Where We Live Impacts How We Live | Shannon Kraus | TEDxPlano

Summary

The speaker reflects on childhood curiosity and creative disruption, now channeled into a career as an architect focused on improving health through design. The talk emphasizes how social, economic, and environmental factors influence well-being more than healthcare itself. Through examples like Roseto, a close-knit Italian community, and projects in Eastern Africa and Washington D.C., the speaker illustrates how design can foster healthier communities. The message encourages using 'design thinking' to positively impact communities by addressing challenges and fostering collaboration, showing that anyone can be a catalyst for change through care and creativity.

Takeaways

• 🏗️ The speaker's childhood curiosity and creativity led to a career in architecture and strategic thinking, focusing on improving well-being through design.
• 🌐 In the United States, health care costs are high, but health outcomes are poor, suggesting that the focus should shift towards community and environmental factors.
• 🔑 Only 20% of health and well-being is attributed to health care, while 80% is linked to social, economic, environmental, and behavioral factors.
• 📈 Life expectancy can vary significantly within the same city, highlighting the impact of where we live on our health.
• 🏠 The story of Roseto, Pennsylvania, demonstrates how a close-knit community with low stress can lead to better health outcomes.
• 🚗 Modern lifestyles centered around cars have led to less physical activity and increased stress, negatively impacting health.
• 🌱 The physical environment plays a significant role in health, and designing healthier communities can improve well-being.
• 🌍 Design thinking can be applied to create healthier communities, even in places with limited resources, like Ketchum Bala, Africa.
• 🌿 The Urban Food Studio in Washington DC is an example of how design thinking can improve access to healthy food and educate communities.
• 💡 Design thinking is an iterative method for problem-solving that considers social, cultural, and environmental variables to create thriving communities.
• 🌊 The impact of design thinking is not limited to the initial solution but can create a ripple effect, benefiting communities in multiple ways.

Q & A

What motivated the speaker’s early interest in exploring and creative problem-solving?

The speaker’s early interest in exploring and creative problem-solving was sparked by childhood experiences, such as climbing a radio antenna and taking apart toys to understand how they worked. These activities, initially seen as mischievous by his parents, laid the foundation for his career as an architect and strategic thinker, driven by the idea of 'creative disruption.'

What is the main argument the speaker presents about health care in the United States?

The speaker argues that while much attention is focused on health care and its costs, only 20% of our health and well-being is attributed to health care access. The remaining 80% is influenced by social, economic, environmental, and behavioral factors, highlighting the need to shift focus to these areas to improve public health.

How does the story of Roseto, Pennsylvania, illustrate the importance of community to health?

The story of Roseto, Pennsylvania, illustrates that a close-knit, interdependent community had lower stress levels and a significantly lower rate of heart disease compared to neighboring towns. Despite unhealthy habits like smoking and eating fried foods, the town's strong social bonds contributed to their overall better health, demonstrating the profound impact of community on well-being.

What changes did researchers observe in Roseto 30 years later, and what caused them?

Thirty years later, researchers found that Roseto's heart disease rates had risen to match those of the rest of the country. This change was attributed to the breakdown of the close-knit community as suburbanization and social isolation increased, leading to higher stress levels and a decline in health.

What example does the speaker provide to demonstrate how design can impact health in underprivileged areas?

The speaker discusses a project in Ketchum Bala, a village in eastern Africa, where new birthing facilities were designed in collaboration with the community. By training local workers in construction and healthcare, the project not only improved health outcomes for mothers and babies but also empowered the community with new skills, illustrating the ripple effect of design on health and well-being.

How does the speaker suggest that our built environment affects health in modern society?

The speaker suggests that modern car-oriented suburbs discourage healthy behaviors like walking and lead to increased stress. Walkable neighborhoods, in contrast, promote healthier lifestyles. The speaker advocates for designing environments that encourage physical activity and reduce stress to improve overall well-being.

What is 'design thinking,' according to the speaker, and how does it relate to community health?

