health design
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healthy cities urbanism studio 2019-20
Contents introduction what is well-being?
physical health
mental health social health ecological health
Introduction The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1948). As a result this book is split into four main chapters in accordance with wellbeing, namely; physical, mental, social and ecological. However, it should be noted that these broad categories are all intrinsically linked and some interventions could be applied across multiple chapters.
This pocket book guide details how architecture and urban design can impact and improve public health through a series of macro and micro interventions; from changes you could make now within your home, to changes that encourage new ways of thinking at a global scale.
Architecture is the “ frame in which we live. We don’t just look at architecture,
we live in it…
architecture is for much more than the eyes. It is for life. And that is why it is such a powerful tooloften devastating but potentially
health-giving. [Day, 2004, p.1]
”
what is well-being? ‘well’ is: ‘In good health; free or recovered from illness.’ ‘being’ is: ‘The nature or essence of a person.’ ‘well-being’ is: The state of being...
happy healthy comfortable
physical health adjective 1. Health, relates to the body, the state of being free from illness or injury. 2. The physical world, having material existence; tangible or concrete.
“
The built environment contributes not only to human injury but also human disease, as illustrated by the epidemic in obesity and overweight now manifest across the country, ranking only second to tobacco related deaths. [Jones, L., et al, 2005]
�
Lack of exercise deadly as smoking is as
[NHS, 2012]
Lack of physical activity
is costing the UK an estima
ÂŁ7.4 billion a ye including ÂŁ0.9
billion to the NHS alone. [Public Health England, 2016]
1 in 4 adults were obese - and In 2016,
Public Health England expects levels of adult obesity may
continue to rise. [Roberts, 2018]
12 hours is the amount of time the average person is
sitting
a day.
[Just Stand Org., 2018]
More than 80% of the world’s
adolescent population is insufficiently
physically active. [WHO, 2018]
ated
3.2 million deaths
ear,
a year are related
physical inactivity. to
[Just Stand Org., 2018]
1 in 3
working age people
have a health condition. in the UK
[Public Health England, 2019]
the problem Studies show that people who live in countries marked by sprawling developments are likely to walk less and weigh more. Only 48% of current built environment practitioners said that increasing walking and cycling activities among prospective residents were part of their design aims. Of this 48%, even less were likely to consider physical well-being within indoor spaces. Our environments now revolve around vehicles, ease, efficiency, with many of our lifestyles being predominantly sedentary, and our physical health is majorly suffering as a consequence.
[Figure 1]
[Figure 2]
the aspiration Through innovative thinking, designers have the ability to encourage physical activity through active design methods. Whether these interventions be as subtle as moving the escalators further away than the stairs from the entrance of space, to pedestrianising entire zones, the power to control and improve people’s physical health is possible through clever infrastructure choices, often unbeknown to the user.
the solutions
Active Design
Pedestrian-scale elements in and around the building exterior, can encourage daily physical activity, such as a stairway instead of a lift or escalator.
Lighting Design
Finding the balance between natural and electric lighting can help reduce headaches and eye fatigue.
Active Spaces
To provide easily accessible active spaces for group or individual exercise. These could either internal or external, or both.
Thermal Comfort
Monitor and control the temperature and humidity of indoor environments in order to reduce itchy eyes, headaches and throat irritation.
Ergonomics
Experts suggest that occupants should regularly alternate between seated and standing positions throughout the day to promote fitness and reduce back/spine problems.
Travel
An improvement in cycle routes, cycle parking and pavements will encourage non vehicular travel and promote physical activity which can reduce risks of cancer and heart disease.
Proximity
Mixed-use developments (such as living, work, commercial, and recreational spaces located within a close proximity of one another have been associated with higher levels of physical activity and lower body weight/obesity.
Zoning
Exterior elements of the project site can also be leveraged to encourage physical activity, such as pedestrian only zones, cycle friendly pavements, outdoor activity spaces etc.
the solutions
Education By improving the physical health education and provisions within schools, you can not only improve fitness from a young age but also encourage leadership skills, self-discipline and sociability.
Healthy Eating What we eat majorly impacts both our physical and mental health. Designing spaces which encourage cooking promotes a healthier, more balanced diet.
Weather Design External areas which can accommodate for bad weather by means of covered walkways and canopied areas, will ensure physical activity at all times of the year.
Hydration Water refill stations should be freely accessible to all. Staying hydrated ensures normal muscle function, and can help to prevent fatigue and excessive eating.
Fitness Provisions Providing cheap and fully accessible services which help to maintain physical health such as gyms, swimming pools, running tracks and sports centres.
Comfort Experiencing any physical discomfort can be detrimental to both our physical and subsequently mental health. The provision of a comfortable environment at both work and at home is paramount.
