What is spatial health? Designing healthy contexts

© Heini Lehtinen, 2018.

Many aspects of human health are much more questions of social, spatial and economic environments than matters of an individual’s willpower and abilities. Design for spatial health focuses on health of individuals through the health of our everyday spatial and social surroundings.

Text Heini Lehtinen, 2018.

“We shape our buildings, thereafter they shape us.” — Winston Churchill

Nurture a garden and it will grow, flourish and nourish the gardener — and not only the gardener, but others in the garden as well.

Gardening is only one example of the reciprocity between us and our physical and social environments. Nourishing our bodies and brains with nutrients, exercise and sleep enable them to function better and perform on a new level. Cherishing our close relationships will more likely enable us to be taken care of in return than when ignoring the people close to us. Empowering a team or a community creates a sense of trust and respect that increases commitment and thrive. Providing environments that enhance health and well-being of our community enables the community and the individuals in it to focus on development instead of grievances.

There are numerous studies about how we respond to our physical and social environments. Occasionally, they also reveal unexpected links between the environments, behaviour and health.

For instance, air pollution might not only be linked to our physical health, but also to unethical behaviour due to anxiety caused by the air pollution. Even a faint switched-on bedroom light at night seems to correlate with increased risk of depression especially among the elderly. Watching TV and driving a car appear to correlate to decline in cognitive abilities. Childhood obesity seems to be much more a question of social, spatial and economic environments than a matter of individual’s willpower and abilities. A poor diet contributes to “aggressively higher” risk of dementia and brain aging, and recent studies are revealing that some foods are neuroprotective — meaning that they guard the brain from harm and support cognitive abilities through a lifetime.

The list of recent studies goes on. As much as especially the Western culture stresses individual willpower and freedom of choice as a path to well-being and thrive, we are much more products of our environments than we would like to think. Willpower is undoubtedly beneficial, but thriving in a physically, psychologically or emotionally hostile environment is near impossible. The freedom of choice is both seeming and dubious.

Reciprocal environments

Winston Churchill’s quote about us shaping buildings and buildings shaping us is an architectural reminder of the Golden Rule or the law of reciprocity, the universal principle of treating others as we wish us to be treated.

In a sense, Mr. Churchill’s words bare even more significance today than they did in his days. The humankind has lived in built environments for tens of thousands of years, but the pace of moving into dense urban environments has increased exponentially in the past decades. At the time of Churchill’s passing in 1965, around 35 per cent of the world’s population lived in cities. Now, estimated 55 per cent of us live in urban environments, and it is predicted that by 2030 two thirds of the people will reside in urban habitats.

Living in dense urban environments affect both our mental and physical well-being. According to the World Health Organization, mental health issues caused by city living will be a major burden in urbanized countries by 2030. Yet seemingly controversially, a research conducted by Oxford University and the University of Hong Kong indicates that residents living in higher-density areas are more active, socially engaged and less obese than those living in the suburbs.

All built environments are designed by humans in one way or another, and they include only reminders of wild nature, the original habitat of the human species. Living in the wilderness also comes with health-related consequences, but in human-designed environments, it is up to us humans how we shape the habitats and how suitable the environments are for us physically, psychologically and emotionally.

Often, the people shaping the environments are not designers, and they don’t have to be. However, designers, architects and urban planners often have a say to our everyday surroundings: location, orientation, proportions, materials, flows of movement, colours, daylight and shadows, how much freedom and safety the environment provides and to many other aspects of the environment. All these elements have a response in our bodies and brains — how we feel and behave in our surroundings, and how our environments support or deteriorate our well-being. They contribute in making us healthy or ill.

Contextual approach to health

As designers normally don’t have medical education, they rarely play a role in acute cases of illness. Through being actively involved in designing human living contexts and built environments from products and services to homes and urban planning, their work still affects well-being and health of both individuals and communities.

A designer’s role to human health is not direct as is a doctor’s, but contextual. Instead of describing medicine, a designer has capacity to create human contexts that support health and well-being. These contexts — circumstances and settings — can be physical, social, emotional, sensorial, experiential, or virtual.

© Heini Lehtinen, 2018.

Observing health through circumstances and settings of human living can be approached as contextual health, which can further be broken down into spatial and environmental, social, cultural and economic health — all of which affect our physical and mental well-being.

According to the World Health Organization WHO, health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The definition further states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”

When we are physically and mentally healthy, we don’t pay attention to our state of health but we are able to focus on developing and nourishing our physical, psychological, emotional and social well-being. Similarly, spaces that support well-being don’t necessarily draw attention to the spaces per se, but the spaces function as a frame for living and enable human thrive.

As WHO’s definition states that health is “not merely the absence of disease or infirmity,” it is also not enough to barely remove the elements that do not support health from our surroundings. We should also actively seek and implement elements that support human enjoyment. A healthy environment that actively supports well-being enables focusing energy on development instead of discomfort, distractions or maintenance of the existing.

Designing healthy spaces

The term spatial health is less established a term per se, but the approach to spaces as sources of health exists in several lines of research, design practice and thinking.

Macro-scale research on geospatial health aims in bringing together health workers and earth scientists in order to develop infectious disease forecasts systems. The branch of research applies geographical thinking to epidemiology, population health and health services, and uses geographic information systems, remotely sensing data and primary data collection to analyse environmental and social factors such as green space, air pollution, land use or community belonging. This data is then used in risk assessment and epidemiological studies in order to detect links between the social and environmental factors and health outcomes such as cardiovascular disease, lung function or birth rates.

On a smaller scale, environmental building standards such as Leadership in Energy and Environmental Design LEED also include the element of human health. A newer, LEED compatible building certificate, WELL Building Standard, focuses exclusively on how buildings can improve human health and wellness.

Both are sustainability standards that in one way or another carry the principles of sustainable design. As in Jason McLennan’s classic book The Philosophy of Sustainable Design (2004), these respect-based principles are:

· Biomimicry — Respect for the wisdom of natural systems
· Human vitality — Respect for people
· Ecosystem — Respect for place
· Conservation and renewable resources — Respect for energy and natural resources
· Seven generations — Respect for the cycle of life
· Holistic thinking — Respect for process

Focusing on health impacts of our contexts, be they environmental, social, cultural or economic, enables aiming in creating healthy contexts, which transmit respect and care — the fundamentals of human well-being — from both the commissioners and the designers.

Contextual, design-based health interventions can be both subtle shifts or complete re-designs. These interventions can be improving air quality in a space to prevent anxiety caused by poor air quality; focusing on making bedrooms calm and dark to improve sleep to prevent mental health impacts of exposure to light at nights; reconsidering the role and placement of a TV in living premises to enable us to focus on activities that better support well-being, and providing food that is nutritious and supports brain health and cognitive ability in workplaces, schools and homes.

In the end, human thrive in built environments comes down to quality of the environments — city living can be either a significant cause of mental ill-being, or a significant contributor to physical, psychological and emotional health. Eventually, it is up to us — we shape the buildings in order for the buildings to shape us. ·

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