Equity from Within: Bridging the Health Gap Through Place-Based Redirective Design Practice

This practice-based research explores the relationship of the built environment to the health of community residents through applying design as a tool for inquiry and synthesis. Our socioeconomic position in society is linked to our health; on average, the better off a person is socially and economically, the more wealth and social capital a person has, the fewer adverse health outcomes they experience. As a result, there is a social gradient in health: those living in

the most deprived neighborhoods die earlier and generally suffer from higher rates of diabetes, high blood pressure, and heart disease than those living in the least deprived neighborhoods; in many neighborhoods, your zip code is a better predictor of health than your genetic code. Just

as there is an increasing wealth gap in the United States, so too is there a health gap which stems from the social, economic, environmental and structural inequalities which shape health outcomes. By critically engaging with these social determinants of health, we can further recognize that health is shaped by the design of places where we live, learn, work and play. In looking at the causes of health disparities, health equity seeks to increase the opportunities for everyone to live their healthiest life possible by addressing these social determinants. Taking a place-based approach and working at the intersection of design for social innovation and public health, this work seeks to demonstrate that intentional design at the neighborhood level will create greater opportunities for individuals to lead healthy lives. Throughout the course of this research, a series of interventions have grown out of place and include the

‘recoding’ of the built environment through active design, the expansion of a food literacy program and a series of community engagement events centered around promoting healthy lifestyles and extending access to local social services. A guidebook of tactics is presented, developed through insights from community-based designers, regional planners and public health experts, which offers practical steps for inclusive and equitable community organizing

and development. By shifting the narrative around health from one focused downstream of individual medical treatment to one looking upstream at prevention and the socio-economic conditions which shape health, we can build healthy communities which allow residents to achieve greater health equity, thus beginning to close the health gap.

Informed by social practice theory, environmental psychology and redirective design practice, this research demonstrates the possibilities for design as a means of encouraging civic action towards local change, for redirecting unhealthy and unsustainable patterns of everyday behavior and proposes actions for furthering equity with and in a community.