Air Quality You can improve external air quality by introducing low-emission zones, and maximising the use of green walls and green landscaping.
Access to Services Making sure everyone in the community has access to the appropriate health services. Work places to promote healthcare packages and bonuses.
mental health adjective 1. Of, affecting, or arising in the mind; related to the mental and emotional state of a person.
The environment “ that we have created
in the past hundred years is at odds with the physical and psychological nature of people... with the technological ability to turn night into day and otherwise artificially control and distort environments, we are finding that we have built places that are bad for our health.
[Lindholm, 1985]
�
61 million
antidepressants
prescribed in the UK in 2015. [The Guardian, 2017]
The number of people acknowledging that they
know someone
close to them who has had
mental illness increased from 58% a
in 2009 to
2014.
65% in
[NHS, 2019]
By 2030, it is
estimated that there will be approximately two
million more adults in the UK with
mental health problems than there were in 2013. [NHS, 2019]
One in six adults
mental health problem UK have a
at any one time.
[National Mental Health Development Unit, 2010]
Mental health issues in the workforce cost UK
employers up to ÂŁ42
billion a year. [Wellbeing.BITC, 2019]
1 in 4
people in the UK will
experience
mental health problem a
each year [Mind, 2019]
31% of the UK
workforce have been
formally diagnosed with mental health issue. a
[Wellbeing.BITC, 2019]
the problem With mental ill-health costing the UK economy an estimated ÂŁ70 billion a year through lost productivity, social benefits and health care, with over 15 million work absence days and almost one in six people with diagnosable mental health conditions, [Public Health England, 2016] it is clear that, as architects, our current approach to considering mental wellbeing within good design needs to not only be reinvestigated and re-evaluated, but also applied on a much larger, urban scale. Current spaces lack a sense of joy, ownership, adaptability and a connection to nature, all of which promote mental illness.
[Figure 3]
[Figure 4]
the aspiration Architectural features and spaces that promote well-being should be praised and emphasised, but they should also be in such excess that they become seamless and commonplace within our surrounding environment. By forcing people to face, and be in direct contact with architecture, urban design and landscaping that unashamedly promotes positive behavioural changes in mental well-being, designers can also utilise their power and strive to extinguish the shame, concealment and embarrassment felt by many of those living with mental illness- which in turn negatively contributes to the health issue itself.
the solutions
View Preservation To preserve and maintain constant visual access to green and blue spaces as looking at nature has been shown to improve mood.
Animal Engagement Provide spaces to accommodate for pets and wildlife in order to reduce stress, anxiety and depression, whilst encouraging playfulness and interaction.
Outdoor Play To provide people, old and young, with access to outdoor environments designed to promote enriching play opportunities.
Evoke Joy Create special moments within a building, for example; a beautiful detail or an interesting use of materials. Avoid visual monotony.
Open Plan Psychologically they can create a greater sense of space, which can make us feel happier and more relaxed.
High Ceilings Links have been proven between high ceilings and feeling a greater sense of psychological freedom.
Colour Colour can be used to manipulate moods and atmosphere. For example, the colour yellow has been shown to stimulate serotonin release.
Biophilic Design To support the integration of the natural world in to the modern built environment by means of natural materials, natural light and lots of vegetation.
the solutions
Storage
The links between untidiness and stress have been proven. Clever storage solutions enable an ‘uncluttered’ environment and mind.
Tactile Materials Tactile materials encourage users to directly engage with their sense of touch, which not only improves focus but aids engagement with our surroundings.
Scale Spaces that are too large can cause isolation, but spaces that are too small can cause feelings of being trapped- the scale of our environments should be efficient and wellsuited to their purpose.
Privacy Humans have evolved to feel much safer in spaces with privacy; the ability to see without being seen. Provisions for this must be considered when designing layouts.
Creating Atmosphere Although very hard to encapsulate, atmosphere plays an integral part in mental well-being. Refer to ‘hygge’ and ‘feng shui’ principles for more detail.
Legibility Streets, buildings, façades and details should all be easy to understand and navigate, in order to prevent frustration and confusion.
Stay Sociable Maintaining relationships and frequent contact with other people has been proven to improve mental well-being. Refer to the ‘social health’ chapter for more information.
Roof-top Gardens Roof-top gardens allow for better views, cleaner air and less noise than their street level counterparts. Being higher looking down evokes a sense of safety, protection and calm.
social health adjective 1. Relating to society or its organization. 2. Needing companionship and therefore best suited to living in communities.
“
Because we so readily take our surroundings for granted and rarely bring them to full consciousness, they can influence us powerfully. This has human, social, biological and ecological implications. We only need to live briefly in a different environment to recognise how much our surroundings have informed us and our society in sensitivities, in values, in way of life.
