Good medicine: how institutions can meet the needs of the modern student with a state-of-the-art health care facility.

TO COMBAT THE GROWING NUMBER OF HEALTH issues affecting college students today, colleges and universities have greatly expanded the range of health services they offer--tackling everything from fitness and stress management to alcoholism and smoking cessation. Unfortunately, these robust programs are often hindered by inadequate and aging health-care facilities.

But now, some institutions are battling back with facilities that make student health a top priority. By establishing prominently placed student health centers on campus, they're creating a welcoming, inviting setting that's more than functional. Schools like Penn State, the University of Arkansas, and the University of Wisconsin--Madison have all recognized that building better facilities means better service and, in turn, healthier students.

And it's not just about improving student health. These facilities also help attract new recruits, reinforce campus values about health, and add academic value by providing research and resource opportunities.

"Gone are the days when there was just a nurse handing out aspirin," says Kevin Kruger, associate executive director of the National Association of Student Personnel Administrators (NASPA). Campuses today recognize that student health issues are directly connected to student retention and academics, requiring a more sophisticated response and room for comprehensive services."

THE NEW CHALLENGE: MENTAL HEALTH

With physical education on the decline and child obesity rates on the rise, today's young people are experiencing a greater number of health problems, including diabetes, asthma, and hyperactivity, according to the National Institutes of Health. Combine that with a societal fixation on image and health, and you get a college population that not only has more medical issues, but also has an enhanced awareness of the importance of their own health and well-being.

In 2005, more than 81 percent of college students reported experiencing one or more health-related problems--anything from allergies or anxiety to back pain or bronchitis--according to the American College Health Association's National College Health Assessment (ACHA-NCHA). The most common health factors that students reported affecting their studies: stress, colds, sleep difficulties, concern for a troubled friend or family member, and depression or anxiety. (See "Top 10 Medical Issues Reported by College Students" and "Top 10 Factors Affecting Student Performance," p. 80).

"In general, students are more aware of health issues, so factors like stress and sickness consistently make the top of the list," says E. Victor Leino, ACHA's director of research. "What's surprising is the increased role that mental health has come to play."

According to ACHA-NCHA data, in 2000 only 10.3 percent of college students reported being diagnosed with depression, while in 2005 that number increased to 16 percent.

"We're seeing more and more mental health issues on campuses nationwide," says Karen Moses, co-chair of the Health in Higher Education Knowledge Committee of NASPA and director of wellness and health promotion for Arizona State University's Student Health and Wellness Center. "More high school and elementary students are being diagnosed with serious mental illnesses, meaning we're seeing more conditions--and different types of conditions than we had in the past."

This reality has led to an increase in mental health programs as well as partnerships between health services and counseling services on many campuses.

"A lot of campuses are looking at how health centers can link with counseling centers and are beginning to look at wellness as a concept, instead of mental versus physical health," Moses says. At the same time, administrators want to meet the expanding needs of a larger number of students but have to work with old facilities the school has outgrown.

HEALTH--THE MAIN ATTRACTION

The Pennsylvania State University, for example, is trying to serve the needs of 42,000 students in a facility constructed to serve 10,000.

"Our building was built in 1929, when the school served a tiny number of students," says Peg Spear, director of Health Services. "It was expanded in 1953 when there were between 10,000 to 12,000 students, but even with a major renovation in the mid-'90s the overall size of the building hasn't changed. We've done everything we can, but we've known for at least a decade that the university would have to build a new health services building."

After years of careful needs assessment, stashing away funds, and Health Services staff convincing the powers-that-be, Penn State is now working with Hillier Architecture in Princeton, N.J., on the design of a new student health center--one that will be located at a crossroads of student activity.

Situated between student dormitories, the academic campus, and sports facilities, the new 60,000-square-foot building will serve as a natural shortcut for students moving from place to place on campus. While passing through, students can grab a cup of coffee and be informally introduced to all the health-related resources available to them including online appointment setup, a full-service pharmacy, a health education resource library, and a seminar conferencing area.

Goals of the buildings design are to be open and inviting, as well as attractive to students and parents. "Parents are a significant force in the college decision-making process and want to see and know how a student's medical concerns will be dealt with," says Kruger.

"More and more schools have parent-specific orientations and programs. Having a health center that addresses their concerns can be a distinguishing factor for a college or university."

Spear agrees. "When you come to Penn State, on a nice day you'll usually see students leading walking tours," she says. "At this point, health services are kind of an afterthought. Tour guides will point across the street and say 'That's where you go if you get sick. They have a lot of great doctors.' But no one comes inside the building. Our new building will be a building that everyone will want to walk through instead of pass by," she adds. Students "will want to walk in and check it out anytime, not just when they're sick."

REINFORCING CAMPUS VALUES

The University of Arkansas's Pat Walker Health Center, a 36,000-square-foot facility that opened in 2004, is a direct reflection of just how much the school values student health.

There the administration recently adopted what is being referred to as a "holistic approach to higher education"--putting the needs of the student first, both academically and health-wise.

