Universal Design and Health  

by the WBDG Accessible Committee and
Victoria Lanteigne, WELL AP, Senior Accessibility Consultant with Steven Winter Associates, Inc.


As the eight Goals of Universal Design (Steinfeld and Maisel, 2012) suggest, an integral part of designing high performance spaces for people with disabilities is incorporating health and wellness into the built environment. In fact, many of the public health concerns targeted by health and wellness design strategies qualify as disabilities under the Americans with Disabilities Act (ADA), such as asthma, diabetes, heart disease, and chronic illness, among others. Addressing public health issues through design can contribute to overall health promotion, avoidance of disease, and prevention of injury. (Steinfeld and Maisel, 2012).


There are several design initiatives that continue to grow in importance and promote the improvement of health and overall human wellness, including, but not limited to:

AIA Designing for Health

AIA National's Designing for Health initiative has a goal to enhance the physical and mental wellbeing of building occupants. The initiative outlines six design strategies to achieve health in the built environment, including: safety, social connectedness, environmental quality, sensory environments, physical activity, and access to natural systems.

Healy Family Student Center at Georgetown University, girl on circular couch with living green wall panels in the background

Healy Family Student Center at Georgetown University was designed to provide access to the natural surroundings. The project received an AIA|DC Presidential Citation for Design and Wellbeing (2015) and is a LEED Gold project awarded in 2016 under LEED ID+C: Commercial Interiors, LEED v2009.

Active Design

Active Design is an evidence-based approach to development that identifies urban planning and architecture solutions to support healthy communities (Center for Active Design). By incorporating features of Active Design, we can have an impact on our most pressing health challenges including the physical, mental, and social wellbeing of communities worldwide. Active Design strategies represent a comprehensive approach, which includes active transportation, active buildings, and access to nutritious foods and active recreation facilities, among others.

The New School, New York City, Example of Active Design

The New School in New York City is an example of Active Design. Interactive spaces are dispersed vertically throughout to activate all levels of the building. Tying them together are three iconic stairs that weave their way through the building, providing ample opportunities for encounters. The project also received LEED Gold for New Construction and Major Renovations 2009 and is an AIA TOP 10 winner.

WELL Building Standard

Established by the International WELL Building Institute, the WELL Building Standard® (WELL) is a performance based program that promotes the concept of health and wellbeing in the built environment. WELL uses an evidence-based system that measures building features that impact health and wellbeing across seven concepts: air, water, nourishment, light, fitness, mind, and comfort. Projects that undergo the WELL certification process may receive a silver, gold, or platinum level certification depending on the number of features met from each concept.

Phipps Conservatory and Botanical Garden

The Center for Sustainable Landscapes (CSL) at the Phipps Conservatory and Botanical Gardens in Pittsburgh, PA, is the result of a unique facilitated integrated design process. The CSL generates all its own energy, captures and treats all water on-site, and is the first and only project to attain the planet's highest sustainable building certifications: Living Building Challenge™, LEED® Platinum, first and only 4 Star Sustainable SITES™ project (pilot), and the first and only WELL™ Platinum Building.

Shared Goals and Design Strategies

There are several shared goals and design strategies among health and Universal Design initiatives. These shared goals, such as the improvement upon ergonomics, sleep, safety, physical and mental health, among others, not only serve to create healthier environments, but also can contribute to better spaces for people with disabilities. Moreover, the inclusion of health strategies in design can assist individuals currently living with disabilities by mitigating chronic symptoms or preventing certain disabilities or injuries from occurring.


It is estimated that 31 million Americans are impacted by Musculoskeletal Skeletal Disorders (MSDs), most common of which is lower back pain.1 Ergonomically designed furniture and fixtures can greatly reduce the pain and discomfort associated with MSDs; and can help to prevent MSD's through better posture and body placement. Visual ergonomics such as eye-to-screen ratio, task lighting, screen colors, and monitor tilt reduce eye strain, and can be particularly helpful for people with low vision.


Approximately 50–70 million U.S. adults are suffering from a chronic sleep disorder. This type of sleep deprivation is associated with increased risk of heart attack, diabetes, obesity, hypertension, and stroke.2 Proper exposure to periods of both lightness and darkness helps humans to regulate an internal clock knows as the circadian rhythm. Features such as adjustable task lighting, proper fenestration, and automated shading or dimming controls can help promote better sleep.


