Design for Health (DfH): Interdisciplinary Approach to Addressing Health Issues Related to the Built
Environment and Poverty in Appalachia
Shelby S. Hicks, MFA, NCIDQ, Assistant Professor; Amy Murphy-Nugen, MSW, PhD, Associate Professor and Sara Duncan, PhD, Assistant Professor
This preliminary inquiry is to prepare for the collaboration
between Interior Design, Environmental Health, Nursing, and
Social Work. This project looks to investigate the Appalachian
community’s generational poverty and health-related issues
pertaining to poor housing conditions. Forty million people live
in poverty, 18.5 million in extreme poverty in America (Alston,
Philip Human Rights Council , 2018). Chronic psychosocial
stress is gaining recognition as a major mechanism through
which poverty exerts a negative toll on children and adults.
Ongoing stress associated with poverty, or the stress of living
with less than one needs, creates constant wear and tear on
the body, dysregulating and damaging the body’s physiological
stress response system and reducing cognitive and
psychological resources for battling adversity and stress
(Wadsworth, 2012). A rapidly growing body of research has
shown that stress responses can have suppressive effects on
immune system functioning (Kennedy, 1990).
Social determinants have a profound impact on health and are
a major factor in the poor health status of Western, NC. High
rates of poverty and poor housing conditions are especially
problematic in the region. In 2018 Jackson County Community
Health Assessment, 33.5% of children under age 18 and 36%
of children under age 5 are living in poverty. Availability of
affordable and safe housing is also problematic in Jackson
County: 45% of individuals who rent report spending more than
30% of their income on housing. Housing units may
themselves be unhealthy, with exposure to mold and other
indoor air pollutants that can negatively impact individuals with
asthma. Participants in the DfH program will learn about these
risks and identify opportunities to intervene to ameliorate them.
INTRO / GOALS /
The purpose of this presentation is to conduct a preliminary
inquiry to prepare for a year-long collaboration between Interior
Design, Environmental Health, Nursing, and Social Work
Students will complete research, participate in a poverty and in-home visit
simulation experience. The students will contribute in round table
discussions with volunteer community members, local community non-
profit organizations, native American communities that address the
issues of poverty, health, wellbeing, drug addiction, and aging in
place. Interior Design students will research WELL Building Standards
and use these standards as the foundation for their design solutions.
The students will form teams, with representation of each of the
disciplines and complete an assessment of a volunteer community
member and their home. In collaboration, student teams will develop
solutions and plans to remediate the built environment issues. Teams will
coordinate with local and regional nonprofit organizations to supply
materials, labor, and solutions for the community member. Pre and post-
assessments will be completed with both students and community
members. Students will be encouraged to present at appropriate
Photo Caption: Book readings selected by faculty, supplied by local
bookstore/coffee shop as well as hosting the book review roundtable. Josh Wilkey,
Appalachia Historian, Author “Writing Appalachia: One Year of Essays” talks about
growing up in poverty. Virtual discussion of the readings was conducted via Zoom.
participate in a
(Covid 19 postponed this
Virtual home visit
is being conducted on
June 15, 2020
Jackson County Department of Public Health, in partnership with Harris Regional
Hospital, the Healthy Carolinians of Jackson County Partnership, and other key
community partners, 2018 Jackson County Community Health Assessment.
North Carolina Department of Commerce, County Distress Rankings (Tiers) (2020,
February 27) https://www.nccommerce.com/grants-incentives/county-distress-
Alston, Philip Human Rights Council . (2018). Report of the Special Rapporteur on
Extreme Poverty and Human Rights on his Mission to the United States of America.
United Nations .
Council of Interior Design Accreditation. (2018). CIDA Standards. CIDA .
Kennedy, S. G.-G. (1990). Principles of Psychophysiology: Physical, Social, and
Inferential Elements. In J. T. Cacioppo, Psychoneuroimmunology (pp. 177-190). New
York: Cambridge University Press.
Staff Inhabitat. (2019, September 14). https://inhabitat.com. Retrieved September 14,
2019, https://inhabitat.com/the-top-5-issues-affecting-interior-design-today/ .
Wadsworth, P. M. (2012, July). CYF News. Retrieved from American Psychological
D. O. Belcher College of Fine and Performing Arts and College of Health and Human Services
Current average indoor radon level in Jackson County is
2.8 pCi/L (2 times the national average). There are
counties in WNC with much higher levels (Facts about
radon: Radon in Water; Radon and Geology, 2015). For
reference, a screening level of 4 pCi/L is the
Environmental Protection Agencies recommended action
level for radon exposure. Radon is the number one cause
of lung cancer. People who smoke have an even higher
risk of lung cancer from radon exposure than people who
don’t smoke (General Radon Information, 2019). Smoking
and existence of radon increases lung cancer risk by 30%.
These five key areas (determinants) include
•Social and Community Context
•Health and Health Care
•Neighborhood and Built Environment
Median value of owner-occupied housing units, 2014-2018 $192,300
Median household income (in 2018 dollars), 2014-2018 $44,028
Top Ten Tracts by Percentage for Severe Housing Cost Burden
Geography Percentage of Households Paying
More Than 50% of Income on Rent
Census Tract 9507, Jackson County 62.60%
Jackson County Tier 2
County Tiers are calculated using four
•Average unemployment rate
•Median household income
•Percentage growth in population
•Adjusted property tax base per
What is the impact of a year-long faculty/student led
service-learning community study/project investigating
how the built environment impacts health and wellbeing
when living in poverty?
Design for Health: has
continued during the Covid19
Pandemic, participating in
monthly zoom meetings,
sharing research on social
determinants, & ACES.
Discussion on JC Community
Health Assessment and the
accuracy of its data collection.
In addition, with Covid 19 the
teams discussed health
issues related to social