"The leadership at the University of Arkansas believes that everyone shares in the responsibility of educating students, even medical providers," says Mary Mice Serafini, director of the health center. "Health care is recognized as being important to a student's overall education. As I like to say, we enhance the value of a University of Arkansas diploma by giving students the tools to develop healthy lifestyles and habits for the rest of their lives."

With student health clearly a top priority, the institution consciously sought to locate its new health facility at a prominent place on campus. Central to the academic, living, and eating facilities, Serafini explains, "it makes a statement."

The Pat Walker Health Center which is named for its lead donor, the Willard and Pat Walker Charitable Foundation--was designed by the Little Rock-based firm Polk Stanley Rowland Curzon Porter (founders Tommy Polk and Joe Stanley are UA School of Architecture graduates). One thing the center has going for it is space--it's 80 percent larger than the old facility. So campus health providers have a larger primary medical clinic with more exam rooms, an improved women's clinic, a counseling clinic, and an expansive health promotion area, complete with classroom space where staff can teach health-related courses and host student organization events or professional development seminars.

"We also have a public atrium that's light and airy and has become a great place for people to gather or to hold events like health fairs or even activities like yoga or tai chi," says Serafini. "Our health center really exemplifies our commitment to student health."

MORE CHANCES TO LEARN

By colocating student health with other student services, institutions can enhance new academic programs as well as research and resource opportunities.

The University of Wisconsin-Madison has partnered with a developer to turn a privately owned strip mall surrounded by university buildings into University Square, an impressive two-tower structure, which will hold student housing, a student health center, and a variety of student services.

"Our Health Services department will be celebrating its centennial in 2010," notes Kathleen Poi, director of Health Services for the university. "And we long outgrew the building we are in. Today we're cut off from campus by a major highway and are working in incredibly cramped space not designed to be a health-care facility.

"University Square will be in a high-density area of campus where students spend a lot of time, with a residence hall complex across the street and other services--like libraries, recreation and athletic facilities, and the student union--within one or two blocks," she says.

The buildings, which are being designed by Potter Lawson of Madison, will have retail on the first two floors with parking underneath. One tower will have 10 stories of apartments, marketed to university students and owned and operated by the developer; the other will have nine stories and contain the activity center, health center, as well as offices for the Registrar, Student Finance, and Bursar.

Poi expects the new digs to enhance the student health center's programs and offerings.

"Our counseling and health services centers will finally be under one roof. We'll be able to offer more sports medicine and in-house physical therapy," she says. "We could potentially even have extended hours, be open on weekends or evenings, whereas our current building's layout doesn't offer the security to make that possible."

Being located centrally with the campus' student activity center--a central resource for student organizations and clubs--creates more opportunity for partnership between organizations and the health office, both recreationally and academically. "Several years back we partnered with the student government to advocate for more space to serve both our needs," says Poi. "Our outreach and education efforts can only be enhanced by being in such close proximity to other student-central entities."

SPRUCING UP AN EXISTING FACILITY

Not every campus has the space or funds to build a new building, so how can colleges and universities make the best of what they've got?

Enhancing the buildings visibility is one option. Landscaping can make the entrance more welcoming and inviting. Providing public space for popular information is another strategy. Officials can generate interest in programs by putting popular health and wellness information in an easily accessible location.

The University of Oregon, which recently remodeled and expanded its existing University Health and Counseling Center, implemented both of these ideas.

Situated near the campus' main entrance and student housing, the Health & Counseling Center is one of the first buildings visitors see when coming on campus. By reconfiguring previously overgrown landscaping, and anchoring a new addition with a two-story glass-enclosed entrance, the university now has a highly visible health center that grabs your attention.

The new entry is also packed with a variety of public functions, such as a juice bar and an information area, which is welcoming and attractive to students. Accompanied by a large covered porch, the area is a natural gathering place.

"It not only marks the point of entry to the building, but also gives the building an inviting presence and identity on campus, in turn making it more accessible to students," says Tom Pene, senior principal at Boora Architects of Portland, Ore., the firm behind the addition's design. "The renovation and expansion enhances both the visibility of the building and its programs."

TOP 10 MEDICAL ISSUES REPORTED BY
COLLEGE STUDENTS

1. Back pain
2. Allergy problems
3. Sinus infection
4. Depression
5. Anxiety disorder
6. Strep throat
7. Asthma
8. Seasonal affective disorder
9. Bronchitis
10. Repetitive stress injury

TOP 10 FACTORS AFFECTING
STUDENT PERFORMANCE

1. Stress
2. Cord/flu/sore throat
3. Steep difficulties
4. Concern for a troubled friend or fatuity member
5. Depression/anxiety disorder/seasonal affective disorder
6. Relationship difficulty
7. Internet use/computer games
8. Sinus infection/ear infection/bronchitis/strep throat
9. Alcohol use
10. Attention deficit disorder

SOURCE: American College Health Association's National College
Health Assessment, Spring 2005

R. Stephen McDaniel is managing principal of the Healthcare and Science and Technology practice groups at Hillier Architecture in Princeton N.J. (www.hillier .com). He has served as designer and project manager on key research and development projects, as well as corporate and education projects.