Architectural Determinants of Health Theory

The Architectural Determinants of Health Theory (ADoH), argues that specific architectural qualities of everyday environments are primary, measurable determinants of health that act through psychological, neurophysiological, and social-relational pathways. ADoH is a middle-range theory within existing public health frameworks, offering testable propositions, causal models, and practical design/assessment frameworks that explain how architecture adds explanatory and predictive power beyond traditional social and environmental determinants.

Nature of the Theory

ADoH is positioned as a middle-range theory inside existing public health determinants frameworks articulated by World Health Organization (WHO), Public Health Agency of Canada (PHAC), and Social Determinants of Health (SDH) frameworks. It refines the “physical/environmental” and “housing/urban design” categories by specifying how concrete architectural qualities of everyday settings function as determinants of health.

Rather than replacing existing determinants, ADoH assumes that upstream social and economic forces allocate different populations to different built environments and then explains how those architectural conditions add distinct explanatory and predictive power for health outcomes within existing public health frameworks.

The 7 Core Ideas of ADoH

The Architectural Determinants of Health Theory proposes seven testable propositions that are instantiated in a family of causal models and operationalised through assessment, design, setting-specific and implementation frameworks that use defined measurable variables to guide both research and practice. The propositions are seen as a theoretically grounded, empirically testable statements about how one or more architectural determinants relate to one or more health-related constructs, meaning a health-related abstract concept that this theory uses to describe and explain a phenomenon, and that can be made measurable through specific indicators.

Positioning the ADoH Theory Into Other Determinants of Health Frameworks

The Architectural Determinants of Health Theory is nestled within existing determinants of health paradigms articulated by the World Health Organisation (WHO), the Public Health Agency of Canada (PHAC), and related Social Determinants of Health (SDH) frameworks.

WHO and PHAC identify a broad set of personal, social, economic, and environmental determinants, including social and structural determinants that shape the conditions in which people are born, grow, live, work, and age. ADoH refines the physical, environmental, housing, and urban design components by specifying how the architectural qualities of everyday settings act as primary, measurable determinants of health through psychological, neurophysiological, and social relational pathways, over and above traditional determinants. ADoH fits cleaning inside the existing determinants of health landscape as a more specific, spatially focused theory that complements – rather than replaces – social, environmental, economic, and structural determinants frameworks.

How ADoH Can Be Embedded in Existing Public Health Frameworks

Existing public health frameworks provide ready-made “slots” where ADoH can be inserted:

In determinants lists (e.g., PHAC, WHO, CDC), ADoH provides a sub-framework under “physical environments” or “housing/urban planning,” specifying architectural determinants and mechanisms.

In SDH conceptual frameworks (e.g., WHO’s structural vs. intermediary determinants), ADoH offers a set of intermediary built-environment pathways that can be diagrammed alongside material circumstances, psychosocial stressors, behaviours, and the health system.

In population health promotion models and “who/what/how” cubes, ADoH populates the “what” (architectural determinants) and informs the “how” (architectural and planning interventions) for sectors such as education and health care.

Explore Constructing Health to learn more about the emerging field of neuroscience applied to architecture.