Designing Healthy Spaces: A Conversation with Dr. Erika Eitland on Public Health and Architecture
An Episode from the Changing Tomorrow Podcast
In today's rapidly evolving world, the role of architecture in public health is more crucial than ever. Dr. Erika Eitland, a leading expert in environmental health and design, shares invaluable insights on creating spaces that promote well-being. This blog post, brought to you by Liveable, aims to unpack Dr. Erika's wisdom and offer actionable strategies for architects, designers, and public health professionals.
Importance of Architecture in Public Health
Dr. Erika Eitland emphasizes that architecture isn't just about aesthetics; it's a powerful tool for enhancing public health. With a unique background in environmental health, she focuses on the impact of design on K-12 schools, affordable housing, and urban planning.
I don't wanna be in the business of energy efficient sculptures. I want to be in a place that is creating thriving environments and healthy buildings.
Health Context in Architecture: Dr. Erika advises architects to understand the community's health needs before designing. This involves data analysis, community engagement, and aligning design strategies with public health objectives.
Multi-Sensory Design: She discusses the importance of considering all senses in architectural design, especially for specific health conditions like Cortical Visual Impairment (CVI).
Investment in Research: Dr. Erika advocates for research-driven architecture to meet the specific needs of a community or project.
The Role of Data and Research in Architecture
Dr. Erika leads the development of Proceed, a public health data tool designed to inform architects and designers about significant health indicators.
Data-Driven Architecture: She underscores the importance of using data to make informed design decisions.
Open Source Collaboration: Proceed is an open-source tool, inviting contributions from architects, designers, and public health professionals.
The Future of Public Health and Architecture
Dr. Erika is optimistic about the future, especially with the new generation of architects who are data-savvy and health-conscious.
Find Community: She advises young architects to find their tribe and focus on collective problem-solving.
Impact-Driven Architecture: Dr. Erika emphasizes that the ultimate goal should be to create a lasting impact on public health through design.
This conversation with Dr. Erika Eitland serves as a compelling guide for anyone interested in the intersection of public health and architecture. For more actionable insights, check out the reading list curated by Dr. Erika, and the resource workbook available for download below. for download below.
Dr Erika’s Reading List
Resource Workbook
Ready to put your insights into practice? Our workbook is your guide to integrating podcast perspectives into your projects and decisions.
What You'll Gain:
Reflective exercises to deepen your understanding
Actionable steps to apply in real-world scenarios
Complete Podcast Transcript
Gayathri (00:01.354)
Hey Erika, so let's do this. This will be a really fun conversation. I can't wait to dive in. But before we begin, if you could choose a superpower, what would it be?
Erika Eitland (00:02.482)
Hello?
I'm so excited to be here with you. So this will be super fun.
Erika Eitland (00:18.742)
So when I was thinking about this question, it was like, okay, I would speak any language so I could just eat my way through the world. And then I was like, no, that's not what superpowers are about. You know, they're about, right though? But I think they're about having positive impact on other people or the situation. And so I think if I couldn't have a superpower, it would be to make anyone laugh. Because if you could imagine a world where you have other people releasing endorphins or like feel good hormones,
Gayathri (00:24.708)
No.
Gayathri (00:28.366)
That is a super power. It counts.
Gayathri (00:46.633)
Yeah.
Erika Eitland (00:48.03)
and we're triggering pleasure and reducing pain or stress or we're just helping reinforce those social bonds. To me, it's that opportunity to invite everybody in. Like if we could probably solve a few world problems with just laughter or like a really good like oxytocin releasing hug. So yeah, I mean, that's.
Gayathri (01:04.784)
Right?
Gayathri (01:08.326)
The ability to make people laugh, that is so special. And it's just like a quick bonding moment. And you don't even need to know the languages then. You can just eat your way through the world anyway, if you can do that. Yeah. Oh, my gosh. Well, Erica, your expertise lies in public health and how it interacts with our health in buildings and spaces and things like that.
Erika Eitland (01:19.33)
Yeah, there you go. Just smile and be like, this is delicious. So yeah, for sure.
Gayathri (01:36.094)
I'm going to ask you a really high-level question, and it's going to seem impossible given you've dedicated your entire career to it. If you could set the stage for our listeners, from your perspective, how would you explain what public health is?
Erika Eitland (01:54.674)
Well, to even say that I have expertise in public health is a funny, funny statement because I think when we think about the word public health, it sounds like one cohesive, tidy thing. And yet it's really a vast network of what I would say is our STEM fields, so science, technology, engineering, mathematics. So we are talking about everything from air pollution to nutrition, epidemiology to immunology, maternal health to mental health. And so this vast network of disciplines.
allow us to think about our sort of, our patient in this case is communities. So if a doctor's thinking about one person at a time, we are really thinking about how are we, you know, tens, thousands, millions of people going to be impacted by certain decisions. And this can be something that is physiological, it can be social, psychological. So there's also diversity in that.
For me, and as we kind of go through, you know, if that's the 30,000 foot view, I have spent my career focused on environmental health science. So I started in genetics, focused on climate change, and then have found myself sort of doing environmental exposure science. And so basically what that means is I'm asking questions of, all right, who was exposed? Where were they exposed? When? For how long? And what makes them critically vulnerable to these substances?
Gayathri (03:13.474)
Hmm.
