At a recent meeting of the Built Environment Network, member Don Orndoff, senior vice president of Kaiser Permanente National Facilities Services, talked about the softening of the boundary between when we’re receiving healthcare and when we’re just living our lives. The visual of that concept, the blurring of that line, resonated with me.

In the past, healthcare has been something we actively pursued. It meant physically going to a healthcare facility. Today, technology allows us more and more to connect with a caregiver by logging onto a computer or using a smart device. In the future, observing, tracking, and communicating our health stats isn’t likely to require any active action on our part at all. The devices we wear or carry and the environment around us will all monitor our health passively, adding to the blurring of that line between seeking care and living life.

So much of the quality of our health is tied to the decisions we make every day about how we live our lives. How do we manage and handle stress? How often do we get out and experience nature and sunlight? Do we surround ourselves with caring friends and people with a positive outlook on life? Do we live an active life and incorporate some form of exercise into our daily routines? Do we make healthy food choices and provide our bodies with the best fuel sources?

Without question, our genetic makeup and even an element of luck play a significant role in our health, but as much as 90 percent of the quality of our health is tied to our daily behaviors. The connection between the design of physical environments and an individual’s choices might not be as obvious, but in many industries this connection is well documented and often even exploited.

The most obvious example of this is in retail spaces where the design of the physical environment is frequently used to significantly impact the behaviors and choices of consumers. What we purchase, how much we purchase, and even why we purchase a specific item is often a direct response to subtle cues designed into the environment.

In their book, Nudge: Improving Decisions about Health, Wealth, and Happiness, economist Richard Thaler and Harvard law professor Cass Sunstein talk about “choice architecture,” or the context in which we all make decisions, and how different environments might nudge us into making a particular choice or changing a specific behavior.

As we design our communities, homes, schools, and workplaces, we have the opportunity to use design as a tool to help guide people into new behaviors that support a healthy lifestyle. And in doing so, all design professionals, regardless of the types of environments they’re creating, become healthcare designers.

The consensus among many is that it’s still murky—what healthcare and our healthcare systems will look like in the years and decades to come. Until there’s clarity, it’s hard to know what designs will have long-lasting value. Physical buildings will always be a piece of the equation, but the scale and role of those buildings will morph into many new permutations of what we have today.

What we do know is that the focus on health and wellness won’t go away. It will be the sustainable healthcare system’s foundation, as it has the best potential to bend the cost curve and has the added benefit of providing a higher quality of life for all people.


Debra Levin is the president and CEO of The Center for Health Design. She can be reached at