Buildings, which are responsible for nearly 40% of global greenhouse gas emissions and up to one fifth of chronic diseases, are in urgent need of a deep transformation. Despite major efforts to construct green and healthy buildings since 2000, global building-related emissions have increased by 10% since 2010, while chronic diseases continue to rise, according to the Architectural Epidemiology organisation.

Against this backdrop, Dr. Adele Houghton and colleagues have proposed a new, transdisciplinary field of research and action for transforming the building sector: Architectural Epidemiology. This innovative framework seeks to reconfigure the role of the building sector from a significant contributor to climate change and chronic diseases into a pivotal force fostering their reduction. Architectural Epidemiology draws on the overlaps and synergies between architecture and public health, bridging gaps between the real estate industry, policymakers, and local communities. The goal is clear: to ensure that building projects not only meet environmental standards but actively contribute to the health and well-being of both communities and the planet.

In order to understand the complexities, opportunities and challenges presented by Architectural Epidemiology, the JHU-UPF Public Policy Center delivered the 15th session of Policy Dialogues, entitled: "Architectural Epidemiology: Rethinking architecture for community and planetary health". This session delved into the transformative potential of this new framework, exploring its capacity to reshape the landscape of architecture for the benefit of community and planetary health and analysing the intricate intersection of architecture, public health, and environmental sustainability.

The speakers were Adele Houghton (President of Biositu, LLC where she works at the intersection of buildings, public health, and climate change), who explained the conceptual framework of Architectural Epidemiology and the importance of working across multiple sectors, and Carme Borrell (Director of the Public Health Agency of Barcelona), who presented the dominant issues relating to housing and health in Spain, and the importance of housing policies for reducing health inequalities. The session was moderated by Mary Sheehan, Professor of Climate Change Policy and Climate Adaptation in Public Health at the Johns Hopkins Bloomberg School of Public Health. 

Adele Houghton opened the session by providing a comprehensive introduction of her unique background. Houghton is a licensed architect with a doctorate in public health and nearly two decades of experience working at the intersection of climate change, health, and the built environment. The importance of her work is the focus on the Parcel Scale, a perspective often overlooked in discussions about the built environment and health. Unlike professionals dealing with larger scales, such as transportation or energy systems, Houghton delves into the immediate impact of architectural decisions. Her presentation shed light on the ripple effect that every new building design, renovation, or change in building activities has on larger systems. She highlighted a significant challenge: the prevailing disconnect between architects and real estate developers, and the wider community in which they work. Current practices tend to narrowly focus within property lines, disregarding the broader systems influenced by these changes. 

In the second part of her presentation, Houghton introduced the "allegory of the medical clinic on the hill," a thought-provoking example illustrating the unintended consequences of architectural decisions. Despite receiving praise for adhering to green and healthy building standards, the clinic's construction inadvertently caused harm to the surrounding neighbourhood, impacting access to fresh produce, community spaces, and exacerbating issues like flooding and traffic congestion. This allegory served as a powerful metaphor for the disconnect between considerations of individual building projects and their broader impact on community health and climate vulnerabilities. The breakdown illustrated by the medical clinic allegory highlighted a lack of coordination and communication at various societal levels, reducing the real estate sector's potential to contribute to broader strategies for addressing public health issues.

Houghton then explained the importance of the proposed framework called "Architectural Epidemiology," which envisions architecture as a tool for promoting community health. By prioritising strategies that consider a building's unique location, including both its natural and built environment, as well as its social and health context, architects can maximise co-benefits for the neighbourhood and align projects with community priorities regarding climate change, population health, and social equity. A key part of this approach is facilitating communication and cooperation between the property developers, local government and local community from the very first stages of a building project. The presentation underscored the need for a holistic and interconnected approach in architectural practices to truly contribute to larger-scale actions addressing pressing global challenges. “And so, we call this approach architectural epidemiology because it draws on components of both environmental and social epidemiology. For those of you who are not epidemiologists, environmental epidemiology basically maps exposure pathways from an identified set of environmental hazards all the way through health outcomes”, Houghton explained.

In the second part of the session, Carme Borrell presented a complementary perspective to the previous presentation. She discussed the recent work of the Barcelona Public Health Agency on housing and health, particularly emphasising the structural and political determinants of housing and related health inequalities. Focusing on the European context, especially in Spain, Borrell highlighted the critical role of housing policies and the market in understanding the intricate link between housing and health, considering housing as a determinant of health. She shed light on Spain's unique situation where housing accessibility is challenging due to market dynamics and an extremely limited social housing stock, making it difficult not only to access housing but also to enhance its quality. She emphasised the need to recognize the influence of market-driven policies on housing situations in Spain and other European countries.

Her discussion delved into statistics, revealing the scarcity of social rent housing in Spain (just 1.5% of the whole housing stock in 2017) compared to other European nations, underscoring the challenges posed by a market-centric approach. Borrell also explored the percentage of GDP allocated to housing expenses in Spain over the years, highlighting a concerning trend of low expenditures, especially during periods of right-wing political governance.

Subsequently, Borrell presented a comprehensive framework linking housing and health, encompassing various aspects crucial to understanding the complex dynamics at play. The emphasis on housing market dynamics, policies, welfare state consideration, and environmental factors was crucial, laying the groundwork for a holistic understanding of how housing affects health and health inequalities. From the conceptual framework, Borrell explained the issue of access to adequate housing, with two important blocks representing dwelling and neighbourhood. She underscored the legal, economic, emotional, and physical conditions of homes, as well as the importance of the built environment and community in shaping health outcomes. The inclusion of axes of inequality such as social class, gender, race, and age, alongside a focus on mental health and other health outcomes, added depth to the framework.

Borrell’s presentation also explored a conceptual framework on energy poverty and health, offering a detailed understanding of the structural determinants, axes of inequality, and immediate and intermediate determinants related to fuel poverty. The stark statistics presented for Barcelona regarding fuel poverty conveyed the urgency of the issue, revealing the challenges faced by a significant portion of the population.

Borrell concluded her presentation by addressing that it is essential to put housing as a policy priority: “Energy poverty is an example of the lack of public policies related to housing and health. It is very difficult to advance in housing and health while housing depends totally on the market…and it is necessary to put housing as a priority in the political agenda”.

The session ended with a round of Q&As, facilitated by Mary Sheehan, in which the participants posed questions about housing policies, the practical use of the architectural epidemiology framework, and lessons from COVID-19 regarding policies of healthy buildings.