Certain change is upon us, and is necessary, in health care. Most excitingly, 21st century health care has the potential to become increasingly predictive, personalized, preventive and participatory (the P4) – driven by consumers, disrupting technologists and entrepreneurs, architects, scientific researchers, clinicians and community leaders.
Medicine already has the ability to be highly tailored to the individual, and science wants to drive us toward improved wellness. Many technological and design innovations are out in front of care delivery, with converging implementation on the horizon. The eventual health advancement possibilities are inspiring and may soon influence the shift from volume to value.
However, the current state of health care is contrary to the potential of P4. Another big “P,” and perhaps the biggest of all, our population is growing and aging. Occurrences of chronic diseases such as cancer, heart disease, and diabetes are increasing, fueled by rapid urbanization, sedentary living and diet choices. And, the social determinants of health (i.e. physical, social and economic environments and behavior choices) have substantial effects on the lives cared for by health systems.
The influence of these determinants has encouraged health systems to focus more on population health for improved patient access and outcomes. But, since these elements are generally beyond the traditional control of health systems, comprehensively improving them requires action from communities and the expertise from a continuum of professions. For example, architects are always considering how the built environment affects communities, individuals and the social determinants of health. There is no doubt the built environment can contribute to creating a culture of health that is more predictive, personalized, preventive and participatory.
Tarrant County Population and Health – Today and Tomorrow
The west side of the Metroplex is a special community; Fort Worth and its surrounding area offer economic and cultural vibrancy mixed with unpretentious charisma. The opportunities that come with explosive growth and rapid change are on the horizon for Tarrant County. According to a North Central Texas Council of Governments estimate, as of 2017, the population of Tarrant County is estimated to be approximately two million people. But, over the next two decades, the county’s population is expected to increase by 50 percent to reach three million people. The over-65 population will increase at a higher rate than any other age cohort, and the community will become more diverse, with high growth among Hispanic, Asian, and African American populations.
While Tarrant County has evolved into an international economy with breadth and depth, no longer dependent solely on defense and oil, there is a significant percentage of the population in low-income conditions, generally concentrated in Fort Worth’s urban center. From a health perspective, according to long-range planning related to JPS Health Network, Tarrant County has key concerns with obesity, diabetes, high blood pressure and cancer. So, there is much to consider as the area continues to grow.
A Culture of Health
With fast-paced expansion and increasing diversity ahead for Tarrant County, a focus on building a “culture of health,” as defined by the Robert Wood Johnson Foundation (RWJF), is necessary for positive impact on individuals, the community and the health systems serving them. Building a culture of health shifts our approach from treatment to prevention and from being “not sick” to well-being and whole-person care. According to RWJF, the principles for a culture of health include working together to ensure that good health flourishes across geographic, demographic and social sectors, that all people have opportunity to make healthy choices, and that quality care is equitable and accessibly affordable so the economy is unburdened by unwarranted spending.
But, how do we create this seemingly utopian culture (strong population health, well-being and equity) with such wide disparities in our communities around the social determinants of health? RWJF proposes four action areas for creating a culture of health, and each can be positively influenced by the built environment through thoughtful, proactive urban planning, community design and architecture.
The Built Environment
Health is where we live, work, learn, heal and play.
Creating healthier communities requires planning beyond healthcare buildings to the entire, connected ecosystem of neighborhoods. Allowing for mobility options such as mass transit, cycling and walking is an important planning consideration. Fostering cross-sector collaboration means developing multi- and inter-disciplinary building types and districts to strengthen the social fabric of communities found in places like libraries, educational facilities, housing, health centers and healthy grocery and restaurant choices. Strengthening the integration of health services and systems into the community requires health centers to be designed and programmed to reflect the populations they serve, resulting in an overall improvement in access and experience. Making health a shared value and priority is accomplished by creating a sense of community, which is often influenced by the design quality of architecture and urban planning.
Urban planning and architectural design is a canvas for developing a culture of health that supports the holistic well-being of community members. There are many great examples of this happening in Fort Worth today: the Cultural District which boasts museums, botanical gardens and trails along Trinity Park with bike sharing stations; the West 7th District which brings together healthy food options and walkable living; and the Near Southside District anchored by Magnolia Avenue which fosters an artisan-spirited, locally-owned, mixed-use district within walking distance to many of the community’s hospitals.
Perkins+Will has played a role in developing the culture of health in Fort Worth as well, with various building typologies’ designs impacting the community in different ways to address different aspects of healthy living.
The new 94,000-square-foot, full-service Cancer Center is located on a tight urban site near downtown Fort Worth. It is a great example of improving access to care and the consumer experience to further integrate health services and health systems into the heart of the community.
Fort Worth Independent School District’s Van Zandt-Guinn Elementary School is located on a 4.7-acre site near downtown Fort Worth. The program components and design of this school (state-of-the-art media center, outdoor learning lab, community gardens, multipurpose communal spaces) foster cross-collaboration within a single building typology and contribute to the key culture of health action area of creating a more equitable community through its maximized connectivity to the surrounding Historic Southside neighborhood.
The City of Fort Worth is striving to bring a community-centered presence to its rapidly developing northern area through the construction of a new branch library. Designed to foster civic engagement and a sense of community, the library features a visually accessible space and a communal place of gathering. Providing a new space for people to come together contributes to the principle of making health a shared value in communities.
Revolution and Convergence
The Fort Worth community has a design revolution ahead – the opportunity to further build a culture of health in the face of exciting growth and development. As the healthcare system shifts to a population health mindset for delivering value-based care, and as technologies and places are designed to further influence the predictive, personalized, preventive and participatory nature of the system ahead, the converging future could not be more engaging. We must contribute to the culture of health where we live, work, learn, heal and play.
Ashley Dias, AIA, ACHE, EDAC, LEED AP, is a senior associate at Perkins+Will. https://perkinswill.com/