Located far from nationally recognized research centers or urban clusters of top universities, the city of Baton Rouge, Louisiana, may not seem like fertile ground for a big advancement in community health care. But a new health district being planned and developed here may demonstrate how new ideas on linking neighborhood planning, community health, and local economic growth can solve entrenched problems in cities across the country.
The Baton Rouge Health District (BRHD), developed by the global architecture and planning firm Perkins + Will, seeks to help the city in myriad ways: bolstering the economic health of area medical offices and improving the health of those working for these institutions, as well as the community at large. Diagnosing the challenges and issues affecting the region in the same way a doctor would examine a patient, the proposal demonstrates how planners are redefining what a medical district can do.
"This center is going to be pulling in resources from all area health care providers, employers, and insurance companies to provide people will resources they normally wouldn’t find when they go to the hospital," says urban planner Basak Alkan, who has been part of the team working on the design of the district since 2014. "Patients can access wellness classes and visit a farmers market. Nothing like this has been created for a health district in the United States before because the incentives aren’t aligned. People have wanted to do it, but the money just wasn’t there."
The economic basis of this redevelopment plan comes from a recent shift in how medical care is paid for and evaluated in the United States, says Alkan. A move away from fee-for-service systems, as well as the Affordable Care Act, have created a paradigm shift towards disease prevention and population health management, according to a report by Perkins + Will. The resulting focus on community-based healthcare has created a push to develop civic centers for health, which underlies the BRHD. By using the economic power of the healthcare industry to support a healthier population, which then reduces costs for hospitals, providers, and insurance companies, the plan seeks to create a positive feedback loop.
The goal of the proposed district, which came from a city master plan study from 2011 by the Baton Rouge Area Foundation and is backed by a coalition of 15 local health care providers including hospitals and clinics, is urban planning for health. The plan calls for the establishment of several new roads in the Essen Lane/Bluebonnet Boulevard/Perkins Road corridor to help knit together medical facilities, new parks and a Health Loop trail to promote physical fitness, as well as building a new diabetes and obesity treatment center to address a key community health challenge. The district will be overseen by a nonprofit organization (a director, Suzy Sonnier, has already been named), transforming a disconnected collection of medical offices into a true neighborhood.
Anchor districts based on healthcare, such as the Texas Medical Center, have been around for decades, but this may be the most comprehensive one yet proposed, looking beyond land use and transportation issues to healthcare collaboration.
"Rather than focus just on the medical center, we wanted to focus on healthy placemaking," says Alkan. "We looked district wide at where the hospitals could invest facility investment dollars to make a more healthy environment."
According to Alkan, the neighborhood is currently a "food swamp," filled with unhealthy dining choices, and lacks green space and connected walkways, leading to unhealthy habits, unconnected space, and car-centric transportation. Perkins + Will research found that behavioral factors, such as diet and physical activity, as well as the environmental factors that influence those behaviors, accounts for 70 percent of overall health outcomes.
The concepts here can apply to other communities across the country, says Aklan. Hospitals are often among the largest employers in many areas, so they can serve as economic catalysts and help anchor these sorts of districts.
"The way that places are designed make or break communities," says Alkan. "Every government is trying to address these problems right now. The real issue is financing."
Building infrastructure to improve the health of the wider community adds a new dimension to planning and urban design, as well as helping communities escape poverty. Janice Barnes, Global Leader for Planning and Strategies at Perkins + Will, is working on a health district concept for a hospital in Brooklyn, the Wyckoff Heights Medical Center, that’s trying to improve neighborhood access while encouraging healthier behavior. She believes numerous issues facing poorer urban neighborhoods can be addressed with an health-focused approach.
"If you go back to Maslow and his pyramid of needs, there’s a basic need for shelter, food, and health," she says. "If you can’t get the basics down, you can’t aspire to better outcomes. What we’re struggling with is an inability to attack the root of the problem. Why are these the only choices people are making? What is missing in the neighborhood?"
Hospitals are increasingly becoming partners in this planning. The huge shift towards lowering costs means they’re looking beyond their front door to the neighborhood, and examining ways to prevent patients ending up in the emergency room. The preventative approach has led to a wider perspective on how hospitals operate, collect data, and view community relations. It’s a new phenomenon, Alkan says, that can also become a catalyst for changes in the community.
"It may seem like there’s no way to design people out of poverty," she says. "But if you look at design broadly, and include a long-term strategic and facility plan, there is a lot we can do for these issues."