No need to worry about health insurance. What people really need are healthier buildings.
And architects? Think of them as “upstream doctors,” working to beat sickness and disease at their source, before people are affected.
This idea will be among the topics of discussion at the upcoming U.S. Green Building Council (USGBC) in Philadelphia, Greenbuild, in mid-November. Sparking the conversation is the splashy launch of the Building Health Initiative last week by the USGBC’s Northern California Chapter, during its annual gala.
Drawing both applause and skepticism, the venture is notable for its big backers across various sectors. Google and Genentech have signed on, representing big real estate holdings. Healthcare provider Kaiser Permanente is a partner, as is the hugehealth benefits group CalPERS, to endorse the health impact of ideas behind the Building Health Initiative.
Building materials companies also have joined, in an implied pledge to make safer, less toxic products. They include Armstrong World Industries, carpet maker Interface, glass supplier View Inc. and a division of U.S. Concrete. Architects, engineers, construction lawyers and two big contractors, Webcor and Swinerton, are also involved, to design and construct better in what is cast as a public health effort.
Yet one of the lesser-known nonprofit founding partners stood out — a tiny group suddenly thrust into the spotlight of the new healthy buildings movement.
The startup called HealthBegins is a self-described ”think-and-do tank”of doctors and public health experts “that demonstrates how a smarter health care system improves health where it begins — where we live, work, eat, learn, and play.” HealthBegins says it works for the sake of health professionals who are ”not content with a system that simply sends patients back to the same conditions that make them sick,” according to founder Rishi Manchanda.
In this way, health care isn’t about treating people who are already sick. Instead, it’s “a vehicle to address and prevent the unhealthy social conditions that cause disease.” For example, your office or school — and that’s where architecture and building materials come into the equation.
But this time, it’s unlike the mold and microbes obsession of the 1990s anti-sick-building movement. It also transcends the main focus of groups like Healthy Building Network, an environmental justice group that has shed light on toxics in construction such as arsenic-laced wood, formaldehyde, PVC and paints with bisphenol A. And efforts like the Urban Land Institute (ULI) Building Healthy Places Initiative started last year, which lobbies for developments with better transit, more grocery stores and walkable neighborhoods, are wrapped into the new USGBC launch.
From arsenic to obesity
In this way, the Building Health Initiative takes aim at a raft of challenges, using a holistic worldview more common in Northern Europe than in Northern California. They’ll examine toxic materials and ways to avoid them or lessen their effects, as well as climate change and other public health impacts of building practices. Though it’s unstated, presumably this includes “active design” and urban planning, which are meant to encourage walking and the use of stairs as part of combatting obesity, diabetes and other effects of a more sedentary lifestyle.
In phase one, for example, the tech giants Adobe, Genentech, Google and Salesforce.com will act like real estate epidemiologists as part of the Building Health Initiative. Their focus? Procurement practices that allow them to consider “materials transparency” — meaning the use of emerging standards such as Health Product Declarations (HPDs), so they know what if any poisonous materials are being used in their workplaces.
Adobe also pledged to survey their LEED-certified facilities to compare employee health patterns there as opposed to their workplaces without LEED ratings.
Manchanda, known for his homeless veterans clinic in Los Angeles, sees this kind of inquiry into what we build as essential to better long-term health — and even reining in the nation’s runaway healthcare costs.
Tracing sickness to its source
In a book published this summer called “The Upstream Doctors,” Manchanda builds on his TED talks about improving the health of vulnerable populations. It boils down to environmental health justice, with this challenge: “In the context of growing healthcare costs, ever increasing rates of obesity, diabetes and poverty-related diseases, isn’t it time for doctors and hospitals to work with communities to fix the leaks in our apartments causing mold or the neighborhood designs resulting in food deserts?”
The subtitle of the book is “Medical Innovators Track Sickness to Its Source.” And as the Building Health Initiative reminds us, these medical innovators are going to include non-health practitioners such as architects, general contractors, city planners, procurement managers — and even commercial painters.
The big question is if and when these consciousness-raising efforts will actually move the needle on public health. HealthBegins and the Building Health Initiative want to help slow runaway health care costs and reduce increasing health disparities among Americans. That’s decades away. And for many years industry and academia have already studied many of their focus areas. What we’ve mainly learned along the way is that there’s little political will to change large-scale public policies.
At a time when the Affordable Care Act is taking aim at reducing health costs by reducing the incidence of disease, maybe the idea of starting “upstream” will finally catch on.