February 19, 2018

Touching every aspect of our lives, the built environment is a powerful determinant of both individual and population health. While the public health sector has developed a robust understanding of the relationship between health and the human-made spaces in which we live, work and play, it has been limited in its ability to effectively influence the built environment. The Green Health Partnership—a research and development initiative comprised of industry experts in partnership with the U.S. Green Building Council, the Robert Wood Johnson Foundation and University of Virginia School of Medicine—was founded on the idea that the lessons learned by the green building movement could provide the public health sector with guidance on how to transform the built environment. In today’s post, I explore how the Green Health Partnership’s effort in developing the LEED v4 BD+C Rating System’s Integrative Process for Health Promotion pilot credit can guide the prioritization of design decisions based on both project- and community-specific health needs.

Identifying an Effective Process

Around 2013, the real estate sector was just beginning to develop an interest in health. The Green Health Partnership team leveraged this interest to develop new health promotion tools for use by green building and real estate practitioners. By assessing longstanding green building tools, they discovered a number of existing health-related strategies within LEED and other green building rating systems. Those strategies, however, were scattered throughout the rating systems without a clear organizing framework.

In addition to traditional green building tools, there is a growing number of rating systems specifically focused on health, such as the WELL Building Standard and Fitwel. While these systems introduced new, health-focused strategies for use by building practitioners, none of these approaches allowed practitioners to strategically prioritize according to population need or environmental context. The development of the LEED v4 BD+C Rating System’s Integrative Process for Health Promotion pilot credit in 2015 was meant to address this gap in tools by defining an efficient process for promoting health and well-being and deploying it through existing green building platforms.

The Integrative Process for Health Promotion pilot credit within LEED was inspired by the integrative process from green building as well as health impact assessments from public health—a structured approach to placing health as a decision-making lens to inform decisions at a variety of scales within a variety of sectors. An integrative process aims to bring together all members of the project team at the beginning of the project to take advantage of synergies that would lead to a more positive environmental impact. The Green Health Partnership successfully identified an opportunity to create a similar process for health.

After aligning the key principles of health impact assessment with the components of integrative process, the Green Health Partnership team identified four key elements of an integrative process for health promotion. This involves the project team working with a public health practitioner to engage the community impacted by the project. The team uses this engagement, along with existing community health data, to understand the impacted population’s health needs. The project team then considers how they might address those needs through the design, construction and operation of the project and prioritizes strategies accordingly. In the final part of the process, the team documents how the impacts of those decisions might be monitored and measured over time.

Putting the Process into Action

Through the pilot testing of two medical office buildings in the mid-Atlantic, we’ve learned that practitioners and owners have an appetite for a tool exactly like this. During the early stages of the design process, the GS&P team and the owner invited several public health professionals to participate in design charrettes. The team started by reviewing the available health impact assessments and community needs assessments for the project locations. This research resulted in identifying the key public health concerns for the communities, which included socioeconomic insecurity, access to healthcare, obesity, diabetes, cardiovascular disease, cancer and oral health. Through a brainstorming session, the team developed a list of strategies that could be incorporated into the facility—either through design or programming—that would help address some of the major health concerns in the area. We then worked to prioritize those strategies, which ranged from active stair design and bottle-filling water fountains, to concerts and health fairs on the plaza, and partnerships with local grocery stores to highlight healthy dinner recipes. Strategies that were deemed top priorities and worked within the client’s budget will be incorporated into the design of the buildings, and provisions will be made to accommodate the type of programming the client would like to have at the facility. A measurement plan was created to gauge the success of each strategy.

Goal-setting workshop and brainstorming sessionActive stair designed to encourage stair use

Contributing to Enhanced Community Health Conditions

Supporting high-performance, cost-effective and health-promoting project outcomes, the Integrative Process for Health Promotion pilot credit is available for use within the LEED pilot credit library, however; any project can incorporate the process, regardless of whether they are pursuing LEED certification or not. By working with public health practitioners and leveraging public health information, designers are able to better understand public health concerns and design the built environment in a way that contributes to improved community health conditions.