Planned Morbidity: Examining the Architecture of Health Through a Systems Lens
Most systems approaches examine phenomena based on three key elements that anchor systems: boundaries, interrelationships, and perspectives (Williams and Hummelbrunner, 2009). For clarity, when thinking in terms of boundaries, think marginalization; in terms of interrelationships, think community, and in terms of perspectives, think bias. The systems of societies are constructs and their form and function were determined by the architects that designed them, based on their biases, to serve specific communities. Marginalization was an intended byproduct, planned into the scaffolding of the system and its boundaries. So this begs the question: how were the spaces in which we live, work, and play designed to create the communities we engage with and the resources we do or do not have access to? Who designed these spaces and what bias planned who ought to benefit and who ought to suffer? Perhaps most importantly, what does that mean for the marginalized? The boundaries of systems abut marginalization, and at this intersection lie the social determinants of health, that drive morbidity and mortality. This text examines how the form and function of urban design systems created one of the most predictive models for determining health outcomes..
Marginalization by Design: William Levitt and Suburbia
The suburbs were designed to be a solution for the lack of available housing for veterans returning home from World War II, an inexpensive utopian solution to central business district congestion and chaos. The brainchild of William Levitt, these houses were affordable, mass produced representations of status arrival. These homes were grouped into communities called Levittowns after their namesake and promised homeowners an escape from the ills of modern city life. Levittowns were the inaugural suburbs, collections of Cape Cod-styled row houses with yards and modern kitchens (Roos, 2026) positioned outside of the city center on Long Island and later in Pennsylvania. Levitt houses were simple and like Henry Ford’s automobile, were designed to be mass produced and inexpensive. Also, like Ford’s automobile, they were an escapist solution for a white middle class exodus from the dense, predominantly black urban neighborhoods. Both the automobile and the Levitt house became tools for crafting the modern day system of housing disparity and wealth inequality between white and minority populations. Levitt towns epitomized the concept of the American Dream and simultaneously set in motion a health nightmare for marginalized minorities outside their borders. Levitt fought to defend his segregationist white enclaves and the sprawling Levitt houses of the 1940s-1970s were the foundation for the modern housing crisis (Berenson). Today, zip code is the greatest predictor of health (Graham, 2016) and the architecture of suburbia in large part designed who’s health would suffer most.
How Suburbia Determines the Social Determinants of Health
The social determinants of health posit that the conditions in which people are born, live, work, play, and age and access to resources (money and power) drive health outcomes (World Health Organization). Levittowns were suburban precursors; a system formed by William Levitt and organized to fulfill a specific function: provide inexpensive housing communities for white families outside of central business districts and removed from the poor, criminal immigrant, and general urban unpleasantness (Graham, 2016). In so doing, the suburbs became an escape from the industrial, sociopolitical, and psychological adverse effects of inner city life. Designing housing structures in enclaves away from the city center meant living in those houses became accessible only to those with the personal transportation resources or financial means to commute outside of the suburb for work, school, play, shopping, and other activities of daily living—mostly middle class white families. The suburbs were a symbol of status; the manicured landscaping and clean uniformity aesthetic stood in contrast to the boisterous chaos of the central business district and density of mixed residential and commercial use spaces. The Great Migration of blacks and African Americans to the city centers in the early 1900s, driven by the expansion of transportation (Badger, 2016) and the walkability of the city center meant lower income residents (often black and brown persons) were out and about, visibly engaging with the space and the amenities available to them within their means. This also meant increased exposure to exhaust and manufacturing chemical byproducts as wartime expansion contributed to increased off-gassing and air pollution. Urban crowding meant increased opportunities for communicable disease transmission. Furthermore, the psychological burden of living within close proximity to so many people, sharing so few resources contributed to reduced cannot be understated.
The Creation of Levittowns
The creation of Levittowns determined who would gain access to better health outcomes. Distance from the urban center meant better air quality, escape from overcrowding and poor sanitation, and the need for a car meant personal transportation for getting to medical appointments and the privilege of choice: choice over which doctors to see, which grocery stores to shop, and which places to convene. Keogh (2023) argues that politicians and activists conceptualized the Levittown as a model for creating poverty-free egalitarian communities and with blinders set in motion the construction of suburbs across the United States. William Levitt designed the cookie cutter, and Frederick Law Olmstead made the dough, churning out aesthetically pleasing suburbs in Riverside, Illinois, Brookline and Chestnut Hill, Massachusetts, Roland Park, Maryland, and Yonkers and Tarrytown Heights, New York (Graham, 2016). This further cemented the disparities between minorities and the white middle to upper classes and is evident in modern health disparities: the worst health problems and morbidity remain concentrated in marginalized and segregated neighborhoods (Corburn, 2006).
Conclusion: A System Full Circle
William Levitt, son of a developer who built his fortune on Great Depression mortgage foreclosures and Levittown’s namesake, drafted the prototype of what would become the American Dream, yet died destitute and in ill health at age 86 (Thomas, 1994). Though the irony of the Levitt’s death in poverty after crafting being the architect of idyllic white American utopian planning cannot be underscored, the purpose of this text is not to wax poetic about the life and legacy of a white supremacist. Instead, examining how systems are formed and persist provides insight into how their function can be augmented to benefit the very stakeholders they marginalize.
References
Badger, E. (2016, March 17). White flight began a lot earlier than we think. The Washington Post. https://www.washingtonpost.com/news/wonk/wp/2016/03/17/white-flight-began-a-lot-earlier-than-we-think/
Coburn, J. (2006). Urban planning and health disparities: Implications for research and practice. Planning Practice & Research, 20(2), 369-381. https://doi.org/10.1080/02697450500414652
Graham, W. (2016). Dream cities: Seven urban ideas that shaped the world. HarperCollins.
Keogh, T. (2023). In Levittown’s shadow: Poverty in America’s wealthiest postwar suburb. University of Chicago Press. https://doi.org/10.7208/chicago/9780226827742.001.0001
History.com Editors. (2019, June 10). Levittown. HISTORY. https://www.history.com/topics/1950s/levittown-suburbs-tract-housing
Keogh, T. (2023). In Levittown’s shadow: Poverty in America’s wealthiest postwar suburb. University of Chicago Press. https://doi.org/10.7208/chicago/9780226827742.001.0001
Thomas, P. (1994, January 30). William J. Levitt, pioneer of postwar suburbia, dies. The Washington Post. https://www.washingtonpost.com/archive/local/1994/01/30/william-j-levitt-pioneer-of-postwar-suburbia-dies/5b966bf8-0a69-436c-aa0b-4f3a8e63ed95/
Williams, B. & Hummelbrunner R. (2009). Systems concepts in action: A practitioner’s toolkit. Stanford University Press.
World Health Organization (n.d.). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1