AIA/LA Healthy by Design Panel Addresses How Best to Incentivize Healthier Placemaking

David Abel: When Community Planners assemble, is there room at the table for a public health perspective? Dr. Fielding, you’ve been pressing the case for health assessments and for breaking down silos between the built environment and public health. How much progress has been made?

Jonathan Fielding: I think we’ve progressed a good deal. I think there is a broad understanding, at least amongst those in public health, and a dawning understanding in policy makers—those that are willing to listen anyway—that there is a very inextricable relationship between our social environment, our physical environment, and our economic environment, on one hand, and health on the other. What we’ve lacked is some of the tools to crosswalk, to do intersectional efforts. For example, what’s the health benefit of increasing mass transit, or a master bicycle plan, or closing some streets off as walking streets?

We now have better processes, including one that’s called Health Impact Assessment that looks at the health impact of doing things in other sectors. That was recognized by the creation of the National Prevention Council that has all of the parts of the federal government together asking what can we do in HUD, transportation, economic policy, and agriculture that can at the same time be a win for health at the population level. Those tools are now increasingly being used. It’s still relatively early.

There is also modeling that is going on. For example, I think everybody heard of the modeling that recently determined that Los Angeles was going to be in 2050 an average of 4-5 degrees warmer, with increased wildfires, and with increased endemic diseases like dengue fever. We have to look at what we can do at the front end, but we also have to realize that there are some things that we’re going to have to adapt to that are going to be hard to turn around.

We are now at the point where it’s really hard to turn around very quickly, and I would also add two things: one, that we’ve been focused on trying to have health be part of the general plan of cities, so LA has now adopted a health element in the overall plan. Planners have to think about how the built environment in LA City is going to affect health. That’s one of the givens now that wasn’t there before; we’ve been working closely with planning departments.

I think the tools are growing, the understanding is growing, that we can’t get to better health unless we improve our physical environment. That has not yet penetrated public understanding. It is at the visceral level; it is not at the policy-making level. That’s part of our job.

David Abel: Chet Widom, again, the question: is there room presently at the table for including a public health perspective on the future growth of our communities? If I’m not mistaken, the state architect’s position reviews state buildings and schools; I’m going to make the hypothesis that there isn’t room at the table now for health, but correct me if I’m wrong.

Chet Widom: Well, you’re correct in terms of our ability at the Office of the State Architect to have an impact directly by law. But I believe there is the bully pulpit, and I’m spending a lot of time talking about that, trying to influence boards of education, trustees of school districts, that they have that responsibility, besides just providing space for students.

I recall, not too long ago, looking at some projects for the LA Community College District where the whole goal seemed to be, by some, to just get the classes in as opposed to creating an environment that would enrich the opportunities for better health. We are now looking at buying chairs for schools that have to be oversized. We’re buying chairs that are oversized because many of the students cannot fit on regular chairs. I’m looking at how we make sure that the stairs in those schools become attractive places for people to walk up, that we are not interested in just getting people quickly from one place or another.

I bring that to the case because I’ve just been diagnosed with diabetes, and walking about in my community drops my blood sugar level. But I want to walk in environments that are going to be safe, that are going to be attractive, that are going to give me some reason to want to be out there. I think that there is room at the table.

David Abel: Kate Diamond, the second question for our panel is, are there good examples—existing urban laboratories—for examining the nexus of health and the built environment? I’m betting you have some projects.

Kate Diamond: I do. I did some further homework in the last week preparing for this. The first thing I would send everyone to is that our colleagues in the AIA chapter of New York City have been convening for close to ten years a conference called Fit City. They have been looking really closely at policy pieces, they’ve taken it to Washington DC, they have a “Fit Nation” piece that they share on the website with fantastic background and fantastic pieces. They are an exemplary set of architects engaging in public policy and public discussion in New York. They’ve taken it from the outside of cities where clearly the more that we make streets that are comfortable to walk, that are safe to walk.

When I came back from Seattle where I lived downtown and walked a lot of places and was kitty corner to a market with fantastic fresh fruit and vegetables, I moved downtown when I came back to Los Angeles. And downtown has come a long way. There are a lot more people. The best part of it is you see people walking dogs. On the other hand, my route from my apartment is mostly through parking lots and past holes in places. Even the buildings that were impelled in their conditional use permits or entitlement process to put in ground floor retail, they haven’t rented them. They’re dark; the lighting is questionable; the quality of the sidewalk is broken and falling apart.

