The secret of change is to focus all of your energy, not on fighting the old, but on building the new.
—SOCRATES
Whatever good things we build end up building us.
—JIM ROHN
YOU COULD BE forgiven for thinking that my entire time with the New York City Department of Health and Mental Hygiene was spent on the Active Design Guidelines and Fit City conferences! They were both big aspects of the work to make progress on, and vital stepping-stones for, the work I wanted to do in terms of health and the built environment. And the relationships I made working on these projects were central to so much of the good work that came out of them. Without Fit City, there would have been no Active Design Guidelines, and without the Active Design Guidelines, I’m not sure how successful I would have been with some of the other initiatives I was so eager to get off the ground. But as time-consuming and exhausting as the work on conferences and guidelines was, it didn’t happen in a vacuum. As the Active Design movement gained momentum, my colleagues and I had many opportunities to put our ideas into action, both in New York and farther afield.
“The Little Sign That Could”
When I arrived in New York from Atlanta, with my CDC experiences in West Virginia fresh in my mind, I was eager to get one particular initiative off the ground: the development of a sign that would encourage people to take the stairs. Simple, right?
Not exactly. Flash-forward to the Fit City 3 conference in May 2008 (and note the date: two years after I started my work in New York). I’m watching from the front row, sitting among roughly three hundred other audience members in the darkened room. Dr. Thomas Frieden, commissioner of the New York City Department of Health, and Rick Bell, executive director of the New York chapter of the American Institute of Architects, are standing at the front of the room, under bright lights that illuminate a large sign on a stand. The sign—three feet by two feet—features a white stick figure climbing a white staircase pitched against a bright, lime-green background. Above the figure, in white, are the words “Burn Calories, Not Electricity.” Below the figure, also in white, is “Take the Stairs.”
It was such a simple message, presented in such a simple way. And yet, I knew only too well how much hard work it had taken to get to this day. Two years of cooperation with the Department of Health and Mental Hygiene’s assistant commissioner of Communications, Geoffrey Cowley, and the Department of Design and Construction’s design services team led by Victoria Milne. Two years of working toward sign-off and endorsement from multiple partners, including Mayor Bloomberg’s GreeNYC Office (the public campaigns side of the Mayor’s Office of Long-Term Planning and Sustainability), AIANY, and the Real Estate Board of New York, the city’s most powerful lobby group. Two years of meetings and memos and late nights and compromises geared toward the creation of a sign that was more than just something I dreamed up on my own, one that featured the logos of the key partners who supported the initiative. Yes, two years for this “simple” sign to be finalized and released.
Little did I know when we started working on this sign that it would garner enough attention to be used not only in New York but in Oregon, in California, in Atlanta (at the offices of the National Center for Environmental Health at the U.S. CDC), elsewhere in the United States, and even as far away as London, England, and at the University of Alberta in Canada.
In many ways, it was “the little sign that could,” a symbol for me—and other like-minded people—of what the Active Design movement could accomplish with creative thinking, dedication, and cooperation. It was, no doubt, a step in the right direction. We were off and climbing.
Testing…Testing…
I first met Nancy Biberman, founder and executive director of the Women’s Housing and Economic Development Corporation (WHEDco), in 2008 not long after the “Take the Stairs” sign had been unveiled. When our paths crossed, I was busy looking for places to integrate and test the stair-prompt sign, the ideas we were working into the Active Design Guidelines, and the LEED Innovation Credit for Physical Activity. Nancy was putting the finishing touches on her second affordable housing development, Intervale Green, which was striving to improve both quality and sustainability in affordable housing developments.
Intervale Green, located in the Bronx, was a direct result of Mayor Bloomberg’s goal to build or preserve 165,000 affordable housing units during his tenure. According to the Guide for Community Preventive Services, tenant-based rental-assistance programs that provide low-income families with more housing options had been shown to improve health-related outcomes. Additionally, where there are health disparities and inequities resulting from the built environment, improving the designs and amenities in and around affordable housing developments could assist families with restricted incomes who could not otherwise afford some of the health-promoting amenities or programs that others of us might take for granted (e.g., gym membership, children’s sports programs). Even access to safe and convenient transportation modes that are not car-dependent could be a very important measure to improve health equity. There are studies showing, for example, that households living in completely car-dependent neighborhoods are sometimes required to spend roughly 25 percent of their household income on transportation, while households living in neighborhoods with options to walk, bicycle, or take transit might spend only 9 percent. For those with limited incomes, being able to get by without a car could mean having money for healthier food and for active recreation programs for their children. If certain jobs and needed services require a car to get there, it could also prevent those who cannot afford a car to have less access to such jobs and services.
