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March 20, 2013
by Rick Bell FAIA Executive Director AIA New York
A view of the San Antonio River Walk, just north of Houston Street.

The Metropolitan Health District of the City of San Antonio, in collaboration with the San Antonio Department of Planning & Community Development, the Mayor’s Fitness Council, AIA San Antonio, and the UTSA College of Architecture convened a conference on Tuesday, 03.19.13 called “Public Health and the Built Environment.” A packed ballroom at the St. Anthony Riverwalk Wyndham Hotel brought together an equal number of architects, designers, and public health professionals, evoking comparisons to our own Fit City conferences.

Among the featured speakers were Dr. Thomas Schlenker, Director of the San Antonio Metropolitan Health District and Dr. Annette Zaharoff, Chair of the Active Living Council. A breakout session called “Healthy Places/Healthy People – Austin: Partnering across City Departments to Create a Healthy Community” recalled interagency collaboration in New York. It was led by Dr. Philip Huang, Medical Director of the Austin Health & Human Services Department and Garner Stoll, Assistant Director of Planning & Review for the City of Austin. Other speakers included Julia Diana Murphy, Special Projects Manager in the San Antonio municipal Office of Sustainability, talking about bike share and Tenna Florian, AIA, LEED AP, an architect at Lake Flato Architects, talking about “What is Healthy Design.”

Ms. Florian described projects in San Antonio that follow the principles of the NYC Active Design Guidelines, showing that cities have major similarities in their ways of using design to address the epidemic of obesity. In presenting the AIA’s Ten Principles for Livable Communities, she spoke of how some projects in Texas are designed on a human scale, preserve urban centers, and provide varied transportation options. Building vibrant public spaces and creating a neighborhood identity were as important as conserving landscapes and insisting that “design matters.”

The keynote address for the conference was delivered by this author, on the invitation of Dr. Schlenker. An abridged version follows.

Fit City and the New York City Active Design Guidelines

In an article for the Texas Monthly a while back, Molly Ivins gave some advice on the formula for writing a speech: start with a joke, put the meat in the middle, and end by waving the flag. Standing here in San Antonio to talk about Active Design in a room filled with architects, designers, health professionals and public agency staff, I’d like to ask if there are any elected officials are in the room, invoking the spirit of Molly Ivins – who straddled New York and San Antonio and said: “Good thing we’ve still got politics in Texas – finest form of free entertainment ever invented.”The subject of the talk today is “What are the challenges of relating design to public health policy?” as demonstrated by the interdisciplinary effort that resulted in the creation and use of the Active Design Guidelines published by the City of New York. To talk about the Guidelines, I’ll be describing examples of buildings and sites which incorporate principles of Active Design, which, to a large extent bring us back to public health policy.

If you have already seen the CDC’s Behavioral Risk Factor Surveillance System statistics showing two decades of rising obesity trends among adults, it’s OK to head up to Oklahoma or, better yet, Colorado. Even the cheerful, seeing this gradually darkening series of maps for the first time, start to despair. I’ll run through twenty some odd years very quickly because, like Molly Ivins, I’m an optimist – she called it “practically a congenital disorder.” She did write, however, in The Bill of Wrongs: “Experience has taught me that things are likely to get worse, so these will eventually turn out to be the Good Old Days, and think what a fool you’ll feel like later if you don’t enjoy them now.” Statistics showing that a third of adults in the U.S. are now obese, however, are hardly enjoyable.

When we discuss why the obesity numbers are so much better in Colorado than Texas or New York, usually people talk about hikers, backpackers, and skiers, moving to that state and bringing with them lower body mass index numbers than we see on the fashion industry’s runways in Manhattan. What we should say, however, is that with BMI percentages over twenty percent, Colorado is not that great either.

Something has to be done, and public health professionals and architects, working together, may have an answer.

The first chapter of the Active Design Guidelines talks about the public health imperative arising from environmental design. It describes Central Park, which took shape in 1857 in New York as “the workingman’s lungs.” The Guidelines also details how reformers, physicians, elected officials, and design professionals gradually changed living conditions and housing typologies, reducing the incidence of cholera and other infectious diseases. Coincidentally, the AIA was founded in New York City that year, an otherwise terrible moment marked by the aptly-named “Panic of 1857” that rivaled the Great Depression in its local economic impact. Game-changing infrastructure, however, can be accomplished even during an economic downturn if there is the will – and public health incentive – to do so.

