Five key takeaways from Dr. Sanjay Gupta's Day 2 keynote at AIA24

“So much of life is serendipitous,” said Dr. Sanjay Gupta, neurosurgeon and CNN chief medical correspondent, in a keynote conversation with AIA president Kimberley Dowdell, AIA, NOMAC, at the AIA 2024 Conference on Architecture in Washington, D.C., on Friday, June 7.  

Gupta credits serendipity with bringing him to both medicine and journalism. In a wide-ranging interview with Dowdell, Gupta discussed his upbringing in Detroit, his experiences covering conflicts and natural disasters for CNN, and his thoughts on the many intersections between design and health. We outline the key takeaways below.  

“Wealth does not buy health.”  

Dr. Gupta emphasized the disparity between the amount that the United States spends annually on health care -- $4 trillion a year – in relation to the overall health of U.S. citizens. “I think you expect certain things in return for that [spend],” he said. Despite the U.S. being theoretically well-prepared for an event like the COVID-19 pandemic, its population still suffered a high mortality rate.  

“One of the things I think is really important is, if you look at our population as a whole, about 70 percent of the population had preexisting conditions that really set them up for more illness, or even death,” he said. “There is this solace I think people take sometimes – we're spending $4 trillion, we’re one of the wealthiest countries – wealth does not buy health.” Due to a focus on retroactive treatment of disease rather than prevention, as well as racial and wealth disparities, are major contributors to the high cost of medical treatment.  

Using early pandemic data out of Chicago as an example, Dr. Gupta said, “You were twice as likely to get sick and die depending on the color of your skin, or where you lived within that city. That was shocking.” Addressing racial health disparities must be a focus of both the architecture and health care industries going forward, he said.  

How can we build greater resilience into our health care infrastructure?  

Dowdell asked Gupta how we might be able to build greater resilience into our health care infrastructure in the future.  

“I think there has always been this sort of dichotomy in public health between public health and profits – the idea that you have to sacrifice one to get the other,” he said. “Public health systems – [for] as much as we spend on healthcare, they have been pretty woefully underfunded. We will spend all this money to pull people out of the fire – these incredible scientific advancements for advanced stage cancers, advanced heart disease, things like that. But the idea of building resilience means truly investing in prevention and public health over profits. Nothing in the system is designed to incentivize that.” There are many countries, he said, that spend a fraction of what the U.S. does and have robust and effective public health systems.  

Good design choices can have numerous positive impacts on health.  

“I’ve spent a lot of time in hospitals and healthcare institutions all over the world,” Gupta said. “For a long time, hospitals were thought to be these sort of sterile environments, and sterile was what was associated with better health care outcomes. And then these studies started coming out, even in the early- to mid-90's, looking at the fact that just putting a window in a patient’s room was associated with a 20% reduction in mortality from cardiac factors. It was pretty clear something was happening there.” There is data now, he continued, showing that for patients and for staff, exposure to air, light and ventilation – and insulation from noise – can have numerous positive benefits. For Gupta, this was demonstrated at a hospital in Kigali, Rwanda, with open hallways. “Other countries don’t have the luxury of hermetically sealed healthcare spaces,” he said, which can have unexpected positive benefits.  

City planning and public health used to be intertwined. Can we bring them together again?  

Dowdell cited an NYU study demonstrating health disparities in Chicago. Life expectancies in the city’s northern Streeterville neighborhood hover around 90, while on the city’s South Side, residents of Englewood live to be about 60 years old. “That’s a 9 mile and 30-year gap,” she said, asking Gupta what he thought the reason was for this drastic difference and what could be done.  

“Structural racism has an impact on healthcare in ways that we are still starting to understand,” Gupta said. “Zip code is one of the biggest predictors of health outcomes, and it’s not by accident,” he said. “It’s not one of those things that just happened. It was by design.”  

“We see places around the world where people are extraordinarily healthy,” he said. “Where they live longer but they have not just a longer lifespan, but a longer health span. Some people call them Blue Zones – there are all sorts of ways of looking at these places. That sort of data is becoming important in thinking about public health and planning in terms of urban design overall, but also building design in terms of how we look to the healthy cities of tomorrow. There are a few places in the country where they’re starting to do this.” The planned community of Lake Nona, Florida is one good example, he said.  

AI is here to stay. What are the implications for both design and healthcare?

Dr. Gupta, who sits on the National Academy of Medicine’s Subcommittee on Artificial Intelligence, said that he was optimistic about the potential for the new technology, but that AI-generated information should by vetted by humans for the foreseeable future.  

“In the healthcare model – maybe it will be the same for your world as well, in architecture – I think it’s a very good tool, but I think the way we’re approaching it is through a ‘Trust, but verify’ model,” he said.