Some architects and planners are now intentionally designing-in building features that push people to be healthier.

Devin Madden, a coordinator with The Partnership for a Healthier New York City, helped introduce the concept of "active design" to students at The Renaissance Charter High School for Innovation. The adults enlisted the kids' help to work on the health problems in East Harlem. 

"The students knew about diabetes, they knew about obesity from the media blitz on obesity, but they also saw it happening to their community and to their families personally," Madden said.

The teachers asked the kids: "So, what do you want to do about it?"

The students wanted to start with changes at school.

"They said nobody's drinking water from the water fountains, the water fountains are disgusting and dirty and nobody wants to use them," Madden said.

The students decided to add a few plants or pictures of waterfalls to the area to make the old, white porcelain fountains seem more refreshing. The administrators had a better, bigger idea.

"The school team said: 'Listen, it's actually one of our priorities to encourage water consumption in school. We want our students drinking water. We're tired of seeing them drink the Arizona ice teas. We want to see our students drinking water.' So they got these newer, cooler water fountains," Madden said.

The new coolers have a spout to quickly refill a water bottle, and the water is cold.  Before, it was lukewarm. The school bought three new fountains for about $1,000 each.

After the project, about 77 percent of students said they use the new fountains--up from about 50 percent. Behavior change is the goal, advocates say. They're convinced that how you plan a space—or a neighborhood--shapes how people use it.

Envisioning a healthier neighborhood 

During a breakout session at New York's FitCity conference in May, urban planner James Rojas laid out table-sized maps of each New York borough and asked participants to re-imagine their community. 

The groups sifted through a pile of colorful baubles and bits, wooden blocks, pipe cleaners and plastic beads, then used the found objects and art supplies to build their own version of a healthier neighborhood.

Rojas says for planners and architects, often the hardest job is getting people to collaborate. He's sat through endless community meetings where open space advocates sit on one side of the room, while density advocates sit on the other. They talk about zoning and regulation, Rojas said, they rehash worn-out ideas such as adding bike lanes and farmers markets.

"We need to go beyond that. We need new ideas," Rojas said. "I shake it up. I give people a different way of looking at the world. All the materials kind of scramble their brain. People have an easier time building a solution than talking about it when it comes to city planning and architecture."

At one table, architect Gerard Paul pointed to his group's vision and said he wants to get rid of Brooklyn's postage stamp yards where each lawn is cut off from the next.

"Imagine you took out all the fences and this became a big park," Paul said. "So every block had a big park behind the houses. Of course there are issues of privacy, issues of ownership but I think, as planners, you can deal with that."

Sarah Wolf, Active Design Manager with the NYC Department of Health and Mental Hygiene, Bureau of Chronic Disease Prevention and Tobacco Control, says the city is trying to share building-design ideas that get residents up and moving.

"It's just about cueing the mind," Wolf said. "It's that point of decision where it's sometimes not even a conscious decision, but you see the stairs, so you just take the stairs because it's the first thing that you see."

The workshop was held at the Center for Architecture. There, Wolf pointed out the stairwell.

It's painted white and bright orange. Artwork covers one wall, and there's a mezzanine half way down where people can pause to rest--and look at more artwork--before descending to the ground floor.

And, the heavy stairwell door stays propped open. Wolf says that small feature creates a flow that subtly directs visitors from the lobby directly to the stairs. It's also an example of a healthy design idea translated into real policy. This year New York relaxed the building code that used to require stairwell doors to remain closed.

"And so, in the case of a fire, what these magnetic hold-opens do is they release the door allowing the door to close to control fire," Wolf said.

The building owners have also placed signs by the elevator encouraging people to take the stairs. The Centers for Disease Control and Prevention has tested similar motivational prompts with sayings such as "Fight fat. Frequent these flights."

A local example 

Mayor Bloomberg and his anti-obesity agenda kicked off lots of healthy-design changes in New York City, and those ideas are popular in Philadelphia, too.

The Public Health Management Corporation just moved to a brand new office space at 1500 Market Street.

The architects and designers planned lots of chances for people to sneak exercise into their daily routine.

Christina Miller, a senior program director at PHMC affiliate the Health Promotion Council, says the first thing you notice when you walk into the reception area is a "beautiful, grand staircase."

Putting wide, attractive stairs at the entrance to a building is one of the healthy design strategies that gets a blue star rating in New York's Active Design Guidelines for strategies supported by research and strong evidence.

Miller said other ideas are driven more by common sense or corporate culture.

The Public Health Management Corporation doesn't have vending machines filled with chips and soft drinks, but the organization does put out free fresh fruit each Monday morning. There are also treadmill desks on each floor for everyone to share.

In the communal kitchen you'll find big trash cans for the entire floor. No one in the office has an individual wastebasket under his or her desk.

"It seems like a really small detail, but you have to get up and go to the trash can at some point during the day. There's no avoiding it," Miller said.

PHMC designed the office to match its mission, she said.

Miller says she and other health educators are out in the community constantly telling people "eat your broccoli" or "walk a little more," but back in the old office, she never took the stairs.

"I always took the elevator because the stairs didn't feel safe. It was loud, it was dark, not a place I personally felt safe or comfortable," she said.

There are things designers can do to set the stage for healthier choices, Miller said. But ultimately employees do what they want.

"We're right above Suburban Station. As soon as you get off the El there's a Dunkin' Donuts right there. So if worse comes to worse and you really want your doughnut you can really go downstairs and get it," Miller said. "But here in this building you are not going to find it."

Some companies dedicate indoor space for bike parking and provide showers for people who cycle to work. Others give their workers bouncy stability balls to sit on during long meetings. And some advocates are lobbying for adult playgrounds at work where employees can go for a work-sanctioned recess.

"It's a wonder what a little nudge can do," Miller said.