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How COVID-19 will change the way we design our homes
Pandemic-inspired housing innovation will collide with techno-acceleration.
Around the world, home builders are vigilantly reading tea leaves in the fog, trying to figure out how to survive (and even thrive in) an unfolding economic disaster. And we mourn the fallen, working to keep our loved ones healthy and safe.
COVID-19 has drawn a political dividing line in much of the world. It reminds me of something an American revolutionary, Samuel Johnson, said in 1775: "Patriotism is the last refuge of the scoundrel." In my story, the scoundrel is this virus – COVID-19.
Home builders construct the physical environments for families, who turn them into homes – homes we hope are filled with laughter, love, aspiration and celebration. Good housing is the cornerstone of strong communities.
Much of how COVID-19 impacts us will be determined by science, but not all. "The question of how the pandemic plays out is at least 50% social and political," Sarah Cobey, epidemiologist and evolutionary biologist at the University of Chicago, told Scientific American.
Just as the Spanish flu gave us the vanity room, which originated as a hand-washing basin immediately inside the front entry of a home, COVID-19 will influence innovation in home design.
Open-plan, ever-larger houses have ruled the market for decades, even though family size has shrunk and middle-class real earnings have remained flat. U.S. households averaged 2.44 children in 1965 but 1.9 by 2015. With 128.6 million households, that's 7 million fewer children. Yet the average size of U.S. houses grew 62% from 1973-2015, from 1,660 square feet to 2,687. House size was still growing in 2018. In Canada, houses have also grown as families shrunk. In Europe, average house size has grown to 1,880 square feet (which Europeans will say astounds them).
Pandemic thinking will likely favour less-open spaces (though people will crave nature-positive spaces), perhaps reviving cozy dens to supplement living rooms. Spending may shift into less obvious enhancements of safety and comfort. Better interior insulation will enable quieter places. Screened-in porches and outdoor spaces, and new approaches to landscaping will help keep mosquitoes and other disease-bearing critters at bay. A bedroom, kitchen, living room area and bath that is a little removed from the core of the house will accommodate adult children now and elderly parents later (at Lennar, we call this the Next Gen Home). Split HVAC systems can prevent sickroom air from being pumped into everybody's space. Such mini-HVAC systems with no ductwork have become very affordable.
Home-based jobs call for better home offices (Lennar calls this the Next Gen Home Office). The infamous toilet flush in the background of U.S. Supreme Court by-telephone oral arguments underscored the perils of inappropriate home-work spaces. So do videos of children and pets interrupting conference calls or other tasks. A larger home-based work force will drive designers to balance job requirements with the privacy and safety of the family.
Pandemic-inspired housing innovation will collide, however, with three critical forces that were already simmering pre-COVID and are now at a high boil.
- Techno-Accelerations. The pandemic has accelerated the already-brisk integration of real and virtual activities, including remote work, remote health, and remote education. But electric and automated vehicle compatibility, delivery-enablement systems, frictionless purchasing and the Internet of Things (IoT) enabling the remote maintenance and repair of homes . . . all require fast bandwidth – faster even than 5G. It also requires security: in a geopolitical environment where surface attack areas have expanded, we all want military-grade cybersecurity.
- Climate. As China began publicly grappling with deaths from COVID-19 in mid-January 2020, the World Economic Forum's "2020 Global Risks Report" was released. It warned that climate change makes more of the planet hospitable to infectious pathogens. Resilience is therefore the watchword of the remainder of the century. Energy and flood resilience, and smart insurance and other financing products that will encourage a great migration away from the coasts . . . these are the characteristics of the new urban morphology brought about by climate change.
- Social Justice. While COVID-19 did not cause the social justice movement that swept many parts of the world this summer and the U.S. in particular, the virus amplifies economic burdens which, in turn, exacerbate the movement's root causes: income inequality is central to this dynamic. The Institute for Policy Studies found America's 400 richest people are worth $US3 trillion, more than all African-American households plus 25% of Hispanic households combined. There's little doubt these numbers err on the low side now. COVID-19 has wiped out the ready resources of many families and that will spark varying degrees of political reaction globally. Populist housing policies that threaten capital investment could deter home building and contribute to future housing crises. Inclusionary housing programmes that accelerate wealth creation among traditionally excluded populations, enable financing, inject innovation into housing use and urgently work toward housing security for vulnerable populations will underpin how governments reallocate precious housing-related subsidies.
