Architecture for Population Health: How Facility Designs Can Help to Build Healthy Communities

By Kraus, Shannon; Renner, Kate | Health Facilities Management, October 2016 | Go to article overview

Architecture for Population Health: How Facility Designs Can Help to Build Healthy Communities


Kraus, Shannon, Renner, Kate, Health Facilities Management


The idea that healthy behavior can be influenced at the population level by altering the environments within which people make choices has gained traction in health care, architecture and policy in recent years.

For example, increasing the time taken for elevator doors to close or the location and design of a stairway in a mall may increase the likelihood of people using the stairs instead. Similarly, doctors and health care providers have begun to intervene in health through strategies like prescriptions for bike share passes to encourage people to exercise more.

These relatively simple behavior-change interventions require little conscious engagement on the part of the individual to realize their intended effects. With time and repetition, others become part of the way an individual goes about day-to-day life. And, across a population, these actions will increase the general health of a group of people.

This suggests that the built environment and those responsible for its design and planning have a role in shaping the health of communities.

Behavioral change

Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group." As a concept and a method of measuring health, this includes health outcomes, patterns of health determinants, and policies and interventions that link these two, according to David Kindig, M.D., and Greg Stoddart in their article, "What is Population Health?" in the March 2003 American Journal of Public Health.

The Affordable Care Act's (ACA's) main focus is to provide greater access to affordable health insurance, improve the quality of health care and health insurance, regulate the health insurance industry and reduce health care spending. It addresses population health by seeking to expand insurance coverage, improve the quality of the care delivered, enhance prevention and health promotion measures within the health care delivery system, and promote community and population-based activities.

Combined with the ACA, population health will put greater emphasis on overall health and well-being. Systems are incentivized to reduce unnecessary admissions and lengths of stay while providing preventive care so people stay healthy. This shift toward collective health promotion from individualized care reactions has redefined the role of the traditional hospital and the scope of the health care system.

At the core of population health management is behavioral change, which may happen spontaneously or involuntarily without any intervention or systematically through conditioning. Although population health is an encompassing notion, the ambition of improving the health and well-being of all people must begin with defining individual actions. Ten percent of health outcomes are a result of the built environment, while 50 to 60 percent are because of health behaviors, according to an article titled "Achieving Population Health in Accountable Care Organizations" by Karen Hacker and K. Deborah Walker in the July 2013 issue of the American Journal of Public Health. Therefore, improving population health needs to involve altering health behaviors that go beyond the clinical setting and incorporate community and public health systems.

Altering behavior patterns to reduce non-communicable diseases linked to poor diet, lack of physical activity, alcohol consumption and smoking is one of the most important health challenges of the 21st century. Moreover, it is recognized that physical and social environments contribute to these behaviors and that modifying these environments is an important catalyst for change. The term "choice architecture" refers to interventions made across behavioral and environmental contexts to encourage healthy behavior. Health care systems should place an emphasis on taking an active role in the health of their constituents to become wellness campuses versus places for processing the sick. …

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