The impact of the built environment on health

Catherine Simpson of HLM Architects on how hospital design can impact on patient and staff wellbeing

Landscaping is at the heart of design of the new Royal Hospital for Sick Children and Department of Neurosciences in Edinburgh

In this article Catherine Simpson, landscape architect and urban designer at HLM, illustrates how the principles of intelligent urban and hospital design can merge, creating a highly-connected, modern hospital within a parkland to positively impact mental and physical health

Currently more than half of the world’s population lives in cities and this figure is set to rise to 70% in 2050 as global urbanisation occurs at an unprecedented pace. Understanding the effects of the built environment on health is, therefore, critical.

City living confers many benefits, but the negative influences of the urban environment and nature deprivation on human health are increasingly becoming better understood. Both lifestyle - obesity, diabetes, heart disease and cancer - and mental illnesses are on the rise as a result of urbanisation; at a potential cost of billions to world governments.

As healthcare turns towards population and preventative health; the upstream benefits of an intelligent built environment with access to nature, social, recreation and environmental support become ever more apparent.

Castle Hill Hospital in Yorkshire

A growing body of research and clinical evidence supports the importance of designing cities with access to high-quality green space and natural environments. When the evidence is examined, populations that live near to these spaces show better health metrics across a range of indices. These spaces seem to mitigate some of the physical and mental burdens of living in a dense city. Adding to the existing body of research, two studies in 2015 illustrate the importance of natural environments to urban design and human health.

Exciting new research by Stanford University into the effect of walking in a natural environment versus an urban setting has shed light on the mechanisms by which nature exposure may improve mental wellbeing and the inverse negative relationship of an urban setting. In the study, nature experience was shown to reduce both rumination and sug-genual prefrontal cortex activation - a brain region associated with self-focused behavioural withdrawal like rumination - with the urban walk showing increases in both measurements (Bratman 2015).

As healthcare turns towards population and preventative health; the upstream benefits of an intelligent built environment with access to nature, social, recreation and environmental support become ever more apparent

Another study in Toronto, Canada, by the University of Chicago has shown that simply living on a city street with 10 more trees than average improved health perception in ways equivalent to earning an extra $10,000 a year, or being seven years younger; while having 11 more trees decreased cardio-metabolic conditions comparable to having an extra $20,000 in additional income (Kardan 2015).

As the quantity of studies into environmental health benefits expands, and our understanding of the mechanisms by which contact with nature aids our health, it’s becoming increasingly clear that quality landscapes and natural environments are essential to human health.

The design of our cities, our streets and our parklands offers, not only the potential to mediate economic health discrepancies, lifestyle and mental illness, but ultimately to confer valuable potential cost savings to the health system through disease prevention.

However, without greater connections and awareness between design and planning, healthcare and academia, and within public discourse, the argument for intelligent city planning can become lost against the demand for land to build. Globally, cities and countries are densifying at an unprecedented pace and the pressure to continually develop open space and remnant natural environments can overpower more-considered approaches, to the detriment of the city and its residents. This is particularly true in the developing world, where city building occurs at a frenetic pace and planning controls oftentimes cannot keep up.

As we begin to understand more about what makes us healthy, there is an opportunity to reframe how we think about wellness and the hospital to put the hospital back in the pivotal role

While cities confer many benefits, it’s important that we don’t lose sight of human needs for proximity to nature. Modern powerhouse cities like London and Vancouver in Canada offer examples for how cities can simultaneously densify and retain greenspace. Case studies such as historical planning in London offer templates by which parks and green space can be created. Perhaps paradoxically, the Victorians had an enlightened view about the benefits of nature on human health, and landscape was once at the forefront of healthcare and recuperation as well as healthy city planning, which in part explains the sheer amount and quantity of London parks and green space.

Critical to the future of urbanisation and health, though, is ensuring that planners and legislators are aware and empowered to serve their populations through strong planning and health policy.

The evidence also supports health and care facilities that utilise green and therapeutic environments fostering better health patterns and safer, more rapid healing environments. These need to be sustainably incorporated into hospitals and the wider built environment to improve health and mental wellbeing.

The key is utilising the principles of intelligent urban and hospital design to create hospitals within parklands and landscapes that not only provide patients with high-quality restorative and invigorating environments, but intelligently increase green public space, thereby endowing hospitals with highly-efficient, health-enhancing landscapes and civic architecture.

As we begin to understand more about what makes us healthy, there is an opportunity to reframe how we think about wellness and the hospital to put the hospital back in the pivotal role. This is precisely what we are doing at HLM. We believe hospitals should, and can be part of the urban fabric, not by just incorporating green courtyards which aid faster healing and reduced medication, but also substantial landscapes and parklands, therefore reframing the hospital at the centre of the population health movement.

The design of our cities, our streets and our parklands offers, not only the potential to mediate economic health discrepancies, lifestyle and mental illness, but ultimately to confer valuable potential cost savings to the health system through disease prevention

Civic architecture and landscape are at the heart of The Royal Hospital for Sick Children and Department of Neurosciences in Edinburgh, Scotland. Currently being designed, the hospital uses best-practice architectural principles, with every bedroom given a view to surrounding parkland or one of the 22 health-enhancing green courtyards. The hospital contributes to its environment through a strong civic architecture, increased green space and parkland, enhanced urban design, planting and walking and bicycle tracks for health and fitness.

The design of the Edinburgh hospital is an exemplar and demonstrates the principles by which hospitals can take a more-central role in the urban fabric, aiding wellness beyond the hospital walls.

The Queens Centre for Oncology and Haematology in Hull

References

1 Bratman, G.N.; Hamilton, J.P.; Hahn, K.S.; Daily, G.C.; Gross, J.J. Nature experience reduces rumination and subgenual prefrontal cortex activation. Proc. Natl. Acad. Sci. USA 2015, 112, 8567–8572

2 20 Kardan, O., Gozdyra, P., Misic, B., Moola, F., Palmer, L., Paus, T., & Berman, M. (2015). Neighborhood greenspace and health in a large urban center. Sci. Rep. Scientific Reports, 5, 11610-11610.

Companies