Erika Eitland (03:17.686)
they touch, breathe, or ingest. So, you know, the fancy kind of term for it is the exposome which is the sum of all the environmental exposures and our body's responses to those exposures across our entire lifespan. So, you know, no pressure in trying to figure this out. But what's really exciting about that kind of work and when we all sort of think about, well, what's our exposome? You know, even where we're sitting right now,
Gayathri (03:25.852)
Mm-hmm.
Gayathri (03:35.912)
Hehehe
Erika Eitland (03:45.578)
What are you touching? What are you breathing? How does it feel, smell? And so what comes up for me is that even the smallest exposures, even things that are microscopic, what I call the science of the invisible, are having impacts on our day-to-day experience or on outcomes 20, 30 years from now. So the cushion that you're sitting on, does it contain flame retardant chemicals that we know have adverse health outcomes?
and are you exposed to it daily, well, that becomes a problem. So we don't need just like big crises to respond to. Sometimes it's these little things that actually make big differences in our quality and quantity of life.
Gayathri (04:26.786)
Thanks for that explanation. Thanks for differentiating kind of the amount of exposure. And because when you said exposure, my mind directly went to COVID-19. And you showing kind of the differences and the awareness of the possibility or what we're being exposed to in the tiniest bit and how much it is, what the frequency is, is really helpful as we think about it on a larger scale.
Erika Eitland (04:33.227)
Mm-hmm.
Erika Eitland (04:37.95)
Mmm, sure.
Erika Eitland (04:54.206)
Well, and even a jump in, sorry to cut you off, but I think this is something where, even the way that we use words like exposure, COVID is a great example of, there was a real physical health risk we needed to mitigate risks. And so to me, it's funny, by working at a large architecture design firm now, how much that definition has even changed for me, because I'm seeing, okay, we're talking about this sort of physical risk.
Gayathri (04:56.903)
Yeah, no.
Gayathri (05:06.856)
Mm.
Mm-hmm.
Gayathri (05:18.19)
Hmm.
Erika Eitland (05:24.066)
But when we're thinking about even just like environmental justice, how are we removing the psychological threat that comes with believing that our environment is harming us or believing that you're not worthy of a better, healthier environment? So I mean, I'm biased, obviously, from my training to think about those environmental physical outcomes, asthma, diabetes, obesity. But in this process of actually working on the ground, you realize there's this whole other sort of social, emotional.
behavioral component that is also responding to that. So, COVID-19, yes, we were trying not to get sick, but what was our mental health doing? How was our socialization? And those are some of these other indirect maybe health outcomes that we wanted to quantify and understand during the same time.
Gayathri (06:11.926)
Do you think it's necessary for public health knowledge in a way, and I'm going to say at the very rudimentary level, for people working in the built environment?
Erika Eitland (06:27.906)
I mean, I'm biased. I think if the teams and designers, and it could be anyone from an interior designer to someone who's making a shampoo, okay? If we're not thinking about people, then really, you know, from a design perspective and architectural perspective, you're just making energy efficient sculptures, you know? And this is something that by considering people, it is what humanizes this work.
Gayathri (06:40.837)
Mm.
Erika Eitland (06:56.998)
It's why I believe that architecture design needs to sort of take on their own Hippocratic oath, which is, you know, do no harm. And I really feel that there's so much that we have to consider. And I think designers get a lot of pressure now of, oh, we got to think about energy efficiency and embodied carbon. And we're gonna talk about now health, and you want us to think about material health of that, but also ventilation. And yet like, you don't have to do it alone. And I think that's
Public healthers are getting trained more and more to be able to also be bilingual and to be able to share in this process. So yes, we need to be at the table, but you don't have to be the ones to know everything. You can call on help and we're here to be there.
Gayathri (07:32.61)
Okay.
Gayathri (07:46.494)
And I think that's important to note because human-centered design, and I don't like that phrase too much, human-centered design has taken its own life, I think, over the last 10, 12 years, and it means so many different things. And making sure that you're thinking about different aspects of it in every single thing that you design, whether it be furniture or spaces or buildings, is hard.
Erika Eitland (07:57.462)
Thank you.
Gayathri (08:15.862)
But bringing in the experts is, I would say, necessary, given what we know about, with all the great research that's come out and all the research that's making its way into the building industry.
Erika Eitland (08:29.318)
Definitely. And I think that's the exciting thing, right? We are at this incredible inflection point where for the last 30 years, we have documented what we shouldn't be doing. How are these exposures negatively impacting us? Now we're at a point where for the next 30 years, let's be researching, well, what do we do about it? How do we make it better? What is the innovations that we've come to solve some of these problems?
and are they working and how do we make them even better so that there's this virtuous cycle? So to me, I think, you know, and I think about built environment and why it's just so important to this conversation about public health is one, we have power over it and we can change it and make it what we want. I think two, it is, you know, our ex-pizom. We, you know, we occupy it nearly 100% of the time, whether it's indoors or outdoors.
