Clark D. Manus, FAIA, 2011 President

The recent death of Jack LaLanne, the high priest of crunches and treadmills, has inspired a cottage industry of stories on the state of America’s physical health. Most of these stories—no, why hedge? all of them—make depressing reading. As a nation, we’re literally and figuratively in bad shape.

A January feature article in The New York Times graphically and textually documented the battle of the bulge. From the Kennedy administration’s revamped President’s Council on Physical Fitness, in 1961, to Michelle Obama’s Let’s Move campaign against childhood obesity, the number of Americans between the ages of 20 to 74 classified as obese rose almost threefold, from 13.3 percent to 35.2 percent. Expand the pie chart to include the merely overweight and the figure jumps to a staggering 67.3 percent—or nearly seven out of every 10 Americans.

A recent study of hospitals in Camden, N.J., one of the poorest cities in the nation, revealed that 90 percent of the cost of medical care was generated by only 20 percent of the patients. In a Jan. 24, 2010, New Yorker piece, just 1 percent of Camden’s patients accounted for a third of the city’s medical costs. Healthcare delivery systems nationwide are at risk of being overwhelmed. In the meantime, health insurance premiums for individuals and businesses continue to rise, even for those who are healthy.

Leaving aside the impact of soaring health costs on small business, America’s health crisis—and “crisis” is not an overstatement—raises the question of the role, if any, design has as an Rx for the nation’s health. Answering that question requires bridging a deep and wide perceptual gulf.

Mention “health” and “design” in the same breath and most people immediately picture hospitals and clinics. Yet architects have a much larger role to play. We should be trying to keep people out of hospitals. A trip to the emergency room should largely be the consequence of accidents, not the outcome of a poor lifestyle.

At present, this nation’s healthcare system is really not about health; it’s about medical care. Members of the AIA’s Academy of Architecture for Health Knowledge Community advocate a different perspective: We need to shift our focus away from a preoccupation with medical care to a more balanced view of the world. They’re right.

Gaining a more balanced, integrated view of how we interact with the environment and one another is the role of design. Moving toward such a balance goes far beyond diet and exercise. It means giving people choices in how they negotiate their environment. It means restoring whole neighborhoods to health.

In suburban America, as well as within many cities, it’s almost impossible to buy a stamp, shop at a grocery store, or drop your kids at a basketball game without driving halfway to hell and back. This is a direct result of poor design. Whether it’s neglected open spaces, out-of-the-way stairs, limited access to recreation and cultural facilities, lack of generous sidewalks or retail density, or the absence of bike paths—the list goes on—every piece of the larger puzzle affects our health.

Conceived by the AIA and co-chaired by three national leaders from education and practice, America’s Design and Health Initiative (ADHI) aims to articulate specific recommendations for public policy, research priorities, and design guidelines. Since December 2010, ADHI has been building frameworks for lasting collaboration with leaders from a broad range of public and private organizations concerned with America’s health crisis.

But the real challenge is gaining public appreciation of the connection between health and design. Here, too, the AIA is actively engaged. A PBS series titled Designing Healthy Communities, hosted by former AIA Public Director Richard Jackson, will air later this year. Underwritten in part by the AIA, this series will explore the relationship between design and health.

When the day comes that an architect is invited to address the American Medical Association, we’ll know we’ve been heard. When we wake up to a healthier nation, we’ll know we’ve been understood.

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Clark D. Manus, FAIA, 2011 President