[Day, 2004, p.5]
�
2 in 3 people feel
they belong
to their neighbourhood. [Public Health England, 2019]
Loneliness has been alleged to have the same impact
on life expectancy as smoking
fifteen cigarettes a day‌ A lack of social contact can also speed up cognitive
decline, heart disease, depression and suicide. [Orange,. et al, 2019]
Having a friend who is
happy and lives close
increase happiness by as much as 25%. Similar by can
results have been found for cohabitant spouses (8%), siblings (14%) and next-door neighbours (34%). [Mental Health Org, 2019]
Loneliness increases the likelihood of
mortality by 26%. premature
[Public Health England, 2019]
Two thirds of teenagers
prefer to spend time in their bedrooms glued to their
screens. [Express, 2017]
6%
Across the EU, of the adult population
did not have someone to discuss personal
matters with in 2015. [Europa, 2019]
Over 9 million people in the UK across all adult ages – more than the population of London – are
always or often lonely. either
[Campaign To End Loneliness, 2019]
the problem The disparities provoked from physical segregation in relation to urban living can further intensify feelings of social inferiority, hopelessness, low selfesteem and a sense of not belonging- all of which can contribute to worsening mental health disorders at a social scale. With dark facts emerging in the media on the consequences of loneliness- to the extent that in 2018 the UK appointed the world’s first ‘Minister for Loneliness’ [John, 2018], there is an enormous amount of work architects can do to design places that actively help to prevent issues of isolation. Feelings of detachment within buildings can also stem from a lack of individuality and the inability to imprint ourselves on a space; this is the product of a lack of participatory design at both macro and micro levels.
[Figure 5]
[Figure 6]
the aspiration It should be a moral duty for architects to design environments that enhance a diverse variety of natural social connections and interactions, whilst fostering “a sense of community, integration and belonging� [Design Council, 2017]. To improve social, and thereby mental health at a global scale, humans must also be grounded and connected to nature’s life cycle in an attempt to rebalance our inner equilibriums. There must be an acceptance and acknowledgement that we are born, grow old, and die. This aspiration can be enforced through implementing intergenerational evidence-based design; whereby infrastructures act as platforms for encouraging beneficial relationships between the young and old, with co-occupation and multi-use spaces at the core.
the solutions
Community Visioning To collaboratively develop a shared vision, whilst implementing measurements and activities which enhance community involvement and participatory design.
Entrances Adapting and configuring entrances to promote social greetings and connectivity, thus enhancing social interaction.
Public Creativity To foster public creativity and appreciation for art, music and theatre within a social domain, in order for people to interact with likeminded others.
Intergenerational Design Encouraging social cohesion between all ages, by introducing co-occupation and multi-use spaces in order to prevent isolation in the elderly.
Empower Individuality Allow for the personalisation of space. In order for users to develop a sense of ownership and belonging. Giving users options in order to adapt their environment to best suit their needs.
Public Social Spaces To provide public spaces, amenities and programming for community members to socialise, assemble and collaborate in order to foster positive social connections.
Tech Free Zone Zones that quiet, the constant interruptions and stresses of daily life but enhance the formation of relationships.
Safe Spaces Providing overlooked, well maintained spaces enable the user to feel a sense of security and protection.
the solutions
Criminal Justice Raising awareness and acknowledging the incarcerated members of your society not only acts as an early crime prevention scheme, but also prevents further ostracisation of inmates upon release, therefore reducing re-offending rates.
Wider Streets Wider streets allow for more daylight into buildings and also increase the amount of personal space given to pedestrians (both of which improve mood). They also allow for pockets of social interactions without causing obstructions.
Digital Connectivity Within a design scheme, provisions should be made in order to allow for good digital connectivity in order to ensure the networking of wider communities.
Maintenance If a space is well maintained and clean it will immediately encourage more users, and therefore will enhance opportunities for social interactions.
Know Your Area Clear way-finding and landmark architecture can encourage meeting points and ensure familiarisation within an area.
Celebrations To honour local history, cultural practices, institutions and the genuine identity of the project area in order to foster stronger contextual relationships between your design and the society it will reside within.
Integration A mixture of social, affordable, mid-range and high end housing combined with an extensive range of facilities will ensure a diverse, multicultural, well balanced society where equality prevails.
Activities The organisation of social events and physical activities will improve communal cohesion and by default produce meeting places for neighbours to socialise.
ecological health adjective 1. Relating to or concerned with the relation of living organisms to one another and to their physical surroundings.
It’s only in the past “ hundred years or so
that we shifted from spending 90% of our time outdoors to spending 90% of our time indoors... There is now evidence that connects nature with improved health, well-being and productivity as well as enhanced learning, empathy and compassion.
