ARCHITECTURE For Health & Wellbeing

20-21

ISSUE 01

A R C H I T E C T U R E

FOR H E A LT H & WELLBEING

C O N T E N T S 4 - 7

EDITORS NOTE

A B R I E F H I S T O RY

THE SCIENCE OF WELLBEING

8 - 1 1

THE MINDFUL ARCHITECT

1 2 - 1 5

LIGHT

16-19

PHYSICAL ACTIVITY

HAPPY BY DESIGN

SAD TIMES

2 0 - 2 3

N AT U R E

2 4 - 2 5

S E N S O RY G A R D E N S

A PLANT SOLUTION

2

Witherford Watson Mann Almshouse. Natural materials used to replicate Habitat67, Montreal. Design for wellbeing is important for all age groups.

Cover: ‘el patio de mi casa (no) es particular’ (the patio of my house is (not) private) project, Malaga - by Hernández, Paradela and De Andrés.

Designs were influenced by immediate environments.

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E

D I

T

O R S

N

O T E

After a long and bleak winter, and frankly a long and bleak year, imagining bright mornings, fresh air and a change of scene feels almost impossible. This March, of course, marks the anniversary of the first coronavirus pandemic lockdown in the UK. The pandemic has created stresses of illness, isolation and financial insecurity for many; the lockdowns have limited our exposure to nature, reduced physical activity, and have increased our screen time (who would have thought that we would still be in Zoom meetings and virtual pub quizzes???). The pandemic has become a possible turning point in health and wellbeing. Now, more than ever, we must move beyond conversation and towards implementation that encourages both physical and mental health in as many ways as possible. As the lockdown briefings often place responsibility on individuals to look after themselves and their community, it is equally important to remember the huge external influences on humans, such as the built environment.

How much of our lives do we spend indoors? 80 per cent? 90? More?

The design of the average building often leaves room for improvement. Emphasis is often placed on the time efficiency and profit of builds, as investing in real estate, land, and technology is sometimes considered over the actual purpose of buildings: to live, work, learn, or recover.

Avoiding health and safety risks comes as a given, but a healthy environment is one in which there is not only an absence of harmful conditions but an abundance of health-promoting ones.

The World Health Organization now defines health as “a state of complete physical, mental and social wellbeing”, rather than purely an absence of disease.

In the context of an ageing population, increasing obesity and rising mental health problems, a more holistic approach (where health is interdependent with wellbeing) is a necessary means of longterm prevention. In turn, productivity can be increased in schools and offices, whilst the length of hospital stays 4

can be reduced. With collaboration between the disciplines and industries of construction, architecture and urban planning, this magazine can almost serve as a design toolkit that can produce successful projects across a range of sectors (residential, commercial, healthcare, etc.) to encourage the health and wellbeing of building users.

This magazine aims to encourage readers to change their mindset around health and wellbeing by providing an insight into the biology behind the impact of building design on humans.

Check out the glossary at the back for terms highlighted in bold!

Below: sketch of the Psychiatric Center Caritas project, Belgium

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A BRIEF H I S T O RY

Pandemics have shaped cities around the world over the centuries, and Covid-19 will be no exception. White walls and smooth surfaces that characterise the modern architectural movement were born out of the design for sanitariums that treated tuberculosis (TB) patients, as the medical profession blamed the rise of TB on the dark and dusty interiors of the 19th century.

The legacy of Covid-19 has already shifted focus onto health, hygiene, safety and onto our relationship with nature.

Looking back through history, we can see that we are, in fact, returning to ancient principles of design for health and wellbeing. In Ancient Greece, Epidaurus was a landscape of wellbeing as it embraced temples, clinics, houses for sleeping and dream cures, as well as an athlete’s stadium and a theatre for cultural, spiritual and physical relief. Stunning views out to sea were as important to healing as surgical procedures.

Vitruvius, a Roman architect, wrote about the importance of light, the winds and the water and how a house should not be imposed on a landscape but work within it. Further still, Hindu traditions of vastu shastra and Chinese feng shui just show how many cultures valued health and wellbeing in the built environment.