I really worry when I see the end of redevelopment: how, where, and when are we going to take the next steps to improve that? I think there are great examples like Portland, which has become enormously walkable. But someone from Portland referred to the fact that the things that are fabulous in Portland are upper middle class, younger urban dwellers getting the benefits. The poor portions and the ethnic portions of Portland are in as bad shape as many of our communities here in Los Angeles, where they may be transit dependent but don’t have parks, safe streets, or access to many of the things that we think make Portland wonderful. I love some of what Thom Mayne has done, making the use of the stair and the skip stop elevator. But you can have full and complete universal design where those who need it can use it.

David Abel: Dr. Jackson, again back to that question of are there good examples: you’re part of a PBS series on designing healthy communities—where are those examples?

Richard Jackson: The first $150,000 in funding for our PBS series on Designing Healthy Communities came from the American Institute of Architects, on whose board I served as the public member. About $750,000 came from Kresge Foundation, and about a half million came from the California Endowment.

I’m going to give a standard example of a place that works, one that will shock you a little bit, and one that is amazingly local. The first one is Boulder, Colorado. It really does work. A lot of people can live there and be on bikes all the time. The Olmsted sons designed the west to east bike routes that ran along the creeks and had lovely parks all the way along them. A generation ago the city decided they needed to add north-south trails, so people can get along quite well without a car. Boulder is the healthiest city in the healthiest state in the United States. It is a university town with many young and bright people, and like attracts like.

Detroit was the city that was remarkable in the film series. We had two camera crews for three days in Detroit, and it was remarkable to see the devastation that Detroit is dealing with. We did not want to indulge in mere “ruin porn” where we just shoot the wreckage. What Detroit is beginning to turn around with is a reviving culture, in some cases based around food. People want well-prepared, fresh, and local food. The Eastern Market has gone from being a set of underutilized warehouse sheds to now being five large sheds surrounded by green space. The city will have to cluster many of these homes, but there are green gardens now throughout Detroit. More and more, the African American community is taking up local agriculture. The other very positive thing is there is an influx of very bright, young people who can buy a house for a few thousand dollars. As Richard Florida asserts, if you want a city to succeed, you need an influx of creative young people going in. Chet Widom is going to be astounded by the last place.

Lastly, thirty years ago, when I was in the California Health Department, I went to Sacramento every week. I hated Sacramento—parking lot after parking lot, black top baking in the sun, your car would be 140 degrees at the end of the day, and the only way to get to Sacramento was by car. Today, downtown Sacramento is, frankly, magnificent. It feels like San Francisco 30 years ago. It’s filled with young people, lots of interesting restaurants, a minor league baseball team, cleaned up parks, much more culture, and a rail line to the East Bay that is extremely convenient.  I believe the development district had a lot to do with that because it never empties out; it is alive with people there all week long.

David Abel: Dr. Fielding, where does responsibility lie for building healthy places? Cities, schools, transportation, etc.?

Jonathan Fielding: I think that there are several issues there. First of all, you need to have the social norm that’s part of what goes on. We need people to think, “yes, we don’t just do things helter skelter; we do things by a plan, and there are reasons, goals, and measures.” I don’t think we’re quite there, but I think that is very important. I think in public health our job is to really help people understand how healthier communities mean a better quality of life, how thinking about design and urban planning and transportation planning is good for them for their children. We need people to think multi-generationally; it’s really critical.

I think the responsibility is broadly shared. It’s even the question of who is funding development. The banks need to think about this because they don’t want to fund projects that wind up half empty on the retail side; it’s not good for them. We need for everybody to be concerned about this, and we need to think about mixed-use particularly, which we haven’t really discussed here. I have a lot of people working for me—over 4,000 employees—and the significant number that drive two hours to work, each way, is astounding. Think about what that is doing to the environment and to their quality of life. We have to think about places where you can work close to where you live. That’s a responsibility of all the planning agencies, but it’s too important just to be left to planning agencies.

We need a long-term perspective. CicLAvia, for example, is very short term. It’s great because it gives people a sense of what it could be, so that helps people get a longer term perspective. What happens if LA, which is relatively flat, could be a haven for bicycles? We’re not going to be Amsterdam next week, but maybe we can move a little bit in that direction.

One place we haven’t talked about is New York City. New York City has been transformed, at least Manhattan. The bike paths and the wide avenues that separate the motor vehicles from the bikes, the outdoor spaces, the concrete areas that weren’t really being used, are now meeting places. We just had the first urban area like that where there is excess asphalt where you can put tables and chairs and umbrellas-that’s social interaction. We know that increasing social interaction improves health and improves longevity.

David Abel: Chet Widom, for you, where does responsibility lie for building healthier places?