The ghosts of the 2008 financial crisis hang over the pandemic economy. But the 2008 crisis was housing-ignited. High-risk mortgages drove up the prices of houses buyers couldn't afford but bought anyway. This textbook housing bubble was buoyed by an irrational conviction that prices would keep rising and rising. Low interest and inflated housing values led millions to refinance or, in the U.S., extract home equity loans to pay for remodelling, cars, boats, campers, and bucket-list quests. The housing bubble popped and its bad ink seeped through world economic systems.
A 6 January 2020 Washington Post article opened with: "A strong job market and low mortgage rates should sustain the housing market in 2020. The problem will be finding enough homes for buyers. With unemployment hovering at a 50-year low and interest rates well below historical norms, the real estate industry is being dragged down by scarcity in housing stock…."
Within three months, U.S. unemployment had surged to historic levels (more than 23 million Americans were officially unemployed at the start of May, more than 30 million by the end) but that Washington Post article still holds true today. Low mortgage costs in the U.S. and the developed world continue to drive affordability. And the deficit in housing production inherited from the 2008 crisis still constrains supply while, at the same time, millennials all over the world are starting their families.
Sales of existing houses — normally about 90% of the U.S. market — have been eviscerated this year. New homes are favoured over resale, and de-urbanisation is occurring where it can. If new-home sales of the late spring and, as reported in the media, the early summer, continue, 2020 could be a fair year for new home builders. There's been a big jump in online sales of new homes, a global spike in online home-searching activity, and purchasing occurring often without buyers even walking through a house. A new, fully warranted home, bought without having to spend time with realtors and owners, has great appeal.
In the last century, vaccines and the public health movement largely eliminated dreaded contagious disease in much of the world. Industrialised countries have periodic outbreaks that remind us of this danger, among which, the HIV/AIDS, SARS, Zika, and West Nile viruses. Public health professionals tell us we could be entering an era in which mass urbanisation, climate change, stressed natural eco-systems and other factors will yield a pandemic (or something approximating one) every 7-10 years. This will force a reckoning with what it means to work together toward a better future. But we will also realise that we will all seek refuge in a home. Maybe knowing that will be our true last refuge.
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The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
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Vegans and vegetarians often have nutrient deficiencies and lower BMI, which can increase the risk of fractures.
- The study found that vegans were 43% more likely to suffer fractures than meat eaters.
- Similar results were observed for vegetarians and fish eaters, though to a lesser extent.
- It's possible to be healthy on a vegan diet, though it takes some strategic planning to compensate for the nutrients that a plant-based diet can't easily provide.
Comparison of fracture cases by diet group
Credit: Tong et al.<p>The results showed that vegans were especially vulnerable to hip fractures, suffering 2.3 times more cases than meat-eaters. Vegetarians and pescatarians were also more likely to suffer hip fractures, though to a lesser extent.</p><p>One explanation may be that non-meat eaters consume less calcium and protein. Calcium helps the body build strong bones, particularly before age 30, after which the body begins to lose bone mineral density (though consuming enough calcium through diet or supplement can <a href="https://ods.od.nih.gov/factsheets/Calcium-Consumer/" target="_blank">help offset losses</a>). Lower bone mineral density means higher risk of fracture.</p><p>Protein seems to help the body absorb calcium, <a href="https://www.bonejoint.net/blog/did-you-know-that-certain-foods-block-calcium-absorption/#:~:text=Historically%2C%20nutritionists%20have%20warned%20that,may%20increase%20intestinal%20calcium%20absorption." target="_blank" rel="noopener noreferrer">when consumed in normal levels</a>. The recent study, along with past research, shows that people who don't eat meat tend to have lower levels of both protein and calcium. When the researchers accounted for non-meat eaters who supplemented their diets with calcium and protein, fracture risk decreased, but still remained significant.</p>
Credit: Pixabay<p>Another explanation is body mass index (BMI). Non-meat eaters tend to have a lower BMI, which is associated with higher fracture risk, particularly hip fractures. In the new study, vegans with a low BMI were especially likely to suffer hip fractures. That might be because having more body mass provides a cushioning effect when people fall.</p><p>Still, the study has some limitations. For one, White European women were overrepresented in the sample. The researchers also didn't collect precise data on the type of calcium or protein supplementation, diet quality or causes of fractures.</p><p>Another complicating factor: Producers of vegan products, such as plant-based milk, are increasingly fortifying foods with nutrients like calcium and protein, so modern vegans are potentially at lower risk of deficiency.</p><p>The researchers wrote that their findings "suggest that bone health in vegans requires further research."</p>