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Banal, bland and bleak. The three words that described the hospital visit to see my 8-year-old sister, a newly diagnosed Diabetic. All the symptoms were there – rapid weight loss, excessive thirst and constantly needing the toilet – but no-one wanted to face the imminent reality. Watching my sister’s life completely transformed in that one diagnosis was heart breaking. Nothing you say or do can make it better. ‘It’ll be fine’ doesn’t quite cut it.

[A] Sterile conditions of current hospital design
In those depressing days, sat in the barren hospital room of York Hospital’s 1970’s Children’s Ward, the sterile arrangement of a bed covered in a clinical, slightly bobbled, blue, bedspread, the plastic shower-esque curtain and lonesome waiting-room, wipe down chair by the window which overlooked a blank brick wall, I decided to become an architect. I can still recall that smell, sanitisation, and taste the disinfectant in the air as she asked me to ‘make it go away’. Sadly, I can’t achieve that. However, the prospect that I could design calm, caring, therapeutic environments, like those of Maggie Centres, to brighten the difficult times ahead, was something realistically influenceable, or so I thought.

[B] Symbiotic relationship of Maggie Centres combining internal and external therapeutic landscapes
I’m sure you’ve visited people in hospital and can relate. We wish them a quick recovery and speedy return home. If only they had a view of a tree. Roger Ulrich’s Psychoneuroendocrine experiments provided evidence that patients with a view of nature recovered quicker from surgery and experienced less pain, than those who didn’t. Within 5 minutes of witnessing nature, patients stress levels had reduced resulting in increased immune function and resistance to infection.[1] Humans have evolved in, and with, the natural world, which has created an innate biophilic attraction. Juhani Pallasmaa’s work highlights how the sight or touch of nature such as the sun through a window or movement of fresh air, allows us to feel connected to a place, as we age with nature[2].

Widespread inclusion of therapeutic landscaping including green and blue infrastructure around hospitals would therefore reduce patient’s time spent in hospital, whilst also decrease running costs of hospitals, healthcare professionals time required and allow treatment of more people[3]. A very positive prospect for a healthcare system under such immense strain. People could return to work sooner, pay taxes and use their money. Humanitarian design enabling economic vitality. A financially sensible argument. So why doesn’t each hospital room have a green view? Essentially it requires greater initial investment and higher maintenance costs. In a market driven by immediate profit, this is not a priority.

[C] Therapeutic Landscaping at The Nelson Mandela Children’s Hospital
Aidan Oswell’s lecture, ‘Economics and Effective Urban Design’, discussed value. What does this mean? In neoliberalist terms this means immediate gratification. An initial input is assessed in terms of a measurable, normally financial, output. ‘Cost benefit analysis’, ‘time allocation theory’ and ‘investment appraisal analysis’, create economically viable proposals, satisfying the developers desire for maximum profit and perceived worth[4]. In a world obsessed with defining value in quantitative, short-term, monetary gains, can we ever really create buildings, landscapes and environments that are, in the words of Jan Gehl, ‘sweet to their people[5]’?

[D] Robert Kennedy 1968 campaign speech University of Kansas ‘The gross national product does not allow for the health of our children, the quality of their education or the joy of their play…it measures everything in short, except that which makes life worthwhile.'[1D]
As designers, our job is ultimately to enhance the lives of people, rich or poor, through the urban realm. To design as John Rawls said with ‘a veil of ignorance’[6] as if we don’t know our place in society would create a welfare state benefiting all. Out of touch, disillusioned and reckless. These words seem reasonable when describing architects or urban designers’ traditional financial reputation. Just because money isn’t our number one value, does not mean our priorities are wrong though. Society champions narrow-minded capitalism. Has holistic thinking and thus investment in places for people been side-lined?

Precedents of 19th century philanthropic capitalism include Bournville and New Earswick[7] built by factory owners John Cadbury and Joseph Rowntree respectively. They prioritised creating pleasant environments for their workforces to live in, providing fresh food, communal facilities and green spaces, to enhance their employee’s quality of life, making them healthier and happier citizens. Each dwelling occupied only a quarter of its plot and a garden was essential[8]. Additionally, this increased productivity of their workforces and was therefore economically savvy.

