Originally posted Thursday, 30 August 2012

Written by Chris Towery

It may seem far-fetched to believe that a well-designed building could actually boost its occupant’s health, but a new theory known as salutogenic design purports to do just that. In fact, principles of salutogenic design are already being implemented in leading healthcare facilities around the globe, and ultimately, the theory has the potential to revolutionize the entire design industry.

Health Origins

Salutogenic design is based on the broader theory of salutogenesis developed in 1979 by medical sociologist Aaron Antonovsky. The term “salutogenesis” is derived from a mix of Greek and Latin that roughly translates to “health origins.” According to Antonovsky, a salutogenic approach to health focuses on factors that actively promote improved health and wellbeing, instead of focusing solely on factors that cause disease and injury, which is known as a pathogenic approach. An ideal state of health, he says, is attained by addressing the root causes of unhealthiness, not by simply treating an illness.

For most of the last century, the U.S. healthcare system has been based on a pathogenic model primarily concerned with treating disease once it occurs. In contrast, a salutogenic model works to prevent disease by achieving and maintaining an optimal state of wellness. In recent years, however, medical communities around the world have been incorporating a more salutogenic approach by emphasizing the vital importance a healthy and active lifestyle has on one’s overall physical and psychological health. This move to a more preventative model is even seen in the World Health Organization’s new definition of health: “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.” As salutogenesis became firmly embraced by physicians and healthcare professionals, the concept began to spread into other professions as well.

Healthy Design

Today, there is a growing movement across the globe to incorporate Antonovsky’s salutogenic principles into the world of design. Indeed, salutogenic design is already being used to construct many of the world’s most modern hospitals. Simply put, salutogenic design aims to build structures that make people healthier and happier. While at first this might seem like an extraordinarily challenging task, many salutogenic design strategies are quite simple, especially when it comes to promoting improved physical health.

For example, if you want to increase physical activity using design, build large, inviting stairways instead of elevators. Or you might install showers in an office building’s rest rooms, so employees will be more likely to exercise on their lunch hour. By increasing the opportunities for physical mobility and exercise, such design decisions can help prevent chronic health conditions like obesity, diabetes, and heart disease.

But proponents of salutogenic design want to go beyond promoting better physical health and are looking for ways to enhance psychological and social well-being as well. So far, there has been limited research on design’s effect on psychological and social health, but the research that has been done is very promising—and it has already inspired some substantial changes in design theory and practice.

One of the most well-known studies was undertaken in 1986 by Dr. Robert Ulrich at Texas A&M University. In his research, Dr. Ulrich found that surgery patients in hospitals who had access to a bedside window that overlooked trees recovered better than patients with a window that overlooked a brick wall. The patients with the view of nature recovered faster, needed less pain medication, and had improved interactions with hospital staff.

Following that study, Ulrich went on to develop the “Theory of Supportive Design,” which was based on the premise that to promote wellness, hospitals should be designed to enhance patients’ ability to cope with stress. While stress itself doesn’t cause disease, people who experience chronic stress frequently develop compromised immune systems, which leave them more vulnerable to illness. So by lowering the level of stress caused by a hospital’s built environment, designers can actually help boost its occupants’ immune function and overall wellness.

New research in cognitive neuroscience is also providing support for a theory of salutogenic design based not merely on its ability to force users into more active lifestyles or deliver greater exposure to nature—at least not nature per se. Such research is revealing cognition to be less rational and more associative than has traditionally been assumed. This is particularly true when it comes to the way we respond to our environments— built or otherwise. Even more, the associations we make with our environments can have real and measurable effects on our psychological and physiological wellbeing. Our tendency to think in metaphors, then, provides a powerful opportunity for those designing buildings to influence both the physical and mental health of the users of those buildings.