Chet Widom: Let me start by asking a question: how many of you sitting in this audience have ever gone to a hearing or a meeting where your project wasn’t being reviewed but just because you felt you needed to go as a citizen? I have to tell you, it’s very rare. I sat on the charter reform commission for the City of Los Angeles, and I was begging my colleagues to come out to help me, to be there, and to fight for all the things that we’re talking about today.  

I think that one of the places that responsibility lies—and we are not doing our job as architects—is being out in the public sector and trying to advocate for change. There’s always the same group, some really terrific people, but not en masse. The NIMBYs will come out en masse, but I have not seen architects standing out there and fighting for all the things that we are talking about. I think that has to change. Otherwise don’t complain, stop your whining, because the fact is if you’re not part of the solution, you’re part of the problem. We, as architects, are generally part of the problem right now.

David Abel: Dr. Jackson, for you, where does responsibility lie?

Richard Jackson: I’ve been to many a meeting and people say, “what’s the most important thing people should do?” I suggest Safe Routes to Schools and to focus on children, but the truth is, after all is said and done, the most important thing is community engagement. When the community can come together in a dialogue and say these are the two or three things we want the most—and they have to be informed by architects and planners and people who have the technical knowledge—I have been so impressed by the work that comes out.  

I lived across from Fremont Park in Sacramento. Fremont Park was disgusting 30 years ago. It was filled with junkies and drunks, and the community demanded that it be cleaned up. The police agencies, public works, and sanitation have got to be involved. They put a lot into that park, and there is good quality policing now. There are many events now, for example, a sidewalk chalk drawing context. It really is very livable.  

David Abel: For the Panel: if schools boards and districts want to build healthier schools, how do you each recommend they should proceed?

Jonathan Fielding: Certainly we need to have schools that are not just for the students, but are for the community as well. You need the community engagement as part of the school and as part of the siting and the specific architectural features.

We do need joint use, but that should be engineered in at the beginning so it’s not some small gate that you can get through if you know how. You want to have it open and you want to have it welcoming. I think another issue is school sitings. That is a real problematic one. If you look at where land is cheap and abundant, oftentimes it’s next to the freeway. We know that diesel fuel is a class one carcinogen, and air pollution problems are bigger. There’s a lot of balancing that has to go on, but there are design ways that you can minimize some of those problems.  

I think that one of the things that we also need to do with schools is to make sure that they are places where physical activity is the norm. Not just with PE, but where you have stairs, where you have welcoming physical activity areas during recess. We could significantly increase physical activity within the schools. Then we have to think of the nutritional environment. We’ve worked a lot with LAUSD and others on getting rid of vending machines, getting rid of soda. We have an obesogenic environment, and one of the things a school can be is a counter force to that. Not alone, but they can be an important role.
 
Kate Diamond: Joint use means that if everyone is going to share in the making and get their funding in line for the same kind of timeframe, get their boards in line, boards that inherently often don’t trust each other. It took me five-and-a-half years (and I used to think I was more of a diplomat than an architect), and I would lock the city manager and the school superintendent in the room. I went through three city managers and I think four or five superintendents to get the first ever joint city and school district project completed in Glendale. The good news was that I had a client that actually believed that the role we were playing was valuable enough that they paid us hourly for being the ‘project police’ who would lock them in until they worked through those issues. They were great guys that ultimately did it.

The reason it worked was because it started from a community involvement process, and the community was there to remind every new school board member and every new city council member that they had been promised quality. The Glendale Edison/Pacific School is used (other than some five days a year where they shut it down to do maintenance) every other day, weekends, it has a senior center, it has a park, it has a library, it has an elementary school and a community center all compressed into fourteen acres, bringing together every age group within the community.

I don’t remember a better time for architects in terms of the value of what we bring to the table. If you believe passionately that design matters, today people are telling us that we have a critical role in reducing carbon emissions and saving the planet. We have a critical role in health and all our childrens’ futures. What we are doing is not frivolous, not merely aesthetic. Don’t get me wrong—I passionately believe that every project should have beautiful spaces that elevate the human experience. But the criteria for beauty must include reducing the environmental footprint and enhancing social equity. This is a great time to be an architect; we just need to engage to take it to the next level.

David Abel: Chet, how do we create an incentive system through the state architect’s office to encourage what Kate has just referenced? Today, such incentives are not in place for schools, are they?

Chet Widom: You’re absolutely right, and I’m working really hard with a number of legislators and a number of folks who are all trying to figure out how to provide that incentive. There are some incentives for solar pieces; putting PVs on top of a roof is a good thing, but certainly doesn’t make a statement about how we feel about schools.