In many ways, Intervale Green exemplified New York’s new approach to affordable housing developments. In this model, the building and running of the development was left to private-sector developers—some for-profit, others non-profit like WHEDco—who would use funding and incentives provided by federal, state, and local governments to subsidize construction and maintenance. Frequently, middle-income and even market-rate apartments for purchase might be included as part of the building’s offerings and used to help offset the costs of not only construction, but maintenance over time, of the affordable or subsidized units.
Trained as a lawyer, Nancy had founded WHEDco in 1992 to help low-income women and their children, many from the homeless shelter system, with housing, education, and economic development opportunities. Headquartered in the South Bronx, on the tenth floor of their first affordable housing development, Urban Horizons, WHEDco has since developed three affordable housing developments in the neighborhood.
At our first meeting, Nancy and I discussed opportunities for collaboration. Yes, she was interested in putting up our stair-prompt signs in both Urban Horizons and Intervale Green. And yes, she was interested in being a site for a study evaluating the impact of those signs on stair use and physical activity. So far, so good. And then it got even better. While it was too late to change Intervale Green’s design, Nancy was willing to explore the possibility of simple and inexpensive interventions.
That first discussion was fruitful in several ways. It helped to solidify the importance of Nancy’s idea to create Intervale Green’s rooftop garden, where interested residents enjoy access to both fresh produce and physical activity. It led to “painting days,” approximately once a year, to create new mural art on the walls of the building’s stairwell, one floor at a time. And it led to WHEDco’s participation as one of three sites where the impact of our stair-prompt signs was evaluated.
That study took me back to my time in West Virginia. It was definitely a “boots on the ground” operation. Vicky Grimshaw from my staff, and Ashley Perry, our Master of Public Health graduate intern, joined me to hit the pavement—or, in Ashley’s case, the bench. Perched on a bench in the Urban Horizons lobby, Ashley tried to be inconspicuous as she counted the number of people taking the stairs and the number of people taking the elevators, and took note of the direction in which they were traveling. Ashley conducted these counts at the WHEDco building in the South Bronx before the stair-prompt signs went up. And she would count them again immediately after the signs went up, then several weeks later, and then, finally, nine months later.
Vicky and Ashley would also travel to the Riverside Health Center to repeat the exercise. One of them would stand near the elevator and observe people as they traveled either up from the lobby or down to the basement, where food safety and other courses were taught. The other would stand in the stairwell, observing those who entered and the direction in which they moved.
When Ashley was not in the field, she’d be at her desk, diligently entering her data. We, in turn, would use that data to calculate rates of stair use versus elevator use both before and after the installation of the stair-prompt signs; rates of stair climbing versus elevator use going up; and rates of stair descent versus elevator use going down. In a paper we co-authored for the American Journal of Preventive Medicine, we showed that the placement of the “Burn Calories, Not Electricity. Take the Stairs!” sign next to elevator call buttons and outside stairwells increased stair use immediately after posting, increased stair climbing as well as stair descent, and increased stair use significantly even nine months after placement.
Over the year or so that Ashley was with our team, she worked in the field many times. In addition to helping us collect data for the stair vs. elevator use evaluation studies, she also helped us assess what buildings did with the stair-prompt signs once they received the orders for them. We started with a list of 118 buildings whose managers or owners had called New York City’s 311 information line and ordered the stair-prompt signs between May and September of 2008, after the launch at our Fit City 3 conference. From there we narrowed it down to 58 buildings in Manhattan, Brooklyn, and the Bronx. These boroughs were targeted because they housed three of the health department’s highest-priority areas in terms of health needs: East and Central Harlem in Manhattan, the South Bronx, and North and Central Brooklyn. Ashley’s job was to report on whether those who had ordered the stair-prompt signs were using them, and where they were placing them.
