The ways in which we live, work, and interact with one another are subconsciously driven by the design of our communities. It’s no wonder, then, that our health is in some ways at the mercy of our environment. How can we take control of our surroundings, rather than allowing them to control us?

Upon my initial searches of “built environment,” I sulked in the flood of results. Certainly, the phrase casts an ineffectually broad net. Virtually every moment in our day involves an interaction with some aspect of what the CDC defines as our “human-made surroundings.” The attempt to target and transform the built environment’s effect on human health brings to mind a joke popularized by David Foster Wallace,

“There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, ‘Morning, boys. How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, ‘What the hell is water?’”

The built environment is our water, everywhere and always. Naturally, we can become desensitized to the settings that backdrop our experiences. We drive our car for a thirty-minute work commute, purchase inexpensive meals at the nearest available vendor, and on a warm summer night, scroll through Instagram on our apartment balcony that overlooks a concrete courtyard or busy street corner. These are the experiences we’ve normalized, deemed mundanely inevitable. It’s difficult to question something when it’s all that we know. Fortunately, our biology’s knowledge expands far beyond the experience of today.

As we struggle to pinpoint the scale of the topic of the built environment, and develop a plan to change it, our biology has lost no time in getting started. A surge in research of epigenetics and the social determinants of health has allowed us to admire the malleability of our biology, and paradoxically in turn, its fragility. A BBC article discussing the intersection between architectural design and neuroscience highlights the canary-in-a-coal-mine role our bodies have filled, reacting to the environment in which we live and work. Colin Ellard, who studies the psychological impact of design at the University of Waterloo in Canada remarks, “When we ask people about their stress they say it’s no big deal, yet when we measure their physiology we discover that their responses are off the charts.”1 In addition to higher rates of stress, research has shown that people of lower economic status and minority race are likely to have reduced access to recreational facilities which in turn demonstrates an association with lower rates of physical activity and higher rates of obesity.2 When a patient presents with hypertension or diabetes, a physician must take into account the forces of environmental design that are influencing that patient’s lifestyle in order to develop the most helpful treatment plan. For example, instead of simply recommending a patient who lives in a food desert to eat healthier, a physician might shift their plan to a prescription for a “Meals on Wheels” service.

Both our physiological response and the fish that asked, “How’s the water?” offer awareness and insight that allow us to analyze the water in which we are swimming. Without these, we remain voluntarily powerless in our maneuvering through the world. Addressing the problems posed by the “built environment” seems like an insurmountable challenge, but we can start by working toward awareness and insight. In the health care community, we must learn about the design of streets, housing, technology, and green spaces as a sector of preventative medicine. Thomas Jefferson University’s medical school supports the promotion of design-thinking in medical school curriculum. It recently implemented a program called JEFFDESIGN, which combines medical training with design classes to foster the exploration of the health impacts of infrastructure, community, and the built environment. An aspect of its mission statement includes asking, “How do we design healthier cities?”3

When we create cross-disciplinary discussions about the built environment’s impact on health, we further legitimize its importance and catalyze action to integrate intention and enact change. Allison Brooks, an architect specializing in housing and social design, expressed at a Conscious Cities Conference in 2017, “If science could help the design profession justify the value of good design and craftsmanship, it would be a very powerful tool and quite possibly transform the quality of the built environment.”2 Despite all of the unpleasant design in our world, research and intuition are leading us to create spaces that make us happier and healthier people. A chapter from a 2017 book about urban sustainability discussed how urban green spaces can reduce stress and promote relaxation, social cohesion, and psychological attachment to the home area.4 When we recognize the power of human-centered, intentional design, we realize that as it has been harnessed to prevent certain behaviors, it can also be used to promote healthful habits.


1. Bond, Michael. “Future – The Hidden Ways That Architecture Affects How You Feel.” BBC News, BBC, 6 June 2017,
2. Gordon-Larsen, Penny, et al. “Inequality in the Built Environment Underlies Key Health Disparities in Physical Activity and Obesity.” Pediatrics, American Academy of Pediatrics, 1 Feb. 2006
4. Braubach, Matthias, et al. “Effects of Urban Green Space on Environmental Health, Equity and Resilience.” SpringerLink, Springer, Cham, 1 Jan. 1970,

-Mary Cormier, NCEAS Intern

*Mary is a junior at Northwestern University studying neuroscience and anthropology. She is passionate about health equity, humanitarian design, and the power of ongoing education to combat injustice.

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