Committee on the Environment

COTE Book Review:
Architectural Epidemiology: Architecture as a Mechanism for Designing a Healthier, More Sustainable and Resilient World

by Adele Houghton, FAIA, and Carlos Castillo-Salgado

Review by Theresa Mark and Z Smith, FAIA

Architects know that buildings can affect the health of those who spend time in them.  Of course, good design always adapts to the particulars of each site and the needs of the occupants.  But there's a whole field of study that looks at the impact of location, demographics, and policy on health and disease: "epidemiology."  What if architects (and building owners and developers) spoke with public health experts and developed a common language for talking about where to locate and how to shape buildings and outdoor spaces to have the best possible impacts?  That's the premise behind Architectural Epidemiology: Architecture as a Mechanism for Designing a Healthier, More Sustainable and Resilient World (Hopkins Press, 2025), a new book by architect Adele Houghton, FAIA, and public health expert Carlos Castillo-Salgado.

The authors observe that, given finite budgets, there's no one universal "healthy building".  A building located at a site near heavy road traffic may need to invest more of its budget in measures to counteract particulate matter in the air, while a facility for small children whose development is more sensitive to chemical exposures may be willing to spend a bit more of the budget on avoiding chemicals of concern in finishes. 

But where we build (or renovate) can have as big an impact as what design choices we make. A super green building that can only be reached by driving may lead to poorer health outcomes than a less perfect design that can be reached by transit and walking or by bike.  For many architects, the owner has already picked the site, but sometimes owners and developers seek our input in evaluating sites–we aspire, after all, to be the owner’s trusted advisor. Architectural Epidemiology gives us the tools, the language, and the peer-reviewed references to make the case with owners, and to assert ourselves as civic leaders to advocate for policy changes informed by these insights.

For seasoned practitioners, this book can at first seem to be telling us things we already know–the usual laundry list of items captured in LEED, WELL, Fitwel, and Living Building Challenge.  But it provides an impressive and nuanced compendium of all the key issues and opportunities and brings the receipts—the citations showing that these design moves are grounded in sound science. Speaking as a practitioner, one us (Z.S.) found himself exclaiming that he’d wished he’d had this book years ago as a resource for the citations needed to bolster the case being made with clients. 

The other of us, Theresa Mark, is earlier in her career but brought training in both health design and architecture to the table, so looked forward to how this book would stitch these threads together. At the outset of her Masters in Health and Design program after architecture school, she found that the conversation of how the built environment influences human health was already well established in the fields of public health and epidemiology. As with this book, several of her courses opened the topic with London’s nineteenth century cholera outbreaks as the origin of modern epidemiology, which was precisely a case study of how the interaction between infrastructure and where buildings were sited could negatively impact human health. Why is this connection between health and design not meaningfully discussed in contemporary architectural training? As argued in this transdisciplinary resource, architects, developers and all those tasked with designing the built environment ought to have a seat at this table, integrating the data of environmental and social health determinants into our practice. 

Architectural Epidemiology offers this invitation to design professionals. Rather than conceptualizing health-focused design as a specialization, this resource provides a framework for applying epidemiological approaches to all project phases. This framework presents a method of moving beyond general best practices to propose design solutions that are informed by gaps and shortfalls experienced in the particular communities we work with. 

This book also encourages architects and designers to become advocates for community and individual health by providing responses to common concerns regarding the feasibility and efficacy of this transdisciplinary work. Further, Architectural Epidemiology highlights the health impact of architectural design to students as an educational resource, enabling literacy in health assessments and population data. It responds to the gap one of us (T.M.) experienced as a graduate student, wondering why the relationship between health and design had been underexplored in many architecture programs.

This book is a great resource. We hope that its publication fosters greater dialogue and interest in interdisciplinary approaches for the improvement of health in the built environment. 

We hope you will join us for the COTE book talk on 2 December, 2025, 12-1pm EDT. We (Z and Theresa) will join Adele Houghton in discussion of the book and the potential of architectural epidemiology. This event will be hosted by AIA Philadelphia COTE. The event is virtual, free, and will earn you 1 CE/LU HSW (pending) ... register here: https://aiaphiladelphia.org/events/view/architectural-epidemiology-how-architects-can-meet-owner-challenges-community-requirements. 

Z Smith, FAIA, is Principal and Director of Sustainability and Building Performance at EskewDumezRipple. His built work includes academic, laboratory, and residential buildings, including winners of the RAIC Green Building Award and the AIA COTE Top Ten Award. He brings training and experience in physics and engineering to the field of architecture, and is named as inventor on 10 patents and author on over 50 peer-reviewed scientific publications. 

Theresa Mark is a designer and researcher in the New York City area. She served as a Research Fellow with EskewDumezRipple (June 2024-2025), exploring the question: How can we as designers provide equity in the experience and perception of our spaces? Learn more about her research here. 

related links - 

https://www.architecturalepidemiology.org/

https://www.press.jhu.edu/books/title/12502/architectural-epidemiology?srsltid=AfmBOorjry38UqEeC_h2mMyFZe-449W_VOH-pJ9EBKBgLWHyf3ES4c94

Architectural Epidemiology REVIEW / By Vivian Loftness | Buildings & Cities :: Former COTE chair reviews the new book, calling it a “critical addition to the body of literature on health in the built environment, invaluable for design professionals and educators, public health leaders, property owners and managers.” >>> Read more here.