If we're thinking about our schools, hospital, workplaces, sidewalks, streets, that is our built environment. And so we designed it that way. And so how do we ensure that our exposome is serving us in an optimal way? And the fact that this relationship between built environment and health has been really well defined where if anybody wants to go out there and I could give you a list of studies, but if you were to simply Google built environment and birth outcomes.
children's performance in school, productivity of workers. I mean, there's no shortage of research that is able to make this connection. And, you know, I used to say this a lot when I was at Harvard, but this idea that we force people to occupy two spaces. The first is prisons, and the second is our schools. And so to me, that becomes a moral imperative to examine our built environment through a place that gives us dignity.
and that values human life, and even from the earliest stages. So, I mean, built environment isn't just sort of a nice fun word that we get to use. It's actually something that is quite impactful to those populations.
Gayathri (10:39.434)
I think this is the first time I've heard schools and prisons being used in the same sentence. So, and when you think about it, it's so true. They're, you know, these are places that people are being forced to spend time in. I know that there are a lot of parents listening in. What would you recommend that they ask, you know, that they look for when they put their kid into school?
Erika Eitland (10:58.283)
Mm.
Erika Eitland (11:06.558)
I don't know. I think the idea of what should they look for, I think it's actually, you know, just shift the question a little bit, is that is such a socioeconomically driven question. And yet, to me, you know, this idea, if you were to ask a high school student in a building that was built in the 70s,
what do they think about this space? They would say it feels like a prison. So that like relationship of like removing windows, you know, during the energy crisis, that's real for these kids. And I would say that, you know, for everyone that is occupying these spaces, your teachers, your students, that are those decisions being made through a health lens. So, because the other thing is, your children are rapidly growing in these spaces, cognitively, socially.
And yet, as we think about the products that are there, what are things that have maybe been there before we had the research? So things like asbestos and lead. And how are we going to remove those things effectively? And it's funny because during, if we go back to COVID, I think the big difference here was we had all parents shouting about poor indoor environmental quality in their schools. It was a universally understood thing.
And yet, I would argue that the quality of our school buildings has been well documented for the last 30 years as being in very poor shape. You know, there is large governmental congressional reports that have come out saying that 54% of our school buildings need to have one or more building systems replaced. And I would say that low income and communities of color neighborhoods, they've been shouting about this for years.
You know, back in 2013, a student in Philadelphia died because of an asthma attack. I mean, these are things that are persistent. And, you know, I'm like kind of dodging the question of like, what should they look for? I mean, I think it's all the stuff that you can't see. It is about the ventilation. It is about the sort of air quality. What are they exposed to? It's about the acoustics, you know, knowing that teachers...
Gayathri (13:15.35)
No.
Erika Eitland (13:27.37)
have two times the amount of vocal strain than the average American, teachers are predominantly women. And so therefore there's lots of different things that ergonomically could be designed better to serve them and then ultimately serve your children. So, those are pieces that I really feel you've got to hang out with the facility manager if there's an opportunity to renovate or, I don't know, invest in your school building, modernize your school building.
those things need to be voted, yes. That is something that you cannot sort of sit idly and say, oh, we're fine. And I know there's a lot of effort to get sports facilities and that's a part of school pride, but your ventilation system could do more for your children's life than some of these other advancements. And yet we under invest in that generally.
Gayathri (14:19.662)
And the cosmetic, I will say, additions, they look great on paper often. And the things that we need to be asking about require a bit of digging. One of the things that Rick Fedrezia had just had a conversation with him and schools came up, he said was kids who study in healthy environments, they start expecting that of other environments for the rest of their lives. So if they've got
Erika Eitland (14:38.242)
Hmm.
Gayathri (14:49.502)
start expecting great daylight when they go to university or when they start working or when they build a home for their family, like they just get used to it. And one of the pieces that you touched upon was just the access and the ability to ask these questions. So it's not just about do the classrooms have great daylight, it's do kids have access to schools and
If they have access to schools, can they even ask about these questions?
Erika Eitland (15:20.322)
Right. And I think that's, you know, when we think about children and their role in this, you know, if you got a small kid in your life, they're not going to even be able to take their sweater off, let alone ask like, hey, can we turn down the thermostat because my thermal comfort is not serving me right now. So to me, I think when we put our kids also, you know, in the inverse of places that don't serve them, they also take on that, oh, it's me that's the problem.
Gayathri (15:33.246)
Right? Right.
Gayathri (15:38.804)
Right.
Erika Eitland (15:50.078)
You know, it's not maybe the environment. And yet, you know, a few years ago, Jaiseng Park released a paper focused on just thermal comfort and temperature. And the finding was that, you know, if you took an exam on a 90 degree day versus a 75 degree day, you were 12% more likely to fail that exam. And that is equivalent to the Black-White Achievement Gap. And this is a study done with 75,000, you know, New York students.
And to me, that is something that is about the science of the invisible. That is about thermal comfort having this important role. And yet coming from the state of Massachusetts, it wasn't until 2004 that a single school building had air conditioning. So when we talk about built environment, when we talk about schools specifically, to me, like we have to be prioritizing this as our climate adaptation and community resilience plan. It is about, you know, acknowledging
extreme heat and flooding and all of these things that have happened just this summer alone, and being able to do something about that.
Gayathri (16:57.246)
If, and the, okay, I'm gonna rephrase the question I'm gonna ask you. There's a lot of discourse happening about healthy buildings and what healthy buildings look like and feel like and all of those things. What is a belief that you disagree with?