The impetus to the creation of the Active Design Guidelines was a collaboration between the New York City Department of Health & Mental Hygiene and the American Institute of Architects New York Chapter which was manifested in several ways starting with an exhibition called, ironically, “Value Meal,” by curator Laetitia Wolff. It got us thinking about the impact on food purchasing by the manipulation of packaging and advertising by graphic artists.

Shortly beforehand, Dr. Richard Jackson, MD, MPH, was connecting the dots between prevalence of chronic disease and the design features of our sedentary society. He showed slides of someone in Atlanta, for lack of sidewalks, walking his dog with the leash out the passenger side of his car. People laughed at the image, but felt the absurdity of our avoidance of exercise.

Chronic diseases such as obesity, with links to diabetes and cardiovascular disease, has supplanted infectious disease in morbidity and mortality rates. Despite some relatively recent positive news, it is no better among kids than adults. We have now convened seven “Fit City” conferences in New York, bringing together designers and health professionals. Fit City 8 will take place this year at the Center for Architecture on Monday, 06.23.13 These conferences have featured outside experts such as Gayle Nicoll from San Antonio, Craig Zimring from San Diego, and Jan Gehl from Copenhagen.

Back to the Guidelines. They were suggested by an architect, David Burney, FAIA, Commissioner of the New York City Department of Design + Construction. He thought that writing up the proceedings of the conferences we held simply wasn’t good enough. Guidelines, he said, would allow for both public and private sector clients to have a clear statement of principles and some relevant case studies to use as a reference for their own potential projects.

A draft of the Guidelines was on hand for Fit City 3 back in 2007, when the AIA’s National Convention took place in San Antonio celebrating – at a distance – the 150th anniversary of the Institute’s founding in Lower Manhattan. By Fit City 6 in 2010, the Guidelines were in use and the Commissioners of our City Departments of Health, Public Works, Parks, Planning, Buildings, Transportation, and Disabilities were on hand to talk about implementation opportunities.

And at Fit City 7 in 2011, the same agency chiefs, plus Linda Gibbs, Deputy Mayor for Health & Human Services, were addressing the relationship of Active Design principles to the expectations of New York City’s Obesity Task Force, which has attempted to ban “long-neck” soft drinks from the public domain. For Fit City 8, we modestly hope that Mayor Bloomberg will give the invocation.

Over the last two years, with some grant money coming to AIANY from the Centers for Disease Control and Prevention, we could afford to take the show on the road, at least as far as City Hall – the Wilson Building – in Washington, DC, and also to New Orleans during the 2011 AIA Convention.

At our Center for Architecture gallery space – comparable to the one here at San Antonio’s Pearl Brewery site run by Executive Director Torrey Carleton, we’ve also collaborated with conceptual artists such as Copenhagen-based Rosan Bosch on how to bring the need for more physical activity to people’s attention. Her “Jump Zone” sign encouraged people to jump within the delineated nine foot by nine foot square. Her “Weigh-lifting Zone” graphic showed someone pressing two big shopping bags.

The three design-oriented chapters of the Active Design Guidelines focus on Urban Design, Building Design, and what is called Synergies. These link the principles to other efforts and policy initiatives, including environmental design, age-friendly design and accessibility or universal design.

Pages from the Urban Design section focus on Land Use, Play Space, Transit Access, and the Pedestrian Environment. The Active Design Guidelines can be downloaded at www.nyc.gov/adg. If you do so, you will see in this Urban Design section some thirteen specific principles, illustrated by example and case study. Issues addressed can be broadly defined as Land Use Mix, Transit, Parks & Recreation, Children’s Play Areas, Public Plazas, Availability of Fresh Produce, Street Connectivity, Traffic Calming, Pedestrian Pathways, Programming, Bicycle Networks, Bikeways, and Bicycling Infrastructure.

At the core of the urban intervention at neighborhood scale is access to recreation space, a lively mix of uses that encourage pedestrian activity, and the availability, use and safety of bicycling, both for recreational purposes and to get to and from work. Of course it is much more complicated that that, with detailed descriptions about zoning changes that encourage bicycle storage, indoors and out, and the complete streets that also enable access to fresh food and a public plaza or park within ten minutes of every New Yorker’s residence or workplace, as delineated in PlaNYC.

