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AT ISSUE: Cures for an ailing world

How can design intervene to encourage healthier environments and promote wellness?


The quickest fix for unhealthy architecture is to realize the client is an animal and not a machine. All “cures” follow from that. Human perception is the threshold that determines what we see, and it occurs in a brain that evolved much more slowly than our current technology.

This disconnect between what we’ve evolved to see and what we can build today is at the root of much of the dysfunction in our modern environment. It’s a biology and technology mismatch, not unlike our modern sugary diets or overly sedentary lifestyles. Just because we can do these things today — laze around or build blank, boxy buildings —  doesn’t mean that it’s good for us over the long haul. Mother Nature has a way of asserting her hegemony in the end, reminding us we haven’t been following her rules.

Looking at ourselves as animals, we can see how wonderfully weird we are as a species. It’s not merely that we have a huge brain — larger than any other creature on the planet when body mass is considered — it’s how oddly that brain is put together. For one thing, we don’t handle the senses democratically at all. Our brain evolved to prioritize one sense: vision.

While we “see” with our eyes, our brain processes the inputs to create a picture of the world. And though we traditionally talk about four other basic senses, 50 percent of our mental apparatus goes toward visual processing. No wonder the cat looks at you oddly when you can’t tell there’s a mouse in the kitchen or that the dog’s marked the carpet; your vision bias preempts your registering other smelly stimuli.

Understanding our brain’s voracious visual appetite can explain a lot of our architectural experience, including why strolling through the Back Bay can be effortless for blocks on end, while doing so around an office park is much less so. It can help us under- stand why tourists spend time outside Trinity Church but not so much outside the neighboring Hancock tower, arguably another significant Boston landmark. It’s simple, really. The tower’s glass façade doesn’t feed our brain what it delights in seeing: rounded forms, diverse detail, symmetrical arrangements — exactly what’s on the church menu.

This doesn’t mean that every building needs to feature granite and sandstone checkerboard motifs, but it does suggest that it’s critical to consider our biological predispositions: how we love looking at natural materials and shapes, how we innately seek out shade and safe places to sit, how the best new buildings anticipate and meet our subconscious requirements.

And it suggests something else entirely: How much we gain by thinking “inside out.” How much we have to learn about who we are, how we came to be, and what we’re wired to do — since it has secured our survival — and how significant that is for building better places for people. Ironically, only by acknowledging our animal past can we hope to build the most humane places.

“The broader our understanding of the human experience, the better our design will be,” Steve Jobs once said. This idea formed the foundation of Apple Computer’s stratospheric success. There’s no reason it can’t do the same for architecture. ■



Sunlight is a critical contributor to human health. While too much sun can be hazardous, sun exposure contributes to production of Vitamin D and also melatonin, thereby countering bone degradation, infection, and sleeplessness, and boosting mood and energy levels. Having evolved in bright sunlight, we need regular contact with our star’s life-giving rays to maintain our well-being.

Architecture, which shelters us from precipitation and temperature extremes, is our chief mediator of sunlight exposure. And given that Americans work longer hours than citizens of almost every other developed country (the Germans and Dutch have it easiest), our workplaces quite literally stand between us and the sun. Considering the demonstrated benefits of sunlight, how is our workplace architecture performing? Is it helping our health, or hindering it?

Building technology made great gains during the 20th century, but these gains distanced us from light. The modern wonders of air-conditioning, available after 1932, and fluorescent lights, available after 1938, generated today’s bulky, boxy office buildings and single-story warehouses, with vast interiors that are artificially lit and cooled, and correspondingly deprived of fresh air and sunlight. Fluorescents and AC transformed city skylines from dramatic to “inert,” to use Vincent Scully’s term, and converted expensive multistory factories into the faceless sheds that comprise contemporary manufacturing.

The average worker’s loss of sunlight and fresh air was dramatic. While a worker in the Empire State Building was likely to be within 18 to 36 feet of an operable window providing access to daylight and fresh air, a worker in a corporate office park of the 1960s might be 70 or even more feet away from a window that could not open. The office buildings of Mies van der Rohe and som are monuments of Modern architecture, but also memorials to the diminished daylight of the contemporary age.

