When I
was growing up, my father, a now-retired anesthesiologist, would faithfully
call home each evening before leaving work. “What’s it doing outside?” he’d
ask, having spent his day in the windowless confines of operating rooms,
fluorescent-lit hallways, and the hospital cafeteria. I never gave this
question particular thought, but I’ve been reminded of it lately as we’ve been
examining the role of urban medical and research centers in vibrant, innovative
local economies, and how the physical geography of their campuses matters in
this context.
The
health care industry’s impact on cities and regions—through job creation,
purchasing, and real estate development—has gained increasing attention in
recent years, and for good reason: The Bureau of Labor Statistics projects that
by 2022 one in six new jobs will be in health care occupations, found in
settings ranging from hospitals to residential care facilities. According to
the Centers for Medicare and Medicaid Services, by 2023 over 19 percent of the
nation’s gross domestic product will be in health care expenditures.
At the
same time, disparities in disease and mortality rates have called into focus
the responsibility of urban health care centers—including academic medical
centers at urban universities—to use their economic influence to improve the
well-being of the often poor and minority neighborhoods surrounding them. A
recent report by the Democracy Collaborative, titled “Can Hospitals Heal
America’s Communities?” argues that health organizations must be accountable
for “all of their impacts on community health”—not just those related to direct
health services—by using their procurement, hiring, and investment policies to
tackle the “social, economic, and environmental issues that…determine our
health status, our outlook, and our life expectancy.”
At a time
when the nation’s health care system is being upended by new policies,
technologies, and demographic dynamics, these issues are more relevant than
ever. Yet largely absent from the discussion is consideration of how the
physical character of urban health centers, and the relationship they in turn
have with their surrounding neighborhoods, could be more supportive of expanded
and evolving ideas for what it takes to build a healthier society.
Look
around the large urban academic medical campuses where much of our nation’s
care is provided and studied, and you see a starkly similar, and fairly
depressing, spatial form: large-scale, inwardly focused buildings, ample
parking, and scarcely any people in site. While these centers may be embedded
in the urban landscape—and are often only a stone’s throw from busy downtowns
or commercial corridors—they are rarely enmeshed in it. Though their economic
connection to their city and region may be important, it’s fair to say that
their corporeal relationship is barely tangible.
The
ramifications of this disconnection are pretty apparent, if not yet precisely
measurable.
First,
the physicality of these complexes doesn’t make for a healthful experience for
either patients or workers, who have limited access to local food, retail
establishments, greenery, or lively public spaces, and thus limited incentive
to engage with the world outside. (This is precisely why my dad never knew the
daily weather.)
At the
same time, their fortress-like settings make them unwelcoming to those living
or working around them. The huge number of employees, outpatients, and
visitors, combined with other local residents and workers, should provide a
substantial market for commercial activity, health- and wellness-related
programming, and other cultural amenities that would help integrate hospitals
into their communities in ways that directly promote a more holistic social
mission. But in most medical centers, this potential remains hidden behind
tinted glass doors.
Finally,
the self-contained nature of medical campuses inhibits interaction among and
between clinicians and researchers, potentially curtailing the exchange of
ideas and collaborations that spur and nurture innovations in preventing,
diagnosing, and treating injuries and illness. A recent Project for Public
Spaces (PPS) survey of health workers in the Oklahoma City health sciences center—a
classic example of the model described here—found that there were far fewer
spontaneous interactions there than in dense Kendall Square, in Cambridge,
Mass. Yet when they did happen (albeit most often in internal cafeterias) they
were highly valued just the same.
In
recognizing this challenge, stakeholders in Oklahoma City are embracing the
opportunity these findings present as they think about how to evolve their
health care and research campus into an 843-acre innovation hub. The emerging
district encompasses the campus as well as Automobile Alley, a lively
commercial corridor that’s grown up across the highway. Through work with
Brookings and PPS, district leaders hope to develop a unified vision and
specific strategies for integrating innovation, placemaking, and inclusion in
ways that make the area more vibrant and bolster it as a driver of regional
economic growth and opportunity. Similar efforts in Buffalo, N.Y. and Austin,
Texas are also focused on remaking medical campuses in ways that benefit adjacent
communities while facilitating innovation and firm growth.
The Wake
Forest Innovation Quarter in Winston-Salem, N.C. looks to be there already. A
growing campus for research, business, and education in biomedical science,
information technology, clinical services, and advanced materials, the Quarter
is home to more than 60 companies and four leading academic
institutions—including the Wake Forest School of Medicine—with more than 3,000
workers and 5,000 students. Health and wellness is also a major focus of the
Quarter, motivating the creation of the 1.5-acre Bailey Park, a public space
actively programmed to serve the Quarter's tenants as well as the surrounding
residential neighborhoods. Along with outdoor movies and concerts, Bailey Park
offers yoga and fitness classes, in partnership with the YMCA, and a number of
walking, running, and bike events that are all free and open to the public. In
addition, vendors and retailers offer healthy foods in a number of venues,
including a new public market hall that is intended to provide business
opportunities for food entrepreneurs. On any given day, an array of other
community activities, lectures, and classes are happening throughout the
Quarter.
The
opportunity for other medical centers to follow suit is enormous: a recent
report released by Revista estimates that $97.1 billion in large health care
real estate construction projects were either under construction or in late
planning stages at the end of 2015. As these campuses expand into urban space,
they, too, ought to be thinking about the physical form that growth takes, and
how it can be shaped in ways that embrace and promote a more expansive,
inclusive notion of health and well-being.
Jennifer
S. Vey
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