[Buchanan, 2016]
”
1 million species face More than
extinction. [Ecotricity , 2019]
built environment Features of the
impact human health— appear to
influencing behaviours, physical activity patterns, social networks, and access to resources. Over the past century,
[Healthy People , 2019]
the global average sea
level has risen 4-8 inches. Melting Arctic ice is expected to speed up sea level rise. Some experts even estimate that the
oceans will rise as much as 23 feet by 2100, which would flood major coastal cities and submerge some small island countries, causing untold
devastation. [Greenpeace, 2019]
23% of all global deaths are linked to the environment. That’s roughly 12.6
million deaths a year. [World Health Organization, 2019]
7 million deaths Every year, around
are due to exposure from both outdoor and household
air pollution.
[World Health Organization, 2019]
2030 and 2050, climate change Between
is expected to cause
250,000 additional deaths per year. approximately
[World Health Organization, 2019]
11% of the world’s population is currently
vulnerable to climate change
impacts such as droughts, floods, heat waves, extreme weather events and sea-level rise. [Conservation Org, 2019]
the problem Our built environment and its interactions with the natural environment are complex and have a massive impact on the world around us; from well-being to global warming. There is often a struggle between the demands of the ‘internal’ and the needs of the ‘external’. In order to fully succeed, both buildings and people should embody a co-dependency with and respect for the natural environment. However, it is often this relationship which is the first to be disregarded and dismissed in favour of ease, cost and space delegation but this has to change.
[Figure 7]
[Figure 8]
the aspiration Human beings are part of nature, and therefore the spaces we inhabit should also share this connection. We are hard-wired to desire a relationship with “daylight, air, water, flora and fauna� [Buchanan, 2016], so spaces that can bring these elements from the outside in prove invaluable to our health and well-being. The ecological health, efficiency, and sustainability of the building itself should also be considered during the construction stage and its life-cycle thereafter. Appropriate environmentally friendly responses to both proposed and existing infrastructures are a must, as the consequences of the construction industry are paramount to our entire ecosystem.
the solutions
Healthy Materials Consider the environmental impact of the materials, not just how it looks. For example, what it contains and the emissions released in its production and transportation.
Contextual Potential Use the environment to guide construction. The orientation and landscaping of a building can effect local ecosystems, transportation, and energy use.
Life Span The adaptability and permeability of a building feed into how sustainably feasible it is. Consider how its use could adapt to future changes.
Avoid Disruption Consider how grounds work, noise, smells, traffic disruption and road blocks might effect the existing context and surrounding neighbourhoods.
Renewable When possible always use renewable forms of energy such as biomass, solar panels, wind turbines and hydro-electrics.
Climate Adapting the building to perfectly suit the local climate can save energy, time and money in the long-run, even if it seems the more expensive option initially.
Enhancing Indoor Indoor plants reduce pollutants by improving the air quality, whilst also providing positive mental stimulation.
Conservation Look at using or integrating existing buildings in order to reduce the carbon footprint of new construction, whilst also maintaining the heritage of a site.
the solutions
Waste Management Ensuring there are proper waste provisions will help the building and surrounding context breathe. This could vary from providing sufficient bins to efficient sewage plans.
Urban Allotments Growing and eating homegrown produce not only reduces carbon emissions (on food transportation), but also encourages feelings of empowerment and selfsufficiency.
Environment Control Providing efficient and appropriate ventilation and moisture control will help the building breathe; avoiding damp and mould within the building fabric. Consider the design of openings and drainage.
Education Using nature to educate, engage and involve by means of activities such as group gardening in schools and local communities, helps to improve ties to the natural world.
Daylight Access to daylight not only impacts occupant’s wellbeing but also reduces overall energy consumption. Sunlight ingress calculations should account for seasonal variances.
Transition Consider how the building transitions from internal to external. Large open spaces that open up to the outside might increase adaptability and allow for fluidity of movement.
Acoustic Comfort In addressing internally generated noise, floor plans should be designed with intent and use in mind. Consider acoustic separation within the constriction via materials and the design of rooms sizes.
Natural Materials A heightened connection and awareness to nature can be formed by using natural materials. Such materials not only express the craft of their construction, but also re-engages our primitive relationship to making.
“
Architecture has responsibilities to minimise adverse biological effects on occupants, responsibilities to be sensitive to and act harmoniously in the surroundings, responsibilities to the human individualities who will come in contact with the building, responsibilities not only in the visual aesthetic sphere and through the outer senses but also to the intangible but perceptible ‘spirit of place.’ [Jenks, et al. 1997, p.149]
”
references
[all iconography produced by authors]
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health design
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Authors Agne Arlauskaite Hannah Bracewell Phillippa Budd Alexi Chomyszyn Kawshik Choonee Emily Dance Sophia Ehiobuche-Johnson Shi Eng Jonathan Gomes Alexander Hussey Esra Ibrahim Nutawat Siraviwat Siân Trezise-Hardinge