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The foundation for child health starts at the floor

Credit: Tom Murphy

Architect Peter Williams sees design as a way to help improve the lives of the most vulnerable people on the planet, arguing that there is a strong connection between better home design and improved health.

Williams grew up in a home with a dirt floor in Jamaica. Life would take him to Columbia University where he studied architectural design. The Sept. 11 attacks and the Iraq war drew him into the anti-war movement. He quickly realized that there was more to the world than architecture.

Williams began to consider other ways that to use his passion for architecture. A fellowship allowed him to conduct research on HIV in KwaZulu-Natal province, South Africa. It was there that he connected design to health, and drew a line back to his own life growing up in Jamaica.

The poor living conditions that Williams and his family experienced contributed to his father’s paralyzing illness. The poor conditions started at home, specifically with the floor. Not only did the house design contribute to Williams’s father to falling ill, it made his life more difficult. Narrow doorways made it impossible for him to use a wheelchair.

“I realized that poor housing design was behind my father’s problem and what prevented him from accessing the help he needed,” said Williams. “We argue that health needs to be addressed at the home, but the priorities should be shifted from a treatment-based model to one that focuses on vulnerable physical environments; and that is often where people are living.”

Doing something as small as replacing a dirt floor with concrete can have a significant impact. The Mexican government ran a program more than a decade ago called Piso Firme. It offered families the ability to replace their dirt floors with concrete.

World Bank researchers then looked at the health outcomes of families who got new floors. The health gains were remarkable. The complete replacement of dirt with concrete for flooring caused parasitic infestations to fall by 78 percent, cases of diarrhea fell by 49 percent and an improvement in cognitive development of up to 96 percent. Williams was right, improving the health of children starts at the home.

The number of people living in urban slums is expected to reach 1.4 billion people by 2020. Many of those people will face health challenges. Most won’t have access to clean water, and will live in areas of poor sanitation and a lack of adequate housing.

“If we are talking about getting the most from our funds, I would argue that the evidence overwhelmingly supports that it should be invested in creating an environment that does not put families at a greater risk,” argues Williams.

The strong evidence and an eye for design led to the founding of ARCHIVE Global in 2006. Programs are based on the belief that health is connected to housing. At a time when innovation is a buzzword in global health, Williams is advocating for simpler, proven solutions.

“There are many development challenges, we are faced with the question, even internally, how do we get the best outcome for our buck,” he said. “Those are the kind of approaches we favor.”

A new initiative by ARCHIVE Global will target improving homes in Savar, Bangladesh. Dirt floors will be converted to concrete and paired with workshops on health and hygiene. The hope is to build on the evidence from Mexico and make the case that improving homes is a cost-effective investment for preventing child deaths.


About Author

Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]