Design is always about transformation to an imagined future. As a practicing architect who designs hospitals, I know that the world of green building and the world of healthcare share a common mission: to protect and promote health. And I believe we can transform healthcare by building health. How? It starts with this simple shift in perspective: If we use health as the inspiration to transform practice, we can heal our hospitals and the planet.
Every innovation begins with an inspiration, and the healthcare sector needs to own this one. We all know that wellness is more than healthcare and more than physical well-being. We also know that we won’t have healthy people if we don’t have clean water, air, and soil. Doctors take the Hippocratic Oath — “First, do no harm” — making it their basis for action. But if every system took this new and certainly timely pledge — “A health system shall cause neither human nor ecological harm” — what would healthcare look like?
Imagine a world in which the delivery of healthcare created nothing but health. Unfortunately, that’s not the world we have today.
For the last 70 years, US healthcare has been stuck in a massive industrial paradigm that has very little to do with health. It is a “sick care” system that is so focused on curing advanced stages of disease that it’s largely irrelevant to the health needs of most people. Healthcare’s ultimate delivery machine — the hospital — has evolved into an increasingly specialized tower of disease. No expense too great, no building too large. And when one hospital will no longer suffice, we build 21 side by side! The Texas Medical Center, near downtown Houston, is the largest in the world, with 7,000 beds and 106,000 employees at 68 institutions, clustered on 1.5 square miles.
Healthcare has become a 20th-century industrial system, like agriculture, chemicals, or fossil fuel energy. And like those systems, it creates waste, some dismal work environments, and a load of externalized harm. Our inconvenient truth is that the system actually contributes to the problems it is there to solve.
The system is energy intensive. According to JAMA (the Journal of the American Medical Association), US healthcare puts 217 million tons of carbon into the atmosphere every year. Hospitals alone contribute more than 3 percent of the country’s total output — 80 million tons. The average US hospital operates at 2.5 times the energy intensity of European hospitals. Even as healthcare seeks to perfect its antiseptic care environments, it dumps pharmaceuticals in our water supplies, disposable plastics in landfills, and greenhouse gases in the atmosphere. All this waste contributes to environmental degradation and poorly affects health — and it’s all preventable.
And how does it feel to inhabit these environments? Hospitals have endlessly deep floor plans where caregivers literally never see the light of day. Summer, winter, day or night — it’s always the same inside. The buildings can’t function without massive inputs of electric lighting and mechanical ventilation — a permanent life support infrastructure. They are, to use a medical metaphor, comatose. It is certainly ironic that we task caregivers to keep us alive in buildings that feel dead.
So how do we transform this 20th-century industrial model from a system that delivers sick care to one that builds actual health?
Farmer and philosopher Wendell Berry reminds us that when health is the aim, “a good solution acts the way a healthy organ acts within the body.” These solutions fix problems without making new ones. They create a cascading series of benefits instead of externalized harm. There is an emerging movement in architecture called “restorative design” that seeks these “good” solutions. Its ideas can be applied to virtually every operational system in healthcare, not just to buildings. Restorative design means moving from solutions that degrade health and the environment to solutions that do no harm and heal some of the harm we’ve already done. It’s about solutions that stop making us sick.
Until today, we have focused on doing “less harm,” but with health as our inspiration, we can become restorative. As architect William McDonough wrote in the seminal book Cradle to Cradle: “There’s nothing exciting about being less bad . . . to be less bad is to believe that poorly designed, dishonorable, destructive systems are the best humans can do.”
Think about a healthcare worker who walks all day on shiny vinyl flooring. Healthcare workers account for more than 40 percent of adult occupational asthma, an issue linked to the cleaning chemicals used to wax and strip vinyl flooring. But it doesn’t end there. In so-called Cancer Alley, Louisiana — an 80-mile length of the Mississippi River that’s home to 150 chemical plants, including vinyl manufacturing — 91 percent of residents have at least one health problem linked to chemical exposure. When we walk on a vinyl floor, we don’t see the asthma connection or the health impacts on the people of Cancer Alley — and that’s a problem. We won’t have a healthcare system that creates nothing but health until that harm is made visible, until we connect our practices with their environmental and health consequences: land development and habitat destruction, energy and climate change, chemicals and toxic body burden. Unfortunately, today, most of the environmental and health costs of our healthcare system are not transparent.
But there is some good news: When the costs do become transparent, the healthcare community acts. In 1995, a nonprofit organization called Health Care Without Harm made the community aware that medical waste incineration was the second largest contributor to dioxin emissions in the United States. Within a decade, hospitals shut down 99 percent of their 5,000 medical waste incinerators.