Designed to Thrive: creating salutogenic environments

Tye Farrow B Arch, M Arch UD, LEED AP, FRAIC, AIBC, SAA, OAA, NSAA, NLAA, Assoc. AIA

Creating salutogenic environments Designed to Thrive

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Appalling?

Appalling?

How does this environment affect us?

How will this environment become un-acceptable?

. . . cause health?

Thunder Bay Health Sciences Centre

Salter Farrow Pilon Architects Inc., of which Farrow Partnership Architects is a successor firm

Our pathology-centric world Agenda for health How people (really) make decisions A way forward: Five Vital Elements

Kaplan Medical Center Farrow Partnership in collaboration with

Uzi Gordon Ltd. Architects and Town Planners

Context

WE LIVE IN PATHOLOGY-CENTRIC

WORLD

I learned a lot of pathology, & a lot about medicines. We were taught virtually nothing about health.

Richard J. Jackson, MD, MPH Professor and Chair

Dept. of Environmental Health School of Public Health, UCLA

Former Director, U.S. Centers for Disease Control & Prevention

“ ”

We find what we look for :

Seeing Health?

Why do we have a commonly-used term that refers to origins of disease:

Pathogenic

while the similar term meaning origins of health is relatively unknown:

Why do we have a commonly-used term that refers to origins of disease:

Pathogenic

SALUTOGENIC

. . . time to look for 8,000 ways to cause health.

SALUTOGENIC

. . .Cause health

. . .Cause health abnormalities . . .Cause health problems

. . .Cause health risks . . .Cause ill health

. . .Cause health abnormalities . . .Cause health problems

. . .Cause health risks . . .Cause ill health

. . .Cause Health?

1st: Communicable diseases

2nd: Non-communicable disease

3rd: Accelerating optimal health Salutogenesis

Dr. Lester Breslow & Three Eras Public Health

Ray Pentecost

Communicable disease Mid 19th century to mid 20th century

1st

Urbanization & industrialization Communicable disease: TB, cholera, malaria, yellow fever

1st

Example: London chorea outbreak of 1854 & Dr John Snows discovery of the source

1st

Central park & park movement Urban design set backs Public transportation Departments of sanitation Public health movement Results: longer life expectancy & rise of chronic disease 1st

Non-communicable disease Mid 19th century to mid 20th century

2st

Changes in our physical and

cultural environment

have fueled this burden of

chronic disease

2nd

2nd

Changes in our physical and

cultural environment

have fueled this burden of

chronic disease

Reduced daily-life physical exertion Marketing & manufacturing of tobacco Changing food quality & distribution Car centric design suburbs Biological ability to avoid adverse health compromised 2nd

The U.S. consumes $2.7 trillion in ‘disease care’ spending 70% to 75% relates to chronic disease

VALUE?

2nd

70% all deaths globally from chronic disease 1/3 all deaths before sixty years of age . . . . one’s most productive years

2nd

. . . tell me your postal code I can tell you how long you will live First time in modern history that your children's life expectancy is shorter than yours

2nd

“

”

Common source epidemic

2nd

Chronic disease

Reaction

New Urbanism UN Noncommunicable disease resolution (second health resolution in its history)

NYC Department of Planning Active Design Guidelines

3nd

The evolution of “livability” criteria

1931 (U.S.A. )

- literacy rate - farm electrification rate - deaths from typhoid fever - number of lynchings - teacher’s salaries

source: The Atlantic Cities

2013 (U.S.A. )

- public transportation

- affordable housing

- quality of schools

- low crime rate

- air quality

- walkability

- access to hospitals

- access to parks

- infrastructure quality

- social capital


DESIGNED to SURVIVE

Best of what we know

Best we

can be

DESIGNED to THRIVE

Generic solution

Replace

Cope

2013

- public transportation - affordable housing - quality of schools - low crime rate - walkability - access to hospitals - parks - social capital

- integrated mobility? - health-causing housing? - cause health? - citizen engagement? - walk worthy? - cause health? - diversity of uses? - social capital?

2030


DESIGNED to SURVIVE

Best of what we know

Best we

can be

DESIGNED to THRIVE

Generic solution

Replace

Cope

literacy farm electrification typhoid fever deaths lynchings

public transportation quality of schools walkability affordable housing

cause health integrated mobility walk worthy diversity of uses

WELCOME

SALUTOGENESIS to

Aaron Antonovsky coined salutogenesis

Latin salus = health & Greek genesis = origin.

Aaron Antonovsky coined salutogenesis

Latin salus = health & Greek genesis = origin.

Salutogenic Pathogenic Health activation Deterioration

Antonovsky saw a continuum, rather than either / or.

