Recently, Baton Rouge Business Report published an article on the planning process we’ve launched for the formation of a new Medical District in South Baton Rouge. Developed in the last three decades, this suburban area is a growing hub for health care in the city and larger parish, with two competing hospitals and a large number of clinics. As elsewhere in the country, these providers are feeling the pinch associated with rising demand and diminishing reimbursements.
We began our inquiry by asking a simple question: How can we make this place work better for overall health? Not only patient health outcomes, but also the health and well-being medical staff, physicians, support workers and facility-adjacent neighbors?
As studies have shown, Americans are among the unhealthiest people in the developed world, and not for lack of healthcare spending. In fact, there’s no amount of healthcare spending that can get us out of the growing obesity epidemic and related chronic diseases that are burdening our healthcare industry.
Research shows that access to quality healthcare accounts for as little as 20% in overall health outcomes. Behavioral and environmental factors such as diet and physical activity play a much bigger role. Much of this evidence comes from the Centers for Disease Control and Prevention based in Atlanta, and other public health entities that have traditionally focused on keeping the public healthy and free from disease. Recently, they have been joined by a growing contingent: the healthcare industry. In fact, the growing awareness of the link between health and the built environment is fundamentally changing the ways we think about health care and design.
As an urban designer who works closely with health systems, I have been able to observe the transformation at both fronts. The urban design profession has been thrilled by the emerging evidence that ties great, walkable places to active and healthy lifestyles. Cities and communities have taken notice (even Atlanta, that bastion of automobile culture on the East Coast, is putting in bike lanes!). The massive ship that is the larger healthcare industry, however, is going to be harder to turn. While we’ve seen health systems adopt all sorts of innovative programs to keep patients healthy (and out of the ER and the hospital), little attention has been paid to the huge role played by the built environment—and more specifically, the built environment in which these very systems exist.
Back to South Baton Rouge. Essen Lane, the major arterial that serves the Medical District, carries six lanes of cars barreling onto or off of I-10, the highway that cuts the city in half. I walked out from the hospital campus and stood at a traffic light on there for 10 minutes, unable to cross. There was no pedestrian signal, and no marked crosswalk. Not a good sign for a healthy, walkable community.
We, as urban designers have a huge role to play. And I know that change is possible.
It’s happening in La Crosse, Wisconsin, where we recently completed a participatory joint plan for the Gundersen Health System and the adjoining neighborhood, Powell-Poage-Hamilton. Our work built the case for three different types of “health-supporting” interventions for the greater project area. For the neighborhood, which already had walkable street grid (over 500 intersections per square mile!), we recommended a revitalization strategy targeting blighted property. (Feeling safe is a critical component of a healthy community.) For medical campus, with its few access routes and sprawling surface lots, we took a different approach: working with our medical planners, we created a street and open space framework plan that will enable Gundersen, and the neighborhood behind it, to re-establish their connections to the Mississippi waterfront over time. (Access to open space is another factor in overall health).
The key to the La Crosse plan, however, was in the transitional zone between the medical campus and the neighborhood. An 80-foot wide state route and parking lots separated the two. This area was selected, at community meetings, as the target area for the “mixed-use catalyst development.” Our market study demonstrated such development to be economically feasible with the use of affordable housing tax credits—an ideal rental option for medical support staff who would like to walk to work. It would also include a small café / restaurant: no more deliveries crowding up the hospital drop-off at lunch-time!
Less than a year after the plan’s adoption, there’s a good possibility that a mixed-use development may indeed happen there. Gundersen and the City have identified funds, through their existing tax-increment financing (TIF) agreement to implement the plan’s recommendations. On their side, neighborhood participants are forming a Neighborhood Development Corporation to address their priorities in partnership with the other neighborhoods. (The plan can be downloaded on the City’s website)
The tide is looking up for La Crosse, Wisconsin, thanks to the stewardship of Gundersen Lutheran, the commitment of the City, and the dedication of neighborhood residents. I am hopeful for similar successes in Baton Rouge. And I know that we can get there as long as we keep our eyes on the absolute target: health.