In the spring of 2009, Ashley would take the subway to her “neighborhood of the day.” Dressed in comfortable walking shoes and business-casual khakis—a public health worker’s field uniform if ever there was one—she would walk to the buildings on her list. Some were locked and inaccessible. At others she would flash her New York City Department of Health and Mental Hygiene badge and then wait while the doorman or guard checked to see if she could enter. If she wasn’t sent away, she’d wait patiently until she was told to go ahead, or until someone came to escort her around. In the end, Ashley assessed twenty-four buildings and was able to write a report showing that about half of those had posted the stair-prompt signs. She learned that buildings with stair access from the lobby and/or other floors were more likely to have posted the stair-prompt signs than those that had no stair access or restricted access. It seemed that good access to stairs was an important complementary measure for stair-prompt posting.
That last bit of information led to further action. In 2010, after publication of the Active Design Guidelines, I hired a staff member specifically to help me help those building owners and managers. Johnny Adamic was in his late twenties, a young man from Wisconsin who would bound up eight flights of stairs every morning on his way to our office—he definitely practiced what he preached when it came to stair use and physical activity. He was the perfect person to make building owners and managers more aware of the free stair-promoting signs, and to help them post them correctly. Johnny had a master’s degree in a field completely unrelated to health, or even to the built environment, but he had worked for a year between his undergraduate and graduate degrees selling hospital building equipment, like handrails. I knew his enthusiastic attitude would be what we needed to help us implement our stair-prompt strategy successfully. Johnny would get the building managers and operators he worked with to order the best type of signage—styrene rather than paper—to stay up permanently next to the elevators and outside stairwells. He would create a package of materials to send out with the signs that were ordered, like good adhesives to both post the signs and keep them up on the walls. And, never one to let an opportunity go to waste, Johnny would also pass along a copy of the Active Design Guidelines and encourage those he visited to integrate other strategies if possible.
From 2008 through the remainder of the Bloomberg administration, nearly forty thousand stair-prompt signs were distributed to over a thousand buildings in New York City.
The Green Codes Report: Planning for Healthy Growth
In 2007—when I was in the midst of my work on the LEED credit, the Riverside Health Center, and the stair-prompt sign—New York City launched PlaNYC 2030. In anticipation of the population growth projected for the city, from 8.2 million residents to an anticipated 9 million by 2030, the Mayor’s Office of Long-Term Planning and Sustainability was calling for a serious discussion. How would this population growth be managed? New York was already a crowded and congested city. When I first arrived in New York, traffic jams were a constant, day or night, weekday or weeknight. The streets of Manhattan, particularly in places like Times Square, were overcrowded with people crammed onto not-wide-enough sidewalks. Housing was expensive and already increasingly unaffordable to many. Public parks that were present were already very well used by an increasing number of people living here. Many of the parks that were available, like Central Park in Manhattan and Prospect Park in Brooklyn, were built in the 1800s. More parks for this growing population were sorely needed. Now we needed to house, move, and provide healthy, open, active spaces for another nearly one million new people. We knew that, if nothing else, we needed to ensure that the additional million or so people didn’t make all of the city’s challenges even worse.
In a series of meetings with key infrastructure agencies, the Mayor’s Office asked some important questions: How could the government ensure that the city would remain environmentally sustainable, and that quality of life would be maintained—or even improved—for its residents? How could it ensure that the growth of the city would not be accompanied by even worse traffic congestion, air pollution, and overcrowding or loss of available and accessible recreational spaces? Goals and objectives were set. Supports for walking, cycling, and public transit as viable and desirable modes of transportation was a key proposal. Having every New York City resident live within a ten-minute walk of a park or playground was another. Where large parks might be missing or impossible to add, small pocket parks, including pedestrian plazas, would be used. I followed the discussions with interest. If ideas like this came to fruition, there would be sweeping changes indeed. The objectives also introduced key opportunities to promote and protect health, and I knew the next version of PlaNYC would need to include health outcomes explicitly.
Following the launch of PlaNYC 2030 as New York City’s master plan for growth, policies were enacted to help ensure its goals were met. In 2009, I was presented with an opportunity to take part in the policy-making process when Laurie Kerr, senior adviser in the Office of Long-Term Planning and Sustainability, got in touch. Laurie and I had known each other for a few years; in fact, it was during a working session around a joint panel presentation for the national conference of the American Institute of Architects in 2007 that she and I had come up with a phrase—“diseases of energy”—to describe the non-communicable diseases whose risk factors of physical inactivity and unhealthy diets were linked to the overconsumption of external energy sources and an underutilization of the energy within our own bodies. Laurie told me that a task force was being formed with Urban Green, the New York City chapter of the U.S. Green Building Council. The goal of the task force was to undertake the work, as described in earlier sections of this book, to “green” the city’s design and construction codes from building right on down to plumbing. Laurie wanted the Green Codes Task Force to include a Health and Physical Activity Technical Committee. Would I be willing to serve as co-chair?
