About eight years ago I transitioned from the music industry to the healthcare industry. After a decade as label manager for Asthmatic Kitty Records, I was offered the opportunity to help design, build, and program a new public hospital campus for Indianapolis. On the surface this might seem like a dramatic career change, but my role now is very similar to the work I was doing with the label. With Asthmatic Kitty, I worked to build community and develop a space where we could create, collaborate, and thrive. Now my job is to support Eskenazi Health in the design of programs and spaces that meet the needs of the Indianapolis community, support the development of healthy physical and social infrastructures, and—similar to the record label—foster a culture in which our citizens can create, collaborate, and thrive.
Eskenazi Health is Indianapolis’ public health system. It comprises a downtown hospital and ten primary healthcare clinics throughout the city. While the hospital has had different names over its 160-year history, the mission has always been to serve the health needs of the community regardless of their ability to pay. While there are other hospital systems in the city, as the public hospital, Eskenazi Health supports uninsured individuals and those that are vulnerable to rising healthcare costs.
In 2014, a new downtown hospital campus was completed thanks to what is believed to be the largest gift ($40 million) ever given to a public hospital in US history. This LEED Gold-Certified campus is one of the most sustainable hospital campuses in the country. It features a robust public art collection and a diverse music program that celebrate the many cultures and communities the hospital serves.
But perhaps its most unique feature, one that was designed as both a place for healing and an aspiration for the city of Indianapolis and beyond, is the rooftop farm. On top of the six-story outpatient building is a public outdoor space with raised garden beds, beehives, composting bins, and places to gather, sit, share a meal, and look out on the skyline of Indianapolis.
The Sky Farm, as it is appropriately named, has a dedicated sky farmer and produces about 3,000 lbs. of food a year. The food goes to a nutrition education program for patients and employees and to the organization’s various dining facilities. Not only does the Sky Farm provide access to nature for patients and employees, it also provides access to the direct consumption of nature. Evidence shows eating a healthful and mostly plant-based diet plays a significant role in preventing, managing and even reversing chronic illness such as heart disease and diabetes.
The Sky Farm is aspirational by design. It physically expresses the hospital’s missional value of accessibility to healthy food for all. The Sky Farm has also helped inform the food procurement of the hospital system. Three years ago, Eskenazi Health purchased roughly three percent of its food products from “local” sources (then defined as a 250-mile radius, an area that stretches as far as St. Louis). Today, the hospital system buys more than 40% of its supplies from Indiana agriculture, with a goal of passing 50% by the end of 2018. Money used for food procurement becomes reinvested locally and grows the economic viability of local farms. Fresh foods that have been recently harvested not only taste better, but are packed more densely with micronutrients and decrease the need for preservatives. There is also a decrease in the hospital’s carbon footprint by the reduction in food transportation and packaging.
About 50% of the determinants for health are related to lifestyle or factors that influence lifestyle, such as diet and the built environment, while only about 10% of an individual’s health is impacted by the biomedical model. Unfortunately, in this country, we have disproportionately funded this 10%. Healthcare has primarily been in the business of treating sickness as opposed to building systems that keep people healthy.
Culture manifests itself through the design of the built environment. And conversely, the built environment shapes the way we move, what we value, and how we interact with one another. I have witnessed this ongoing dialog between culture and built environment firsthand on the Eskenazi Health campus, where design continues to shape the institutional culture, and the culture of our organization is physically illustrated through the design of the campus. This intentional design of the campus builds on the strengths of our past, addresses the needs of the present and imagines and moves us towards a better future.
We need to start designing systems and environments that support better health outcomes because of a person's direct experience with these supportive systems and environments. We need to build (and sometimes tear down) spaces and places to advance social and economic equity. We need to imagine a new design language for our neighborhoods, cities and world that restores, inspires, offers hope and activates agency. We need to prioritize people over profit, and continually advocate for the investment of resources into the design of accessible, sustainable and equitable public spaces and institutions for all.
Michael Kaufmann is Vice President of Civic Investment for Health & Hospital Corporation, manages musicians Son Lux and Hanna Benn, and is founder and owner of This Is Meru (thisismeru.com). Michael has a rich history of cultural entrepreneurship, city-building and artist management. He works to empower others to create and experience surprising beauty.