SMALL is the New BIG

[Carol Ebert, MSN, RN]

Right now in order to survive this pandemic we have to avoid crowded offices, crowded events, crowded restaurants, crowded classrooms, crowded churches, crowded public transportation, clinics and hospitals, and even our friends and other people who aren’t related to us. That means the old ways of doing things aren’t safe anymore and we need to unleash our creativity so we can re-imagine our lives from the ground up.

I know in a forward-thinking nation it is not popular to look back and yearn for our past ways of living, but there are lessons to be learned and models to follow that might be useful right now. For example, when I was young awhile ago, these are the things I was used to:

• lots of exercise
• fresh air
• safe neighborhoods with kids playing outside at each other’s houses
• families sitting out on their porches and visiting
• small class sizes
• no crowds
• home visits by my doctor to keep me out of his clinic when I was contagious with the measles

I walked everywhere to shop, visit, go to school, play in the park. There were neighborhood shops dotted everywhere so I could get whatever I needed as long as I walked there.

So what ideas can we borrow from the past that worked so well then? Could they work again now? For me, the easiest way to begin is to look at the big picture and create a system of manageable-sized neighborhoods whether in the inner city, in the suburbs or in small towns. Because the need for social distancing is a priority right now and moving forward, we need to think smaller and less crowded.

FACT: We need to redesign our neighborhoods to create a “community feeling” once again and provide basic services easily accessible and affordable.

Following this model means that if an outbreak were to occur (and it probably will again) we can manage it more effectively because the neighborhoods have their own identity and support system to do effective contact tracing and isolation. In other words, we can control potential breakouts much easier, one community at a time.

In addition, building healthy communities improves immunity! Social engagement is associated with a stronger immune system, especially for older adults. This means that you are better able to fight off colds, the flu, and even some types of cancer.

So it is time to pull out all the stops and start thinking more creatively about how we can reimagine a country that is focused on optimal health and not optimal wealth. Here are some of my thoughts.

Healthcare

What was

Hospital and clinic appointments required for everyone.

What could be

Keep patients out of the hospital unless for emergencies and procedures and deliver quality care close to home. Design each neighborhood to foster a sense of community and trust by providing the following services:

Create small neighborhood clinics staffed by a Nurse Practitioner, Pharmacy tech, and a Wellness professional in a neighborhood building that already exists so it only requires outfitting and not building a new facility. I remember when we had a small clinic like this example staffed by a very popular General Practitioner in one of our neighborhoods that had a street of small businesses convenient to the residents but of course, it was shut down and everyone had to go to the “big house” to be seen.

A mobile van assigned to different areas each day to do basic screenings and exams, including a Food Shelf to provide healthy food to those in need and provide a small book lending library.

A visiting nurse/health corps making home visits annually for all children 1-5 (similar to how England manages the health of children) and also checks on the health of other family members. This could be a jobs program for student nurses, nursing assistants, health corps workers like the Peace Corps, wellness specialists.

Provide WIFI in every home to make Telemedicine available to each home from both the neighborhood clinic and the main campus

Education

What was

School Classrooms that were overcrowded and teachers had trouble meeting the needs of all students, which often led to discipline problems and kids dropping out

What could be

In the past, there were more small towns serving farming communities with one-room schools and very few students. Perhaps we could create small schools in each neighborhood just like Daycare Centers serve small groups of younger children.

• Improves the mental and physical health of students
• Everyone knows each other, can walk to school together and get exercise
• No need for crowded school buses.
• Builds a support system for each other; it takes a village to raise healthy children and this would create that village.
• Class sizes would be smaller so teachers can provide more attention to students to improve learning and prevent dropping out
• Windows that open and let in fresh air
• Consider teaching students outdoors full-time based on successful models already in place

Socialization

What was

Large facilities for crowded group gatherings

What could be

Small community facilities in each neighborhood within walking distance.

Repurpose a parking lot or field into an open-air multipurpose facility with a roof and sides that open for fresh air to accommodate community activities for all different age groups.

Create more open-air green spaces called “pocket parks” for socializing and group activities. If we can find space for dog-parks, we can create small people parks too!

Close some streets and let businesses expand into the open air. Times Square in New York City has done this successfully.

Encourage small shops and restaurants to open in neighborhoods with staggering hours to meet the needs of different demographics and sliding glass doors leading to outdoor seating to allow fresh air to circulate. Like Japanese homes.

Repurpose closed big box stores or shopping malls to be open-air farmers markets which in turn support local farmers.

Did you notice that some of my ideas have already been created and used, but many have been sidelined in our quest to consolidate and grow bigger? Maybe we need to dust them off and bring them out of storage!

I hope you enjoyed my trip down memory lane. Just because I am suggesting a return to the past or “Back to the Future” doesn’t mean we have to do it their way. With all of our technological advancements, we can take the benefits of this down-sized way of life and make it even better and more relevant while retaining all of their benefits. Stay tuned. The best is yet to come.

“It’s a Small World After All”.

Resources

The Health Benefits of Socializing

Schools Beat Earlier Plagues With Outdoor Classes. We Should, Too

In Sweden, Teaching Outside Is In

10 Iconic Streets and Spots in NYC Open For Outdoor Dining