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City planners and healthcare providers need to talk about their common goals

May 20, 2019

By Andrew Irvine

How can healthcare providers and civic leaders coordinate community health goals, providing effective wellness while reducing healthcare costs?

Imagine this scenario: I am a healthcare patient, returning to the job market after years away—having completed rehab and dealing with some chronic health issues. While I get back on my feet, I can be prescribed subsidized housing through a hospital-developed affordable-housing program, get healthy meals with ingredients grown in a city-sponsored urban garden prescribed by the hospital, and access a job-development program at a city college, also prescribed at a discount through my healthcare provider. Similarly, for maintenance of my health, I’m prescribed a swimming program at a nearby fitness center.

Now, with support for my food, clothing, and shelter, am I more likely to succeed in staying healthy and realizing my potential as an individual?

This approach does not sound like healthcare practice as we’ve known it, but it may reflect a new reality and a convergence of interests. In fact, we think that the practice of urban placemaking, which explores strategies for achieving livable cities, has a lot to say about providing healthcare that reaches out to the community. 

Dubai South is a master-planned community. Shown here, a mixed-use district center with community hub that integrates a medical center, K-12 school, municipal services, and a retail core. The big oval roof is a large community center that houses community gardens, meeting rooms, community kitchens, and wellness facilities.

A new reality for providers

Healthcare institutions are responding to changes in healthcare reimbursement (moving from fee-for-service to a proactive-care model). The goal is improved community health and avoiding development of costly chronic illnesses. Douglas King and research partner Jingfen Guo have identified in their population health research that healthcare institutions have latent assets such as available space, availability of health expertise, and trained/committed administrators with developed leadership skills to be leveraged within the wider community.

What could it mean for promoting healthy living in city for a broader segment of the population? What could it mean for reducing healthcare costs in the long run?

Population-healthcare management seeks to keep as much of the population as possible from falling into the category of the chronically ill, where the bulk of healthcare dollars are spent. The transition to this proactive approach to healthcare in the US has brought providers new rules for compensation.

Providers are now reimbursed (by Medicare and Medicaid, for instance) based on results achieved on alternative methods of community care. And they can be penalized if their patients are readmitted. As a result, we’re going to see providers develop approaches that address the root causes or lifestyles (frequently termed “the social determinants of health”) that result in poor health outcomes. These approaches often shift the responsibility for maintaining health from the individual to shared responsibility between the provider and the individual.

The two most telling social determinants for health are “zip code where you live” and “level of education.” Recognizing that socioeconomic factors such as access to employment and education impact health, some hospital systems are already diversifying their approaches. The most progressive groups are investing in programs for job development; developing affordable housing; and creating programs for healthy lifestyle, fitness, and nutrition, which can include urban gardening and social activities.

We think healthcare institutions will be looking for partners that promote health in the population, and that partner may be local civic leadership for the community that surrounds the healthcare institution.

Dubai South was planned as a walkable community with a comprehensive network of nature-based parks and open space.

Urban placemaking

Simultaneous to the emergence of this new healthcare reality, city planners have become keenly interested in promoting amenities that enhance city life—anything from parks and bike paths to bike-share programs and community gardens. Achieving “walkable cities” has become a mantra. Livable city concepts are largely driven by civic government’s interest in attracting and retaining residents and businesses to fuel economic development.

Many cities are turning to urban placemaking experts for strategies to enhance aspects of city life such as walkability or active green space that make cities more livable, but it’s unlikely that they’re coordinating with major healthcare institutions. Comparing presentations at major placemaking conferences such as the Environmental Design Research Association events, or conversely, major healthcare conferences such as Healthcare Design (HCD), there is a noticeable gap within the presentations featured at these parallel events.

We propose that there’s a convergence of interests (with complimentary resources) between cities, which want to boost their livability, and healthcare institutions, which are looking for new ways to reach out to members of the community and keep them healthy. And it is time that city planners and healthcare providers started talking about what they have in common—and putting it into action.

Questions abound

What kind of amenities and community assets might be attractive to the young urbanites that cities desire that could also be useful in providing a potentially reimbursable service that could be prescribed for clients of a healthcare provider?

What’s the role nontraditional providers of healthcare-related services in all of this? Major players entering the healthcare market include Walmart, Target, YMCA, and Amazon.

What possibilities might this convergence unlock for overcoming the challenges facing an urban-healthcare provider—from achieving equity in access to reducing healthcare costs in a community?

What could it mean for promoting healthy living in city for a broader segment of the population? What could it mean for reducing healthcare costs in the long run?

We think it’s time for healthcare providers, civic leaders, and nontraditional providers to start talking and coordinate across their goals for providing coordinated community-health opportunities.

  • Andrew  Irvine

    Andrew is an energetic, creative, hands-on professional with a passion for design and is known by his clients as someone who delivers exceptional quality.

    Contact Andrew
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