Design thinking is described as an iterative, creative problem-solving method that considers social, cultural, and environmental factors to create solutions that help communities thrive. It can influence not only immediate issues but also generate positive 'ripple effects' that improve health and well-being over time.

What example does the speaker provide from Washington, DC, to demonstrate how design can address food access and health?

The speaker shares the example of the Urban Food Studio in Washington, DC, created by the Capital Area Food Bank. This project combines sustainable design with nutrition education and gardening, teaching individuals and families how to grow their own food. It addresses food access, which is a root determinant of health, and empowers people to make healthier choices.

How did the speaker’s personal experience during the 2013 Boston Marathon influence their view on community?

During the 2013 Boston Marathon, the speaker witnessed spectators and strangers coming together to help runners affected by the bombing, despite the fear and chaos. This experience reinforced the speaker's belief in the power of community and shared humanity to address challenges, including health and well-being.

What final call to action does the speaker give to the audience regarding design and health?

The speaker encourages everyone, regardless of profession, to engage in 'design thinking' to improve community health. By observing, engaging, and collaborating with groups working on local challenges, individuals can create a ripple effect of positive change, shaping healthier communities through thoughtful design and problem-solving.

Outlines

00:00

🚀 Early Exploration and Creative Disruption

The speaker reflects on their adventurous childhood, recounting stories of climbing a radio antenna and taking apart toys. This early curiosity, while viewed as mischievous by others, was seen as a form of 'creative disruption.' The speaker connects these experiences to their current career as an architect and strategic thinker, focusing on design and challenging perspectives to address complex social issues, particularly around community and well-being.

05:02

🏥 The Disconnect Between Health Care and Health

The speaker introduces the idea that despite the U.S. spending more on health care than any other country, its health outcomes are poor, such as low rankings in life expectancy and infant mortality. They argue that focusing only on health care costs misses a larger issue—only 20% of health is attributed to health care access, while 80% is determined by social, economic, and environmental factors. These factors, like where we live, significantly affect chronic diseases and overall health.

10:04

🏘️ The Roseto Mystery: Health in Close-Knit Communities

A story about Roseto, a small town in Pennsylvania in the 1960s, illustrates how community and social interaction impacted health. Despite unhealthy habits like smoking and eating fried foods, the town had low heart disease rates, which researchers linked to the community’s strong social bonds and low stress. However, as suburbs expanded and isolation grew, this changed, and Roseto’s heart disease rates eventually aligned with the rest of the country, emphasizing how social structure affects health.

15:07

🚶‍♂️ The Modern Lifestyle and Health Decline

The speaker highlights how modern suburban life, with its dependence on cars, lack of walkability, and limited access to fresh produce, has contributed to declining health in the U.S. Children walk less, food deserts have grown, and stress levels have risen. However, they suggest that since physical environments greatly impact health, creating healthier communities can significantly improve well-being. By focusing on how we design neighborhoods and cities, we can foster healthier lifestyles.

🌍 Building Healthier Communities Through Design in Africa

The speaker shares an example from Ketchum Bala, a village in eastern Africa, where local community members worked together to build new medical facilities. Despite poverty and a lack of resources, sustainable construction methods were used, and community members gained valuable skills. The story of Julianne, a woman trained to assist with childbirth, shows how design can directly impact community health. This project illustrates how collaboration and local engagement are critical to creating lasting change.

🌱 Urban Food Studio: Growing Healthier Communities

In Washington D.C., the Capital Area Food Bank created an 'Urban Food Studio' to address food insecurity. It expanded a garden into a multipurpose space that provides cooking workshops, gardening education, and sustainable practices. The initiative shows how improving access to food is about more than just providing meals—it's about empowering communities to make healthier choices through design and education. The studio demonstrates how local action can have a significant impact on health.

🌊 The Ripple Effect of Design Thinking

The speaker emphasizes how 'design thinking'—a creative, problem-solving approach—can create ripples of positive impact beyond the initial project. Using examples from Ketchum Bala and the Urban Food Studio, they explain how small changes in design can lead to broader improvements in areas like skilled labor, sustainability, and access to food. By focusing on how physical environments influence behavior, design thinking encourages healthier communities.

