Why Is This Important?

Challenge
How can the built environment foster positive health outcomes long before any patient steps foot into a hospital? According to the United Nations, approximately 68% of the world’s population will be living in cities or other urban centers by 2050. Urban design has the potential to be at the forefront of improving overall population and community health in the years to come. For this reason, it is vital for communities to identify, evaluate and prioritize designing for wellness in the urban built environment.

Aim
This study examines two main points. First, the study examines urban design strategies for wellness, such as designing for increased physical activity or better nutrition, and these strategies’ role in impacting the health and well-being of an urban population. Second, the study seeks to create an observational methodology for measuring how existing urban design in the built environment negatively or positively impacts population wellness, with the outcome being a new tool that can be leveraged for informed decision-making. In addition, this study explores insights into the variety of built environment metrics that influence human behavior towards wellness. By delving into the field of urban design and wellness, we help increase understanding into how urban design can contribute to a broader spectrum of care.

What We Did

Approach
This study utilizes two reviews of the literature, the creation of an observational tool to test existing environments, and pilot studies of the tool to examine how communities can benefit from understanding design for wellness in their own urban built environment.

Method
An initial literature review was conducted to understand how urban design and planning influence health and wellness broadly. Thirty-two urban design metrics, divided into five categories, were identified from the literature as influencing either psychological or physiological aspects of human health. From there, a second literature review was conducted to understand the characteristics of existing observational tools for health and wellness.

Based on the findings from the second literature review, a novel tool was developed that analyzes urban design characteristics for positive wellness outcomes. The tool, called WellMap, was created using descriptors and diagrams that allow one to score a specified study area. WellMap is designed to lend insight and prioritization to what a community or project site could do to contribute to overall healthier decision making. The WellMap tool is complemented by a design guideline matrix that offers urban design strategies dependent on the resultant rating, an Excel scorecard that automatically visualizes comparative results, and a client template for project teams to create a one-pager that summarizes all information.

What We Found

Literature review #1:

• Research into what makes cities & communities healthy is plentiful – the question is no longer what makes a healthy community, but where do we start?
• Urban design influences wellness by encouraging healthy human behavior, such as walking instead of driving or eating fresh produce instead of fast food.
• Wellness has multiple definitions but defining it as pertinent to human behavior and lifestyle choices is critical. In other words, access is important.
• Generally, most existing research is embedded in how the built environment can facilitate higher levels of physical activity.

Literature review #2:

• Existing tools seek to rank environments based on the relationships between metrics. These tools are not designed to direct or curate additional data about the built environment.
• Existing tools include a selective group of indicators to be used as a basis for analysis.
• There is a disconnect between how we identify, evaluate and prioritize existing environments for wellness.

Five Factors Were Identified From the Literature Review That Influence Physiological and/or Psychological Wellness in the Built Environment:

Design Factors

Designing communities with provisions for physical activity (namely, walkability) has a sizeable impact on wellness. This impact is felt both through formal massing that affects human physical activity and through influencing external factors, such as vehicular speed, which are linked to vehicular and pedestrian fatalities.

Diversity Factors

A mix of land use and accessible destinations, such as shops within neighborhoods and communities, influences whether people choose to commute via walking, connect multiple walking trips or participate in leisurely walking.

Density Factors

As density tends to encourage mixed-use facilities, sufficient densities alongside other built environment factors increase the probability of individuals walking for transport and creating local businesses that attract people and support a local community.

Distance Factors

Access to facilities such as public parks, green spaces, health care facilities, grocery stores, third places, etc., support positive healthy lifestyle choices by allowing people to be active or practice other healthy behaviors.

Destination Factors

Major anchor institutions that spur economic development by helping to create mixed-use destinations increase the probability that residents and visitors will decide to participate in physical activity.

These five factors formed the foundation of the WellMap tool, which was piloted in three distinct areas within Atlanta.

Pilot Study Analyses

• Single land use areas with low levels of density tended to be rated lower for urban design attributes that contribute to wellness.
• Mixed-use areas with high levels of density tended to be rated higher for urban design attributes that contribute to wellness.
• High disparities between diversity and destination categories can occur between study areas due to a lower number of variables that are available to be rated in those categories.
• Variables within the design subcategory appear to be positively correlated.

Deliverable
Findings and insights from the literature reviews, WellMap tool creation and pilot studies led to the development of key considerations, design goals and a design considerations matrix for urban design and wellness. These are compiled into a comprehensive report of the study and a full PDF, Excel spreadsheet and one-page template of WellMap that is available for use and distribution to project teams.

What the Findings Mean

Application
A decentralized, holistic approach to health and wellness in our communities is trending, and urban design for health affirms this through consideration of how buildings, streets, public spaces and communities foster health and wellness for all. WellMap seeks to make stakeholders aware of the larger context in which they are operating and how their project can tie into an existing network of wellness fluidly and efficiently by identifying inequities in the built environment. What we have learned is that although urban design by itself does not ensure wellness, designing for networks of wellness can positively influence healthy human behavior. Efforts toward understanding how the built environment can foster wellness should be focused on identifying applicable study areas for project sites, evaluating what components within the study area are most important and prioritizing concrete metrics to determine how best to intervene.

Future
There are several directions that future research could lead, many of which involve testing and evaluating the efficacy of the WellMap tool, as well as its connections to wellness and health care at large. Viable options for exploration include improving user observational methodology through testing for inter-rater reliability, recommending ideal study area sizes and cross referencing WellMap scores with contextual health data to determine associations between urban design and health outcomes.

As the rise in population in urbanized areas worldwide increases, so should our efforts in designing our cities and communities to support health and wellness. This is our call as designers to respond with knowledge through designs and strategies that maintain positive health long before anyone steps foot in a hospital. The built environment and the design of the everyday will become a first line of defense and a major influencer of population health at large.