The human condition is changing rapidly. The last century brought unprecedented shifts in the ways we obtain and use energy, communicate, travel, eat, work and raise our children. From the metropolitan scale to that of rooms and products for everyday use, many of the features of our environments today would have been unimaginable to our early forebears. The flows and cycles of energy, carbon, nitrogen and other materials, and the systems that undergird the earth’s functions are also quickly changing.

While we are a highly adaptable species, we are showing signs of stress—high burdens of depression and anxiety, cardiovascular disease and cancer, attention deficit and autism spectrum disorders, asthma and infertility, many of these trending in the wrong direction. The built environment offers many opportunities to mitigate this stress through both art and science. From a design perspective, this presupposes the integration of empirical evidence with traditional form-driven problem-solving methodologies. Evidence-based design across scales can promote health while yielding manifold co-benefits: physical activity, disaster resiliency and sustainability.

Promoting Physical Activity

The public health community is increasingly concerned about the current “syndemic” (or conjoint epidemics) of sedentary lifestyles, overeating, obesity and associated diseases—hypertension, diabetes, heart disease, stroke and some cancers. Routine physical activity appears almost diabolically engineered out of our daily lives. Roadways favor motor vehicles, not pedestrians; grand buildings feature iconic elevators in their lobbies, while stairways remain hidden behind fire doors.

Working together with public health professionals and planners, designers can help remedy what urban theorist Nan Ellin calls “place-deficit disorder,” starting with the basics – stairways, sidewalks, landscapes and contiguous urban spaces – which they can compose to attract greater pedestrian use. Grounded in empirical research, the Active Design Guidelines: Promoting Physical Activity and Health in Design, produced in 2010 by the AIA New York and the New York City Department of Design and Construction, describes principles of building composition and spatial organization that increase physical activity across all income levels and generations. This and many other emerging initiatives exemplify the potential for good design to promote healthy places through the use of scientific knowledge.

Designing for Resiliency

The devastation left in the wakes of Hurricanes Katrina and Sandy – among the largest, deadliest and costliest storms in US history – underscores threats posed by extreme weather events, rising sea levels, flooding, storm surges, heat waves and droughts. Such disasters destroy property, displace people, fracture communities and upend lives. Evidence-based design can help reduce vulnerability and enhance the resilience of buildings and infrastructure, but most importantly, the communities who depend on them. Design strategies for water management include reducing water use, increasing rainwater capture and water reuse, conserving water during shortages and controlling water during surges and floods, as well as optimizing the recreational and aesthetic value of waterfront development.


Sustainability is an aspirational goal—an equilibrium state in which human needs are met equitably, within the carrying capacity of the earth and without threatening the ability of future generations to meet their needs. The journey to sustainability offers the hope of continuity and security. Designers possess the unique skills, knowledge and practices to specify the use of benign materials across scales based on life cycle analysis, energy conservation, carbon management, and environmental and health impacts. As designers expand these practices, they educate their clients, inform the public and shift the market.

Increasing Opportunities Equitably

Many of the factors affecting human health and wellbeing, whether short-term and measurable (e.g. obesity and asthma) or long-term and elusive (e.g. hope for the future), occur inequitably among persons with different income levels. Concerted efforts to address social and health disparities can help achieve fairness. Recent studies demonstrate that links between greater access to green space and lower mortality are more pronounced among the poor than the wealthy. Housing initiatives that offer better homes for low-income persons, workplace design that protects workers, and universal design that improves access for activities by persons with disabilities—these practices benefit vulnerable populations and offer designers unlimited opportunities to help foster fuller, healthier lives.

A Growing Movement

Many in the building and design fields are increasingly focused on public health. Activity is growing around the intersection of design and human health in the form of a broad-based movement comprising diverse organizations such as the US Green Building Council, the American Institute of Architects, the Healthy Building Network, the National Center for Healthy Housing, the Center for Active Design, Public Interest Design and Practice Greenhealth, among numerous others. Working together, such organizations can disseminate information about existing and emerging programs of research linking design and health, sponsor initiatives and competitions that explore their interdependence, and underwrite programs that integrate them within the professional curriculum. New partnerships can help expand knowledge and hybrid methodologies. As the public learns about the health consequences of products, buildings, landscapes and urban development, the market for evidence-based health-elevating design will continue to grow.

Instead of sacrificing the present for the sake of the future,” New York Times columnist David Brooks recently wrote, “Americans now sacrifice the future for the sake of the present.” In counterpoint, we envision an emerging alliance of design professions working together with public health professionals toward a sustainable future with unprecedented measurable effectiveness across scales— focused on life cycle and resilience, oriented toward enduring responsibility, and imagining a future where the opportunity to achieve health and well-being is a fundamental human right. As the combined resources of allied disciplines further converge around new calls to action, we see a future for professional education and practice mutually empowered by design insight and empirical evidence to create and improve healthy buildings, neighborhoods and cities that elevate, optimize and advance human potential. In offering this picture, we remain soberly mindful of the costs of inaction— costs here and now, costs across the life of our built environments, and most importantly, costs passed on to future generations.