People take in the view over West 20th Street on the High Line on June 11, 2014 in New York. Formerly an elevated train track, the High Line was converted to an elevated park in the Chelsea section of Manhattan and opened five years ago. (Stan Honda/AFP/Getty Images)

Standing on the edge of the Anacostia River, with the disused piers of the old 11th Street Bridge in front of him, Scott Kratz says he doesn’t yet know what the four design teams will propose for a new urban park on the site. The finalists have until September to submit drawings for the competition. But one thing is certain: The winning team will address public health issues as one of the central features of the park, which will reuse the old bridge piers to span the river and connect neighborhoods that have vastly different economic, demographic and health profiles.

Communities east of the river have the highest incidence of obesity in the District, and higher rates of Type 2 diabetes and hypertension, says Kratz, who is leading the $35 million private initiative. Unlike those on the largely gentrified west side of the river, Anacostia residents lack easy access to fresh food, supermarkets and green space. The bridge park is inspired by the enormously successful High Line Park in New York and the Atlanta BeltLine park system, which reuse obsolete urban infrastructure to create “linear parks” with significant public health benefits.

Health Beyond Health Care: A Special Report

And so the park, slated to open in 2018, will include play areas to attract users of all ages and physical abilities; spaces for yoga, Zumba and dance; and perhaps a farmers market or urban garden. It also will connect Washingtonians to the Anacostia River and its ecosystem, which some studies show could have a significant impact on residents’ mental health and well-being.

The 11th Street Bridge park is part of an increasing awareness among city leaders nationwide about the degree to which urban design affects health. The basic connection isn’t new: Urban designers in the 19th century responded to appalling mortality rates from infectious diseases by creating better systems for sanitation and fresh water, and drafted building codes that alleviated overcrowding and mandated access to natural light and air for tenement dwellers.

Many of this country’s most beloved urban parks were also created during the 19th century, to offer the working class access to recreation, exercise and natural beauty.

“They didn’t have the science behind it that we do now,” says Nancy Somerville, chief executive of the American Society of Landscape Architects, which has embraced the tenets of healthy design as fundamental to its mission. “But the whole vision was grounded in the need to have access to a clean, healthy, living landscape.”

The health concerns are different now. Chronic ailments, such diabetes and heart disease, and lifestyle issues such as obesity, have replaced infectious disease as the major health worries plaguing our sedentary society. And not surprisingly, the urban planning challenges have changed, too. Today, the design buzzwords are all about connectivity, linear parks and “complete streets”— with shared space for walking, biking and ready access to transit. Urban planners are working hard to invert the basic urban-suburban relationship of the past century, encouraging people to live more densely, with a smaller environmental footprint, and lifestyles that are more socially and physically engaged with the built and natural environments.

“We are looking at an avalanche of chronic disease,” says Richard Jackson, a doctor whom many credit with pioneering the field of wellness design. Jackson began championing the connections between design and health more than 15 years ago, when he served as head of the National Center for Environmental Health at the Centers for Disease Control and Prevention.

Although it may have made sense, he argues, to disperse our population out to the suburbs in the decades after the World War II, the ill-effects of living in a world designed around automobiles are piling up rapidly.

“We have engineered activity out of American life,” he says.

A generation ago, architects were worried about “sick buildings”— poisoning us with toxic materials or poor ventilation. Today they are changing our physical engagement with buildings, nudging us toward the stairs, forcing us to walk a bit farther to use the microwave or the restroom. They are studying how we relate to windows, ambient temperature, and the pervasive noise of heating and cooling systems, with powerful new tools to quantify and evaluate what were once just hunches about what makes buildings agreeable to humans.

All of this is part of an even larger concern about the fundamental design of the world we live in, from how we structure our businesses, our nonprofit organizations and the habits of daily life — whether that’s our experience in the lunchroom, our relationship to media and entertainment, or how we get food from farm to table.

If Jackson is credited with jump-starting the conversation, former New York mayor Michael R. Bloomberg (I) may ultimately be credited with moving those ideas outside the ivory tower of think tanks and schools of public health. Although Bloomberg was widely derided in 2013 during his effort to limit the size of sugary soft drinks sold in New York, the impact of his 12-year administration on healthy design has been quiet but pervasive. In 2010, New York City issued its Active Design Guidelines, which have helped set a national standard for rethinking the built environment.