Erika Eitland (17:17.194)
Um, one. Listen, I love this question. And at first I thought you said discos. And I was like, oh, what discos are happening? Discourse. That helped me. Um, you know, to me, I think when I'm approaching this conversation about healthy buildings, I think having worked in this space, we, you know, when we think about workplace,
Gayathri (17:17.232)
One.
Gayathri (17:27.603)
Uh...
Discourse, yeah.
Erika Eitland (17:45.594)
you have something called the healthy worker bias. So the healthiest workers are the ones who actually participate in these physical environments because they're healthy enough. And when we, for my dissertation, I was looking at schools and which schools were getting green schools in Massachusetts. And it was one of these things where we found that it was the higher performing students were actually getting these green schools. So then when we saw, okay, you went from a bad school to a new school, what was the impact? We saw very minimal change.
And to me, that means that there's a certain ceiling effect of who gets access to a healthy building, is people who are already healthy or higher performers. And the juicy stuff, the thing that we could really do is actually if we prioritize our vulnerable communities, if we think about our low income or communities of color that need to be diving in and sort of, I think we would see the biggest change.
in their health outcomes by putting in these healthy buildings. But I think the very specific belief that I really am struggling with or disagree with is all we need is equitable design and then we'll make progress. And I don't think it's enough. I think when I hear EDI, so equity, diversity, inclusion work, I agree it's extremely essential to the process.
because it means we're gonna be fixing a broken pipeline of ensuring that we're bringing in diverse designers that are helping them overcome economic, physical, or social barriers. And to me, even if we think about it from a racial perspective, when less than 10% of AIA members are black or African-American, Hispanic or Latin A, yeah, we need to fix that pipeline for sure.
15 to 20% of the population is neurodiverse. Okay, yes, we need to bring in people who are not perceiving the world in the way that we think it is. And all of this is necessary work, but it takes time. And I would say when it comes to just equity and this discussion about healthy buildings, equity is simply defined as we're recognizing that each person has a different circumstance and we need to allocate resources and opportunities
Erika Eitland (20:03.902)
so they can reach an equal outcome. And it doesn't acknowledge the intergenerational trauma. It doesn't acknowledge the exposures that they experience. It doesn't acknowledge the context that they might be in, and it requires healing. And I think that not addressing those past harms through just simply an equity lens is holding us back from actually having a healthy building movement that makes huge impact.
We need a lens of restorative environmental justice. And what does that look like or mean? To me, it begins sort of with redlining, if we take this as a really simple example. So in the 30s, you have the Homeowners Loan Corporation basically putting out racially discriminatory lending practices that are impacting where people can live. And why is this relevant to health? Well, a century later,
There's been studies done that show that the average life expectancy is almost four years less than those non-redlined communities. So to me, there's this moment where by having this built environmental policy, it is having impacts today on our life. And yet it's in those redlined communities. Well, why is this happening? Well, they're experiencing an excessive urban heat island. They're experiencing higher levels of air pollution. They're more often.
located near toxic waste sites. So this form of environmental racism is well-documented. So we have the research, that's not the problem here. And we have people who are out there advocating for it, and that's not the problem. But if we are going to take this into a movement, we need to be treating architecture as a form of reparations that is addressing that past harm. So to me,
I think the difference here is that work can start happening tomorrow by prioritizing people. It goes back to sort of humanizing this process. You know, we can't hide behind these corporate commitments. We have to be tailoring our design. It's not a checklist. And to me, you know, if we tailor to those occupants and communities we're trying to serve, then we're gonna tackle the thing that's hitting the most. Is it air pollution? No. Oh, is it obesity?
Gayathri (22:14.958)
Mm-hmm.
Erika Eitland (22:26.83)
Oh, okay, then it might be a different solution. Is it cancer? Why is that happening? So, you know, I don't wanna be in the business of energy efficient sculptures. I want to be in a place that is creating thriving environments and healthy buildings. You know, we are always in a process of either healing or getting sick. It is a continuum. And to me, I think this restorative justice lens has an opportunity to actually push us much further along
who gets to be healthy, getting to equity, quote unquote. And honestly, people are like, oh, that's hard. I don't even know where to start. Oh, this feels so overwhelming. Growth spurts are painful and yet so, so necessary. And I would say that my time at Perkins and Will, it's been interesting because we're also in the fight to figure it out. We don't have the special recipe to hand to you. The firm has adopted this.
Gayathri (23:18.838)
Yeah. All right.
Erika Eitland (23:25.766)
Jedi lens, so justice, equity, diversity, inclusion. And to me, I think as we're trying to figure it out, it just has become very clear that, you know, it takes everyone to change everything. It can't just be, you know, a philosophy or a couple of key people. Even the small decisions matter. So, you know, if I think it's my interior designers, interior designers don't pick products that have probable carcinogens in them. Like we don't, you know, even at small doses, there's lasting impacts.
Gayathri (23:44.046)
Mm-hmm.
Erika Eitland (23:54.282)
Are you designing a firehouse? Don't put it in there. They are exposed too much outside of the firehouse to be exposed internally. You know, if you're an architect, have you advocated with your engineers for better ventilation and acoustics? You know, we know 600,000 teachers miss a day of work because of vocal problems. So if we're thinking about vocal injury as sort of this huge impact to our economy, then how can we do better?
