The Ultimate Test for Design

Does it Cause Health?

What if our health became the basis for judging every building and every public space? What if every person, everywhere always asked, “Does this place cause health? How does it make me feel?”

By Tye S. Farrow and Sharon Vanderkaay

Need for a higher purpose

There is no such thing as a neutral place. What we build either enhances or erodes our health. The full range of design factors that influence our total health extend beyond the state of our physical health, to include qualities that affect our state of mind.

Until recently, attention has been focused almost exclusively on the technical end of the sustainability spectrum. LEED for example, has been primarily effective in assessing eco-responsibility from this standpoint. By contrast, attention to environmental responsibility from a place-making and life-enhancing point of view has been nearly absent. A building might therefore attain LEED Platinum status, while being extremely unhealthy in terms of its social, cultural and psychological impact. The Living Building Challenge moves to expand the eco-evaluation scope to include health, equity and beauty as well as site, water, energy and materials. Equally, the New York City Department of Planning’s Active Design Guidelines focus primarily on physical health activity [such as walkability] but fall short of the larger basket of total health.

The time has come to take the next leap forward by assessing total health—encompassing social integration, brain stimulation and spiritual regeneration—as part of our evaluation criteria. In other words, responsible building today cannot be isolated, placeless and rootless. If what we build is not beloved, it is at risk of disposal.

Our quest now is to make the places we live, learn and work a thriving habitat. Yet the sustainability movement is frequently hampered by politics and disagreements regarding the best way forward. Given this reality, the intersection between individual and public health can be a unifying cause that serves to accelerate progress. In order to succeed, the cause and criteria must be easily understood and embraced through a common, critical eye by all of us.

Studies indicate that public awareness campaigns based on fear and negative global consequences attract initial attention, but they are ineffective as a means to change behaviour and results. Yet when we become aware of the physical, psychological and spiritual elements that affect our own day-to-day environment, our values and norms can shift. The higher purpose of “creating a world of places that make us feel better” is motivating and less overwhelming than the fearful concept of staving off climate change.

Focus on the desired result

It’s time to redefine the parameters that the sustainability movement has focused on. We need to shift our interests as to what are the elements that allow humans to thrive; socially, intellectually, environmentally and economically. There is an overarching, pressing need to assess and fuel the demand for buildings and places that cause health rather than merely aspiring to stop doing harm.

The distinction between causing health and preventing degradation is crucial. The cause health view is focused on leveraging human assets and capabilities—regardless of their current state—and engages us in building on these strengths to optimize health.

The concept of optimizing health is a revolutionary departure from our historical focus on preventing, curing and/or reducing disease. For evidence of this imbalance, consider the term pathogenic, which is widely understood to mean “causing disease.” A corresponding term for “causing health,” salutogenic, is relatively unknown. If causing total health became the basis for judging every building and every public space, we would raise public aspirations beyond prevention, sustaining and walking. This broader concept of whole health aims higher than a goal to sustain.

The movement to cause health builds prosperity by moving upstream to reduce the unsustainable burden of illness on society. Cause Health is a model of abundance and regeneration rather than scarcity because it channels today’s wasted downstream resources [including human energy and capabilities, as well as financial assets] to instead create places that allow us to thrive mentally, physically and socially.

Beyond good intentions: how change really happens

Major shifts in norms and values have happened in the past when people saw themselves as benefiting personally, rather than being coerced by laws, lectures and frightening news stories. We can also observe how attitudes toward food and cooking reflect society’s evolving values and self-image. One end of the food spectrum is dominated by empty calories, unhealthy diets, fast food and lack of social engagement around cooking and eating. These conditions are coupled with unsustainable food sources and practices. The negative side effects of this soulless approach to food consumption range from obesity and chronic disease to disengaged families that lack the socially unifying aspects of eating. For some, food and cooking has become a sensory-deprived, unfulfilling, utilitarian exercise.

By contrast, there is also evidence of increased appreciation for food origins and preparation by people with higher expectations for what and how they eat. These individuals see themselves as part of a movement that not only cares about food sustainability and nutrition issues, but also wants to enhance the social and sensual experience of cooking and eating. Rather than merely consume unhealthy and boring meals, this higher level of appreciation reflects changing values across all boundaries of society.

The very notion of consumer is being questioned today, with some calling for the substitution of pro-sumer and others for the use of citizen as a means to emphasize that we are all affected by the consequences of these attitudes, beliefs and behaviours.