“It is an amazing piece of work from a government agency,” says Mary Fitch, head of the American Institute of Architects chapter in Washington, D.C. The strength of the document, experts say, is its consistent connection of design ideas to reliable public health data, and its input from representatives of the city’s departments of design and construction, health and mental hygiene, transportation and planning.

Rick Bell, head of the AIA’s New York chapter, said the roundtable approach allowed for the incorporation of what may have seemed, in isolation, to be counterintuitive ideas. He cites the importance of benches for walkers. “People won’t walk unless they feel they have a resting place along the trajectory.”

The New York AIA has partnered with the city to sponsor annual “Fit City” symposiums, which have helped disseminate the guidelines to a national audience. In many ways, the Active Design Guidelines are a frontal attack on how architecture and urban design were practiced for at least 50 years after World War II. The standard mid-century office building — accessed by car from a far-flung suburb — was designed around the elevator core, with large floor plates that isolated people from windows. Windows were fixed in place, and energy-inefficient systems did the work of climate control.

“The era from about 1945 to probably around 1995 is chock-full of some of the worst buildings ever built,” says Carl Elefante of Quinn Evans Architects, which specializes in historic preservation and sustainable design. Architects of that era, he says, assumed that essentially unlimited energy resources could be found to sustain a “grid” of “plugged-in buildings.” When it came to their effect on wellness, it was simply assumed that people would adapt to the building, not the other way around.

The recently opened new home for George Washington University’s School of Public Health exemplifies how much has changed since then. Designed by the Boston-based Payette firm, the Milken Institute building is structured around an open atrium crisscrossed by attractive staircases rising to the top floor. Elevators have been placed behind an opaque partition wall in the lobby, and the doors are timed to close slowly — a small psychological deterrent to their regular use by the able-bodied.

By lowering the standard distance between floors from 14 or 15 feet to 12 feet, architect Peter Vieira says, the designers were able to add a floor, which gave them greater flexibility to configure the interior. They designed stairs without landings and lower rising treads, which made them more attractive to users. They opened up internal spaces to more light, added an internal garden, and created areas near windows for students to gather, study and mingle. Vending machines in these social spaces sell only healthful snacks.

Lynn Goldman, dean of the school, works from a standing desk, a feature present in all the faculty offices. She says the school has tried to provide as many bicycle racks as possible. Although the windows don’t open — Washington’s environment is too extreme, its air too full of pollen, its urban landscape too noisy — the quiet interior climate system uses filtered outside air.

She also cites aesthetics as playing a major role in how people use buildings. “You can try to brainwash people to take the stairs,” she says, but if the staircase is “dirty and it’s unpleasant, and it’s the last place you want to spend time, you’re not likely to go to the trouble of using it.”

Margaret Montgomery, sustainability leader for NBBJ -- a global architecture, planning and design firm, talks about designing within the confines of an older building. (Meena Ganesan/Washington Post Live)

Aesthetics may turn out to be the most important factor when it comes to reconfiguring the urban environment. People fled to the leafy suburbs in the middle of the past century because it offered an attractive, compelling vision of the good life. Many people also found the modernist office building, with its banks of elevators and austere interior spaces, intoxicatingly beautiful. It modeled the future for a society that believed in limitless progress.

It also may be a crisis in the aesthetics of contemporary architecture that is driving more firms to think about the interrelated issues of sustainability and healthy design. In the past 20 years, there has been a breakdown in agreement about what constitutes beautiful architecture, whether it should look modern or post-modern, revert to traditional forms or explore wild new sculptural possibilities. Unsure about what the new “ism” will be, architects are thinking more about fundamentals of how buildings should serve us.

Aesthetics are subjective, and much of what is appealing about healthy design, and projects such as the 11th Street Bridge park, is grounded in a particular social vision of the good life: that cities can be beautiful and that diversity, interconnectedness, social engagement and mobility are essential to a full and rich existence. But not everyone loves cities, American individualism runs deep and resistance to social engineering is pervasive, as the widespread mockery of smaller beverage sizes in New York demonstrated last year.

“Give people choices,” is the mantra of the healthy design movement. But healthy design isn’t only about choices. Sometimes there are nudges, and some may feel a touch of coercion. So one prominent designer adds a caveat: “The best design is invisible.”

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