And it's estimated that we lose $2.5 billion per year, purely just for teacher vocal string. So that's insane. And then you have urban designers at the table. And I would say that, are you thinking about and creating places for people with chronic conditions? So if we even just take obesity, the National Institutes of Health estimate that we have 30% of the American adult population overweight, 42% have obesity.
In the U.S., you know, it's estimated we have $14.3 billion in direct costs of just childhood obesity. So there is an economic connection, there's a design connection, and are we, you know, from our urban design perspective, are you creating places for them to rest, to be physically active, and yet acknowledge that it's not just about having a beautiful park to walk through, but the whole person? What are these other elements that are going to make them feel
and be able to do it in a way that is physically right for them. So I see this as an opportunity for us to say, health, yes, it's about healthy buildings, but it is also about tailoring. It is also about addressing those past harms. Because otherwise, you know, if the 1% is the ones getting these healthy buildings, then we're limiting our progress we could be making.
Gayathri (25:47.09)
It's not healthy for the wealthy, which is something that we've started seeing. You touched upon something that's super interesting because these topics, redlining, childhood obesity and people who are overweight, we see that increasing around the world. They seem so distant if you're sitting and working on a building. And what you essentially are saying is that everybody has a responsibility.
Erika Eitland (25:49.378)
Yeah. Oh, I've never heard that. Yeah.
Erika Eitland (25:59.786)
Hmm.
Erika Eitland (26:05.93)
Hmm
Erika Eitland (26:11.936)
Yeah.
Gayathri (26:17.402)
And I like to say everyone can make an impact within their circle of influence. And so just knowing, kind of understanding what you're working on and the impact it can have on people is enough for you to campaign or campaign is the wrong word for you to advocate. Yeah, I've been using campaign a lot with my nephew trying to campaign for things during his summer vacation.
Erika Eitland (26:21.803)
Mm-hmm.
Erika Eitland (26:34.754)
Cheer lead, advocate.
Gayathri (26:46.722)
for you to advocate for better options. And the better options are not always the fancier ones, are the ones that get the most, I would say, attention or can be taken pictures of.
Erika Eitland (27:00.274)
Yeah, I mean, I think what's interesting about this is that design is been really aesthetically driven. I mean, I think we prioritize the imagery because it allows us to see it and feel transported. But I would say that the built environment, and especially as it relates to health, but just maybe our overall experience with it, is the fact that it impacts all of our senses.
Gayathri (27:10.81)
Mm-hmm.
Erika Eitland (27:29.266)
It impacts what we smell, what we touch, what we hear. And when we think about inclusive design, those things become important. Because if you cannot see the sexy image with the blurred people walking by, then you miss what all those other elements are. And so I think, you know, as we're trying to advocate for healthy buildings, we're trying to prioritize certain things.
Gayathri (27:39.064)
Mm-hmm.
Erika Eitland (27:58.758)
I really feel we have to be taking it from not just a visual perspective, because to me, so much of my work is about what are the physical ramifications? How does high levels of CO2 impact your brain function? Those are things you cannot see. But when it comes to productivity in the workplace, it comes to our students' performance, those things are primary. And so...
I feel like we have to take the time to really document how are we impacting the physical aspects of our occupants, how are we impacting the psychological, the social, the interpersonal aspects. And so, you know, in our team, so I'm the co-director of the human experience lab at Perkins and Woll, and one of the things we keep going back to is just the socio-ecological model, this sort of nested approach to how we think about health influencing us.
with us as the individual and then sort of the kind of interpersonal, then the community level, then the policy and environmental levels. And we are nested within those things. And so we have to be, I think, aware of that context.
Gayathri (29:12.622)
That's, I think there are two elements here that I wanna kind of dive into. The first is understanding the larger picture in which your project lives in. So for example, the requirements for a project in the city center and downtown New York is very different from one in a different neighborhood with a different socioeconomic situation, so to say.
It's about taking a step back and taking a look at what you're working on. And I think it's always easy for us to have a conversation, right? It's always easy for us to say it. It's harder to do. And you're on the ground working on making these spaces healthier and better. What are the biggest obstacles that you're seeing when you're in your work as we start looking at these buildings?
Erika Eitland (30:13.358)
I, so there's two parts of this. One I think is timeline and the second is value engineering, which is all about budget. And so in the design process, I find that health thinking is actually the most important in those very early design phases. It needs to be considered even as soon as, you know, groups get RFPs or we're starting a project, it needs to be embedded. The who.
the when, where are people spending their time? What is the adjacency? How do we create efficiencies for people? Are we putting windows in a place that people are actually going to use those windows? Or are they in a hallway that nobody actually is in except for maybe five minutes of the day? So there's that sort of aspect to it where we, whether it's cheerleading championing, campaigning or advocating for healthy buildings, that has to happen in a very tight timeline at the very beginning. And it means by
working with the client or whoever we're sort of building for to be able to understand them, to then be able to respond and say what research is relevant. And then, you know, we come to the other side of it, which is the value engineering, that if we are sort of applying public health thinking and research like butter on toast, it's easier to scrape that off. But if we are sort of embedding it early in that design process...
