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Design for Life

How architecture can alleviate the health consequences of racism

Kimberly Dowdell

Chicago, where I live, has the greatest gap in life expectancy of any U.S. city. The average person living along the “Magnificent Mile” in the wealthy, predominantly White neighborhood of Streeterville can expect to live to the age of 90. Just nine miles to the south, a person living in the predominantly Black neighborhood of Englewood can expect to live to just 60. There should not be a life expectancy gap of this magnitude between any group of humans anywhere in the world. One of the many questions that emerges from these statistics is how did this happen? The other is how do we fix it?

Unfortunately, Chicago is not all that unique when it comes to U.S. cities with major discrepancies in life expectancy. Washington, D.C., New York, San Francisco and New Orleans - indeed just about every major American city - all have dramatic gaps in mortality based simply on where one lives. More often than not, the neighborhoods with the worst life expectancy outcomes are poor and mostly Black.

These disparities have been revealed and magnified during the coronavirus pandemic. Since Covid-19 arrived in the U.S. earlier this year, Black Americans have been three times more likely than Whites to contract the virus and twice as likely to die from complications caused by the disease. Sadly, the impact of Covid-19 adds credence to the adage: “When White America catches a cold, Black America catches pneumonia”.

Yet it is often much worse. Routinely in America, Blacks are dying because of discriminatory policies and practices that have remained in place - and largely unquestioned - for decades and even centuries. The viral video showing the May murder of George Floyd at the hands of the Minneapolis police opened the world’s eyes to just one of these injustices: the fact that Black men are more than twice as likely to die in police encounters than their White counterparts.

Racism and inequality are not unique to the United States. As the Reverend Dr. Martin Luther King, Jr. once stated: “Injustice anywhere is threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects us all indirectly”.

King’s words are precisely why racial injustices and inequities should matter to everyone and particularly to those of us in architecture. As licensed architects, we have made a commitment to protect the health, safety and welfare of the people who experience our design efforts, which is everyone. This Hippocratic Oath for architects should motivate us to do something about the discrimination that we see around us as it, too, is negatively impacting people’s health, wellness and livelihoods.

While it is true that architects do not directly have the power to rewrite the laws and policies that have allowed for systemic racism and injustice, we do have the power - and privilege - to effect positive change in three key ways: 1) Understanding health equity, particularly the social determinants of health, and using this knowledge to inform our design work. 2) Recognizing the impact of environmental racism and climate change on Black and minority communities and how design can be both a cause and a remedy to this type of injustice. 3) Diversifying the profession of architecture so that a wider pool of architects can more closely reflect the communities they serve.

None of these objectives will be easy to achieve. All will require that we educate ourselves, our clients and our communities. But each is vitally important if we want our cities to be healthier, more prosperous and more just for future generations.

 

Social Determinants of Health

Let us start by examining how we got here. How did we reach the point - 150 years after the end of slavery in America and 50 years after the Civil Rights Era - that we still see such wide gaps in quality of life between Black and minority communities and their White counterparts?

Consider the following: the net worth of a typical Black family in America is one tenth that of a typical White family. Black unemployment in the U.S. is 50% higher than White unemployment. Life expectancy of Black males is five years shorter than White males. Black men are six times more likely to be incarcerated in prisons and jails. Blacks are also less likely to receive a high school diploma or graduate from college than other races in the U.S., more likely to experience persistent symptoms of emotional stress and less likely to receive quality mental health treatment.

These socio-economic factors are what healthcare workers refer to as the social determinants of health. Their research has found that human health and mortality are influenced by five key determinants: 1) personal choice, such as choosing to smoke, drink and participating in other unhealthy behaviors; 2) family history and genetics; 3) environmental conditions, including safe housing and neighborhoods and access to transportation; 4) healthcare availability; 5) social determinants such as education, employment, discrimination, financial strain, concentrated poverty, imprisonment and support services.

When it comes to mortality, a person’s personal choices and genetics have the biggest influence on health - 40% and 30%, respectively. Most interesting to me, however, is the role of social determinants (15%) and the environment (5%). Together, these factors are twice as important as access to healthcare (10%).

Think about that for a moment.

Social and environmental surroundings have a much bigger impact on people’s life expectancy than the medical care and treatment they receive. As someone brought up to believe in the “healing power of Western medicine”, I find this remarkable. This is also encouraging to me as an architect because environmental conditions and social factors are both within our wheelhouse to improve.