Top: St. John’s tuberculosis sanitarium, early 20th century Bottom: an ancient healing sanctuary in Epidaurus

With the medicalisation and institutionalisation of life, birth, death, and even the domestic, the idea of architecture for health was removed from mainstream construction. In response to slums, denser cities, confinement and ‘miasma’ (bad air), modern sterile environments became the norm.

Nowadays, architecture attempts to deinstitutionalise space, where distinctions between spaces collapse. At the extremes, offices start looking like industrial lofts or nurseries, whilst homes look more and more like hotels. However, with global health issues and problems of climate change, interiors become an important retreat, that go beyond serving as mere shelter.

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THE SCIENCE OF WELLBEING The notion of wellbeing consists of two key elements: feeling good and functioning well. The science of wellbeing in the built environment is a relatively recent area of inquiry that is, nevertheless, beginning to reveal consistent and widely accepted findings.

Whether you’ve seen it on the app store or on television, “wellbeing” is cropping up everywhere and becoming a popular buzzword, alongside trends of “selfcare”. The term can often be associated with middle-class health endeavours and conjure up images of crystals and meditation. However, the pursuit of health and wellbeing is firmly rooted in science and is absolutely not limited to the middle-class.

Wellbeing can be difficult to quantify, making it hard to prove that buildings can have a positive impact on human life. However, as scientific research shifts towards an approach of both quantitative and qualitative (listening to experiences and feedback) methods, wellbeing within buildings has been shown as a critical element to health (especially for those in poorer areas).

Whilst we are all different, buildings can universally affect how we feel and act in a space and can even be personalised to meet the variety of preferences and needs of different users. Designs should ‘nudge’ users into positive behaviours.

With an overall theme of bringing the natural outside world in (to stimulate the senses), health and wellbeing can be encouraged in buildings through interior design, the use of light, and by making physical activity easier.

“Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health”

-World Health Organization: The determinants of

health 7

Below: importance of plants, light and views Opposite page: example design of a ‘healthy home’

THE MINDFUL ARCHITECT Ben Channon

was an architect for over eight years, specialising in residential design; became a WELL Building Standard Accredited Professional; and now works as a wellbeing consultant. Self-branding himself as the ‘mindful architect’, Ben founded the Architect’s Mental Wellbeing Forum and has recently published his book ‘Happy By Design’, after being crowned a ‘rising star’ by RIBA (Royal Institute of British Architecture) in 2018. Illustrations by Ben, himself.

The WELL Building Standards encourages wellbeing through 10 design concepts: air, water, nourishment, light, movement, thermal comfort, sound, materials, mind, community 8

IN CONVERSATION

What does wellbeing mean to you?

The ideal scenario is that we don’t want to have to think about our health. Our health shouldn’t be something we are worrying about; it shouldn’t be something that bothers us on a daily basis.

The ideal scenario is that we are free from any kind of health worries, and that to me is wellbeing.

Do you think there is a disconnect between how we think about health and the influences of our surroundings?

demand, through the market. Obviously, the general public are becoming way more clued up on these issues anyway – you only have to read a Sunday newspaper now and in one of the magazines there will be a section on health and wellbeing or mental health. At the other end, a lot of funders are really petrified of being seen to be unethical or getting sued for providing buildings that are ‘unhealthy’. So, I think consumers and funders are going to meet in the middle.

Are there challenges across different sectors which make encouraging healthy buildings more difficult?

“There is this feedback loop - if Generally, it is often seen as a we look after our luxury, rather than an essential. the project type, physical health, we Whatever one of the first things to be also look after our cut will be the plants. This is part of ‘value engineering’, mental health, and eventhough we know that nature has so many benefits, vice versa”

Yes, the built environment plays a massive role and people don’t often realise. RIBA did a survey last year and they found, something like, just below a quarter of people thought that their home had an impact on their happiness. And I was just like, are you joking me?

Exactly! Do you think people are aware of the science behind ‘wellbeing’?

