Natural disasters test the seams of our cities and health systems. During hurricanes like Sandy, Harvey and Maria, community infrastructure buckled under the pressure of torrential rain, gusting winds and prevention measures designed for a bygone era.
When we see areas of the country devastated by a natural disaster, we often blame nature. But the storm is only half the story. While we tend to think of a natural disaster as a single event, a disaster’s worst effects often emerge weeks, months or even years after the initial emergency, as the devastation is amplified by an already flawed environment. Disasters happen when cities are unprepared for the stress an event like a hurricane can cause. They happen when cities are not designed with resilience in mind.
To withstand disasters, then, we must first build more resilient cities. This requires a multi-tiered approach. First, we must consider the city as a whole and the foundational role urban planning, design and community dynamics play in creating health in metropolitan areas. Next, we must design specific buildings so that they maximize personal well-being.
With hurricane season well underway, now is the time to rethink how we approach disaster preparedness. Here are three ideas to consider.
1. ARCHITECTURE IS A DRIVER OF HEALTH
Health emerges from our shared context. Our health is profoundly shaped by the social, economic and environmental conditions we encounter each day. It’s no surprise, then, that the built environment is one of the key drivers of health. Evidence has shown that architecture and urban planning have the power to affect a person’s physical, mental, social and economic well-being, for better and for worse. We spend 90 percent of our time indoors, which means the decisions architects make can have major ramifications for health.
For example, people experience a 15 percent boost in productivity when they work in environments with fresh air. Meanwhile, patients at hospitals with ample natural light are less depressed, experience less pain and ultimately have shorter stays. On the opposite end of the spectrum, studies have found buildings that are poorly designed and/or made from hazardous materials can increase the likelihood of asthma and depression and undermine cardiovascular health.
Despite the obvious interconnectedness between heath and design, historically there has been little overlap between the health and architectural fields. Changing that could lead to new and unexpected ideas about how to create more thoughtfully designed buildings and cities. To build cities that can withstand disasters, we must take a multi-disciplinary approach, bridging the worlds of architecture, public health and policy. Working together, we can ensure the spaces people inhabit promote well-being in every sense of the word.
2. THOUGHTFUL ARCHITECTURE IS THE BACKBONE OF RESILIENT HEALTH SYSTEMS
It is important to remember that architecture does not start with a building; it starts with the community. When we think about health after disasters, we tend to think of how well hospitals—the physical structures themselves—can withstand the event. But hospitals are just one part of the community, the makeup of which matters as much for community resilience as the hospital structure itself and often more. Think about the questions that arise during an unexpected event: Where do people get access to clean water? Is there a plan in place for restoring electricity? How will people find food and shelter? These issues have very little to do with the layout of a hospital.
Architects have the power to shape health in communities well beyond designing the walls of a medical facility. Promoting health in advance of disasters is integral to creating the resilience needed for recovery. When communities are healthy before large-scale traumatic events, they are likelier to stay healthy after them. Promoting health through urban planning requires an integrated approach to design that must begin long before a disaster strikes. Fortunately, both architects and healthcare providers routinely convene teams that draw from a wide range of expertise, which makes them a natural conduit for facilitating cross-sectoral discussions.
Sometimes, promoting health in a community is as simple as providing a neighborhood with more access to green spaces and nature. Other times it is more complicated. In the case of Hurricane Maria, the health of residents of Puerto Rico was closely tied to the island’s substandard infrastructure. Many households went without power for more than 84 days and without water for more than 68 days. A lack of mobility and transit infrastructure only exacerbated these issues.
Improving how a city mobilizes during an event can also have a significant impact on health. Cities need plans in place for ensuring people have access to healthcare, no matter where they are. Instead of centering health care on the hospital hub, architects, urban planners and health providers should develop a system of ambulatory clinics, micro hospitals, accurate care clinics and home healthcare options to ensure people have access to healthcare even when they cannot get to a hospital.
Making that happen is part simple awareness of where a city’s pain points are and part understanding whomto work with to fix them. Conversations around creating more holistic health systems must happen upstream, well before the construction of new health facilities. Working within a “healthcare bubble” is easy. Coordinating with healthcare administrators, public health officials, and government agencies like the Department of Transportation takes effort, but it is worth it to better understand the underlying issues that a community faces.
3. HEALTHY BUILDINGS MEAN HEALTHY PEOPLE
If a holistic approach to urban design provides the backbone for a health system, then buildings are the joints that allow people to receive flexible, individualized healthcare. Putting time and energy into designing buildings that promote health and resilience is central to creating healthy populations.
This is certainly the case during moments of crisis, but the benefits of resilient architecture extend beyond the scope of natural disasters and into everyday life. Designing for prevention is good design, period. For example, increasing the amount of natural daylight in a hospital means the building can function without as much energy duringa disaster—but it is also linked to better recovery, stress reduction and improvement of mood in non-disaster settings.
Disaster preparedness can pay dividends in other ways, too. According to a 2017 report from the National Institute of Building Sciences that studied the outcome of more than 23 years of federally funded disaster mitigation grants, allocating funds towards disaster prevention can save the U.S.money in the long run.The organization found that every $1 spent on hazard prevention saves $6 in future disaster costs. This includes measures like strengthening a building’s structural components for earthquake resistance, constructing elevated buildings in flood-prone areas and adding hurricane shutters and subterranean “safe rooms” to locations that experience severe weather like tornados.
After Hurricane Katrina, the architecture firm NBBJ worked on two hospital projects in New Orleans, implementing resilience measures that would safeguard against future flooding(full disclosure: one of the authors is a partner at NBBJ). At the recently opened VA Hospital, they moved the emergency department and critical imaging equipment 21 feet above flood elevation.
Additionally, the hospital is designed to operate independently for five days or more on backup fuel stored at the energy plant. When a flood does strike, the building’s infrastructure is flexible, with an emergency department ramp that doubles as a boat launch and a parking garage roof that can act as a landing pad for helicopters. The work in New Orleans and elsewhere teaches us to think about resilienceas a core element of a building’s design, to be considered from the very start of the architectural process.
Going forward, architects and health professionals need to engage earlier and more often to ensure that the built environment provides the kind of support that will lead to cities, buildings and people able to withstand and bounce back from unexpected events. Strong, thoughtful architecture is not a decorative touch; it is the foundation that underpins our cities and allows health to flourish.