. Concentrating commercial and entertainment businesses in relatively easy access to each other encourages residents to park vehicles and walk between venues. Urban areas are increasingly using permeable awnings to provide shade during daylight hours thereby making walking comfortable while filtering sunlight and creating a festive street-lit atmosphere for evening gatherings and socializing.

Blight is also a large problem, and not just because of its negative aesthetic impact. Urban decay and blighted areas are often synonymous with a high percentage of abandoned and dilapidated buildings and structures. Removing blight not only makes those areas physically safer, but also contributes to reducing crime and violence. Removing or rehabilitating deteriorating buildings alleviates asthma, lead poisoning, and other air borne and environmental hazards that contribute to serious medical conditions that disproportionally affect children, and because of economic considerations, inordinately impact people of color.

Dr. Ku calls blight “a toxic stress,” and points out that this stress makes a physical impact on residents, often resulting in much lower life expectancy than in non-blighted areas. Blight is, therefore, a gigantic mental health minefield, and urban residents live with an increased risk for stress-based anxiety and mood disorders than do rural residents.

As such, mental health is, therefore, as important as physical well-being. And, urban design helps combat mental health problems.

The above overlooks other factors that lead to mental health problems in urban areas of which there are many. Noise pollution, transportation, and fear of crime impact the physical and mental health of community residents. Thoughtful urban design can incorporates discreet public safety attributes, makes accessible and encourages the use of public transportation and reduces vehicular congestion and air pollution.

Ultimately, there is a misunderstanding in regard to city planners and even the medical community that a healthy living environment is an important consideration for achieving a quality lifestyle and enviable livable community.

It is far easier and less expensive to prevent disease and illness as opposed to treating or curing it. Disease prevention and healthy living starts with where and how we live.

Urban design makes several contributions to community health and well-being. It can help concentrate and facilitate ready access to available healthcare facilities. It can create space and promote the development of facilities that contribute to pursuing healthy lifestyles. It can affect the mental attitude of residents as well as help eliminate that which is depressing and non conducive to worry-free living.

Urban design that addresses the well-being of the individual and the community can by itself affect health outcomes —if landscape designers are smart and confident enough to promote and incorporate these design features in their work.