But all is not lost. Momentum is growing to encourage or even require minimum levels of daylight exposure for office and industrial workers. Germany is ahead of the United States, not only in reducing total hours worked but in requiring proximity to windows. Its national industrial standard specifically governs the provision of daylight to building interiors, emphasizing the psychological benefits of exposure to daylight for workers and residents. As a result, most German workers are effectively within 8 meters (26 feet) of the outdoors.

And while the US has no national building code at all, never mind one governing daylight exposure, numerous energy-efficiency codes mark the happy coincidence that increased daylight is also one of the best ways to reduce energy usage for lighting and cooling. One industry study indicates that new fenestration technologies alone could reduce energy usage in commercial buildings by up to 13 percent.

We stand at the edge of a revolution in improving health through building design, and architects will be key players. By integrating daylight and fresh air exposure into every new structure, designers can improve the quality of all of our lives while reducing energy waste. The formal outcomes may be surprising, as boxy, insensitive structures make way for lighter, attenuated, more responsive architecture. Bringing back the light is something that all building designers and building users can anticipate with joy. ■



In this day of over-shared celebrity playlists, I offer my ballot of places in Greater Boston that exemplify the kind of space that promotes healthy cities. My list goes like this: Commonwealth Avenue, Boston Common, the Public Garden, Mount Vernon and Chestnut streets, East Broadway in Southie, the Wilderness in Franklin Park.

These spaces are filled with trees, and that’s what makes them great — lines of American elms or London planes, groves of mixed hardwoods, lofty mature campus canopies, or many-storied successional forest species competing for space and light. I would not want to live in the city without trees.

Tree-lined streets and shady parks or wilds make our cities livable. Shade cools the city’s surface by as much as 20 degrees, canopies and roots intercept rainfall and help harvest its benefits, healthy tissues provide for uptake of pollutants, leaves release oxygen to the air we breathe, and all this wood keeps massive amounts of carbon from escaping into the atmosphere and turning up the heat. And the part I like most: Trees define urban space like nothing else in our design arsenal.

Imagine Boston without trees. It’s easy; just check out East Boston, where canopy coverage amounts to about 6 percent (compared to US Forest Service recommendations of 35 percent). For contrast, think of Roslindale and West Roxbury, where larger home lots and mature shade trees bring the coverage up as high as 49 percent.

A 2014 study by researchers at Boston University and Hofstra reported that Boston’s overall canopy coverage measures at 25.5 percent, with an error rate of ±1.5 percent. That is significantly down from the previous mark of 29 percent coverage reported in 2006. The decline could in part result from recent improvements in the way data are analyzed, but an international downward trend is confirmed by other studies.

Yale Forestry Researcher Thomas Crowther estimates, for instance, that Canada possesses around 9,000 trees per inhabitant; the US, with its broad open plains and sprawling cities, around 700 per person. In the 2006 Boston study, the num- bers were thus: around 1.2 million trees in total, or two trees for every citizen. Not enough!

In 2006, then-mayor Thomas Menino responded with a proposal to plant 100,000 new trees in the city, an increase that would get Boston closer to that 35 percent goal. The Boston Globe reported in 2013 that the city was far behind. The great recession had taken its toll on canopy expansion because the city’s proposed increases rely substantially on private development, public park expansion, campus redevelopment projects, and homeowners. Now, with Boston’s boom in construction, it’s time to rally.

Here is what we need to do: Be vigilant in protecting the trees we have, and be opportunistic about where we can plant. Translate these goals into enforceable rigor in project approvals. Exceed Boston’s Complete Streets guidance, which outlines provisions for planting in all but the narrowest streets. Plant trees on every project, and give them good life support below grade. Think of the living biology in the soil and root world as the reciprocal of the tree we see above grade — you can’t have one without the other. Let’s aim for higher than 35 percent coverage. That’s the radically transformative project that will make the physical structure of Boston robust, resilient, and spatially beautiful. ■



People sometimes ask me why, as a practicing pediatrician, I care so much about housing. But how can I not? For many of my patients, a stable, decent, affordable home is like a vaccine — it quite literally keeps them healthy. That’s why it’s essential for everyone, from architects and builders to public policymakers, to understand how important quality housing is to health and well-being.

When thinking about housing as a vaccine, you can think first about each part of housing that makes it so effective. Housing can be a stabilizing force, where families can get to know their neighbors, and children can attend the same school. Research shows that children who move more than once in their first few years of school are more likely to be kept back a grade. Our work with Children’s HealthWatch, a five-city pediatric research center, shows that families who move more than two times in a year look as bad off as homeless kids do in terms of general health, risks of hospitalization, and developmental delays.