There’s so much information now coming from neuroscience and environmental psychology that demonstrates the way that the world around us affects us. I find that when I talk to clients about it, I won’t just talk about designing for wellbeing, I will call it designing for healthy buildings.

Do you think that wellbeing has been promoted well in your industry?

We have got a long way to go. Developers have got on board with sustainability, in part, because it’s come in through laws, like zero-carbon targets set by the government. There haven’t been many planning policies or government requirements to meet ‘health’ in buildings.

So, is it just an effect that starts with policy?

That’s one way. The other way is consumer

such as student happiness, attendance, performance, memory, and all kinds of stuff in schools.

So you have to convince developers of the added financial value in order for healthy design aspects to be funded?

Generally, we say extra build cost is anywhere between 2% and 7%, which can put people off.

But, yes, there are arguments to be made; the evidence is so important, but it can be even more difficult without quantitative data. There is also a brand and marketing value, though.

What is your hope for the future of wellbeing through design?

One thing I hope is that it does become more engrained into policy, to go beyond the bare minimum. Also, the negative health impacts of safety measures are forgotten. Like, after Grenfell, they are talking about banning wood from many types of buildings, but we know that wood has loads of health benefits for us, both physically and mentally.

Do you think health will meet the same priority level of sustainability (with BREEAM standards)?

They are really complimentary, with lots of overlaps! One shouldn’t come at the expense of the other – they can and should exist side by side.

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HAPPY BY DESIGN

‘Happy people’ show more activity in the front left side of their brain. Bio-psychosocial approaches show how external sources, such as the built environment around us, can give rise to biological markers of happiness in the brain. Our complex nervous systems consist of neurons which transmit the ‘happy chemicals’: serotonin, dopamine and, also, oxytocin.

Low levels of serotonin are associated with depression, so designs of control, aesthetics and comfort could be vital to tackling the current mental health crisis.

With a range of settings and users within buildings, and the prospect of future changes in society, design must be adaptable and responsive to user needs, behaviours and requirements.

In particular, buildings should aim to offer a freedom of choice, personalisation and control over surroundings, as ‘one size doesn’t fit all’. For instance, localised temperature controls, light dimmers, or even windows that can be opened can avoid the release of cortisol.

Studies have shown that people who rate themselves highly on various happiness criteria also had a lower heart rate and lower cortisol (stress hormone) levels.

Lower levels of cortisol are also shown to reduce long-term risks of obesity, type II diabetes, high blood pressure and problems with the immune system. This, once again, highlights the close link between mental and physical wellbeing.

Work-related stress, depression, anxiety accounted for 40% of workrelated ill-health and 49% of working days lost in the UK 2016/17

Image by office haratori

A simple pop of colour can improve a boring staircase to spark feelings of joy and stimulate its use

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One in four in the UK suffer from a diagnosable mental health issue

Image by Noshe

Open plan offices and communal gardens are good examples of how design can create spaces for socialising (key to happiness). Although, design must also consider the different personality types of building users. For instance, introverted personalities may prefer the use of quiet and private breakout areas, or even nap pods (a study by NASA found that a 40-minute nap improved overall emotional regulation, performance by 34% and alertness by 100%). Each of these spaces can be useful for a sense of mindfulness, as an engagement with the surrounding environment and the present is encouraged. MRI scans have shown that mindfulness can lead to a smaller amygdala size.

Left: a collective space as a destination in a building - forming connections is key to happiness Below: designs for Google offices include nap pods, even for some quiet time alone

A part of the brain that is related to stress and anxiety is called the amygdala. It receives inputs from sight, sound and touch, thus, aesthetic designs that appeal to the senses are important - see the Sensing Spaces exhibition by the Royal Academy of Arts for inspiration!

An aesthetic building can not only spark positive emotions of joy and curiosity, but also help users to focus, for example, through the use of colour.

Research has suggested that red can enhance performance on some detail-oriented tasks, whereas blue can enhance performance on a creative task.