[E] Bournville – investing in healthy living conditions for a happy workforce
Bournville is still cited[9] in ‘Good Design: it all adds up as being exemplary in terms of quality housing provision because of Cadbury’s futuristic outlook. Poor quality housing is predicted to cost the NHS £600 million treating the health repercussions and society £1.5 billion from individual loss of earnings per year[10]. By applying prevention is better than cure to our built environment, we could invest money and resources into economic, environmental and socially beneficial development. This really is a no-brainer.

[F] Hammarby Sjostad – Biophilic Urban Design to increase resident wellbeing
‘The value of urban design‘ collated quantifiable research and evidence to showcase the greater shared benefit to society. Resistance to neoliberalist capitalism is starting to occur through groups such as Extinction Rebellion[11] and fiscal systems accounting for whole life costing. Now it needs implementing in urban design. The 3C pillars should influence future urban design – compact, connected and coordinated[12]. By taking inspiration from Timothy Beatley’s green urbanism and sustainable urban development approach, such as Hammarby Sjostad, Stockholm [13] we can create biophilic design, intertwining nature with the urban realm as a fundamental design principle, for long term benefits of citizens. Scandinavia in general[14] have high taxes which are reinvested in well maintained parks and public facilities, accessible public transport and extensive cycling routes[15], enabling more symbiotic relationships between the city and its users and consistently being scored as some of the happiest places to live in the world.

[G] Despite bitterly cold weather, Scandinavian countries investment in public realm initiatives, such as extensive cycling routes, been they are consistently ranked in the top countries for citizen wellbeing
My naïve optimism and human focus for hospital design has so far been unrealised whilst working. But why reserve therapeutic design and enhanced wellbeing for just hospitals though? Council House 2, Melbourne, incorporated basic boiphilic design, resulting in a 10% productivity increase in the first year and payback period of less than 5 years. [16] We could design all our urban environments with symbiotic relationships between nature and the built environment, improving every day for everyone.

It requires a brave reconceptualisation of value. No longer just determined by immediate profit, we need the foresight to see the long-term benefits of investment in high quality place making. This can create much happier, ‘liveable’ cities for people, with consequent economic benefit. Surely this is the society we deserve.

 

[1] Bernheimer, L. (2017) The Shaping of Us: How Everyday Spaces Structure Our Lives, Behaviour, and Well-Being. 01 edition. London: Robinson, p138.

[2] Pallasmaa, J. (2005) The Eyes of the Skin: Architecture and the Senses. 2nd Edition edition. Chichester : Hoboken, NJ: John Wiley & Sons.

[3] Bernheimer, L. (2017) The Shaping of Us: How Everyday Spaces Structure Our Lives, Behaviour, and Well-Being. 01 edition. London: Robinson.

[4] Oswell, A. (2019) Lecture 2:Economics and Effective Urban Design. Principles and Practice of Urban Design TCP8090, Newcastle University, delivered 17th October 2019.

[5] Oswell, A. (2019) Lecture 2:Economics and Effective Urban Design, Principles and Practice of Urban Design TCP8090, Newcastle University, delivered 17th October 2019.

[6] Rogers, R, and Brown R. (2017) A Place for All People: Life, Architecture and the Fair Society: Architecture, Society and Me. Main edition. Edinburgh: Canongate Books,  p299.

[7] JRF. (July 9, 2003) “Neighbourhoods That Work,”. Available at https://www.jrf.org.uk/report/neighbourhoods-work. Accessed (January 6 2020).

[8] The Guardian. (September 23, 2016) “A Visit to George Cadbury’s Model Village of Bournville – Archive, 1901 | UK News | The Guardian.” Available at https://www.theguardian.com/uk-news/2016/sep/23/george-cadbury-model-village-bournville-birmingham. (Accessed November 14, 2019).

[9] BusinessLive. (September 30, 2014) “114 Years on, Why George Cadbury’s Bournville Is Still the Role Model for Successful Housing.”  Available at http://www.birminghampost.co.uk/news/regional-affairs/114-years-on-george-cadburys-7857178. (Accessed November 14, 2019).