We’d come a long way since 2006. It had been only three years since my work in New York had begun, and now health and physical activity considerations were being integrated into numerous city policies and processes—even those that, on the surface, seemed to have nothing to do with “health.” And I was being invited to participate in initiatives, such as this one, that once would have had no health representation or consideration. I said yes, of course, I’d be pleased to accept.
We got down to work immediately. The committee, like the other eight technical committees formed, would have only a few months to brainstorm and then finalize a set of recommendations that would green New York City’s construction codes and, in our case, simultaneously promote physical activity and health. We knew we needed the best people to help, and so we invited William Stein, a private-sector architect with the firm Dattner Architects, to co-chair. Bill was, after all, the lead architect on a project that won an affordable design competition, a project his team called Via Verde, or the Green Way (see chapter 6 for more on this project). I knew Bill, and Bill was familiar with our work on integrating physical activity and health into building, site, and community design. Even before the time of our Green Codes committee, Bill had already agreed that his team would use the Active Design Guidelines and integrate the LEED Innovation Credit for Physical Activity into Via Verde. We filled out the committee with a combination of senior staff from city departments, including Planning and Buildings, and representatives from private-sector architecture and engineering firms.
The day of our first committee meeting arrived. I had invited Dr. Gayle Nicoll, who had worked with us in drafting the Active Design Guidelines, to present potential opportunities for the committee members to consider: opportunities that could be incorporated through allowances in the international building codes; that were being used in other jurisdictions; and that were being shown by health and building research to be important but not currently implemented in real-world buildings.
Via conference call from San Antonio, Texas, Gayle presented research on buildings and physical activity, particularly around the facilitation and encouragement of stair use. We heard how visibility of the stairs from the building entrance appeared to be a critical element. We heard how aesthetic elements like music and art, along with design considerations like wider staircases, had been shown to increase stair use. We heard how stair-prompt signage—such as the “Burn Calories, Not Electricity” sign that had been created in New York City the year prior—showed strong evidence of successfully getting people to be more active in their day-to-day lives. Gayle then proceeded to review several pieces of new technology that were now permitted by international building codes. Technologies like magnetic “hold-opens” that could keep stair doors open most of the time, but would demagnetize when a fire alarm rang, allowing the doors to close, such as the one that the American Institute of Architects New York Chapter was already using in their Center for Architecture to promote visibility and use of their main fire stairs. There was also new glass that could withstand fires for an extended period of time without exploding, unlike previous types of glass that couldn’t be used to cover large areas of fire-stair doors and walls. We heard how these technologies were now being used, or at least were allowed, in other jurisdictions. For example, in Kentucky’s building code, magnetic hold-opens were allowed for use to keep stairwell doors—even fire doors—open, and the stairs more visible.
The architects on the committee were well aware of all the items not permitted by New York City codes, including magnetic hold-opens. And from our individual daily experiences, many of us also knew that stair use in New York could be challenging. Staircases were often relegated to the back corners of buildings. Frequently, the doors to access the stairs were locked. If they did happen to be open, it was not uncommon to find the stairs poorly lit, and painted in a drab gray, if at all. And with our stair-prompt initiative still in its infancy, signage encouraging stair use was hard to find. I also knew that many people were frustrated by the lack of stair access. After the new stair-prompt sign was launched at Fit City 3 and reported in the press, the number one complaint that New Yorkers raised in their comments was lack of stair access; this was brought up in between 20 and 25 percent of all the comments made about the announcement. Many New Yorkers said they wanted to use the stairs in the buildings where they worked and lived, but they found it difficult—or even impossible—to do so. I shared this information with the members of my Green Codes Task Force Health and Physical Activity Technical Committee.
In February 2010, one month after the release of the Active Design Guidelines, the Green Codes Task Force Report was published and announced at an evening event at City Hall. The room buzzed with excitement as men and women in suits greeted and congratulated each other on a job well done. It was clear that the hundred-plus invitation-only attendees were thrilled, anticipating that the recommendations would become the basis for the next steps to a greener—and also healthier—city. I could see members of my committee scattered here and there across the large second-floor room, a room you entered after ascending the beautiful curved staircase that greeted you in the center of the City Hall lobby right in front of the building’s main entrance. Ah—the buildings from the old days, where the staircase was an integral part of the grand entrance!