Housing also needs to be of decent quality, which can mean the absence of things that make us sick, such as pests or mold, but also include things to make us feel well, such as natural light, exposure to green spaces, and fresh air. Deteriorating or unsafe housing poses risks of asthma, lead paint poisoning, and serious injury. We spend untold millions treating chronic diseases such as asthma, or the behavioral problems and learning disabilities associated with lead exposure, yet every dollar spent in housing can help prevent many of these negative outcomes before they happen.

Lastly, housing must be affordable. We know 20 million families in the United States are housing insecure, often forced to choose between rent, eating, or heating their homes, paying more than half their paycheck toward rent and having to go without other necessities.

The good news is there is a housing vaccine to make you healthy. Our research shows that families who receive a subsidy to help them pay rent are protected from the health stresses of moving frequently or living in overcrowded conditions. If unaffordable rents were leading to food insecurity, subsidies can also help protect them from stunted growth or other illnesses associated with inadequate nutrition. Similar to receiving one shot against multiple diseases, young children who live in stable, affordable housing are much more likely to be well: developmentally normal, not underweight or overweight, in good or excellent health, and with no history of hospitalizations.

Professor David Williams of the Harvard School of Public Health put it best in the documentary Unnatural Causes: “Housing policy is health policy.” Housing matters, particularly to young children. Strategic investments in the critical developmental window from pregnancy to three years of age can change the trajectory of a child’s life.

When administering childhood vaccinations, we make sure a child receives the right dose. The same goes for housing. Just as vaccines in early childhood have a lifelong payoff for a child and for society, making sure families can avoid housing insecurity is preventive medicine that will help put a child on the right path from the beginning. ■



The building and interior spaces we create communicate with users through their architectural elements: walls, floor pattern, ceiling configuration, color, lighting, and materials. Collectively, these elements tell people where to look, where to pause, where to go next. They shape how people will feel throughout their journey. When this communication is clear and cohesive, the result is a healthy space, stress-free and easy to navigate. The key to success is this: Less is more. Say less, and say it with clarity.

Clarity begins with clear edges. Where are the boundaries that tell me how big and what shape the room is? Where are the cues that tell me where to go next? Psychological studies tell us that humans perceive rooms with simple, clean geometry better than those with compound shapes. Clearly defined spaces, linked together, provide easy wayfinding. A visitor should arrive at a destination “naturally,” using subtle architectural cues rather than signage, which poses issues for the visually impaired and those from different cultures.

An interior space should also refrain from saying too much. Visual clutter and sound chaos not only impede the clear reading of a space but also are major sources of stress in themselves. As designers, let’s restrain ourselves from introducing too many “design ideas” into our projects. On the stage of architectural simplicity, there can be only one main character at a time.

In the healthcare sector, similar principles can be applied to one special group of users — people with chronic pain. According to statistics from the National Institutes of Health, approximately 76.2 million Americans, or one in four of us, have suffered from pain lasting longer than 24 hours, and many suffer from pain on an ongoing basis. The physical environment plays a huge role in how we cope with pain and how we heal. For instance, we know that natural light is good for healing, but too much is harmful. In our firm’s design of cancer hospitals, we take special care to arrange infusion bays so that patients have views to the outdoors but also have control over how much light is allowed in. Soothing interior colors, with low contrast, are also recommended.

Users of healthcare facilities include not only patients — suffering from pain and treatment side effects, and fearful about their future — but also family and friends who worry for their loved ones, the hearing and visually impaired, the aging, and non-English speakers who navigate unfamiliar environments with diminished or challenged senses and/or language barriers. Another group of users, medical professionals, do important and challenging work on short timelines with tremendous consequences. Healthcare facility architects and designers need to recognize the importance of design that soothes, comforts, and reduces stress for users.

It’s also important to acknowledge that healthcare facilities aren’t the only place where one finds the sick, the disabled, the stressed, and the overworked. At any time, we all can fit into these categories, and we visit and navigate buildings of all types. While there is a place for building spaces that are stimulating and invigorating, there is also a need for public buildings that allow simple and easy dialogue with users.

When it comes to communicating with building users through architecture, say less but say it with clarity and consistency. Less is healthy. ■