Assessing the Potential of Integrating the Health Impact Assessment in Normative Architectural Practice in Order to Promote Population Health and Health Equity in Design Decision-Making

Abstract

Scientific research has demonstrated that the design of the built environment can negatively contribute not only to ‘mortality’ (life/death) outcomes in populations, but also to ‘morbidity’ (overall health and well-being) outcomes. Moreover, the design of the built environment has been shown to enable inequitable distribution of deleterious health impacts across particularly vulnerable, sub-populations, including low-income individuals and families, newcomers, and racialized groups. Public health organizations, who are charged with improving population health and health equity outcomes, have neither the capacity nor the position to effectively influence the public’s health alone. Based on the mechanisms through which an individual or a population’s health is determined, there exists an opportunity for architectural designers to contribute to promoting population health and health equity through architectural design. Of the values considered within normative architectural practice, however, public health in aggregate—in particular, the impact of design decisions on building end-user- and community-health and well-being—is generally not one. Further, the design decision-making models and tools used in normative architectural practice are limited in their ability to address complex public health problems. If architectural designers are to contribute more effectively to improving the public’s health and well-being by promoting population health and health equity through architectural design, then the design decision-making models and tools used in normative architectural practice must be reinvented, and the discourse of the architectural discipline, widened.

The Health Impact Assessment (HIA) of today is a structured, scientific and contextual evidence-informed public health tool that aims to prioritize the public’s health in policies, plans, programs, and projects—particularly in those outside of the health sector. It has been regularly employed across diverse disciplinary and political settings to examine the population health and/or health equity impacts of a wide-range of decisions, especially including urban- and transportation-planning design decisions. HIAs have yet to be employed in most architectural practice to evaluate the population health and/or health equity impacts of architectural design decisions. A scoping review of seven case study HIAs—all focused on modifying the built environment—was conducted to assess the potential of integrating the HIA in normative architectural practice in order to promote population health and health equity in design decision-making. Though limitations in the investigation exist, findings suggest that the HIA has strong potential to be an effective tool in normative architectural practice, enabling improved decision-making quality and facilitating the consideration of population health and health equity in design decision-making; in turn, enabling health promotion through architectural design. HIA integration, however, will necessitate a voluntary shift in practice, which would be best supported by buy-in from architectural clients, improvements to existing regulatory frameworks, and commitment from the architectural community at-large to collaborate intersectorally and to up-skill.