Image from officesnapshots.com

Although, aesthetics must not be prioritised over the comfort of the user. Widely understood to be a condition of mind which expresses satisfaction with the environment, comfort can be achieved by a supply of clean, fresh air. This can not only avoid pollutants that are harmful to the lungs, but also provide a direct connection to the outside world and appeal to the senses (imagine the feeling of a light breeze or the scent of cut grass).

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We’ve all had noisy neighbours at some point. Noise can cause anxiety and even disrupt sleep, concentration and productivity; nevertheless, acoustic comfort can easily be achieved with soft furnishings, carpets and curtains. Overall, comfort can reduce stress and stimulate happiness. Further examples include how high ceilings can give a sense of freedom and elevation has been proven to provide feelings of safety.

Photograph by Camillo Botticini

A use of light and shadow can also

create

aesthetic

designs

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LIGHT

Staff in offices with no natural daylight have been shown to sleep 46 minutes less than those with daylight, on average

Left: from the

project Homo

Technologicus by Isra Safawi - a

visual commentary on the integration of digital technology into our lives and how this impacts our habits, lifestyles, health and environment

Sadly, being glued to phones and laptops is no longer something that only younger generations are guilty of. Most of us know, all too well, the pain of headaches, eye strain and a struggle to get to sleep if we stare at our screens for too long.

But, what is the impact of lighting in the enclosed spaces that we spend most of our time in? We increasingly see buildings built with less windows and more artificial light. Not only is natural light aesthetic and comforting, a lack of it can often be disorienting, and even distressing, as building users have no reference to the outside world, time or weather.

The colour of natural light changes subtly throughout the day: from warm, orange hues at sunrise and sunset to cool, blue hues during the day. Vital for physical and mental health, humans have an internal body clock (circadian rhythm), that synchronises our minds and bodies to the sunrise-sunset cycle. In the evening, this causes an increase in melatonin production, a hormone that regulates sleep. Whereas the shift to blue-white light during the day is a trigger for wakefulness, as levels of cortisol and histamine increase. A disruption to the natural levels of these key hormones and chemicals in the nervous system could result in unnecessary stress on a range of systems in the body. This could even increase blood pressure, cause digestive issues and result in anxiety or depression.

High lighting levels in buildings (where lower energy consumption light sources are likely to be of a blue hue) at night is an example of an inappropriate environmental cue that can reduce melatonin production, leading to poorer sleep quality. This also lowers the release of histamine in the morning, making us feel drained and unenergized, effecting mood and productivity.

As if it couldn’t get any worse, cortisol levels are also excessively raised, causing stress and inflammation.

Whilst still making sure to give users control over their surroundings, building design can help to rectify this modern issue through the simple use of glass windows (preferably with a view to nature). Although, the accompanying heat gain or loss must be considered when designing. Also, remember that lower floors get less sunlight; deep spaces create dark areas at the back of the room; and rooms that require privacy (i.e. bathrooms) should have higher level windows.

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SAD TIMES

Above: the ideal daily cortisol and melatonin cycles, as part of our circadian rhythm

SAD is a form of depression.

Symptoms include:

• Tiredness and lack of energy

Seasonal affective disorder (SAD) is a type of depression that is mostly related to changes in the seasons. It can make you feel unenergized and moody. Whilst many experience the symptoms of SAD, it hasn’t always been taken as seriously as it should be. Although the exact causes of SAD are disputed, it has often been linked to a reduced exposure to sunlight (hence the seasonal aspect) and, therefore, disrupted circadian rhythms. It is thought that melatonin production becomes higher than normal, making those with SAD sleepy throughout the day. On top of this, a lack of sunlight may lead to lower serotonin levels (one of the ‘happy chemicals’), which can affect mood, appetite and sleep.

