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On Well (Winter 2015)

Sho-Ping Chin FAIA would have been humbled and proud to learn that the "Well" issue of ArchitectureBoston is dedicated in her memory. She was a passionate architect who cared deeply about these issues. She would also have appreciated the bold blasts of color in the issue, a visual signature of her spirit and wit!

Kevin Sullivan FAIA
Payette, Boston

Robin Guenther FAIA's article ("Building health") rightfully focuses on the healthcare industry's need to "clean up its act" when it comes to reducing its large environmental footprint. Guenther challenges those of us working in healthcare to lead the way in producing restorative environments for healing. More than 1,400 US hospitals and many state hospital associations have in the past four years joined the Healthier Hospitals Initiative and pledged to take action and report their progress in six challenge areas, including energy reduction, toxic chemical elimination, waste stream reduction, and serving healthy food.

Partners HealthCare in Boston was one of the seven founding systems of HHI, and I have the privilege to serve as its steering committee chairman. The initiative issues an annual report highlighting gains made and dollars saved by integrating sustainable practices into everyday operations. Its success led to the creation of the international Global Green and Healthy Hospital organization, which has 20,000 hospital and healthclinic members across the globe. It is heartening to know that many healthcare organizations are embracing the pledge to clean up their act.

But our work doesn't end there. To be truly transformative, we need to leverage the purchasing power of healthcare to move the markets to produce safe products utilizing safe manufacturing processes —from IV bags and medical devices to furniture and building materials. While the concept of restorative design is rooted in healthcare, it is applicable to every place you make, every building you construct, every environment you take pride in showcasing. An array of accessible tools can help with this; I recommend the WELL Building Standard, the Pharos Project, and Perkins+Will's Precautionary List, all of which benefit from epidemiological research. Ridding our buildings of toxic chemicals is a challenge we have to take on if we are dedicated to creating healthy environments for living.

John Messervy AIA
Corporate Director of Design and Construction
Partners HealthCare, Boston

We can transform healthcare by building health both inside and outside the walls of the hospital. Robin Guenther FAIA's call for healthier healthcare environments is well complemented by Gary Hilderbrand FASLA's call for action to revitalize Boston's efforts to increase the city's urban forest ("Trees"). One need only visit Worcester neighborhoods decimated by the arrival of the Asian longhorned beetle to understand what it would feel like to live in a city without a network of street trees, and the negative impact on our psyches and physical bodies.

The walls of healthcare facilities must not only be constructed of nontoxic materials, they must also become less dense and less opaque — allowing for the landscape of our beautiful city to filter in and support the health and healing of patients and staff alike. Connections to nature, even one as modest as a view to a healthy street tree, promote and support this process.

Our firm is fortunate enough to be supporting Brigham and Women's Hospital, under the leadership of its president, Dr. Elizabeth Nabel, in achieving these goals of connecting the inside back to the outside — harkening back to a time when the direct connection to Olmsted's Riverway supported the healing processes at the hospital. We're creating landscape spaces in every nook, cranny, and rooftop we can find. All of these landscape inser­tions strengthen the hospital's connection to nature and its supportive healing capacities but also integrate into the city's forest network. Let us once again think of our urban forest as a critical part of our urban spatial network as well as our city's healthcare network. A beautiful Boston will also be a healthier Boston.

Kaki Martin ASLA
Klopfer Martin Design Group, ​Boston

Creating healthier buildings depends on mindset, not cost, notes Robin Guenther FAIA. She suggests that we don't always follow best practices because we're not aware of the harmful effects of our decisions and because it's often easier to fall back on old ways of building.

This challenge of translating public awareness into action is similar to the problem faced by efforts to encourage environmentally sustainable behaviors, regular exercise, retirement savings, and other good-for-us actions. With our limited attentions, the micro-actions that build long-term future benefits are often drowned out by the noise of other everyday concerns. Psychologist Elke Weber advises that the most effective strategy to promote these kinds of behaviors is to "make it simple, and make it personal."

Applied to healthy environments, "simple" might mean that the experts and advocates shoulder up front the heavy lifting of advocacy, community engagement, and design to create systems that make health-promoting behaviors and opportunities — bike travel, affordable housing or nutrition — routine and easy to access. "Personal" might mean focusing on local issues to inspire action. Alyssa Haywoode ("Case study: Mattapan") describes how residents there are galvanized more by a personal stake in a better neighborhood than by abstract data connecting environmental features to long-term health outcomes.

The "Well" issue of ArchitectureBoston seems timely. Along with the launch of the WELL Building Standard, administered by the US Green Building Council, I'm hopeful about the growing public appreciation of the important connections between health and design.

Tyrone Yang AIA
Yang Architects
Somerville, Massachusetts

Robin Guenther FAIA raises an excellent point that healthcare buildings and the neighborhoods in which they reside need to be healthier for the people who work there and for the patients who receive care in them. Indeed, building healthy facilities should be a baseline standard for any healthcare provider.

But hospitals face many demands in meeting their responsibility to the health and wellness of the communities they serve. Determinants of health include individual behavior, social environment, physical environment, genetics, and access to and quality of healthcare — and facilities are only one part of this. For people, communities, and entire populations to achieve health and well-being, hospitals need to work with all the private, public, and nongovernmental organizations that are working to improve population health.

At the same time, hospitals face difficult choices in capital allocation. How much of their scarce resources should they invest in facilities? In installing new information systems that will enable them to provide care more efficiently and reliably? In network development and sustainability?

Hospitals are a key part of the population health movement and must continually operate with an eye toward positively impacting a wider population.

Sarah Markovitz AIA
Co-chair, BSA Healthcare Design Committee
Principal, NBBJ, Boston

As co-chair of the BSA Access Committee, I was glad to support Michael McHugh AIA ("Project recovery") and countless others who came together in the weeks after the Boston Marathon bombings to initiate the Renovate for Recovery program. We all owe a debt of gratitude to the design community for providing technical and material support to those most affected by the bombings. Through the program's endeavors, nearly 10 homes have been adapted by creating accessible bathrooms, stairs, entry- ways, kitchens, and more for residents with permanent mobility impairments.

Meanwhile, a 2014 study by the Joint Center for Housing Studies at Harvard reminds me what many of us already know: Our country faces a critical shortage of accessible housing. Due in part to our aging housing stock, just 12 percent of homes in the Northeast have three or more accessibility features like extra-wide hallways and doors, accessible electrical controls, or a no-step entry. According to the City of Boston's 2010 Analysis of Impediments to Fair Housing Choice, the number of accessible units in the city would accommodate only one-fifth of the 50,000 residents of Boston who need them.

The challenges that those most affected by the bombings have been forced to confront are the same ones thousands of Boston residents are faced with every day. As the Renovate for Recovery effort moves toward its final project closeouts, the question is: What comes next? Instead of receding into history, what if the lessons learned through the program were to become the building blocks of a permanent program of renovation, with dedicated funding and compensated technical support? This should be the lasting legacy of this difficult chapter in the history of our city.

Josh Safdie Assoc. AIA
Principal, Kessler McGuinness & Associates
Newton, Massachusetts