I want to go back to that whole idea of involvement. We cannot turn out great schools or great environments, or great facilities without great clients. I do not believe that it’s all in the power of an architect. A lot of it is the power of having great clients, and that means we have to help educate clients. I don’t mean educate them because we’re experts in architecture; I’m not trying to demean their position, but we have to be willing to do that. We have to be willing to make sure that we get out on the street and make sure that good clients are elected. I cannot convince people to do great buildings as a state architect unless I have great clients.

Larry Isenberg at LACCD had a vision. It didn’t work completely the way we’d like, but Larry brought us a vision. We need more visionaries sitting in school districts and on city councils that are willing to take those steps.

David Abel: Panelists, your closing thoughts, picking up on that theme of how we take the existing hardscape of metropolitan Los Angeles to get to the goal of designing healthier places.

Jonathan Fielding: I think we go back to getting communities to feel that they have an ownership interest in what happens around them and getting them engaged in the process of saying, “ok, we’re here, we can’t change how we got here, we can change what we do going forward.” We should give them visions of what that could look like, making it very tangible. We should also get them to think about their children and their grandchildren because if we don’t think that way then we’re going to have the short-term thinking that too often drives decisions made in the political sphere. People are not thinking long-term or they’re saying well I don’t care because this is going to be after I’m gone, when in fact it’s their progeny and the progeny’s progeny are going to be the ones that inherit it.

So community engagement, the right kind of education, thinking of messaging in ways that are effective with the different constituencies, are absolutely essential. I think that’s the common denominator for different parts of our community and how we get to a healthier, better urbanscape.

Kate Diamond: First of all, I would say that having left Los Angeles for four years, gone up to Seattle and come back, I want to tell you that things are changing in Los Angeles. Downtown is better. There are more places where people are talking about bicycle routes, about pedestrian environments, and we are opening the first light rail that will get to the Westside. That will bring middle class ridership to the MTA, and then they’ll learn how to provide better service. I believe that change is way too slow, and I think the heart of it is that we’ve spent generations with single purpose designs. We treat the LA River as a flood control issue instead of seeing it as a multi-purpose multi-layered urban amenity, natural place, storm water treatment, healthy community opportunity. If we would treat every aspect of our city, thinking of it as a multidimensional, multidisciplinary, multicommunity place, we would change the way we look at problems. We would change our solutions, and we would move faster into a better future.

Chet Widom: Some people think that AIA stands for “Ain’t it awful.” I look at Los Angeles as a really great place, and if we were to focus on the positives, if were to begin to link the downtowns, the Culver Cities, the Santa Monicas, the Pasadenas—all these small areas that are beginning to really change—and reference the fact that we are really a new city, I would ask members of this community, and maybe ask AIA, to start looking at how we show the story of how Los Angeles is changing. We can’t just look at how bad it is. Maybe I’m trying to be a little too much of a goody two shoes here, but I think we’ve got some great opportunities for the future. Let’s start celebrating those, and maybe they’ll become the vehicles to get the next to Culver City to begin to grow.

Dr. Jackson: In health decisions, we Americans accept fairly serious long-term risks in exchange for short-term benefits. When you buy a fast food meal and super-size it, you save a few cents and gain an ounce of body fat, which costs you between $3-6 in lifetime healthcare costs. We need to do real accounting of the costs over longer periods. When I served on the AIA Board, I loved being on the committees where we would view various projects. The thing that impressed and amazed me about architects was that design truly is problem solving. The ones I loved were the designs that confronted difficult situations, an inadequate budget, and an oddly shaped site, and the architect created something that makes you say, “wow, this is terrific!”  

David Abel: In closing, it’s been a pleasure to be part of this panel discussion. I will say one thing that picks up on Chet Widom’s comments. When New Schools / Better Neighborhoods (NSBN.org) was engaged in how to build community centered, joint-use neighborhood schools, I often recounted that more than 70 years ago the US Core of Engineers was brought in by LA County to solve a problem they defined as “flooding” of the LA River. The Board of Supervisors requested only that the Core solve the perennial flooding problem, and the Core did so by constructing a hardened channel. If the Board had asked a different question, reflecting other needs and values, we wouldn’t be spending so much time and money today in revitalizing the LA River. Likewise, when it came to building $100 billion worth of new schools, our school and city leaders ask only for more seats. That single challenge defined how we spent $100 billion. If the client had asked a different question, we’d have a much different result. Thus, as Chet shared, the client defines the problem, which circumscribes the results achieved.