💪 Personal Stories of Community Resilience

The speaker recounts their experience at the 2013 Boston Marathon bombing, witnessing how strangers came together to support one another in a time of crisis. They draw parallels between this shared humanity and the need for communities to unite and solve health challenges together. The message is that while political systems focus on 20% of health issues (health care), the remaining 80%—determined by social and environmental factors—can be influenced by community efforts and design thinking.

Keywords

💡Creative disruption

Creative disruption refers to the speaker's approach to problem-solving through unconventional methods. In the video, it is illustrated by the speaker's childhood habit of taking apart toys to understand how they worked, which is later tied to their architectural career. The term suggests that breaking established norms can open up new possibilities, aligning with the video’s focus on innovation in design.

💡Social determinants of health

Social determinants of health are the social, economic, environmental, and behavioral factors that influence a person’s well-being. The speaker highlights that 80% of a person's health is shaped by these factors, rather than direct medical care. This concept is central to the video’s argument that community design and infrastructure can have profound impacts on health outcomes.

💡Roseto effect

The Roseto effect refers to a phenomenon observed in the 1960s in Roseto, Pennsylvania, where the close-knit community experienced remarkably low rates of heart disease, despite unhealthy habits like smoking and eating fried foods. The speaker uses this example to emphasize the health benefits of strong social ties and communal living, reinforcing the idea that community structure impacts health.

💡Built environment

The built environment encompasses the man-made surroundings that provide the setting for human activity, such as buildings, neighborhoods, and cities. The video highlights how the design of the built environment, from walkable communities to green buildings, can influence behaviors like exercise and social interaction, ultimately affecting health and well-being.

💡Design thinking

Design thinking is an iterative problem-solving process that focuses on human-centered solutions by considering social, cultural, and environmental factors. In the video, the speaker advocates for applying design thinking to create healthier communities. Examples include collaborating with local communities to develop functional health centers and urban gardens, showing how thoughtful design can improve health outcomes.

💡Community infrastructure

Community infrastructure refers to the physical and organizational structures needed for the operation of a society, such as buildings, transportation systems, and water supply. The speaker discusses how inadequate infrastructure, especially in impoverished areas like Ketchum Bala in Africa, can severely limit health outcomes, while improvements can foster well-being and economic growth.

💡Urban food studio

The Urban Food Studio is a community project in Washington, DC, aimed at improving food access and teaching sustainable gardening and cooking practices. The speaker uses this example to show how design can address food insecurity, a key social determinant of health, by empowering people to grow their own food and make healthier choices.

💡Walkability

Walkability refers to how friendly an area is for walking, which is influenced by factors like the presence of sidewalks, pedestrian crossings, and proximity to essential services. The speaker discusses the decline in walkability in modern suburban environments and its negative impact on physical activity levels and health. The promotion of walkable neighborhoods is presented as a design solution to improve public health.

💡Health care reform

Health care reform refers to the efforts to improve the delivery and cost of medical care. While the speaker acknowledges the importance of health care reform, they argue that focusing solely on medical care overlooks the broader social determinants of health. The video suggests that redirecting some resources to improving community infrastructure and environments could lead to better health outcomes.

💡Ripple effect

The ripple effect is the idea that a single action can have far-reaching consequences beyond its immediate impact. In the video, the speaker uses examples like the Ketchum Bala birthing center to illustrate how a small design intervention can improve community health, enhance skilled labor, and create lasting change. This concept supports the speaker’s call for broader thinking about the role of design in addressing health challenges.

Highlights

The speaker reflects on their childhood experience of creative disruption, where curiosity and exploration were key to understanding their environment.

Only 20% of health and well-being is attributed to quality and access to health care, while 80% is linked to social, economic, environmental, and behavioral factors.

Life expectancy can be determined by your zip code, with studies showing significant differences in life spans between neighborhoods.