And it becomes integral to the sort of three layered funfetti cake with the frosting. And you can't really remove the butter at that point. It is in everything. And so it's a little more protected from decisions that would remove, you know, the healthy aspects of that building. So a really great example is the William E. Carter School. It's a Boston public school. And it has been really interesting example for me because being trained in
sort of exposure science and thinking about ventilation and air quality and all this. It really changed the way that I actually approached design and in my own profession, which is this is a school for students who have severe disabilities, cognitive, visual, auditory, mobility. And the way that they perceive the environment is very different than an average student. And even students we know are more vulnerable than their adult counterparts.
Erika Eitland (32:36.51)
But this is a population that has, most of the students have cortical visual impairment. So CVI, it's one of the fastest growing disabilities in the higher income countries because many of these children would have died in childbirth, but because of medical advancements, they're now living through their life, you know, early life course. And so what's interesting is now they're entering school.
And what are we gonna do to help support them? And this building was built back in the 50s. The hallways were so narrow that you couldn't fit two wheelchairs down the same hallway. These are students, there's 30 students in this school coming from some of the most economically disadvantaged communities to the point where many of them are living in public housing without elevators. So their parents are bringing them home.
from the school bus and then carrying them up three flights of stairs. And so it is something where, again, how does our design give dignity? How do we respond to these health conditions where, you know, we're going to create a space that because of this cortical visual impairment, which is actually a neurological sort of challenge, not necessarily an optical one, we have to think, okay, well, what else is the environment telling us? So how are we thinking about noise?
And can they way find by that? How are we thinking about all the factories? So what can they smell? So on one half of the building, it's the swimming pool, on the other half, it's the cafeteria and that creating sort of that understanding of where you are from these other senses. Then the amazing thing about something like CBI, so cortical visual impairment, is that with the proper training, guidance and sort of environment, these students can start to see again.
And I think that's like the most magical part of this. And what became important was, OK, now we're going to look at the neuroscience and the ophthalmology research and try to understand that. And this is not my expertise, but yet sort of sitting down and realizing, OK, we also know that red and yellow are the easiest colors for our eyes to see because of their long wavelength. So we're going to use teachers and staff that work with these students. They use yellow and red.
Erika Eitland (35:01.43)
deliberately in their pedagogy. For us, we've sort of deliberately lined certain doorways with red or yellow to help with their own visual latency. So it takes students also a couple of extra moments to be able to understand where they are, to know that, oh, I'm transitioning from classroom to outdoors or we're going somewhere else in the building. And so creating these spaces where we're not covering everything in it because it diminishes its...
necessity to have impact. So, you know, being able to figure out, OK, we're going to use color in a way, we're going to use smell in a way, thinking about ventilation, knowing that this is a population that is more sensitive to epilepsy and knowing that air pollution is also a huge issue because this is an urban site. It's in the middle of Boston. It's right next to symphony where you have a major tea line and computer trail like rail right behind it.
To me, when I like look at this, we also had to realize that those noises can be alerting, distracting. And so how are we not going to oversaturate or overstimulate these students, but actually protect their own learning and creating the independence and allowing them to communicate in the way that's best for them. So to me, I mean, what's magical, and it goes back to sort of those first two points, which is, you know, I was involved from the very beginning of that project.
and time and money were given, which is something that not all firms can do, but given to do that research, to understand the ophthalmology, the neuroscience, the occupational health aspects of this, and then be able to also have built it in so directly that integrated, you know, funfetti cake, that when it came to value engineering, especially during inflation being at its peak, some of these features couldn't be taken out. They were too protected.
And they were too valued by both the design team and the client to say, no, you can't do that. You need to find the money. We're not giving this up. So, you know, this is an example of like one school that definitely needed this type of thinking. But I would say that most building types, that combination of early involvement and doing the research and embedding it to the mission of that place will lead to a result that it stays protected and integrated.
Gayathri (37:27.206)
And that initial investment of time and money is going to serve so much more in the long run. That's a really great example. And thank you for walking me through all of these. Sorry. All of these pieces that went into making that school, you know, comfortable and a place that makes kids with CVI feel like they can belong.
Erika Eitland (37:34.272)
Yeah.
Gayathri (37:56.65)
or they can function because it's such a small piece, they probably don't feel like that in any other space, except for the school. So it, go ahead. No, no. No, I was just continuing that thought. So go right ahead.
Erika Eitland (38:05.642)
Yeah, go ahead, go ahead. I'm all excited now. So this is what happens with me.
Erika Eitland (38:16.902)
No, I mean, I think for me, what's interesting is that this is a school that'll serve students from ages 3 to 22. So in terms of like an indoor environment in their life, outside of their home, this is the second most important space to them. And is something where, you know, even the teachers and staff who are there are just these rock star people. Like you can't, the very first time I went, I literally cried afterwards because the way that team supports these students.
Gayathri (38:24.546)
Bye.
Gayathri (38:30.846)
Yeah.
Erika Eitland (38:45.91)
They were giving everything they got. So it was also like, how are we gonna improve their efficiency? How are we gonna make sure that they have moments of restoration? Are they able to have moments where they can take these students out of a larger group if that's feeling overwhelming to them? You know, where is the staff space? Is it located near outdoors so that they can take that moment? So it's the importance of these buildings as individuals life.
is almost 20 years. And yet, if I think about how long buildings typically last, where it's 50, 60 years, I mean, think about the hundreds of students, thousands of students that are gonna go through that space. And so I think that's why, like to me, this design field still feels like public health, because if we think about the temporal aspect of it, there's a lasting implication, and the number of people that will spend and use that space is pretty wild.
