Health and the built environment – shared problems and shared spaces

Inspired by some of your comments on last week’s post about architecture and anti-depressants, this week I want to pass along another interesting nugget I stumbled across in my research about the role architecture plays in health.

Designing Healthy Communities is a project aimed at rethinking the role that the “built environment” has on key public health problems: not only depression but also heart disease, asthma and cancer. Dr. Richard Jackson, a leading physician who helped establish the California Birth Defects Monitoring Program and led 15 years of work at the Center for Disease Control on environmental causes of disease, argues that the way we design our environments has important consequences for our health.

Suburban sprawl, for example, prevents us from being able to easily walk or bike to the places we need to go; our dependence on cars to get around makes us more sedentary, which increases our risks for heart disease and other illnesses, and adds pollutants and toxins into the air we breathe, contributing to our development of chronic diseases like asthma and cancer. Because of this, cities like Denver are designing new live/work areas (like this one in Belmar) that make it easy for inhabitants to get around on foot or bike.

On the other hand, not having enough open areas in dense urban spaces prevents children from being able to play safely, away from moving vehicles – also encouraging sedentary lifestyles during key developmental stages – and minimizes access to fresh produce by not providing spaces for people to grow their own fruits, vegetables, and herbs. Preserving spaces for community gardens, as they have been doing in New York City, is one way to improve people’s access to these products.

Philosophically, this project is interesting for several reasons. First of all, it suggests once again that health is not something that we can isolate to a single cause. Certainly cancerous cells are a cause of cancer – but so might be where and how you live. But more  importantly, this project is a powerful reminder that health and disease quite simply cannot be tackled at an individual level. Finding solutions and cures to chronic diseases like heart disease, cancer, and asthma will not happen if we continue to focus on individual bodies as the “site” of illness or health. The causes of disease and their remedies will only become clear if we zoom out our focus on the problem to include not only the person but our environment as a whole, including the environment that we design and build to sustain and support our living.

This makes health a collective issue. Collective issues are tricky. They require cooperation, collaboration, dare I even say – consensus.

Many of us are accustomed to thinking of health as something we can pursue, choose, and foster individually. Academics in particular (including philosophers like Foucault and Deleuze and Guattari) have struggled long and hard to critique the normative and exclusionary definitions of health that tend to problematize individual differences. Western approaches to health, although they do promote a general norm that applies indifferently to all, encourage us to think of health as something that we can achieve through individual effort – if we just have the right exercise regimen, eat the right foods, take the right pills, or take ourselves to the right doctor for the right tests and treatments.

It is important to retain space for individual differences, preferences, and choice in defining and pursuing health. But much is at stake in this parsing out of where and to whom health belongs. We cannot solve the kinds of chronic and widespread problems we are facing if we do not also think about health as something that we choose and pursue together. We share our living environments and we (often unequally) share the effects that these have on our bodies. We can only promote health if we are willing to rethink some of the ways we have chosen to organize our lives together.

Why don’t we start by thinking about what kinds of living arrangements make for both healthy individuals and healthy communities?

(Note: there is a four-hour film series on Designing Healthy Communities that will be showing on PBS this spring; it’s also posted on the website. Check it out!)

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