Similarly, the Guidelines section on Building Design has general principles, examples and, case studies. Pages from the book discuss, in detail, such major themes as Stair Use and Bicycle Parking & Storage.

Some of the local case studies in the Active Design Guidelines are relatively well-known. Corner stairs connect the working floors of journalists and editors at the New York Times Building by Renzo Piano and FXFOWLE. Beautifully-designed stairs create additional retail space at Apple Stores by AIA Gold Medalist Peter Bohlin, FAIA, and here at the original SoHo store, in collaboration with Ronnette Riley, FAIA. We see careful attention to creating an appealing stair environment in recent work such as Fiterman Hall by Pei Cobb Freed and Partners and the Gates Foundation Headquarters in Seattle by NBBJ.

Through their dimensions, location, aesthetics and way-finding graphics, stairs are increasingly becoming the primary paths of vertical circulation in schools, office buildings and even architectural galleries. Elevators, of course, exist to provide equal access to all spaces for those who cannot navigate stairs, whether they are carrying heavy packages, pushing book-carts, or getting about in a wheelchair. They simply are not the first thing you see upon entering a building.

Buildings can be programmed to have accessible roof gardens, connected by exterior stairs, as we see at the recently completed Via Verde affordable housing complex in the South Bronx, designed by Dattner Architects and Grimshaw Architects working with developers Phipps Houses and the Jonathan Rose Companies. And, elsewhere, ramps that suggest and follow desire paths of movement animate commercial spaces, conference centers and courthouses, from the Tokyo to the Bronx.

Increasingly we see exercise facilities located within buildings. Some may still prefer to receive chits or reimbursement to join a nearby health club, but we find that people will get more exercise if there is equipment on the premises. And, lastly, for Building Design, even the form of the building can encourage movement, both around it and on adjacent plazas. An example is the reworking of the entrance to the Brooklyn Museum, by Todd Schliemann, FAIA, of Ennead Architects.

The Active Design Guidelines concludes with an analysis of linkages and relationships to a few other areas of increasing change and connection. They include mention of the Active Design innovation credit given by the US Green Building Council as part of its LEED rating system.

A newly opened part of Brooklyn Bridge Park, Pier 5, has soccer fields, bringing active recreation to the East River waterfront in Brooklyn.Designed by landscape architect Michael Van Valkenburgh, FASLA, the park brings much needed play space also for the adjacent upland neighborhoods.This was very much a factor in community discussions of the park design.

And, as bicycles becoming increasingly prevalent given safe and connected networks of dedicated bikeways, we see the need for imaginative intermodal juxtaposition, and bringing bike storage to new heights of creativity.

The case studies, of course, do not have to be in New York City to make the point. Obesity is almost ubiquitous, and the things that are being suggested by the Guidelines as a result of discussions between designers and health folks around the country – and around the world – are beginning to be better documented.

Environmental concerns, certainly prevalent after the nuclear meltdown in Japan, suggest that energy conservation rather than merely searching for new sources of energy can help shape a future where stairs regain their importance.

To conclude, I’d like to come back to the public health politics of active design, where municipalities from New York to Birmingham have increasingly started to equate decisions about public health resource allocation to prevention by design. We’ve seen, at our Fit City and Fit Nation conferences, workshops that bring these principles home on a project example basis to other cities. In San Antonio, the City’s identity to convention-goers and conference-attendees is to a large extent conditioned by images of River Walk here in San Antonio. There is much more enhanced recreational access for residents, in the Mission Reach Ecosystem Restoration and Recreation Project described by Stephen T. Graham, P.E., Assistant General Manager of the San Antonio River Authority.

Molly Ivins said, “You can’t ignore politics, no matter how much you’d like to.” And the central public health issues of the day, from AIDS and autism, to obesity and heart disease, not to mention nutritional decisions and gun control, start with interdisciplinary or trans-sectorial discussions. As for guns, Molly Ivins famously said: “I am not anti-gun. I’m pro-knife. Consider the merits of the knife. In the first place, you have to catch up with someone in order to stab him. A general substitution of knives for guns would promote physical fitness. We’d turn into a whole nation of great runners.”

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