Gayathri (39:44.818)
Mm-hmm. And the long-term impact of that as well. Erica, I want to talk about you for a second. We spoke about a lot of things, but I want to focus on you. You're probably the only person in the public health professional working in a leadership role in a company in the building industry across the world that I know of.
Erika Eitland (39:52.834)
Okay.
Gayathri (40:11.606)
So that means that you probably took... Well, if somebody listening is please reach out and I'll keep you posted, Eric. I'll connect you both. But can you tell me a little bit about your journey and what got you here?
Erika Eitland (40:11.858)
Oh gosh, I hope not.
Erika Eitland (40:17.978)
Yeah, I wanna know you too.
Erika Eitland (40:31.418)
It has been a real example of serendipity favors the prepared. You know, I'm half Indian. So naturally, my mom's like, so you're going to be a doctor, like a medical doctor. Yeah, it's got to be doctor. And to me, I did genetic engineering and stem cell research in undergraduate. And that was clear droplets and clear droplets. And that was having impact. So then without a.
Gayathri (40:43.43)
You're going to have the DR in your name. Yes.
Erika Eitland (41:00.178)
a job or even a bank account really, I moved to New York. And there, you know, ended up meeting and networking with such amazing people who kind of took a chance on me. And one of the very first jobs that I got was doing sort of a needs assessment for Astoria Houses, which is a part of the New York City Housing Authority complex. And, you know, going to community meetings and hearing pre-Superstorm Sandy.
Gayathri (41:22.975)
Mm-hmm.
Erika Eitland (41:29.718)
just the level of need that was there. And what were young mothers facing? Squirrels falling into their cribs and all this stuff. And I remember going to a community meeting in the basement of this big public housing building. And I, I'm 20 years old, I'm a punk. And I walk in there and I stand up to ask a question. And this woman who must have been running it for 30 years yells, sit down, this meeting isn't for you.
And it was the fastest lesson in listen, be a like humble, radical listener. And I think that has been something that really served me. You know, I ended up going to Columbia University for my master's focused on climate. And it was really about understanding how did these two things connect. And then by listening and, you know, also being in love with
architecture student at City College at the time, going to City College after my classes and public health wrapped up and like, oh, we're talking about the same thing. I'm hearing what you're saying, but we're not connecting it. And so that evolution of just realizing how do I play operator? I connect you to you and me to this and how does this all fit together? And I think that systems thinking has really been quite helpful for me to kind of constantly evolve. And so, when I told my mom that I was gonna be a
Gayathri (42:38.306)
Hmm
Erika Eitland (42:57.082)
a doctor, but it was going to be in public health. She, at first, was a little bit like, huh, how did we get here? And yet, I think that evolution really has made a lot of sense. And so then, never in a million years did I think I'd be at a big architecture firm when I started this journey. And yet, to me, I think this is one of those places where we can make radical difference. We can really touch sort of individual projects, give examples like the Carter School.
start to figure it out because it has, we don't have time to waste. We don't wanna write just research articles that are sitting on shelves collecting dust. We just have too much at stake. Things are changing too fast and I think we need everybody on the team to kind of start figuring this stuff out. So I feel very lucky for having sort of this unique path.
Gayathri (43:34.221)
All right.
Gayathri (43:48.746)
If you could give your younger self a piece of advice, what would it be?
Erika Eitland (43:55.582)
I think have more fun. I think it, have more fun. I think it took me quite a while to realize I just needed to have more fun. And why I say this is that, you know, whether it's climate change and urban heat island, or it's, you know, the obesity epidemic, or it's, you know, the world is on fire, and it's five different flavors. You know, you open the news and you sort of get paralyzed by that. But the idea is, is that
Gayathri (43:57.584)
Have more fun.
Erika Eitland (44:25.222)
if we were to use joy, if it goes back to my superpower, I think we as a species are meant to be together. And we're at a point where we have complex problems that require lots of different skills and perspectives to actually work on the ground. And so I have found that by having more fun, you bring more people in, you don't have to do it alone.
And that pressure that you put on yourself of like, I gotta be the one to change the world. That's not, nobody changed the world by themselves. And I think there's definitely leaders in the field. And yet I think the biggest thing that I am so grateful right now is the incredible teams that I work with. Nothing happens just by myself. There is easily 15, 20 people who are
stealing sort of their midnight hours to literally work on making this happen because they believe in that with me. And so, for any of the young designers, be yourself, have fun with it, find your people, and if you can't find them, go somewhere else. Because you cannot waste sort of precious time trying to fit into someone else's mold. We just don't have time for that. So, um, yeah, have more fun.
Gayathri (45:47.562)
Have more fun and find your people. That's really powerful. Where can folks find you, Erica? I mean, do you want to talk about your amazing podcast?
Erika Eitland (45:56.534)
Oh, yes. So, I'm calling in for my closet. So, thank you. You know, I'm in a design field. You got to have something up on the walls. No, I mean, for me, so I am the co-host of Inhabit, which is a podcast dedicated to understanding the power of design. And so I've had great co-hosts and we're on our season three right now.
Gayathri (46:03.552)
Very pretty closet.