Why build nourishing environments?

What we build has the power to improve our capacity to thrive economically, socially and culturally. To achieve this, buildings and places must be designed to optimize total health rather than merely help us to cope with life. When we look around today we see too many streetscapes composed of empty calorie designs that fail to supply our need for brain food. Such boring, emotionally vacant or frenzied schemes numb our senses and drain our energy. Buildings that sit as physically and culturally disconnected objects do nothing to promote lively social integration. Health-causing places reward all the senses and connect people with life on the street.

In the past, discussions about architecture, interior and urban design predominantly confined themselves to matters of style or taste, zoning or density. Now we must work to expand our capacity to see how a place makes us feel. For this essential shift in values to occur, there must be a way to readily diagnose the health of buildings and places where we live and work. How healthy is this place? How does it make me feel? What are the elements that come together to make me feel this way?  These simple “test questions” make it possible for all of us to become an advocate for places that cause health.

Expectations for the quality of our habitat are beginning to rise, and this consciousness must be actively supported. It may seem like an overwhelming task to raise awareness so that we will expect more from our built environment. But in a knowledge-based economy, we cannot afford to settle for facilities that drain our spirits rather than feed our minds.

For example, walkable neighbourhoods are becoming widely recognized for offering many health and economic advantages. However, in order to reap their full benefits, it is vital to understand that distance, safety and access are only part of the recipe for success. Boring, repetitive streetscapes make even a short walk unappealing – whether in the city or the suburbs.

We need “walk-worthy” as well as walk-able streets. Does a technically walk-able street possess qualities that cause health, or does it add to the anxiety, alienation and depression that cause disease? What are the visual, physical and spatial qualities that nourish our brain, ignite our spirit and motivate us physically and result in thriving neighbourhoods? How will such places become assets that inspire and enable people to reach their full potential?

Evidence of the senses

We are in the early days of the Century of the Brain and ongoing research regarding neurogenesis and neurasthenics. This pursuit will contribute scientific data to support our understanding of how places affect our state of mind. Case studies that highlight environmental cost savings associated with causing total health rather than prevent disease will strengthen this insight. While evidence-based design will always have a place in decision making, there is also a need to develop greater awareness and a gut reaction or instinctive reaction to the qualities of design in our everyday lives.

What we build reflects the image we have of ourselves. The need for a bigger picture of total health and the environment comes at a time when the very meaning of health is changing. In the past, anyone who avoided disease was considered healthy. Today health is recognized as much more than a neutral state of being free of illness.

Advantages of a strengths-based approach

What if we understood the health-causing potential of every building, every public space and every home? Dreary design and merely functional places would become unacceptable. Instead, people would expect optimistic design that encourages social interaction, pride in community identity, connections to nature, cultural meaning and a positive legacy.

While the pursuit of new cures and better treatments cannot be neglected, restrained expectations for our personal health limit our sense of future possibilities and fuel an unsustainably costly health care system. For example, a pathology-oriented approach to growing older narrows how we see capabilities and options. A focus on what’s wrong instead of what’s strong reinforces inequalities in society because problems and gaps appear to be overwhelming. In terms of serving the public, there are limits to the benefits of government-sponsored risk reduction programs.

Major leaps toward thrivability, more equitable population will not happen until a wider light shines on the question: What causes health?  For example, Dr. Joshua Bamberger, Medical Director for Housing and Urban Health in San Francisco has observed that, “Since 1999, our agency has provided housing for more than three thousand chronically disadvantaged adults. People who are housed in more aesthetically pleasing, functional, safer buildings have had dramatic reductions in health-care utilization. The more beautiful the housing, the better the outcome.”

The term cause health emphasizes that health is a resource for our whole society. Taking a strengths-based approach to causing health would involve an ongoing campaign to recognize and nurture the health assets that exist within each place and each person.

Every construction project built today should be a legacy project, built to be beloved for generations to come.  While dismal places that cause disease and depression are currently tolerated, we can learn to see how these places make us feel, while raising aspirations for what they can be. When the ultimate test for design is “Does it cause health?” we’ll  have a concept of environmental responsibility that brings diverse people and ideologies together.

Tye Farrow is the founder of Farrow in Toronto. He has gained international recognition for the design of buildings and places that enhance health and raise expectations for design. Sharon Vanderkaay is a design strategy, research and communications specialist based in Toronto.

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