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.
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.
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. 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.
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. 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.
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. 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’?
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’ 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 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. Additionally, this increased productivity of their workforces and was therefore economically savvy.
Bournville is still cited 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. 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.
‘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 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. By taking inspiration from Timothy Beatley’s green urbanism and sustainable urban development approach, such as Hammarby Sjostad, Stockholm  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 have high taxes which are reinvested in well maintained parks and public facilities, accessible public transport and extensive cycling routes, 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.
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.  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.
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