So, what exactly can architects and designers do to improve the social and environmental determinants of health in communities of color? The answer is simple. We must think more holistically. We must think beyond just the client and building occupant and consider how a project might impact the broader community and serve as a public asset or catalyst for change.

This means we must place more emphasis on transit connections, ensuring that the projects we build are accessible to people and workers from all areas of the community. As my colleague Domenic Salpietra has done, we need to look at how public transportation agencies like the Chicago Transit Authority can stimulate investment in underutilized communities of color.

We must advocate for programming that connects our projects to the community in ways that are more than just physical. How could a partnership with a local school or university enhance a project? How could incorporating space for a social services agency or community nonprofit benefit the neighborhood and building users?

We must embrace projects viewed as controversial. Much attention has been brought to the injustices fostered by the criminal justice system and whether it is ethical for architecture and design firms to contribute to these types of projects. The injustices of the system are disproportionately shouldered by Black Americans, who are arrested at higher rates than any other race and often denied access to a fair judgment, due to systemic racism coupled in many cases with an inability to pay for proper legal defense. Improper sentencing and racially prejudiced policies have led to mass incarceration in the U.S. for decades, most drastically impacting Black Americans. Incarceration breaks up families and places even more financial and emotional strain on vulnerable communities, particularly in Black neighborhoods, exacerbating socio-economic and health disparities.

Yet even with much-needed sentencing reforms, our society will continue to require facilities that administer the law, which includes courthouses, public safety centers as well as places to rehabilitate the mentally ill and buildings to house those who have been convicted of breaking the law. We must examine the best ways to administer the law, challenging our judicial system to make changes that will reduce the need for detention space and requiring our public leaders to increase the availability of programming that will prevent people from entering the judicial system in the first place.

In circumstances where detention is necessary, we must deploy architects to make corrections facilities more humane and, ultimately, to reduce recidivism. My colleague Jeff Goodale has spent the past three decades championing creative approaches to facilitating the continuum of care that is so important to protecting the health, safety and welfare of all people who are housed within the judicial system.

 

Environmental Racism and Climate Change

On the planning side, architects and designers must do more to address two additional health threats that disproportionately affect minority communities: environmental racism and climate change.

The U.S., like many nations, has struggled when it comes to equity and justice for Black and other minority communities. Although slavery ended in America with the conclusion of the Civil War in 1865, legal discrimination continued for the next century in the form of Jim Crow laws.

These laws, which originated in the South but soon spread across the nation, limited where Blacks could work, shop, travel and live. Jim Crow laws worked to further disenfranchise Blacks by restricting their ability to vote or seek justice for nearly 5,000 extrajudicial lynchings of Black men, women and children that occurred in the U.S. from the late 1800s through the early 1900s.

One of the most pernicious legacies of Jim Crow was redlining. The result of this racist lending policy that stifled investment and new infrastructure in minority communities remains visible today. Redlining helps explain why Black neighborhoods are often located in “food deserts” that lack grocery stores with fresh fruit and vegetables, why so many homes and buildings have fallen into disrepair and why these neighborhoods often have fewer parks, greenways and areas for outdoor recreation.

At the same time, redlining opened Black neighborhoods to a type of investment unwanted elsewhere: factories, refineries and other forms of high-polluting industry. Today, Blacks are more likely to live in areas of elevated air pollution - “sacrifice zones” - and are at an increased risk for premature death due to airborne toxins. In an era of climate change and pandemics, the consequences of environmental racism could get worse before they get better.

A recent study by Harvard University found that Covid-19 patients living in regions with high levels of air pollution were more likely to die of the virus than those living in less polluted areas. Other studies have found that flooding in the U.S disproportionately impacts Black neighborhoods, which are often located in low-lying sections of cities and at greater risk for sea level rise due to climate change. As a result of redlining, many Black neighborhoods also have more pavement, fewer trees and higher temperatures that make residents more susceptible to heat stroke and other
heat-related illnesses. Blacks often have fewer resources to prepare for or cope with the effects of climate change.

Yet here, too, design has the possibility to alleviate the effects of environmental racism and climate change and make our cities healthier and more resilient for everyone.

As architects, we can begin by advocating for updated and responsible building and zoning codes. A role model of mine in this regard is Anica Landreneau, director of HOK’s Sustainability practice. Anica has testified before the U.S. House of Representatives about the need for new building codes nationwide to reduce greenhouse gas emissions and save lives. She has helped orchestrate Washington, D.C.’s Clean Energy Act, one of the nation’s most aggressive responses to climate change. She also has collaborated with the American Institute of Architects to author new guidelines for healthier and more resilient building codes. As Anica says, “healthy communities are resilient communities”.