The story of Roseto, a town in Pennsylvania, where strong community bonds led to reduced stress and better health outcomes, even though the residents engaged in unhealthy behaviors like smoking and drinking.

By the 1990s, as suburbs expanded and community cohesion diminished, Roseto’s health advantages disappeared, illustrating the impact of social isolation.

Modern urban design promotes car-oriented suburbs that discourage walking and contribute to the rise in chronic diseases like obesity.

The speaker advocates for investing in healthier communities through design rather than solely focusing on health care reform.

Ketchum Bala Agonda, an African village, benefited from community-led design, where a project trained locals in construction skills and sustainable methods, leading to improved health infrastructure.

Julianne, a local woman in Ketchum Bala, was trained to deliver premature babies during the construction of new facilities, directly saving lives and improving community health.

The DC Central Kitchen's Urban Food Studio helps combat food insecurity by teaching urban families how to grow food, using sustainable methods like rainwater collection and solar energy.

Design thinking is emphasized as a method for practical, creative problem-solving that takes into account social, cultural, and environmental factors.

The ripple effect of design thinking can go beyond the initial project, improving broader community health and infrastructure.

The speaker highlights the importance of engaging with and collaborating on local issues to create healthier communities.

A personal story from the 2013 Boston Marathon bombing emphasizes the power of community, where strangers came together to support one another despite the chaos.

The speaker concludes that the solution to health challenges lies in our shared humanity and the 80% of health factors we can control, advocating for community-driven change through design thinking.

Transcripts

[Music]