Designing for safety protects people from physical harm, and removes impediments that cause anxiety, stress, and psychological harm. For people with disabilities, safety is paramount when determining accessible routes to all features, elements, and spaces of buildings and communities. In addition, the comfort of knowing spaces are easily accessible can reduce stress and anxiety for individuals with disabilities who often experience challenges while navigating the built environment. Design strategies such as open sightlines, wide usable routes, clear and defined circulation paths, and thoughtful lighting can help to achieve a sense of safety in the built environment.

Physical Health

Over two thirds (69%) of American adults are overweight, and more than one third (35%) are obese.3 In addition, behaviors said to contribute to obesity rates such as lack of physical activity and poor diet can lead to heart disease, type 2 diabetes, certain types of cancers, etc.4 Physical fitness can help to reduce anxiety and stress and alleviate chronic pain, which is particularly important for people who are dealing with mental illness or certain physical disabilities. Design strategies such as exterior pedestrian amenities, interior circulation paths, adjustable sit/stand workstations, and spaces for physical fitness that include options for people of all abilities greatly enhance the opportunity to improve physical health.

Mental Health

Major depression is one of the most common mood disorders, affecting 16 million adults in the U.S.5 Furthermore, mental health issues such as chronic anxiety and stress lead to increased risk of cardiovascular diseases and gastrointestinal disorders. While mental illness is considered a disability under the ADA, current accessibility laws and codes do not include design requirements to address this epidemic. The addition of certain aspects of the built environment can greatly improve mental health, such as beauty in design including art, music, and colors; options for social connectedness; and spaces that celebrate culture and spirit.

Universal Design in Residential Construction

As the population ages, Universal Design is gaining in popularity in residential home construction to allow occupants to age in place or who become disabled. Universal Design concepts and strategies, properly considered at the beginning stages of concept design can be successfully implemented without adding significant cost to the overall construction budget. Installation of textured floors aids in slip resistance as a person ages. Proper location of outlets helps avoid having loose electrical cords that create a tripping hazard later as the occupant ages. Concepts such as widened doorways and hallways represent increased circulation/flexibility, and later when needed, also ensure increased mobility and barrier free accessibility which allows aged persons to stay in their home longer and thus reduce making a decision to transition into assisted living units which already have barrier free access accommodations. Aging in place improves the physical and mental wellness of an increasingly growing aged population.


The USO Warrior and Family Center at Walter Reed in Bethesda, Maryland is a 16,000 square foot project designed as a facility for wounded soldiers and their families and caregivers. A focus group was led during the planning stage of the project to determine what types of features were important for likely building occupants, which included elements such as normalcy, recreation, education, work, and respite. The Center is designed to address injuries that impact both physical and cognitive abilities; as well as mental wellness. The Center demonstrates both health and Universal Design strategies; and as such was the recipient of the AIA|DC Presidential Citation for Universal Design in 2014, and the AIA|DC Presidential Citation for Design and Wellbeing in 2015.

The USO Warrior and Family Center at Walter Reed in Bethesda, MD

The USO Warrior and Family Center at Walter Reed in Bethesda, MD demonstrates both health and Universal Design strategies.

The USO Warrior and Family Center community room with large windows
The USO Warrior and Family Center community room with natural design materials

The Center contains community rooms to promote social connectedness, and large windows to bring in natural light and elements of nature.

The Center is universally designed to provide physical access, open sightlines to promote safety, and natural materials for a calming effect.

Additional Resources



1 [Katz, Jeffrey N. Lumbar Disc Disorders and Low-Back Pain: Socioeconomic Factors and Consequences. The Journal of Bone and Joint Surgery 88a.2 (2006): 21-24. Web. 26 Aug. 2014.]

2 [Institute of Medicine. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: The National Academies Press; 2006.]

3 [National Institute of Diabetes and Digestive and Kidney Diseases. Overweight and Obesity Statistics. October 2012. https://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx. Accessed September 15, 2016.]

4 [World Health Organization. Unhealthy Diets and Physical Inactivity. NMH Factsheet June 2009.]

5 [Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-49, HHS Publication No. (SMA) 14-4887.]

6 [American Heart Association. Stress and Heart Health. June 2014. http://www.heart.org/HEARTORG/HealthyLiving/StressManagement/HowDoesStressAffectYou/Stress-and-Heart-Health_UCM_437370_Article.jsp#.V9rlgI-cH4g. Accessed September 15, 2016.]