[10] Dezeen. (July 12, 2011).“‘Good Design: It All Adds up’ – RIBA Report on Benefits of Good Architecture,”. https://www.dezeen.com/2011/07/12/good-design-it-all-adds-up-riba-report-on-benefits-of-good-architecture/. Accessed January 14, 2020) via https://www.penoyreprasad.com/wp-content/uploads/2012/08/Publications-RIBA-Good-Design-It-All-Adds-Up-Penoyre-and-Prasad.pdf

[11] Oswell, A. (2019) Lecture 2:Economics and Effective Urban Design, Principles and Practice of Urban Design TCP8090, Newcastle University, delivered 17th October 2019.

[12] Floater, G., Dowling, D., Chan, D., Ulterino, M., Braunstein, J., McMinn, T., Ahmad, E., Global Review of Finance for Sustainable Urban Infrastructure.
Coalition for Urban Transitions. London and Washington, DC. Available at: http://newclimateeconomy.net/content/cities-working-papers. LSECities “Global Review of Finance For Sustainable
Urban Infrastructure” https://lsecities.net/wp-content/uploads/2018/01/NCE2017_CUT_GlobalReview_final.pdf (Accessed January 13, 2020)

[13] Beatley, T (2012). ‘Planning for sustainability in European cities’, in Larice, M. and MacDonald, E. The Urban Design Reader. London, UNITED KINGDOM: Routledge. p446-457

[14] BBC. (March 20, 2017)“Can We Be as Happy as Scandinavians?” BBC News. sec. Available at World. https://www.bbc.com/news/world-39331314. (Accessed 15 January 2020).

[15] Savage, Maddy. (2019) “What the Nordic Nations Can Teach Us about Liveable Cities.” https://www.bbc.com/worklife/article/20191112-what-the-nordic-nations-can-teach-us-about-liveable-cities. (Accessed January 16, 2020).

[16] Beatley, T. (16 Dec. 2010). Biophilic Cities. 2nd None ed. edition. Washington, DC: Island Press. p116

 

Image References

[A]  Unsplash

[B]  ArchDaily. (27 Apr 2016). Maggie’s Cancer Centre Manchester / Foster + Partners.  Available at: https://www.archdaily.com/786370/maggies-cancer-centre-manchester-foster-plus-partners. (Accessed 16 Jan 2020).

[C] Holmes, D. (2017). GREENinc Landscape Architecture. The Landscape Spaces of Nelson Mandela Childrens Hospital. Available Via: https://worldlandscapearchitect.com/the-landscape-spaces-of-nelson-mandela-childrens-hospital. (Accessed January 15 2020).

[D] Rogers, S. (2012). Bobby Kennedy on GDP: ‘Measures everything except that which is worthwhile’.  Available at: https://www.theguardian.com/news/datablog/2012/may/24/robert-kennedy-gdp. (Accessed January 15 2019).

[1D] Quote. https://www.jfklibrary.org/learn/about-jfk/the-kennedy-family/robert-f-kennedy/robert-f-kennedy-speeches/remarks-at-the-university-of-kansas-march-18-1968

[E] The Guardian. (September 23, 2016) A Visit to George Cadbury’s Model Village of Bournville – Archive, 1901 | UK News | The Guardian. Available at https://www.theguardian.com/uk-news/2016/sep/23/george-cadbury-model-village-bournville-birmingham. (Accessed November 14, 2019).

[F] The nature of Cities. (2014) Hammarby Sjöstad — A New Generation of Sustainable Urban Eco-Districts. Available at: https://www.thenatureofcities.com/2014/02/12/hammarby-sjostad-a-new-generation-of-sustainable-urban-eco-districts/(Accessed January 15 2020).

[G] Visit Copenhagen. (2020). Bike Guide. Available at: https://www.visitcopenhagen.com/biking. (Accessed January 14 2020).

 

 

 

 

 

 

 

 

One response to “Does money really grow on trees?”

