The New Grand Strategy, extended

Jul 17, 2017

The idea of sustainability has to expand to include the development of buildings that promote healthy outcomes for the public.

After reading Ed Friedrichs’ article, “The New Grand Strategy,” I was inclined to email him and suggest a complementary extension of our “national strategic imperative.” Consider, if you will, an expanded definition of sustainability that focuses not just on the built environment, but one that includes the people who use it. When designers and developers do so, we are rewarded with positive health outcomes in addition to the environmental benefits associated with walkable communities, regenerative agriculture, and resource productivity – just as Mark “Puck” Mykleby describes in his book, The New Grand Strategy – Restoring America’s Prosperity, Security and Sustainability in the 21st Century.

We need healthy approaches to place making. The vast and ever-increasing percentage of GDP expenditure on reactive health care – live one’s life, get sick, treat the symptoms – must leverage architecture, planning, and development to proactively create the latent conditions in the built environment that improve health outcomes, slowing down or potentially reducing the growth of GDP spending on traditional, reactive healthcare. (Global Economist Thierry Malleret estimates that over the next 20 years, total global healthcare expenditures on the treatment of chronic disease will total $47 trillion.)

As design helped conquer the epidemics of late 19th and early 20th centuries, what if the design choices we make now addressed the chronic conditions of today – obesity, heart disease, and isolation? Can the idea of sustainability extend from “green building” and the environmental science driving the development of buildings, to community planning and the health outcomes of the people who occupy those buildings?

Historically, good design choices have proved themselves essential to creating health-giving environments at home, work, study, and play. With the belief that there is no greater achievable sustainability than health and well-being, I’d like to offer our findings on an initiative we call Designing for Healthy Living.

Our firm, Hart Howerton, partnered with the University of Virginia’s Center for Design and Health and brought together medical, public policy, and business school participants to verify our firm’s proposed “punch list” for constructing the conditions for improved health. We wanted to find out if the annual worldwide investment in commercial real estate could be made in a “smarter way,” in a way that helped alleviate chronic health conditions. Could building communities in a new way proactively change health outcomes and, by extension, help protect our national economy from the “material” risk posed by rising healthcare costs?

Published jointly in 2014, Designing the Healthy Neighborhood is a synthesis of available studies in a multiplicity of areas, from urban planning to nutrition to gerontology. It makes its focus the community infrastructure necessary to install opportunities for healthy living. We identified nine principles. Some of these principles are pre-development ideas, ideas like “smart location.” Some are design opportunities to embed within plans: integrate nature, mix uses, incomes, and generations. Others, like “pride of place,” rely on both physical settings and long-term programming to create a sense of community, and “circulation alternatives” – walkability and other modes of “active transportation” – which research associates with a reduced risk of obesity and cardiovascular disease.

Our collaboration substantiated our original premise that health can be a “deliverable” through design. Healthy living, like LEED, the green standard, could be a primary guideline. And, it’s not limited to physical health – it’s places for people, for community interaction, for mental stimulation, for continued social and academic learning. It’s places that people enjoy being, or being together, as well as facilitating physical activity and fostering social interaction.

That’s how our initiative of Designing for Healthy Living evolved – we identified basic elements of design that optimize the quality of complete well-being, for mind, body, and spirit, in creating new communities. Our principles are buildable components of a design that can be applied by anyone reading this in order to infuse their project with the same positive health outcomes. Our findings bore evidence that the right design might programmatically empower and encourage healthier lifestyle choices, helping reduce or prevent certain chronic conditions and their reactive care. We encourage you to try, too, in pursuit of health equity.

If you’d like to read more about our findings with the University of Virginia, please click here.

Tim McCarthy, AIA, LEED AP, is the managing principal of Hart Howerton. He leads the firm’s sponsored research at the University of Virginia’s Center for Design & Health and is an active contributor to ULI’s Building Healthy Places Initiative. He can be reached at

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