• Anxiety

‘Bright light therapy’ can be used to aid people with sleep issues and SAD. This ‘re-sets’ the circadian clock, but this must be maintained by regular sleep patterns. In the same way that sunlight does, the therapy exposes the eyes to safe amounts of light for a specific and regular length of time. However, it must be carefully delivered during the daytime, with considerations of the time of year and appropriate light wavelengths (to get the shifts between

• Loss of libido • Overeating • Problems concentrating • Irritability • Problems sleeping • Feeling tearful and sad 14

2 million people are thought to be effected by SAD in the UK and Ireland

Soft-white light can be used in bedside lamps to trigger melatonin

Image by

for a better sleep

iconiclights.com

Mild forms of SAD are called ‘winter blues’ orange and blue light). The improvements to sleep are crucial for memory consolidation and the resolve of emotional issues. With increased motivation, attention and cognitive performance, alongside a ‘happier’ mental state, benefits could be seen across healthcare, commercial and educational settings.

In case reduced sunlight truly is the cause of SAD, buildings must try to maximise its users’ exposure to sunlight, through windows for instance, as a precautionary measure. To accommodate those who already experience SAD, the use of ‘smart lighting’ is becoming more widely available. The ability to replicate the subtle changes in natural light to synchronise our circadian rhythms is a great example of how technology and artificial intelligence can aid wellbeing, rather than over-controlling human life.

Where there are budget constraints, buildings can strategically use light bulbs of different temperatures to mark spaces for different purposes; study, relax, work, sleep. For example, in areas that call for the alertness of users, such as in an office or school, blue-white light could be used. Whereas, in areas that call for a calm and relaxing atmosphere (such as bedrooms), soft-white light (with the orange hue) can be used, as it triggers the release of melatonin.

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Strategically placed windows can expose building users to natural light

Design by BuckleyGrayYeoman

PHYSICAL

an easier choice, for example by

ACTIVITY

lifestyles have become the norm

Designs should make exercise providing bike storage facilities Opposite page: cartoon highlighting how unhealthy

Opposite page, bottom left: a successful campaign in New York City that encourages physcial activity in buildings through signage

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Modern comfort, combined with electronic entertainment, sedentary labour, stress, poor eating habits and alcohol consumption contributes to the unhealthy lifestyle of the average UK citizen.

Despite the widely known benefits of physical activity on our wellbeing and health, many of us still find excuses to avoid it and fall well short of the recommended 30 minutes of moderate exercise a day. Design, across all sectors, has the potential to nudge users of buildings to be more active, without them even knowing. As ‘sitting becomes the new smoking’, incorporating movement into our everyday lives can drastically improve our physical health, mental wellbeing, and cognitive function. In children especially, exercise is vital for brain development and improved social skills.

In 2015-16, the NHS spent £154 billion on chronic illness Endless campaigns have encouraged taking the stairs over a lift, but how often do we actually listen to this (very sound) advice? Stairs designed with aesthetics in mind could provide the motivation needed. Further, circulation routes within buildings can encourage activity, with wide and well-lit corridors, or pathways that lead to a point of interest (views, art, greenery). Critically, these routes must also be accessible for the physically disabled and those with wheelchairs. Although it sounds obvious, shared exercise spaces or even bike storage provisions, that are accompanied by shower and changing facilities, could be what it takes to get more people exercising more often.

Such design aspects are, thus, synergetic with other goals in spatial planning, such as sustainable design and universal access; users are nudged to choose the stairs over lifts, cycle rather than driving, and take part in active recreation rather than watching that new series on Netflix.

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HORMONES RELEASED DURING EXERCISE Dopamine, the reward and motivation chemical, contributes to feelings of alertness, focus and happiness. This helps to bring about a ‘flow state’, where the feelings experienced encourages people to exercise again. Dopamine also plays a crucial role in memory - this will be useful in commercial and educational settings. With an ageing population, it could also be useful in reducing diseases of the brain and nervous system, and their symptoms, such as Parkinson’s or Alzheimer’s Disease.

Serotonin, a chemical responsible for happiness, is released, boosting mood and a sense of wellbeing. It also improves appetite and sleep cycles, leading to more energy and clearer thinking.

Endorphins are released, triggering positive feelings in the body (you’ve probably heard of the runner’s high). Endorphins activate ‘opioid’ receptors in the body, which can diminish the perception of pain, so you can push through the discomfort of exercising, or even have reduced symptoms of disease.

