Better Living Through Better Design – The Health Care Blog

BY KIM BELLARD

We’re almost two weeks past Hurricane Ian. Most of us weren’t in its path and so it just becomes another disaster that happened to other people, but to those people most impacted it is an ongoing challenge: over a hundred people dead, hundreds of thousands still without power, tens of thousands facing a housing crisis due to destroyed/damaged homes, and estimated $67b in damages.  It will take years of rebuilding to recover.  

In the wake of a natural disaster like a hurricane – or a tornado, a flood, even a pandemic – it’s easy to shrug our shoulders and say, well, it’s Mother Nature, what can we do?  There’s some truth to that, but the fact is there are choices — design choices — we can make to mitigate the impacts. A Florida community called Babcock Ranch helps illustrate that.

Babcock Ranch is located a few miles inland from Ft. Myers, which was devastated by Ian.  It bills itself as “America’s first solar-powered town,” with an impressive array of almost 700,000 solar panels. More than that, it was built with natural disasters in mind: all utilities are underground, it makes use of natural landscaping to help contain storm surges, streets are designed to divert floodwaters, making use of multiple retaining ponds. 

It survived Ian with no loss of power, no flooding, and no major damage.  Its community center is serving as a refuge for people from communities that were not as fortunate. A spokesperson for Syd Kitson, the man behind the development, told CNN: “It’s a great case study to show that it can be done right, if you build in the right place and do it the right way,”

Mr. Kitson told 60 Minutes: “So as soon as the sun came up the next morning, I jumped in my car and I started driving out. And the only damage were a few down trees and a few shingles off the roofs. That’s it. And so our recovery was maybe a day.”

Good luck, or good design?  As NPR said about one Babcock Ranch family whose home escaped damage: “But it wasn’t just luck that saved Wilkerson and his wife, Rhonda, or prevented damage to their well-appointed one-story house. You might say that it was all by design.”

The project was begun in 2015, with first residents moving in in 2018.  It currently has some 2,000 homes – ranging from condos to starter homes to estate houses – and 5,000 residents (which Mr. Kitson expects will grow to 50,000). 

Jennifer Languell, a sustainability engineer who helped design the project and now lives there, told NPR

We felt you could develop and improve land, not just develop in a traditional way where people think you are destroying the land. 

The things that we do, you don’t see. The strength of the buildings, or the infrastructure that deals with stormwater, or the utilities. You don’t see that stuff.  Which is good, because most people don’t need or want to think about it.

One could argue, well, Babcock Ranch was further inland, it had more recent construction with more stringent building codes, it didn’t have mobile homes, it wasn’t built in floodplains.  To which I’d argue: Those. Are. Design. Decisions.  

Babcock Ranch was designed not just to withstand hurricanes but also:

…to offer residents multiple ways to improve their physical and mental wellbeing. From the Lee Health Healthy Life Center, to carefully planned greenspaces and nature trails, to our robust resident programming, there are countless ways to get active, expand your social circle, and build a life that positively shapes your overall wellbeing.

It’s all about design, about the choices we make…or don’t think to make. 

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I’ve been thinking about the role of design in health since I was fortunate enough to get to know Steve Downs, then at Robert Wood Johnson Foundation and now at Building H. Back in 2017 he wrote about how it was important to “build health into the OS of our daily lives.” As the Building H website warns: 

Modern life is great at making us happy – in the short term.

In the long term, it’s killing us. By design.

From cheap calories to free freeways, from second cars to second refrigerators, our everyday environment is engineered for convemience, passivity, and gratification. 

The result: An epidemic of obesity & diabetes, depression & chronic pain.

And if you’re thinking healthcare can solve this…you’re already too late.

To this point, The New York Times recently reported about how trying to contain the epidemic of diabetes through medical care is doomed to failure.  In words Steve would agree with, Dr. Dean Schillinger, a professor of medicine at UCSF, told NYT: “Our entire society is perfectly designed to create Type 2 diabetes. We have to disrupt that.”

The article further asserts:

There is no device, no drug powerful enough to counter the effects of poverty, pollution, stress, a broken food system, cities that are hard to navigate on foot and inequitable access to health care, particularly in minority communities.

Dr. Schillinger was one of numerous experts who was part of the National Clinical Care Commission, which issued a report earlier this year urging Congress to put more focus on the social and environmental factors that contribute to diabetes and make managing it more difficult. They called for a “health-in-all-policies” approach, whether those are health, housing, nutrition, or environmental policies. 

As Dr. Schillinger told NYT

It’s about massive federal subsidies that support producing ingredients that go into low-cost, energy-dense, ultra-processed and sugar-loaded foods, the unfettered marketing of junk food to children, suburban sprawl that demands driving over walking or biking — all the forces in the environment that some of us have the resources to buffer ourselves against, but people with low incomes don’t.

Steve would urge that this approach should not just apply to diabetes.   

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Babcock Ranch isn’t Utopia.  I doubt there aren’t many low income people there. I suspect it doesn’t have many people of color. I’d be interested to know what happens to its sewage and trash. Its residents probably still drive too much, eat too much (of the wrong foods), and get too much medical care.  It may have survived Ian very well, but it is still in Florida, where there will always be another hurricane, which might prove more damaging.

But still.  Babcock Ranch is an example that design can make a difference in our lives, in our safety, and in our health.  Let’s hope it doesn’t take too many more disasters for us to learn that lesson.   

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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