exploring from just about the time I
could walk whenever I go over to my
grandparents house I would sneak out and
climb this radio antenna you get some of
you may know what that is radio antenna
up the side of the house and get onto
the roof even though I knew I would get
into trouble and let’s just say the fire
department may have been called on one
occasion other times I would take apart
my toys new or old just to see how
they’d work or to reconstruct them as
something else well I’m sure my parents
thought of it as me being mischievous I
now think of it as creative disruption I
enjoy how even a small shift in
perspective can open up new
possibilities now as an architect and
strategic thinker my career’s largely
devoted to doing just that by creating
buildings and places that help improve
the well-being of others a career
focused on design which challenges me to
see things from multiple perspectives on
the issues that we face so today at a
time when we’re increasingly socially
divisive in tempted to isolate ourselves
I want to talk with you about the
impacts on your health the importance of
community and the role of design in
addressing these challenges I want to
shift your perspective in the United
States today we spend more annually on
health care than any other country in
the world and yet we rank last by almost
any measure
we’re 39th in infant mortality 36 and
life expectancy just to name two when
you look at the headlines much of our
time and attention is focused on health
care and its rising cost now clearly
this is an issue that can and must be
addressed but what if I told you we
might be looking at the problem from the
wrong perspective what if I told you
that just 20% of our health and
well-being is attributed to your quality
and access of health care
research shows that 80% 80% of your
health and well-being is directly
attributed to social economic
environmental and behavioral factors
factors which trigger sharp rises and
chronic diseases like obesity and
diabetes factors which relate both
directly and indirectly to how and where
we live your life expectancy is
dependent on your zip code a 2013 Robert
Wood Johnson Foundation study found that
has fused two train stops in the same
city can mean a seven-year difference in
life expectancy 13 years in some
locations
now before you pack your bags you should
know this is true of Detroit Dallas DC
El Paso pretty much most places why
because where we live impacts how we
live I want to share a story that
illustrates this in the 1960s there’s a
small rural town in eastern Pennsylvania
called Roseto
Rosetta was an Italian immigrant
community named after a town in Italy
that featured closely spaced houses and
walkable streets at zero crime rate zero
suicides and a heart disease rate that
was nearly half that of the national
average as well as neighboring towns
they’d have a single death under the age
of 45 due to heart disease men were
living so much longer that there were
more widowers than widows what was truly
remarkable is that they worked in stone
mines ate fried foods drank wine in
abundance and smoked habitually they did
pretty much all the things that health
professionals warned against and yet
they lived longer why researchers
studied the town pored over death
records and what they found is that they
live longer because they were less
stressed they were less stressed because
they looked out for one another in a
close-knit community if one family was
sick others pitched in families would
cook meals together town elders would
help take care of the kids imagine a
town where weddings was spread out from
the church into the neighborhood streets
there wasn’t a social hierarchy there
wasn’t this keeping up with the Joneses
mentality
in short they shed stress in a very
healthy way interdependently together
and drink as much as they wanted however
researchers also made a prediction that
within a generation as suburbs expanded
houses grew fences popped up that social
economic isolationism would set in and
change this the community would divide
stress would rise and health would
decline so they went back in the 1990s
thirty years later study the town again
and found this to be true today risotto
has the same heart disease rate as
anywhere in the United States where we
live impacts how we live unfortunately
today our lifestyles totally geared
around cars we drive more and walk less
children walk or ride a bike to school
fifty percent less than they did just
thirty years ago that’s a drop from
sixty percent to just ten percent
many of us live in food deserts where
fresh produce is non-existent and fast
food is most convenient over the last
sixty years we have slowly and
methodically replaced walkable
neighborhoods walkable communities with
car oriented suburbs that not only limit
healthy behavior but may then discourage
it our stress has never been higher now
there is good news the good news is that
our physical environment where we live
work play and heal does account for much
of our health that we can control so the
solution doesn’t rest alone in improving
the delivery of health care it rests in
delivering healthier communities imagine
if we could take even a small amount of
the effort underway with health care
reform and reinvest that into how and
where we live and what if we could do
that through design think about it in my
profession as an architect today we
design green buildings to be resource
and energy efficient to do less harm to
an effect be less bad but what if
tomorrow we design buildings in places
that actually promote and encourage
health and well-being this is where the
opportunity lies so that where we live
impacts how we live in a positive way
not only is this happening but is
happening in a place with limited
resources little skilled labor and
virtually no infrastructure Ketchum Bala
agonda is a village in eastern Africa
rich in tradition and culture this is
evident through their celebrations where
men women and children dress at vibrant
clothing and celebrate together however
it’s also one of the country’s most
impoverished two dollars a day
is the average Admiral annual income
life expectancies 15 years below global
average at 56 years infant mortalities
double the global average with one in 26
newborns dying before their first
birthday now some of this is due to a
need for better medical facilities but
much of it is due to community
infrastructure and resources women would
be turned away from the birthing center
due to capacity issues some after
travelling long distances on the back of
a motorbike while already in labor many
wouldn’t make the trip often the result
is women giving birth at home without
assistance or sterile equipment clearly
new facilities were needed but in a way
that would work for and be embraced by
the community this is not something that
could be dropped in from afar by
Outsiders that assume they know it’s
best to be successful the design had to
be in collaboration with the community