Minority communities can also be made healthier - more
resilient - with new investment and tax incentives to make up for decades of redlining. Black neighborhoods are often located in the oldest parts of cities, with building stock that is ripe for reinvestment and upgrades. As the U.S. looks to rebuild its economy following
Covid-19, minority neighborhoods could be ideal places for investment and revitalization without the displacement often fostered by gentrification. Well-designed retrofits have the additional benefit of being healthier for the environment as they require less energy and fewer embodied carbons than typical new builds.

As planners, designers and advocates, we must inform clients and municipalities of how important greenspace is to a wide array of health benefits by reducing stress, boosting air quality, promoting physical activity and allowing for local food production in the form of community gardens. But it is not enough to just consider outdoor air quality. We must advocate for healthy indoor environments, too, through programs like the WELL Building Standard, to ensure that building occupants have clean indoor air, access to natural light and comfortable environments in which to live and work.

The best way to achieve these objectives, I would argue, would be through design teams that maintain direct connections to minority communities. Yet in this arena, the U.S. is also deficient.

 

Diversifying Architecture

Today, Blacks in the U.S. represent 13% of the population but only 2% of the nation’s licensed architects. The number of Black women in the profession is particularly dismal, accounting for fewer than 500 licensed architects or just 0.4% of the nation’s 116,000-plus architects.

Racism comes into play here. While many firms today are actively trying to diversify their studios, architecture has not always been accepting - or within reach - of minorities. For decades, many universities and architecture schools refused to accept Black students, and those who did achieve degrees often had trouble landing jobs. One needs to only look at old photos of architecture studios, with their scores of White architects huddled over drafting tables, to see how homogenous this profession has been - and largely remains today.

Yet America is changing. By 2045, the number of Whites in the U.S. is expected to fall below 50% of the population. For the good of the profession and the health of the people it serves, it is imperative for the profession of architecture to change along with the times.

Imagine, if you will, if notorious public housing projects like Cabrini-Green in Chicago and Pruitt-Igoe in St. Louis had been designed by Black architects from those neighborhoods. How might those designs have differed from the Le Corbusier-influenced buildings that were erected - and razed - within a few short decades?

I believe that architecture teams desperately need people from a diversity of backgrounds, perspectives and experiences to solve the design challenges facing our communities. That is why as the president of the National Organization of Minority Architects (NOMA), I have helped launch the 2030 Diversity Challenge for Architecture. The task is straightforward: double the percentage of Black architects from 2% to 4% by 2030. That would roughly equate to adding 2,500 - or more - Black registered architects in the U.S. in this decade alone.

Diversifying architecture is one way our profession could quickly and meaningfully improve communities of color. With more Blacks and other minorities in architecture, we will improve our collective understanding of and imprint on society. In turn, we create designs that are more responsive to the needs of society. Equally important, by diversifying architecture we demonstrate to young people everywhere that this noble profession is open to and accepting of all. Winston Churchill once said, “We shape our buildings; thereafter they shape us”. By fostering diversity in the profession of architecture, we will shape a more just and equitable future.

The built environment is just one legacy an architect leaves the world. An arguably bigger and longer-lasting legacy comes from inspiring and enriching the lives of other people. I ask, how many of you regularly devote time to mentoring young or aspiring architects, particularly those from minority communities? Many organizations, including the ACE Mentorship Program and the National Organization of Minority Architecture Students (NOMAS) and NOMA Project Pipeline Summer Camps, are eagerly awaiting architects to share their time, expertise and, most of all, their encouragement.

 

Where to Go From Here

The summer of 2020 in the U.S. has been defined by Covid-19 and Black Lives Matter. Connecting these two events is a common thread: racism. Systemic racism has made the virus far deadlier for Blacks and led to public outcry over the disproportionate killing of Blacks at the hands of police.

This summer has also brought to light that racism is more than just civil and criminal injustice. It is a community health crisis. As architects, we have an urgent responsibility to address this crisis by understanding how racism has made Blacks more susceptible to poor health and shortened lifespans due to social and environmental factors and climate change. Equipped with this knowledge, we must design for the life of all people, regardless of their race, class or pedigree. To accomplish these goals, we must do more to diversify our profession to better represent the communities we serve and make a conscious effort to provide holistic solutions.

Then, and only then, will we level the playing field and give everyone - be it a White woman in Chicago’s Streeterville (north) neighborhood or Black man in Englewood (south) - the same opportunities to live healthy, long and fulfilling lives.
As architects, we must design for life.

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