so when I was growing up I was always

exploring from just about the time I

could walk whenever I go over to my

grandparents house I would sneak out and

climb this radio antenna you get some of

you may know what that is radio antenna

up the side of the house and get onto

the roof even though I knew I would get

into trouble and let's just say the fire

department may have been called on one

occasion other times I would take apart

my toys new or old just to see how

they'd work or to reconstruct them as

something else well I'm sure my parents

thought of it as me being mischievous I

now think of it as creative disruption I

enjoy how even a small shift in

perspective can open up new

possibilities now as an architect and

strategic thinker my career's largely

devoted to doing just that by creating

buildings and places that help improve

the well-being of others a career

focused on design which challenges me to

see things from multiple perspectives on

the issues that we face so today at a

time when we're increasingly socially

divisive in tempted to isolate ourselves

I want to talk with you about the

impacts on your health the importance of

community and the role of design in

addressing these challenges I want to

shift your perspective in the United

States today we spend more annually on

health care than any other country in

the world and yet we rank last by almost

any measure

we're 39th in infant mortality 36 and

life expectancy just to name two when

you look at the headlines much of our

time and attention is focused on health

care and its rising cost now clearly

this is an issue that can and must be

addressed but what if I told you we

might be looking at the problem from the

wrong perspective what if I told you

that just 20% of our health and

well-being is attributed to your quality

and access of health care

research shows that 80% 80% of your

health and well-being is directly

attributed to social economic

environmental and behavioral factors

factors which trigger sharp rises and

chronic diseases like obesity and

diabetes factors which relate both

directly and indirectly to how and where

we live your life expectancy is

dependent on your zip code a 2013 Robert

Wood Johnson Foundation study found that

has fused two train stops in the same

city can mean a seven-year difference in

life expectancy 13 years in some

locations

now before you pack your bags you should

know this is true of Detroit Dallas DC

El Paso pretty much most places why

because where we live impacts how we

live I want to share a story that

illustrates this in the 1960s there's a

small rural town in eastern Pennsylvania

called Roseto

Rosetta was an Italian immigrant

community named after a town in Italy

that featured closely spaced houses and

walkable streets at zero crime rate zero

suicides and a heart disease rate that

was nearly half that of the national

average as well as neighboring towns

they'd have a single death under the age

of 45 due to heart disease men were

living so much longer that there were

more widowers than widows what was truly

remarkable is that they worked in stone

mines ate fried foods drank wine in

abundance and smoked habitually they did

pretty much all the things that health

professionals warned against and yet

they lived longer why researchers

studied the town pored over death

records and what they found is that they

live longer because they were less

stressed they were less stressed because

they looked out for one another in a

close-knit community if one family was

sick others pitched in families would

cook meals together town elders would

help take care of the kids imagine a

town where weddings was spread out from

the church into the neighborhood streets

there wasn't a social hierarchy there

wasn't this keeping up with the Joneses

mentality

in short they shed stress in a very

healthy way interdependently together

and drink as much as they wanted however

researchers also made a prediction that

within a generation as suburbs expanded

houses grew fences popped up that social

economic isolationism would set in and

change this the community would divide

stress would rise and health would

decline so they went back in the 1990s

thirty years later study the town again

and found this to be true today risotto

has the same heart disease rate as

anywhere in the United States where we

live impacts how we live unfortunately

today our lifestyles totally geared

around cars we drive more and walk less

children walk or ride a bike to school

fifty percent less than they did just

thirty years ago that's a drop from

sixty percent to just ten percent

many of us live in food deserts where

fresh produce is non-existent and fast

food is most convenient over the last

sixty years we have slowly and

methodically replaced walkable

neighborhoods walkable communities with

car oriented suburbs that not only limit

healthy behavior but may then discourage

it our stress has never been higher now

there is good news the good news is that

our physical environment where we live

work play and heal does account for much

of our health that we can control so the

solution doesn't rest alone in improving

the delivery of health care it rests in

delivering healthier communities imagine

if we could take even a small amount of

the effort underway with health care

reform and reinvest that into how and

where we live and what if we could do

that through design think about it in my

profession as an architect today we

design green buildings to be resource

and energy efficient to do less harm to

an effect be less bad but what if

tomorrow we design buildings in places

that actually promote and encourage

health and well-being this is where the

opportunity lies so that where we live

impacts how we live in a positive way

not only is this happening but is

happening in a place with limited

resources little skilled labor and

virtually no infrastructure Ketchum Bala

agonda is a village in eastern Africa

rich in tradition and culture this is

evident through their celebrations where

men women and children dress at vibrant

clothing and celebrate together however

it's also one of the country's most

impoverished two dollars a day

is the average Admiral annual income

life expectancies 15 years below global

average at 56 years infant mortalities

double the global average with one in 26

newborns dying before their first

birthday now some of this is due to a

need for better medical facilities but

much of it is due to community

infrastructure and resources women would

be turned away from the birthing center

due to capacity issues some after

travelling long distances on the back of

a motorbike while already in labor many

wouldn't make the trip often the result

is women giving birth at home without

assistance or sterile equipment clearly

new facilities were needed but in a way

that would work for and be embraced by

the community this is not something that

could be dropped in from afar by

Outsiders that assume they know it's

best to be successful the design had to

