Peter Williams: Building a Healthy Home

Pretty much from the age of 8 I was determined to be an architect. I grew up in Jamaica where I would always see people making basic changes to their houses, like adding rooms or renovating. I saw a guy mixing concrete on the road once and I remember saying to my dad, “I would like to do that.” He said, “No, son, you want to be an architect. You don’t want to be a construction laborer.”

In terms of the health addition, my dad ultimately developed a disease, which was attributable to poor housing conditions. He became paralyzed and bedridden. I saw the way in which something simple like a donation of a wheelchair from the local church was rendered inoperable because we simply could not move the chair between rooms—the doorways weren’t wide enough. It wasn’t until years later, when I was a design student that I was able to put those things together. On one hand, I saw that housing was directly responsible for my dad’s illness and on the other, housing was also incapable of meeting his cure needs.

Upon completing graduate school I received a fellowship to examine the link between AIDS and architecture in South Africa, the epicenter for the pandemic at that time. I saw firsthand that the context in which people lived presented itself as a risk factor associated with disease transmission. That really allowed me, over time, to reflect on the nexus between health and housing.

I was working as an architect, doing quite well, enjoying what I was doing and participating in an intellectually stimulating environment. I was loving that. It was perhaps the culmination of everything I had studied over the years. When I took a sabbatical to conduct the research in South Africa, I was working for the second largest design firm in the world. The juxtaposition of having those two experiences side by side—designing Apple stores in New York to being transplanted to a country like South Africa—that’s a life-changing experience. It was very difficult to reconcile those two worlds.

I was working on incredible projects. This was pre-recession where it was the Wild West, as I call it, in countries like U.A.E. and Southeast Asia. I was doing a lot of projects, but the more I did, the more there was something pulling me that said it wasn’t for me anymore. I felt that very little was being done to address the health-housing issue in a pragmatic way and there was no organization dealing with the issue globally. So I felt like if it isn’t being done, and I believe it should be done, then simply put, I needed to do it.

Our interest is 360-degree medium- and long-term development. We make a clear distinction between humanitarian work—meaning emergency-type work that we often see in post-disaster context, which is absolutely critical—and the kind of medium- and long-term development work to which we’re particularly committed. We split our time between the pragmatics (delivering projects on the ground, improving lives directly), helping to change and direct policy (where possible at the government level) and working to generate and communicate new knowledge through research.

We were invited to help draft a 360-degree-framework policy, developed by the European Center for Disease Control on tuberculosis in urban areas across the continent. People are sometimes surprised to learn that TB, a centuries old disease, is on the increase.

We also spend our time doing a fair bit of advocacy and outreach. It’s important that we communicate the urgency of these issues to the communities who are affected most.

In Haiti we will be building an additional 20 homes [and creating] a community development program that also involves providing access to clean water to about 3,000 individuals in the community. Beyond that, we have repaired a road in Haiti. People look at this very simplistically and say, “Well, it’s road repair.” But what that road repair is tied to is saving lives. The road now facilitates about 7,000 people with improved access to the markets and health facilities.

We have worked with essentially the leading health care designer in the world, Perkins and Will, to design a health care facility for the community [in Haiti]. We’re also doing a vocational school to provide training for locals. Then there is an agricultural project that we’re working on with an organization called Partners in Health headed by Paul Farmer. They have a subsidiary group called Zanmi Agrikol, which is Creole for Partners in Agriculture.

We’re doing a project in Cameroon, which we launched like our Haiti Project Competition initially to ask design and health professionals to explore the link between housing design and malaria—things like screening housing, something so basic, which is really at the heart of our organization. We’re interested in low-cost, low-tech integrated strategies, which have often been sidelined in global health and housing efforts.

For us it’s about understanding how the components are interrelated. We saw that far too often the model—not only of international development but a lot of successful business practices—is to focus on one specific area and do it really well. Around the world … diarrhea kills about 2 million people every year, needlessly. There is a direct correlation between the lack of suitable sanitation and contracting diarrhea-related illnesses. Yet, it’s not just about having toilets—it’s really about whether toilets are present and whether there’s access to clean water. We are in fact talking about the relationship between two infrastructure components.

In Nepal, work that we are about to get started is based on findings that paving floors can improve the cognitive development of a child by as much as 96 percent, reduce the risk of anemia by as much as 80 percent and reduce that risk of parasitic and diarrhea-related illnesses by as much as 50 percent. This is the exciting way that housing can be a major vehicle for curbing the risk of contracting diseases and therefore the mortality for some of the poorest people on our planet. But the extent to which we can render this effective is the extent to which we can, I would argue, move away from this notion of looking at the issues in silos.

It’s simply not sexy—that’s what we’ve been told. We all know the major headline development issues not just because of the burden they cause, but because of the way in which they’ve been communicated. If you’re in a developed country, your perception of a home is very different from the perception of a home for someone living on less than a dollar a day. So when you try to make the argument that it’s important to develop a healthy home, the typical person in North America will think of a three-bedroom environment. It’s not reductionist enough. We’ve found that sometimes it’s about getting people to think differently about what a home means for families around the world.

We’ve spoken to all the major institutions globally and no one pretends the evidence doesn’t speak for itself. Yet what we have seen is that we tend to align ourselves individually and institutionally to a very mechanistic approach, in which we are keen to find, I hate to simplify it like this, but, the magic bullet. When we attach ourselves to major campaigns that reduce the challenge to a single component, and therefore the solution itself must involve a single component, institutions like that because you base your effectiveness on how many you have done. I would argue that we really should be looking at the kind of 360-degree model a lot more. But it’s a harder sell, frankly.

One of the things that we always try to be clear about is, we don’t adopt a top-down approach. Several months prior to any project getting started are spent learning, listening and understanding how people build, at what cost, over what period of time. It’s really about respecting and appreciating the value in that, because for many, these traditions have been handed down, modified and bettered. We also know that many of the most vulnerable on our planet build incrementally. So the idea of the house being a static entity is not, for many, a reality. It’s something that emerges, something that expands.

I guess the unpredictability that you’re talking about is also about environmental unpredictability. People are quite sophisticated at times in terms of the adaptability and resilience with which they’ve applied their designs. The people who live on less than a dollar a day have been able to borrow from their neighbors or their ancestors to refashion and continually improve their homes. ARCHIVE looks for the nuances in the way that people have already developed a level of resilience. We build on that with lessons we have learned from other environments.

On a large scale, I’d like to see governments and large institutions changing for themselves the paradigm where living conditions of vulnerable people on the planet and health risks are dealt with separately. We are urbanizing more than ever, with multiple issues related to having 9 billion people living on our planet in the next 40 years. A cost-effective approach to this means deploying a strategy which invests in improving two key areas of development: housing/living conditions and health. We think that success for us, and really success for humanity, is about a shift in that paradigm. It already is more cost-effective to address these issues as a paired approach. As the need to house people and to treat people becomes more urgent and more dire in a world of 9 billion with finite resources, we’ll begin to think creatively and more cost-effectively. So we are optimistic that we will change. Unfortunately, you need political will and you need leadership, like any scenario, to usher it through. Until that happens, sadly, we will remain in our present paradigm.