Design can be preventive medicine. While the growth of girth–childhood obesity nearly tripling over the past 30 years–has numerous culprits, much of America’s built environment moves cars rather than people around, and rewards sitting rather than walking. A design diet can help get America moving again, by re-imagining and re-designing the major metropolitan areas where two-thirds of Americans live. Buildings and communities can and should be health-promoting, rather than health-inhibiting. How do we make this happen?

In pondering this question, my colleagues and I at the American Institute of Architects sought out the intellectual firepower of a world class university. After conversations, brainstorming sessions, and further analysis, we built a 10-year partnership between the American Institute of Architects (AIA) and MIT’s Center for Advanced Urbanism (CAU) for Decade of Design: Health + Urbanism. We had already established the Decade of Design Commitment to the Clinton Global Initiative and this partnership served as a catalyst to begin testing models for designing and planning healthier metropolitan regions.

Our first task was to choose which cities to explore. Students were brought together from architecture, landscape architecture, and urban planning into a brand-new course, in order to dig into the data and figure out how health impacts are affected by built form. This convergence of multiple disciplines within one class gave the students in the seminar a unique viewpoint to explore these questions.

We chose eight metro areas for exploration: Atlanta (74.6% of people drive to work), Houston (77% commute to work alone), Los Angeles ($40 billion in infrastructure spending), San Francisco (30% projected Bay area population increase by 2040), Chicago (67.4% of jobs located in the suburbs), Minneapolis (7X less parkland in N. Minneapolis), Boston (53% minority population), and New York (57% adults overweight and obese). All of these cities serve as test laboratories for a solutions based approach to America’s health crisis.

Early in the semester, I presented on the findings of the previous research I had worked on through Local Leaders: Healthier Communities Through Design. In my lecture I told them about the best practices that we explored in cities that incorporate health and design principles into forward-looking policies, and the importance of policy decisions on ultimate outcomes.

The students fanned out across the country over their spring break to study these metropolitan regions. Through fieldwork, geographic and environmental analysis, social factors, and indexed priorities that detailed where design can influence health the most, the students worked with professors to create an in-depth overview of the current state of health and urbanism in the selected areas.

One of the biggest points that arose from the research, covered in the Report on the State of Health + Urbanism, is that there is no “one-size-fits-all” answer. The physical environment influences health outcomes, from obesity to mental illness to childhood development. Housing and transportation choices, planning and zoning, nearby parks and open space, and urban design all affect health. And the natural environment–air and water pollution, hazardous waste–can greatly affect the incidences of diseases like asthma. Finally, the World Health Organization notes that social environment factors, like socioeconomic status, social capital, and access to health services, are key determinants of health.