Designing spaces in buildings for children to exercise is crucial to their Photograph by Thekla Ehling

development

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Western healthcare is primarily centred around the treatment of symptoms, yet many chronic diseases are preventable. Research shows that physical activity can significantly reduce a range of chronic diseases. For instance, obesity may be prevented as the burning of calories, through exercise, can prevent a build-up of fat.

People (adults and, alarmingly, children) with obesity are five and a half times more likely to suffer from type II diabetes than people who are not overweight, three times more likely to have high blood pressure and twice as likely to suffer from arthritis and cardiovascular disease. Physical activity can increase the length and quality of life, whilst helping to combat school dropout rates, office absenteeism and healthcare costs.

Above: UK obesity statistics from 2017 that highlight the current epidemic Right: causes of death in the EU, 2016 -

many from complications of preventable chronic diseases

Engaging muscles is important as it leads to the production of more muscle protein to avoid degradation. Further, joint stability is improved (possibly preventing back pain as we get older); inflammation is reduced; and key enzymes are maintained.

Left: designs can make stairs a point of interest to encourage

their use - this is The New York

Times office, where the stairs

have incredible views onto the surrounding city

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N AT U R E

Imagine you are outdoors. The sun is glistening on the surface of a lake and it’s silent except for the sound of a warm breeze shaking the leaves of a surrounding forest. Take a moment to breathe. How do you feel? Calm? Happy? We connect positive emotions with nature, and this causes us to seek its presence.

‘Sick building syndrome’ occurs when we spend too much time inside of a particular building, away from nature. The NHS suggests that possible symptoms include:

As more and more people gravitate towards cities, connections with nature are lost. Those living in urban environments have been shown to be more stressed, as their amygdala becomes more active in the brain. Often referred to as biophilic design (check out the book Nature Inside), buildings that make references to nature can improve mood, reduce stress and have physical benefits (such as decreased blood pressure or improved immunity).

headaches

dry, itchy skin dry, sore eyes cough tiredness difficulty concentrating

Our reactions to physical environments differ depending on their risk and survival properties.

Modern ‘habitats’ often lack the visual cues that link to survival (water, vegetation, etc). With a release of adrenaline and cortisol, this stress can trigger a physical reaction through the ‘fight or flight’ response (the sympathetic nervous system): our heartbeat and breathing quickens, muscles tense, and digestion slows down.

Although a small amount of stress can be good for us (as it helps us to focus), chronic activation of this response (like an alarm system that stays turned on) can result in the wear and tear of the body, tipping it into an imbalanced state where a large number of illnesses become more likely.

These include anxiety, depression, digestive problems, heart disease, sleep problems, weight gain, memory and concentration impairment.

Opposite page: landscapes photographed by @.rmfelix, during biological field trips across Portugal, with a mission of conserving the natural world

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P

The concept of ‘biophilia’ was popularised by an influential biologist Edward O. Wilson, who is also known for coining the term ‘biodiversity’

Sketches of a residential roof garden design in Wapping, London

by Davis Architects

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Photograph by Tinnaphop Chawatin

A PLANT SOLUTION

Biophilia, although most commonly known as the title of a Björk album, is a concept which suggests that contact with nature is a universal and basic human need, derived from our evolutionary history.

Biophilic design endeavours to forge this connection by referencing or inserting instances of nature, natural patterns or spatial conditions into the built environment.

Top left: an aesthetic office design that incorporates the natural material of wood and windows that provide natural light and views onto nature Middle: an example of a green wall with a range of plant species

chronic lung disease and lung cancer. With more oxygen in the air, blood flow is increased, which can improve energy levels, mental focus and digestion. Although, it’s worth noting that differences between plant species provide large performance variability, and it’s therefore recommended that experts be consulted.

In urban areas, roof gardens, as a space to escape or socialise, are a great way to provide access to nature. At height, the air is cleaner, there is more daylight, there is less noise and users may feel safer. Gardens can also help biodiversity and attract wildlife; interaction with humans, other species, and even soil, has been shown to combat depression - the charity Mind deems ecotherapy as a clinically valid treatment.

