Putting health and wellbeing into healthcare buildings

Ill-considered design decisions and poor material choices often favouring cheaper synthetic products over natural materials are two of the biggest challenges that stand in the way of designing healthy buildings.

That is the view of Oliver G.F. Jones, who maintains that a well-developed wellbeing design strategy that puts occupant wellbeing at the heart of all design decisions and material choices seems the best chance to counter negative effects of value engineering.

Let’s Talk Specification asked a few questions about this increasingly important issue.

Q: Where do you see the biggest challenge in designing and building healthy healthcare buildings?

A: In the context of building healthy buildings, the biggest challenge facing the UK construction sector is raising the general awareness and understanding of wellbeing and building healthy buildings throughout the supply chain, so that all parties understand the physical and mental health implications of their decisions. Ill considered design decisions and poor material choices often favouring cheaper synthetic products over natural materials are two of the biggest challenges that stand in the way of designing healthy buildings. We also need to be conscious of avoiding the complacency and pitfalls that commercial standards and certification can sometimes present.

Over the last 36 months there have been increasing developments in health and wellbeing across the UK construction sector, indeed I have never fielded so many enquiries relating to health and wellbeing design strategies. Many businesses are engaging with American standards and certification systems such as Fitwel and the WELL Building standard, BREEAM also moved to integrate these emerging standards in 2016. While I generally applaud any advances in wellbeing knowledge and application across the architecture and construction sector I would add healthy caution to solely relying on commercial standards and certification methods to advance wellbeing knowledge and uptake in our sector, we must avoid slipping into a tick box culture when it comes to wellbeing. These standards have however proven invaluable in raising awareness and exposure for wellbeing and the impact that poor building and environment design have upon our health.

In order to be truly successful, commercial standards and certification systems need to sit alongside changes in policy and regulations at a government level. Accompanying this we need a deeper professional understanding and awareness at all stages of construction around wellbeing design strategies. A successful wellbeing design strategy should ensure wellbeing is a central focus from the outset and that provisions are made to transition seamlessly into an effective workplace or user wellbeing strategy post completion taking into account the entire lifecycle of the building. Wellbeing must be considered from the outset of a project and become a central tenet of the scheme, becoming a continual, active and evolving element within the buildings lifecycle not just an intermittent retrospective assessment process.

We need to work with government and industry to raise awareness and understanding generally in the area of wellbeing and building healthy buildings, highlighting the potential cost savings to our national healthcare infrastructure. All parties in the construction process should be more aware of the physical and mental health implications that design decisions and the impact that material specification can have upon building occupants. I have always found it odd that we should have to promote wellbeing in our industry, after all we build buildings for people. We should be acutely aware that our decisions as an industry not only have a scientifically proven effect upon both our physical and mental health but on learning, adolescent development, patient recovery, productivity and general levels of happiness.

Q: What are the benefits of natural building products in healthy building design and healthcare architecture?

A: Alongside the renaissance in wellbeing and healthy building design we are undergoing equally positive advances in the fields of biophilic design: design that incorporates nature to leverage the well documented human affinity with nature and natural materials to create positive health benefits; and green and blue infrastructure: traditionally considered at a wider urban planning and design level, green and blue infrastructure promote quantitative evidence of the health benefits and healthcare related cost savings related to connecting, increasing and incorporating green (parks, forests etc.) and blue (lakes, rivers, coastline etc.) spaces into our building and environment designs. The explosion in interest and uptake across both of these fields foregrounds and recognises the importance of natural building materials.

The negative effects of air pollution are well understood, what most people do not recognise is that we are undergoing an epidemic of health issues caused by poor indoor air quality. The American Environmental Protection Agency noted that indoor environments are two to five times more toxic than our outdoor environments. Given that we spend on average over 90% of our lives indoors this should give us cause for concern, yet we still specify synthetic products that off gas volatile organic compounds (VOC’s) despite decades of research linking these compounds to cancer, heart and lung disease. People are also largely unaware that commercial cleaning products and our infatuation with deodorising our internal air using air fresheners emits continuously high levels of VOC’s with many containing p-Dichlorobenzene (PDCB) which studies have shown has an even higher level of estimated cancer risk than most other VOC’s. So I wholeheartedly champion the use of whole natural materials in all healthy building design, in healthcare architecture, education, workplace and residential design.

So how do we counter this epidemic? Well, Scottish GP’s have recently taken to writing “green prescriptions”, a non pharmaceutical prescription introduced by the Japanese government in the eighties known as Shinrin Yoku, literally translated “forest bathing” or a slow and mindful walk in the woods. If we put aside the new-age feel of this for a moment, between 2004 -2012 the Japanese government spent $4 million studying it's physiological and psychological effects. The studies showed that exposure to wood essential oils in the air and a compound called phytoncide caused a significant measured increase in the production and activity of natural killer (NK) cells in the immune system. These NK cells provide rapid responses to viral infected cells and are associated with immune system health and cancer prevention. One of the many reasons why I have had a lifelong affinity and passion for working with wood and I continue to promote the use of whole timber and sustainable timber construction methods.

Q: What are your recommendations for future healthcare buildings?

A: My recommendations for the future of healthy building design are simple, we are ultimately creating buildings for people, so ensure that you have a well developed wellbeing design strategy that puts occupant wellbeing at the heart of all design decisions and material choices. When you are inevitably faced with value engineering on a scheme refocus the notion of value away from short term monetary cash savings during construction and place the emphasis on recognising the commercial value of maintaining focus on occupant wellbeing, faster recovery times, improved learning, increased productivity and reduced absenteeism being but a few of the many long term advantages of valuing natural materials and a design strategy centered around occupant wellbeing. And finally always choose natural materials and natural light over synthetic alternatives because the hidden physical and mental health costs that continue to come to light vastly outweigh the perceived economic saving.

The benefits of what I have discussed go beyond healthcare design, there is a quiet but growing revolution afoot in the UK construction sector around wellbeing and healthy building design that will have lasting implications for all parties within the construction supply chain. This movement has to date largely been driven from the bottom up by many construction professionals, myself included but the ground swell is evident and larger companies and collectives are beginning to engage.

The next big area for improvement will be in residential design. In collaboration with international architects Ryder Architecture we have already convened a formidable alliance of interdisciplinary multinational design and construction businesses to start an international project to reimagine residential design and planning that I will introduce at the Velux Healthy Buildings conference in Brussels this September. Our project will propose a new off site construction mass housetype and design guidelines, focussed entirely on occupant wellbeing with the intention of informing future UK housing policy. 

• Dr Oliver G.F Jones is the Architecture Programme Leader at Northumbria University, UK. His research and consultancy expertise lie in developing wellbeing measurement metrics and wellbeing design strategies. He is a vocal and active ambassador for research and innovation across the UK construction sector and a member of Historic England's Expert Advisory Group. He also has a self confessed life long passion for trees, forests and all things made from wood.