the real solution had to come from
within ultimately the way it was built
and who built it had to be adapted with
a lack of reliable infrastructure such
as power and water and a scarcity of
materials sustainability what an option
it was absolute to help with
unemployment and to improve skilled
trades 40 community workers were trained
in regional construction techniques such
as making mud bricks by hand techniques
they can now carry to other jobs and
other services
however training wasn’t just limited to
construction workers as one example I
want you to meet Julianne
Julianne was trained by a midwife during
the construction of the project and how
to deliver premature babies in just a
few short months Julianne has helped
deliver several premature babies that
otherwise would not have survived
now Julianne in her village illustrate
how a single project it positively
impact the trajectory of a community
starting with expecting mothers but
extending to other families and now
skilled workers who can afford an
education for their kids they didn’t
just build a building they used design
to help shape the health of their
community now for an example closer to
home there’s the urban food studio in
Washington DC the capillary Food Bank
provides leadership training education
and food to over 400 partner agencies
such as churches schools synagogues
things like that 16 percent of the DC
population struggles with access to food
access to food is actually a root
determinant for many of the hospital’s
super-users the capillary Food Bank
realized that improving access to food
had to be about more than just giving
out meals so they launched a
demonstration garden for nutrition
education and gardening basics due to
its success they did engage volunteers
to expand and enhance the capabilities
of this garden the result is a
multi-purpose garden in urban food
studio it provides all season access to
cooking workshops classes and other
educational events reflecting their
values to be environmentally friendly
the structure itself demonstrates
sustainable ecosystems such as rainwater
collection and solar harvesting the
studio teaches individuals and families
that whether you have a backyard or
balcony you can learn how to grow food
and how to stretch your food budgets
farther the result is a place that
empowers healthy choices while improving
in both cases Ketchum Bala and EC he
started through the efforts of a single
individual with Ketcham ball it was
somebody in the area that sat with
village elders to understand what was
their most pressing need with the food
bank it was an individual passion about
sustainable design she found out they
need expanded facilities and then
leveraged her network to bring it to
life in both cases they didn’t just
donate their time they used Design
Thinking to help make it happen so when
we talk about design thinking what are
we talking about we’re talking about an
iterative method for practical creative
problem-solving the type of thinking
that brings together social cultural
environmental variables into solutions
that can help communities thrive but the
real impact to design thinking is in the
ripple effect like a pebble in a pond
design thinking isn’t just about the
initial concern but is about the ripples
that is the impact you can have beyond
the initial idea of being considered
with Ketcham Bala the ripple effect of
building new birthing suites was
enhancing skilled labor and improving
sustainability with the food bank the
ripple effect was about improving access
to food where we live impacts how we
live rural urban or anywhere in between
we can and must come together as a
community to improve our health my
passion if you haven’t guessed by now is
design in my practice with HKS we do
this by thinking beyond the property
lines of our clients on how buildings
impact neighborhoods how neighborhoods
shaped place and how place influences
behavior personally I first committed to
doing this about 10 years ago through
the creation of a design fellowship
within our firm that paired designers
with architectural students to work on a
community need out of a single event it
has grown to cover over five cities and
twenty needs needs that have ranged from
affordable housing in DC to improving
connectivity and walkability in Dallas
from
it’s about shifting our perspective on
what truly impacts our health for using
design in the built environment to
influence healthy behavior fundamentally
for shaping places that encourage kids
and parents to walk or ride their bikes
where we live impacts how we live but
how we live is a choice so what if we
all were to use design thinking to
impact the health of our communities
what impacts would we have what
communities would we create the best
part is you don’t need to be an
architect a designer or health
professional to be a catalyst for change
design is a way of thinking and
problem-solving is in each of us a
single person with a passion to care you
can have a ripple effect of their own
with a profound impact each of a shape
our communities by how we choose to
engage with them or how we choose not to
so to do this sort of design thinking
yourself you simply need to observe
engage and collaborate open your eyes to
the challenges around your neighborhood
schools and towns engage with groups
working on those issues in a way that
aligns with your own passion your own
ideals collaborate with those groups so
that change happens within change also
starts with a commitment to care this
was apparent to me personally at the
2013 Boston Marathon as a runner I was
stopped about a quarter mile from the
finish when the bombings happen before
long there were several hundred maybe
thousand runners held in place tired
dehydrated cold wet held in place while
medical care was rightfully focused on
those injured at the finish held in
place while many of the runners were
starting had medical issues of their own
common to running that far for that long
but magnified by the cold temperatures
in wet clothing I didn’t see the heroics
of those at the finish but what I did
see
with strangers spectators who came
together sharing their own clothing
their own water their own blankets in
some cases opening their own homes to
strangers individuals hundreds of
individuals who came together despite
the fear despite the chaos regardless of
anyone’s politics came together as a
community the day was tragic but like
many I was inspired by our shared
humanity we must shift our perspective
the solution doesn’t rest alone in
Capitol Hill where the focus is on the
20% nor is it isolated away in our own
political echo chambers the solutions in
here it’s in our shared humanity
together through design thinking we can
impact the health of our communities and
the 80% of our health that we can
control this is where we can do more
than just be less bad where we can
thrive where we can recover but Rossetto
lost and what ketcham Bala gained thank
you [Applause]