Authors show how health care can revive small downtowns

LAWRENCE — The basic idea is to achieve a triple win: Revive moribund small-town main streets by concentrating state-of-the-art health care and other service providers there, not only offering healing services for residents’ bodies, but helping them feel better psychologically.

In an article titled “Designing an Environmental Prototype to Improve the Health of Rural Communities,” Kent Spreckelmeyer, a University of Kansas School of Architecture & Design professor, and Tom Trenolone, 2000 KU alumnus and design director at the Nebraska-based architecture and engineering conglomerate HDR, outline ideas they first brainstormed for a small-town client a decade ago. The plan has since won awards, and its principles have been widely adopted in the industry.

Their work was published in the 2024 edition of Oz, the journal of the Kansas State University College of Architecture, Planning and Design. 

“The idea was that it wouldn't simply be a conventional, critical-access hospital for a rural community, but that it would be an economic catalyst,” Spreckelmeyer said. “It would be a community resource ... tied into community redevelopment. HDR had this client in eastern Colorado that said, ‘Let's experiment with that and see how far we can take it.’ And since then, HDR has kind of been applying some of these basic principles in a lot of the rural health care they've been doing.”

The basic idea is to take scattered resources and gather them downtown, achieving critical mass. The design Spreckelmeyer and Trenolone drew up for Haxtun, Colorado, shows a reuse of several Main Street buildings, tearing down some underutilized adjacent buildings and erecting new structures in their place.

“The research part of this project was about going back and defining what health actually means,” Spreckelmeyer said. “The original federal health bill, the Hill-Burton Act, was meant (to create facilities) for appendicitis and child birth and basic medical things, as opposed to now, when rural health is defined by deaths of depression, desperation, increasing disparities in terms of health outcomes (compared to cities) and also just lack of certain simple things like, where do you get a cup of coffee in a small town if you don't want to go to the quick shop and get it in a foam cup? Is there a place to go? And so the idea was: Could you combine a hospital cafeteria with a coffee shop on Main Street? How would that work?”

Spreckelmeyer said that while Haxtun did not, in the end, radically revamp its downtown, “A lot of little pieces that have come out of this have been incorporated, not only by HDR, but a fairly large number of firms specializing in rural health care design have utilized them.”

Spreckelmeyer said Oz has always had a regional focus, and, given the latest edition’s health care focus, its editors reached out to him and Trenolone to write up their work using this new approach to critical-access care, which is the state-of-the-art term for rural health facilities.

“A number of rural communities are beginning to implement ideas like this when they go from an old Hill-Burton into a new critical-access hospital,” Spreckelmeyer said. “Hospital systems in the process of replacing their existing health care facilities are beginning to ask fundamental questions about the nature of rural health and how it fits into the larger issues of community health: How much of those facilities can we combine together, rather than building two separate institutions in a very low-density community? How could you leverage those different activities for multiple services? ... Is there a community swimming pool? If so, could we combine that with a hydrotherapy pool for the older population of the community? I think those kind of issues have become fairly standard now as a part of architectural practice in the rural setting.”