Health Districts

The relationships between our trusted healthcare institutions and the patterns of development that they follow have significant consequences for the health of the population they serve. Concerned with requirements for safety, efficiency and security, health facilities have grown in size and scale throughout the twentieth century, often at the expense of walkability and livability and a connection to the surrounding neighborhoods.

The Health Districts initiative aims to address these issues at this critical juncture in our national healthcare debate and to assist hospitals in their efforts to “do no harm” to their surrounding neighbors. Livable, walkable neighborhoods are a critical component of healthy neighborhoods and of Health Districts - districts that contain one or multiple health facilities. With assistance from a team that includes representatives from federal agencies, architectural firms specializing in health planning, health systems, and schools of architecture, this initiative will work to advance urban design and planning criteria for Health Districts.

CDC's Healthy Community Design Checklist Toolkit and the CNU Charter for the New Urbanism will be the springboards for this investigation. In addition, our efforts will be guided by:

  • The latest research in Evidence-Based Design (EBD), an emergent interdisciplinary field of research that investigates aspects of physical environments that influence well-being and promote healing environments; and
  • Examples of existing health districts that seek to enhance the quality of the neighborhoods where they reside, and provide healthy living opportunities for employees, patients, visitors, and surrounding neighbors.

"As a medic working with returning Vietnam veterans, I would take vets on a walk down the street into the neighborhood. This was one of the best things we could do during their rehabilitation. And the same was true for my father when he returned from World War II. Daily walks just down the street to the church, park, or pool hall reconnected him to life after war." - John Norquist

The Affordable Care Act

The 2010 Patient Protection and Affordable Care Act (PPACA, or “The Affordable Care Act”) is changing the business model of healthcare, with potential long-term benefits for patients, health systems and the needs of the community they serve with greater focus on wellness, prevention and community health. The Affordable Care Act has mandated that tax-exempt hospitals produce Community Health Needs Assessments (CHNA) every three years. These assessments, among other requirements, describe communities served and methods for receiving input on community interests. (See Notice 2011-52). This requirement is an excellent opportunity for health systems to improve public health by collaborating with their neighbors to build healthier, lifelong communities.

Next Steps

The Health Districts Initiative Team will focus on where they can have the greatest impact on fostering the creation of health districts. These include:

  • Learning more about health officials who have jurisdiction over the design of health facilities (such as state departments of health)
  • Exploring the feasibility, usefulness and cost of of creating a planning tool for health systems that would incorporate health impact considerations for determine new facility sitings
  • Identifying health systems with facilities on a variety of scales who are willing to be pilot projects
  • Continuing to identify research on the health benefits of health districts and case studies as examples of viable health districts
  • Hosting webinars and speaking at CNU events on health districts

The initiative will draw on the CDC Sustainability Planning Guide for Healthy Communities, university research prepared by the University of Miami and the Columbia University Mailman School of Public Health; the work of Lawrence D. Frank; thought leaders such as Henry G. Cisneros; Regional Planning Commissions; and hospital associations.

For more information, contact Alex McKeag,
CNU Program Manager, amckeag{at}

The Health Districts Initiative has been made possible by the generous support of the members of the Congress for the New Urbanism.