be in collaboration with the community

the real solution had to come from

within ultimately the way it was built

and who built it had to be adapted with

a lack of reliable infrastructure such

as power and water and a scarcity of

materials sustainability what an option

it was absolute to help with

unemployment and to improve skilled

trades 40 community workers were trained

in regional construction techniques such

as making mud bricks by hand techniques

they can now carry to other jobs and

other services

however training wasn't just limited to

construction workers as one example I

want you to meet Julianne

Julianne was trained by a midwife during

the construction of the project and how

to deliver premature babies in just a

few short months Julianne has helped

deliver several premature babies that

otherwise would not have survived

now Julianne in her village illustrate

how a single project it positively

impact the trajectory of a community

starting with expecting mothers but

extending to other families and now

skilled workers who can afford an

education for their kids they didn't

just build a building they used design

to help shape the health of their

community now for an example closer to

home there's the urban food studio in

Washington DC the capillary Food Bank

provides leadership training education

and food to over 400 partner agencies

such as churches schools synagogues

things like that 16 percent of the DC

population struggles with access to food

access to food is actually a root

determinant for many of the hospital's

super-users the capillary Food Bank

realized that improving access to food

had to be about more than just giving

out meals so they launched a

demonstration garden for nutrition

education and gardening basics due to

its success they did engage volunteers

to expand and enhance the capabilities

of this garden the result is a

multi-purpose garden in urban food

studio it provides all season access to

cooking workshops classes and other

educational events reflecting their

values to be environmentally friendly

the structure itself demonstrates

sustainable ecosystems such as rainwater

collection and solar harvesting the

studio teaches individuals and families

that whether you have a backyard or

balcony you can learn how to grow food

and how to stretch your food budgets

farther the result is a place that

empowers healthy choices while improving

access to food

in both cases Ketchum Bala and EC he

started through the efforts of a single

individual with Ketcham ball it was

somebody in the area that sat with

village elders to understand what was

their most pressing need with the food

bank it was an individual passion about

sustainable design she found out they

need expanded facilities and then

leveraged her network to bring it to

life in both cases they didn't just

donate their time they used Design

Thinking to help make it happen so when

we talk about design thinking what are

we talking about we're talking about an

iterative method for practical creative

problem-solving the type of thinking

that brings together social cultural

environmental variables into solutions

that can help communities thrive but the

real impact to design thinking is in the

ripple effect like a pebble in a pond

design thinking isn't just about the

initial concern but is about the ripples

that is the impact you can have beyond

the initial idea of being considered

with Ketcham Bala the ripple effect of

building new birthing suites was

enhancing skilled labor and improving

sustainability with the food bank the

ripple effect was about improving access

to food where we live impacts how we

live rural urban or anywhere in between

we can and must come together as a

community to improve our health my

passion if you haven't guessed by now is

design in my practice with HKS we do

this by thinking beyond the property

lines of our clients on how buildings

impact neighborhoods how neighborhoods

shaped place and how place influences

behavior personally I first committed to

doing this about 10 years ago through

the creation of a design fellowship

within our firm that paired designers

with architectural students to work on a

community need out of a single event it

has grown to cover over five cities and

twenty needs needs that have ranged from

affordable housing in DC to improving

connectivity and walkability in Dallas

from

it's about shifting our perspective on

what truly impacts our health for using

design in the built environment to

influence healthy behavior fundamentally

for shaping places that encourage kids

and parents to walk or ride their bikes

where we live impacts how we live but

how we live is a choice so what if we

all were to use design thinking to

impact the health of our communities

what impacts would we have what

communities would we create the best

part is you don't need to be an

architect a designer or health

professional to be a catalyst for change

design is a way of thinking and

problem-solving is in each of us a

single person with a passion to care you

can have a ripple effect of their own

with a profound impact each of a shape

our communities by how we choose to

engage with them or how we choose not to

so to do this sort of design thinking

yourself you simply need to observe

engage and collaborate open your eyes to

the challenges around your neighborhood

schools and towns engage with groups

working on those issues in a way that

aligns with your own passion your own

ideals collaborate with those groups so

that change happens within change also

starts with a commitment to care this

was apparent to me personally at the

2013 Boston Marathon as a runner I was

stopped about a quarter mile from the

finish when the bombings happen before

long there were several hundred maybe

thousand runners held in place tired

dehydrated cold wet held in place while

medical care was rightfully focused on

those injured at the finish held in

place while many of the runners were

starting had medical issues of their own

common to running that far for that long

but magnified by the cold temperatures

in wet clothing I didn't see the heroics

of those at the finish but what I did

see

with strangers spectators who came

together sharing their own clothing

their own water their own blankets in

some cases opening their own homes to

strangers individuals hundreds of

individuals who came together despite

the fear despite the chaos regardless of

anyone's politics came together as a

community the day was tragic but like

many I was inspired by our shared

humanity we must shift our perspective

the solution doesn't rest alone in

Capitol Hill where the focus is on the

20% nor is it isolated away in our own

political echo chambers the solutions in

here it's in our shared humanity

together through design thinking we can

impact the health of our communities and

the 80% of our health that we can

control this is where we can do more

than just be less bad where we can

thrive where we can recover but Rossetto

lost and what ketcham Bala gained thank

you

[Applause]