Take, for instance, the potential of a structural metaphor of a tree as shelter. Trees are ubiquitous enough that almost everyone has a set of associations with them, and, for the most part, those associations are shared. Trees are static, stable objects. People gather under them or use them to escape the sun. They are familiar. They offer a reassurance of structural integrity. In Seville, Spain, the Metropol Parasol, designed by German architect Jürgen Mayer H., offers shade for the Plaza de la Encarnación and a defined yet permeable space under its canopy of waffled cross-laminated timber. Like the canopy of a tree, it allows complete freedom of entry and exit while providing a sense of shelter and being firmly rooted.

Trees are just one of the many spatial metaphors that can create such effects. Architect Zaha Hadid uses riverlike spaces, while the Japanese firm Sanaa has designed structures using mountain metaphors, including a student center at the École Polytechnique Fédérale in Lausanne, Switzerland. Some claim the foundation for the psychological and physiological effects these metaphors exert lies in a sort of “evolutionary memory” we have of certain archetypes of space and environment. We have an intuitive preference for or aversion to spaces because of the prospects they offer us for survival, and those preferences affect the stress our bodies experience. This means that the very design and arrangement of the space itself, apart from any implications for how we use that space, can affect our health.

Beyond Hospitals

Ironically, while hospitals are supposed to be designed to promote healing, they can be one of the most stressful of all built environments—they’re often cold, sterile, featureless, crowded, and noisy. But in the wake of Ulrich’s research, hospitals have been among the first institutions to readily adopt principles of salutogenic design. To make hospitals less stressful and more relaxing, Ulrich offered basic guidelines for architects to incorporate into their design, including fostering the occupants’ sense of control over the physical surroundings, promoting social support, and providing access to nature, daylight, and other positive distractions. To this end, the latest hospital designs now incorporate features that make occupants feel more calm and peaceful: single-bed rooms instead of shared, plenty of natural lighting, comfortable waiting areas, landscaped gardens, artwork, fountains, pleasant music, and even in-house spas.

Following the adoption of salutogenic design in hospitals, the push is on to use the same approach in built environments across all market sectors. Some of the facilities where salutogenic design may prove most applicable include schools, airports, retirement homes, and office buildings. But advocates of salutogenesis have even bigger plans in mind. They envision a day when these design principles will be used to construct entire neighborhoods and cities.

To help achieve this goal in the U.S., the American Institute of Architects (AIA) launched America’s Design and Health Initiative (ADHI) in 2011. The ADHI seeks to develop a body of evidence, a research agenda, and recommendations for architects and public health officials that connect design with beneficial health outcomes. With the ADHI’s assistance, AIA hopes that architects will be inspired to play a leading role in promoting better public health by incorporating salutogenic design into all of their projects.

While fostering better health and wellness through design is an admirable goal, what’s most likely to cause salutogenic design to really take off are its more tangible benefits—namely its financial ones. As demonstrated by Ulrich’s study on hospitals, if designers can show evidence that salutogenic design can reduce operating costs and improve productivity, they’ll have a powerful tool for generating new business. And one of the world’s leading proponents of salutogenic design, Alan Dilani, is on a mission to bring just such evidence to light.

Over the past two decades, Dilani, the founder and general director of the International Academy of Design and Health (IADH), has done extensive research on the benefits of salutogenic design. He contends that a building’s design can have a positive impact on both its occupants’ health and its owner’s profits. In addition to the benefits already seen when such design principles are used in hospitals, Dalani has documented several research studies showing that if companies adopt salutogenic design in their office buildings, it’s likely to improve employee health, performance, and retention. In turn, these benefits in human capital should boost the business’ bottom line and far surpass the design’s initial investment cost.

Revolution on the Horizon

While Dilani and others in the movement acknowledge that more research needs to be done on salutogenic design, there’s no doubt the theory is fast becoming a hot topic in the architecture field. The question now is, just how big will salutogenic design become? Some proponents, like Dr. Ray Pentacost, president of IADH, believe it stands to completely revolutionize the future of the industry.

“My vision would be that the creation of environments that contribute to health would become the norm and central to mainstream design thinking,” said Pentacost in an interview with Inform: Architecture and Design in the Mid-Atlantic. “One day, salutogenic design will be widely demanded by clients, city officials, and building users who want the best possible buildings for their communities.”