Health Equity: Can Design Make a Difference?

Interior designers of all specialties, especially health environment designers, strive to positively impact the lives of the people who experience their spaces. One way we can maximize our impact is to understand the Social Determinants of Health (SDOH), defined by the World Health Organization as “the conditions in which people are born, grow, live, work and age.” SDOH can impact all aspects of life including food availability, employment opportunities, access to health programs, and social equality.

By leveling SDOH across populations, we increase the likelihood that people have the opportunity for optimal health. This aspirational concept is called health equity, which means that all people can achieve the highest level of health.

Interior design can support health equity within the built environment. If we understand the key social determinants of health, and associated physical determinants of health, we can design to foster health equity and amplify our positive impact on the health of people who spend their lives in the spaces we create. As we will see, designing to impact the social determinants of health, the root causes of health inequity, can promote “equal opportunities for all people to be healthy and seek the highest level of health possible.”

What are the Social Determinants of Health?

Broadly, the conditions in which people live their daily lives are classified as social determinants of health (SDOH). While this list can differ slightly source-to-source, key determinants include:

  • Economic Stability (ex. employment conditions)

  • Neighborhood and Built Environment (ex. urbanization)

  • Education (ex: early child development)

  • Food (ex. food deserts)

  • Social and Community Context (ex. social exclusion of sub-populations, gender equality)

  • Health and Health Care (ex. access to public health programs)

These factors play the greatest role in health equity. Detailed descriptions of each factor expose the impacts of politics and economics on our world. In a report published in 2011, the Joint Center for Political and Economic Studies found that, “between 2003 and 2006 the combined costs of health inequalities and premature death in the United States were $1.24 trillion.”

These are complex issues, to be sure, buts it’s worthwhile for us to look at them closely and think about how we can leverage this knowledge to drive behavior for positive change through design.

Interactive tools, such as the national tool from the Robert Wood Johnson foundation, are available online [MOU5] to help you understand health equities and disparities in your area. By plugging in your zip code, you can find life expectancy for your county and state and how it compares to the national average. Through a partnership between UTSouthwestern and UTHealth, a tool addressing Texas specifically; this “interactive map reveals the populations and places in Texas where people can expect to live longer—or shorter—lives.” This tools provides comparisons at the zip code level.

Figure 1: Social Determinants of Health and Associated Outcomes, source  www.kff.org

Figure 1: Social Determinants of Health and Associated Outcomes, source www.kff.org

One Step Deeper: The Physical Determinants of Health

Understanding the role of the physical determinants of health as a supporting framework for the social determinants of health is key for designers to maximize their positive impact. As part of the Healthy People 2020 initiative through the Office of Disease Prevention and Health Promotion, physical determinants for health are noted as:

  • Natural environment

  • Built environment

  • Worksites, schools and recreational settings

  • Housing and community design

  • Exposures to toxic substances and other physical hazards

  • Physical barriers, especially for people with disabilities

  • Aesthetic elements

A Compelling Design Challenge

As advocates for our clients and communities, we are accountable for designing environments that, first, do no harm, and, second, elevate health opportunities for each person who uses the spaces we design. Our expertise in person-centered design, evidence-based design and designing for wellness will serve us well.

Consider solutions such as:

Image 1: Supporting communication. Image credit Corgan

Image 1: Supporting communication. Image credit Corgan

  • Create spaces that encourage community involvement.

  • Create spaces for learning and wellness programs to improve health literacy.

  • Create environments that support diversity.

  • Create spaces that support communication among clinicians, patients and families.

Improving social and physical determinants of heath is a complex proposal and involves “intangible factors” described by NEJM Catalyst as, “such as political, socioeconomic, and cultural constructs, as well as place-based conditions including accessible healthcare and education systems, safe environmental conditions, well-designed neighborhoods, and availability of healthful food.” While we as designers may not be able to drive change in all of these areas, lets tackle the ones we can!