  1. Hi Victoria, thank you for bringing up an important issue, such a good read. I agree that hospitals and health care centres are some of the most difficult places for people to be. They have a bad reputation since they are known cold and bland with a depressing atmosphere. But they started to leave this bad reputation behind, their interiors started to change and became more colourful with home-like settings instead of white and bland, although not all of them unfortunately. Along with the beneficial architectural changes, there is a growing recognition of the whole environment of healthcare facilities. Starting with Ulrich’s work in 1984, many researches showed that the relation with nature is beneficial even vital for health and well-being as you mentioned. Nakamura and Fujii (1992) found out by recording brain wave activities that the green environments causes relaxation while the concrete ones cause stress. Obviously green environments essential but it is more than just planting some trees and lawns that surround hospitals, it’s possible to promote health and well-being in more effective ways. Nowadays there are gardens specially designed for cancer patients, people with Alzheimer’s, mental patients and so on. I found those latest developments promising because they might also allow us to design more successful green outdoor spaces via promoting their recreational and restorative qualities.

    You also have a good point mentioning the economic aspects of therapeutic landscapes and in this context, stress reduction is important because improved health outcomes of patients have a positive correlation with potential cost savings. Access to nature causes lower doses of pain medication and short stays as well as reducing the workload of staff. Perhaps its time to think landscape not just in aspects of aesthetic quality and environmental sustainability but rather an economic investment. This issue addresses the whole environment actually because of the presence of natural elements in school and offices as well as health-care facilities has been shown to increase concentration and productivity, Bourneville and New Earswick are good examples in this context.

    I also like to mention an issue that bothers me in terms of facility surroundings which is the school garden designs, at least most of them. Fully covered with asphalt or concrete surface and above this surface basketball hoops and that’s it but no sign of any natural element. Exposure to nature in childhood shapes the environmental values in adult life in addition to educational benefits and positive effects. Wells (2000) found a correlation between children’s access to nature and their levels of cognitive functioning. I think its a good starting point to change our perception and values about nature.

    And also we designers must change our perspective about green areas. We should think green areas holistically because they are more than just decoration. We already know their value in terms of environmental sustainability but we need to expand our knowledge in social and economic aspects of these spaces. In this context, I like to think the evidence-based design as a silver lining that will lead us to create more successful green areas so more livable cities.

    References

    Blair, D. (2009). The child in the garden: An evaluative review of the benefits of school gardening. The journal of environmental education, 40(2), 15-38.

    Cama, R. (2009). Evidence-based healthcare design. John Wiley & Sons.

    Dravigne, A., Waliczek, T. M., Lineberger, R. D., & Zajicek, J. M. (2008). The effect of live plants and window views of green spaces on employee perceptions of job satisfaction. HortScience, 43(1), 183-187.

    Honeyman, M. K. (1992). Vegetation and stress: a comparison study of varying amounts of vegetation in countryside and urban scenes. The role of horticulture in human well-being and social development, 143-145.

    Leather, P., Pyrgas, M., Beale, D., & Lawrence, C. (1998). Windows in the workplace: Sunlight, view, and occupational stress. Environment and behavior, 30(6), 739-762.

    Marcus, C. C., and Sachs, N. A. (2013). Therapeutic landscapes: An evidence-based approach to designing healing gardens and restorative outdoor spaces. John Wiley & Sons.

    Nakamura, R., & Fujii, E. (1990). Studies of the characteristics of the electroencephalogram when observing potted plants: Pelargonium hortorum “Sprinter Red” and Begonia Evansiana. Technical Bulletin of the Faculty of Horticulture of Chiba University, 43(1), 177-183.

    Pollock, A., & Marshall, M. (2013). Designing outdoor spaces for people with dementia. Nursing Older People, 25(7).

    Randall, K., Shoemaker, C. A., Relf, D., & Geller, E. S. (1992). Effects of Plantscapes in an office environment on worker satisfaction. Relf D., op. cit, 106-109.

    Rodiek, S. (2006). The role of the outdoors in residential environments for aging. Routledge.

    Ulrich, R. (1984). View through a window may influence recovery. Science, 224(4647), 224-225.

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School of Architecture
Planning and Landscape
Newcastle upon Tyne
Tyne and Wear, NE1 7RU

Tel: 0191 208 6509

Email: nicola.rutherford@ncl.ac.uk


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