Erika Eitland (46:24.79)
where we're really looking into public space. And yet I think the way that we're doing, I feel very honored because, you know, even just from an optics perspective, architecture predominantly has been driven by older white affluent men. And so to be an outsider, insider, be a person of color, be able to...
Gayathri (46:41.168)
Mm-hmm.
Erika Eitland (46:50.99)
share and sort of reflect on this and yet get to nerd out about things that we think are really important. I think it's been an incredible opportunity to have that science communication and yet have fun with it. Other work that I think is really exciting and relevant to this group is this year we're going to be releasing a public health data tool. So it's a public repository that's going to have the opportunity to...
educate designers on what are big health indicators? Why do you need to care about asthma? Why do you need to care about traffic proximity or NDVI, which is an indicator of greenness? And so give all that context and information and have fun with it. And then we've been pulling in all of the data from CDC and EPA and others and census so that if you're in the US, you can type the address of your site and literally see what are the big health priorities.
And then go through in sort of the third part of this, it's three-legged stool that we've created, is then what are the strategies? What are the recommendations that we think are available to us? So what does the leads, the wells of the world, but what does also the peer reviewed literature tell us? What do we know or think is possible? What are best practices that have been documented? So right now we're actively recruiting sort of in crowdsourcing, what strategies are there that we need to be?
testing from a research standpoint, ones that we should be embedding if they're really well-defined and clear. Because I think we, you know, for me it's really about de-siloing. How do we invite people in? And so we realized that another data dashboard wasn't gonna solve this. You needed to, you know, educate our young designers why the hell this is so important. And we needed to be able to say, okay, now what are you gonna do about it? Well, we don't, we have good guesses.
Gayathri (48:28.779)
Yeah.
Gayathri (48:34.478)
Mm-hmm.
Gayathri (48:43.47)
Mm-hmm.
Erika Eitland (48:45.542)
And yet, one thing that's embedded in this whole, so we call it Proceed. And if you go to proceed.perkinswill.com, you can find it. But what's really exciting is that even that this is just an invitation to think about health early in the design process. It is not about, oh, here's the answer. Oh, it's asthma for you. I mean, public health data, because of privacy, because of access,
Gayathri (48:53.203)
I will definitely add that to the show notes.
Erika Eitland (49:13.35)
we might not be actually quantifying exactly the health outcomes that are most relevant to a senior affordable housing building. But what it allows us to do is from the moment that you receive that RFP, well, what's happening in the neighborhood? Because the minute we walk in the front door of a building, we are carrying our health context with us. And so how are we going to alleviate some of that? And how do we open that conversation with our clients?
Hey, so is this right? Is it asthma? No? Oh, it's about mobility impairments and safety and security. Okay, well then we're gonna have to shift our focus because I think we all can relate, like there's not infinite money. And so we wanna make sure that I might be like, it's asthma. And they're saying, no, it's really about safety and security for me. That their understanding, they are their own best sensors. They are the experts of their community. That's what we need to be prioritizing.
Gayathri (49:48.174)
Hmm.
Erika Eitland (50:10.75)
So, Proceed is just an invitation to think about health and think about it more broadly and start to embody this environmental restorative justice lens into our process. And it is all open source. We're very lucky we received a grant from the American Society of Interior Design Foundation to kick off this work. Perkins and Will contributed significantly to it. And the team, to go back to your people.
You know, we've got urban designers, interior designers, architects. We, you know, I pulled in grad students and I was like, help us, let's get data scientists and engineers on this. And I think, you know, when it comes out and releases in early January, 2024, you will see that thoughtfulness come through. Cause again, you can't do it by yourself. You need everybody to be able to get to something that is actually, I think, impactful.
Gayathri (51:04.834)
I'm gonna keep my eyes peeled for that. That sounds like a game changer. Okay, great. What's giving you hope right now, Erica? As we look into the future.
Erika Eitland (51:07.078)
Oh, I'll send it to you. It should be really fun.
Erika Eitland (51:21.818)
I think there is an urgency and a clarity and an intensity from this next generation of designers. I think they know what's at stake. I don't need to tell them why health matters. I don't need to give them all the sexy stats. They know. And I think they're ready to figure it out and to do something about it. And
I would say that that's the one thing that gives me the most hope because without that sort of engine behind us, the whole train isn't going to move. It's going to stop eventually. And so knowing that there's this continued focus and momentum to thinking about measurement and data and research and health, I mean, this is what it's going to take is those designers who are at this point in their career.
also being in leadership later on and being able to say, nope, this is just status quo. You know, I think knowing that you've talked to Rick Friedriese, what's fun to me is that where were we 20 years ago? We were at the beginning of the green building movement. And now we have this opportunity that to really push for, what is the healthy and green movement look like together? Because it isn't just one or the other. And I'm so tired of us. Well, it doesn't serve energy efficiency.
Gayathri (52:46.581)
Yes.
Erika Eitland (52:47.981)
I've got to do more than that.
Gayathri (52:51.146)
Erica, thank you so much for coming on. And folks, this is Dr. Erica Etland. So this was such a great conversation.
Erika Eitland (52:54.631)
Oh my god.
Erika Eitland (53:00.79)
Thank you so, so much for having me.
Gayathri (53:03.218)
And that's a wrap!
Erika Eitland (53:04.778)
Woo!