Design can take advantage of the relaxing nature of nature, as it provides us with sensory stimulants: aesthetics (colour and repeating patterns), texture, smells and sounds.

The use of windows can also provide building users with views to landscapes, the weather and the natural changes of daylight. Within buildings, nature can be referenced by water features, plants, or even materials (such as wood).

One of the most spaceeffective ways to add green indoors is via vertical green walls. They can act as room dividers to create more privacy and improve acoustics by reducing echoing. Indoor plants can also act as passive and low energy humidifiers; they can help to improve air quality, reducing risks of pneumonia, 23

A Case Study

S E N S O RY

GARDENS Above: Tom Massey’s design of a healthy landscape for The Cassel Hospital ecotherapy garden Right: sensory gardens are common in hospice settings Below: Florence Nightingale

The historical relationship between art and science is displayed as a range of professionals collaborate to design sensory gardens today. Primarily in healthcare settings, but with ideas that can be transferred to other sectors, these gardens aim to tackle our disconnect between mind and body and increase exposure to the outside world.

Long ago, Florence Nightingale recognised these aims as she placed her patients in natural landscapes with access to sunlight and fresh air, as much as possible.

We seem to be coming back to the idea that health and recovery is dependent on sensory stimulation. In 1984, Roger Ulrich measured the recovery time of patients who had undergone invasive gall bladder surgery. The patients were split into two groups: one group had a view to nature, the other looked onto a brick wall. Strikingly, those with a view to nature averaged a day less recovery time and needed less pain medication. This provides a strong argument for the worthy investment into the healthy design of healthcare buildings, with an obvious financial benefit that could help today’s struggling NHS. Users of medical buildings can experience sensory deprivation at the same time as sensory overload. Medical settings are often bleak by design, with a lack of natural lighting and an inability to control environments local to the patient. Sensory gardens, and views onto them, are a great example of how the design aspects discussed throughout this magazine can be used together in harmony. The gardens are aesthetically pleasing, provide access to fresh air, and give a view to natural light and weather. To continue engagement with nature during darker hours (especially important in winter), the garden can be subtly illuminated to avoid the ‘black mirror’ effect of windows. They can act as a space for movement, a quiet escape in a nonclinical setting or for the establishment of a community.

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“The greatest scientists are artists as well” -

Albert Einstein

In healthcare settings, this is not only vital for patient recovery, but also for the wellbeing of visitors and staff, especially with the extra pressure from COVID-19 care.

A great case study is the ‘secret garden’ at Derriford Hospital, Plymouth. As part of a rehabilitation programme, Derriford have found that the garden helps to improve functional outcomes, decrease ventilator days, reduce delirium and decrease ICU (intensive care unit) and hospital length of stay. Whilst the garden can allow for longer visiting times, the weather can still get in the way. To mitigate this, Derriford are looking to build a garden room with piped oxygen, power, skylights, glass walls, benches and raised plant beds, bringing the outside in to stimulate the senses. The success story of 84-yearold Robin Hanbury-Tenison’s recovery from COVID-19 just goes to show how beneficial these design aspects are for our health. To find out more about Robin’s climb of the highest peak in Cornwall, just 5 months after leaving the ICU and finishing Derriford’s

rehabilitation programme, check out Survival: To the Brink and Back on BBC iPlayer.

As with all sectors, there are specific challenges to encouraging wellbeing through building design. In healthcare and medical settings, NHS funding, infection control and the range of users (particularly with patients of different conditions and levels of severity) present can all be barriers to a design that prioritises holistic wellbeing, rather than purely the treatment of a sick body. Infection control limits the range of materials that can be used; materials must be wipeable and water features are a no-go due to Legionnaires disease.

However, on a positive note, sensory gardens show how encouraging wellbeing is not limited to new build design - a common misconception. Simple changes can make a large difference in existing buildings, making refurbishment one less barrier to implementing the design aspects and benefits discussed throughout this magazine.