The staircase, as it turned out, was a major element in our recommendations for environmentally friendly improvements to building and zoning codes. The committee recommended that stair access and stair-use prompts be mandated in all buildings. Access, after all, is critical in terms of supporting a person’s choice to take the stairs. Certain buildings were exempt—psychiatric hospitals, for instance, where safety considerations were a very real concern—but for others, the recommendations were clear: the use of stair-promoting features such as width, aesthetic elements (art and music), and improved visibility (through, for example, the use of fire-rated glass) should be encouraged through the creation of zoning incentives. Zoning could allow developers and building owners to widen the stairs if it didn’t count the stair floor area toward the maximum floor area allowed for particular buildings and building types. Zoning could even offer additional floor area bonuses—for example, the allowance of an extra floor to be added to a building—if the building’s stairwells met certain criteria.
The committee also recommended that magnetic stair hold-open devices be permitted. If international building codes—and other U.S. state codes, like Kentucky’s—could allow them, why not New York City building codes? This measure had seemed simple enough to recommend, but if the stair-prompt sign approval process had taught me anything, it was that sometimes “simple” could be pretty complicated. This time, the complications came courtesy of the Fire Department of New York (FDNY). As we tried to take the next steps with the Green Codes Task Force Report—turning recommendations into actual building code changes—we had to work hard to address the FDNY’s very legitimate concerns about public safety.
Working with the deputy chief of the FDNY and his staff, Laurie Kerr, Keith Wen (director of codes at the Department of Buildings), and I learned that magnetic hold-opens had been prohibited in New York primarily because of the number of very tall high-rise buildings in the city. In buildings like these, open stairway doors on every floor could create a vacuum effect, sucking flames into the stairwell in the event of a fire.
A meeting—then two, then three before we lost count—took place at the Fire Department’s headquarters. With the Brooklyn skyline as a dramatic backdrop, we talked the issue through. We listened to the FDNY’s concerns, and they listened to us. The vacuum effect was certainly something that needed to be taken into account, but I pointed out that the department’s own report from the 1993 World Trade Center bombings had found that a lack of familiarity with the stairs—from location to layout—was also a major reason for delays in escape from the building. Thus, improving stair visibility and encouraging regular daily stair use by building occupants could also help with safety in the event of an emergency.
It took a bit of time, but we hammered out an agreement. Yes, we could safely allow magnetic hold-open devices to be used, but only on three floors of any given building. The compartmentalizing would negate the vacuum effect. The Green Codes Report recommendations for routine stair access and for use of stair-prompt signs would also help us address the issue of familiarity with stairs. Working together, we were able to balance fire safety precautions with the promotion of regular physical activity for building occupants.
As we sat in that room at FDNY headquarters, it was clear that the many months of working together—and meeting weekly—had created a bond between Laurie, Keith, and me. I was so grateful for these allies who were fighting with me to ensure that physical activity and health choices were available to all building users. Our teamwork paid off in June 2013 when Mayor Michael Bloomberg signed an executive order for Active Design, supported by the Department of Citywide Administrative Services, the Department of Housing Preservation and Development, the Department of Design and Construction, and the Department of Transportation. Moving forward, City agencies would be required to review the design of all City-owned or City-involved construction and major renovation projects to assess opportunities to implement Active Design Guideline elements into buildings and streets. The order also required that agencies assess opportunities to promote the use of stairways, and train design and construction personnel in the use of the Active Design Guidelines.
In 2014, the City took further steps, passing new legislation that allowed magnetic hold-open devices for stairwell doors to be used on up to three floors of a building within New York City’s updated greener—and healthier—building codes. With Laurie’s support, we also passed legislation to update the plumbing codes in a variety of ways. Among improvements for both health and the environment were requirements that improved tap water infrastructure for drinking water in buildings. Now, not only do new buildings in New York City need to provide drinking water fountains, but those fountains must also be accompanied by water bottle refilling stations. This measure to promote tap water consumption was a win on two fronts: it greens the city and it promotes healthier beverage consumption.
Mission accomplished—or, at the very least, firmly underway.