THE LEAP UPSTREAM

SALUTOGENIC ORIENTATION

- better medical interventions

- cure disease

- paternalism, entitlement

- fixing parts of system

PATHOGENIC ORIENTATION

- better quality of life

- cause health

- self-reliance, public health

- holistic approach

GOAL

FOCUS

NORMS

RELIES ON

Why do some people remain healthy, while some become ill?

Aaron Antonovsky Father of Salutogenesis

“Sense of Coherence” regarding life and its challenges - comprehensibility - manageability - meaningfulness

The mind: How you feel

“Sense of Coherence” regarding life and its challenges - comprehensibility - manageability - meaningfulness

Alan Dilani’s work relating it to the built environment

The mind: How you feel

Pathogenic: Disease prevention

Salutogenic: Health activation

Pathogenic: Disease prevention

Salutogenic: Health activation

Cause Health

Occurrence Agent – Environment – Host Stopping something from happening or treating it after it occurs

Pathogenic

Continuum: encourage health to occur Filling environment with elements that accelerate health

Salutogenic

…I had to begin to learn less about disease and a whole lot more about the embedded health in the world around me if I was to make an impact.

Richard J. Jackson, MD, MPH Professor and Chair

Dept. of Environmental Health School of Public Health, UCLA

“ ”

The function of protecting & developing health must rank even above that of restoring it when it is impaired

Hippocrates

“

”

In the long run, housing may be more important than hospitals to health

Dr Lester Breslow

“

”

Ministry of health Ministry of education

Ministry of municipal affairs & housing Ministry of economic development

. . . Intentionally have created silos?

3nd

Ministry of health Ministry of education

Ministry of municipal affairs & housing Ministry of economic development

Ministry of health, education, municipal affairs,

housing & economic development

. . . Intentionally have created silos?

3nd

U.S. Centers for Disease Control & Prevention

. . . You find what you look for?

3nd

U.S. Centers of Health Creation U.S. Centers for Disease Control & Prevention

. . . You find what you look for?

3nd

Accelerating optimal health: Salutogenesis

Start of 21st century

3rd

Living longer / greater expectations Life to full potential: designed to THRIVE Sense of Coherence: How environments make you feel . . . perform . . . & prosper 3nd

People make decisions based on an emotion level.

Change what people SEE on an emotional level

dis-ease health

How healthy is this place?

The question:

Understand: How healthy?

Five Vital Elements Nature Authenticity Variety Vitality Legacy

Salutogenesis: Designed to Thrive

Nature Design that is inspired by the natural world 1.

Credit Valley, Farrow Partnership



Give us something that’s alive!

“ - Cancer patient survey response

” Credit Valley, Farrow Partnership

I am in good hands.

“ ”



NOC, Port-of-Spain, Trinidad and Tobago Farrow Partnership and associate architects co-rd Limited




Authenticity Design that draws on meaningful local influences 2.

St Mary’s Hospital

St Mary’s

On tack to be LEED Platinum & carbon neutral, completion November 2013 Farrow Partnership Architects in association with Busby Perkins + Will Architects

Farrow Partnership Architects in association with Busby Perkins + Will Architects

Farrow Partnership Architects in association with Busby Perkins + Will Architects

Variety A range of experiences and a sense of discovery 3.

Kaplan Medical Centre, Israel

Farrow Partnership in collaboration with Uzi Gordon Ltd. Architects and Town Planners







Farrow Partnership Architects and KMBR Architects

Mission CRC



Farrow Partnership Architects & KMBR Architects


Vitality Regenerative space facilitates flow of people and ideas 4.

E

w

Thunder Bay Health Sciences Centre




Abundance

State of mind - feel

Knowledge era

Optimistic

Engage

Captivate

Overflow

Entrepreneurial




Colchester East Hants Health Centre, Canada

A

B

C

WHW Architects and Farrow Partnership Architects





Legacy Design that makes a lasting contribution to health 5.

Protea Health Promoting Lifestyle Centres, South Africa

Protea Health Promoting Lifestyle Centres, South Africa

Protea Greek god

that was able to change

between many forms

Farrow Partnership Architects, Clark Nexsen, Ngonyama Okpanum & Associates



Centre of influence

Versus

Centre of Excellence

Farrow Partnership Architects, Clark Nexsen, Ngonyama Okpanum & Associates Legacy: Change the way people think about, see health

E’Terra Samara

E’Terra Samara

E’Terra Samara

E’Terra Samara

E’Terra Samara

find shared meaning do their best work

develop their capabilities connect with nature

discover their strengths communicate a sense of abundance

build a legacy

SALUTOGENESIS “Design to Thrive”: environments that:

strengthen social networks

How will you cause health?

Tye Farrow B Arch, M Arch UD, LEED AP

FRAIC, AIBC, SAA, OAA, NSAA, NLAA, Assoc. AIA

END

Health & Medicine

Designed to Thrive: creating salutogenic environments