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Above: sensory gardens are also a great addition in educational settings Below: Robin Hanbury-Tenison in Derriford Hospital’s ‘secret garden’

“Going into the garden, it made me feel alive again”

GLOSSARY OF TERMS A

made in the adrenal glands.

Cortisol is essential for health, but too much can be dangerous.

of the ‘fight or flight’ response to fear, panic or perceived threat.

D

Adrenaline A stress hormone mostly produced by the adrenal glands (at the top of kidneys). It is part

Amygdala A collection of cells, with an almond-like shape, near the base of the brain (in the temporal lobe). It is associated with emotional processes, such as stress and anxiety.

B

Biodiversity The variety and variability of life on earth across several levels, from genes to ecosystems.

Bio-psycho-social An approach that combines the disciplines of biology, psychology and socialenvironmental factors.

C

Cortisol A hormone involved in the body’s stress response that is

Delirium An abrupt change in the brain that causes mental confusion and emotional disruption.

People can also become sleepy and drowsy.

Dopamine Acts as a chemical messenger between the body and brain. It is released when your brain is expecting a reward.

E

Endorphins A group of hormones secreted within the brain and nervous system, having a number of effects on the body. They are produced and stored in the ‘pituitary gland’ in the brain.

F

Feng Shui The Chinese words translate to mean ‘wind’ and ‘water’, respectively. This concept 26

derived from an ancient poem that talks about human life being connected and flowing to the surrounding environment. It is now the practice of arranging pieces in living spaces, in order to create balance and harmony with the natural world.

H

Histamine Often known for it’s role in allergies, it is largely involved in immune system responses. It can also act as a brain chemical (neurotransmitter).

L

Legionnaires Disease A lung infection you can get from inhaling droplets of water that contains certain bacteria. It is a severe form of pneumonia.

M

Melatonin A hormone primarily released by the ‘pineal gland’ in the brain, at night. It has long been associated with the control of the sleep-wake cycle as it acts on receptors in the body.

Levels peak in the early hours of the morning and should

reduce during daylight hours.

Miasma Now defined as an unpleasant smell or vapour. In Ancient Europe and China, miasma

theory suggested that diseases (such as cholera and chlamydia) were caused by ‘bad air’ that emanated from rotting organic matter. The theory was replaced by the germ theory of disease in the 19th century.

N

Neurons An electrically excitable cell that communicates with other cells via specialised connections (synapses) and chemicals (neurotransmitters). They are the fundamental units of the brain and nervous system. They receive sensory stimuli from the external world and send motor commands to our muscles in response.

O

Oxytocin A hormone and neurotransmitter released in response to the activation of sensory nerves. It is often associated with labour,

breastfeeding and sexual activity (sometimes called the ‘love hormone’). However, it can also be released in response to low intensity stimulation of the skin, such as

from touch and temperature. It helps to regulate our emotional responses and pro-social behaviours (trust, empathy, communication, etc.).

Q

Qualitative Relating to, measuring, or measured by the quality of something, rather than quantity. It can be descriptive and observational to allow for an in depth analysis of ideas and experiences.

Quantitative The use of numbers and statistics to create data to analyse. An emphasis is placed on the testing of theory.

S

Sanitarium An establishment for the medical treatment of longterm illnesses. They are most typically associated with the 27

treatment of tuberculosis (TB) in the late 19th century and early 20th century, before the discovery of antibiotics.

Serotonin The key hormone that stabilises our mood, wellbeing and happiness. It has impacts on the entire body, from emotions to motor skills, and is mostly found in the digestive system.

V

Vastu Shastra Translating to the ‘science of architecture’, it is a traditional system that originated in India. Incorporating Hindu, and sometimes Buddhist beliefs, designs aim to integrate architecture with nature, functions of structure, and ancient beliefs through geometric patterns, symmetry and alignment.

A Research on biological sciences has proven the relationships between movement, socialising, happiness, nature and health.

This magazine highlights how architectural design, across a range of sectors, can encourage social, mental and physical wellbeing for all building users.