Despite the importance of urban medical centers to our communities, it's their considerable constraints and not their humanistic missions that typically drive design. Whether shielded behind parking lots or landscaping, or announcing their presence in the neighborhood with impenetrable, mute walls, these facilities are generally “non-urban” at best.

Although arguably the epitome of the community facility, these buildings are almost always incongruous interruptions in a city’s fabric. Even though they are large, highly complex structures packed with critical programs and adjacencies, there's a way to better weave these facilities into our communities. They can feel more "a part of" than "apart from" our lives and the public realm.

The solution begins with an understanding of what a holistic urban health center can be. Beyond standard inpatient and outpatient services, ideas of wellness offer a broader definition and set of possibilities. Diet, exercise, and finding peace and equilibrium in one’s life are all crucial. Urban health centers should also support these needs. With an understanding of the shifting healthcare landscape and a cognizance of what shapes vibrant streetscapes, we embark on an exciting path toward better integrating urban health centers with our lives and our cities.

Through the programming of the ground floor, for example, an urban health center can become a civic hub, blending with its neighborhood while creating a comprehensive concentration of health-related services. Depending on space availability, this could include such offerings as a YMCA, private fitness center or yoga studio, retail pharmacy, day spa, retail optometrist, and a green grocer or farmers market. In addition, multipurpose ground-floor space can conveniently allow for patient education or general community use.

While the local market will determine the viability of each component, a combination of these offerings would serve multiple functions. It would support community health and wellness, compliment the larger mission of the institution, and activate the health center’s ground floor in an unexpected and exciting way. This pedestrian-friendly ground floor could then integrate with what is often surrounding neighborhood retail.

There will, of course, remain a need for a lobby or check-in area and often emergency room or urgent care access on the ground floor. However, many other components could migrate up (such as clinics) or down (loading and support) within the building. This can transform the health center’s relationship with the city, providing active street frontage and reinforcing the pedestrian realm.

Another casualty of the typical urban medical center is open space. Both the density of cities and the inevitable growth of the centers themselves typically lead to little or no meaningful open space. In the rare event that a park or significant landscaped space can be a part of the health center’s environment, it provides the benefit of integrating nature as an active and/or passive component.

Nature’s power as a calming and healing force is well documented, and while opportunities available in an urban environment are limited, small, non-ground-level solutions are also possible. The potential to utilize the roof of the diagnostic and treatment platform as a roof garden, for example, offers a way to capture considerable open space located at the heart of the medical center, either as a visual amenity, place of respite, or space accessible for activity.

Given the crucial role urban medical centers play in the well-being of so many, a new approach can find fertile ground for meaningful change. Through enhanced offerings that address health and wellness needs, ground-floor frontage that activates the street, and open space that successfully connects us to nature, a new type of medical center can help usher in a new attitude toward health and the city.

Scott Habjan, AIA, is an associate director and senior designer in the healthcare studio at Skidmore, Owings & Merill (New York). He can be reached at scott.habjan@som.com