Architecture offers new prescriptions for building health

LISA ROCHON, Ottawa November 11, 2011
This is what I see when I gaze into my crystal ball at the future of health-care design: a free-flowing Canadian hospital tuned into the needs of women, with a luminous pavilion marking its front entrance; a rehabilitation centre in Europe set in the quiet of a forest; and in Africa, magnetic neighbourhood centres of wellness to help stem the onslaught of chronic disease.

In fact, I'm not dreaming. Let's start with Canada. Women's College Hospital, designed by Susan Black, a partner with Perkins Eastman Black Architects in a joint venture with IBI Group, is planning a revolutionary model of care in Toronto, with a big front room wrapped in pink glass. The “ambulatory” facility will combine research and education with specialized clinics in, say, depression or cardiac-arrest prevention, all of it with an emphasis on outpatient care. Led by women for women, the uberhospital, whose construction begins next year and will cost an estimated $300-million to build, is scheduled to be completed in 2015.

The expectations are huge. Black will have to give great physical expression to a program that requires doctors to work in problem-solving teams. Although the proposed pink glass is bold enough to avoid being a mere cliché, anything designed with a ham-fisted use of curved drywall or even pastel tones – because women might appreciate such things – risks being dismissed as architectural drivel.

The future of wellness depends not only on such superhospitals but also on intimately scaled centres of health. I'm not talking about the scruffy afterhours clinics that make Canadian health care look as though it lives on skid row. I'm talking small, meaningful instances that touch on the sublime.

Case in point: the Groot Klimmendaal rehabilitation centre, which hovers like a cool glass machine within a forested landscape near Arnhem in the eastern Netherlands. Designed by Architectenbureau Koen van Velsen, the building sits crisply and quietly within the woods. It looks less like a health-care building than a three-storey gallery that happens to house a pool, theatre, sports facilities, restaurant (and, yes, clinic). Last week, the centre won the award for health building of the year at the World Festival of Architecture in Barcelona.

At Groot Klimmendaal, the general public and the centre's patients share the rehab clinic and its fitness facilities. That intensified use of health-care spaces makes absolute sense. At a time when rates of obesity and diabetes are skyrocketing, there is a new urgency to prevent chronic diseases. The encouragement of good health has, historically, been given scant notice at hospitals anywhere in the world. But that's changing.

In South Africa, Toronto-based Tye Farrow, an expert in hospital design, has been commissioned to create several centres of wellness – in rural, urban and township areas. The winner of a competition, decided by an 11-person jury from five continents, Farrow Partnership Architects Inc. were the design leads on a team that includes American firm Clark Nexsen and South African architects Ngonyama Okpanum.

Last week in Cape Town, they presented their winning ideas of wellness to South Africa's health minister, Aaron Motsoaledi. Even while that country struggles to eradicate high levels of tuberculosis and of HIV, long-term wellness is being heavily promoted. The centres are designed with a sculptural structure of an emblematic protea flower blooming white and resplendent at the complex's core. Surrounding it are educational clinics, a theatre, a library, fitness centres, and kitchens that serve as demonstration areas for healthy cooking and eating.

Tagged as Health Promotion Lifestyle Centres, their core's design, says Farrow, makes use of a lightweight, Teflon-coated material stretched over a metal frame to create the symbol of the blossoming flower. The surrounding buildings, with simple pitched roofs, are constructed of cinderblock or brick. Naturally ventilated and sustainably designed, of the lifestyle centres Farrow says, “We wanted to create something … that is symbolic enough to create massive outbreaks of health.”

Farrow Partnership Architects have designed hospitals in Mississauga and Thunder Bay; Doha, Qatar; Port of Spain, Trinidad; and have a carbon-neutral hospital under construction in Sechelt, B.C. But the enthusiasm in Cape Town for architecture that excites and enlightens people about health is especially rewarding. “We've never seen anything like this anywhere,” Farrow says, about the notion of wellness being trumpeted so loudly through architecture. Six lifestyle centres are to be completed across South Africa by 2014.

Our health bill in Canada is enormous. In Ontario alone, $47-billion is set aside this year to cover the Ministry of Health's budget. That's 41 per cent of the province's total budget, and most of it is being spent on treatment and rehabilitation – not prevention.

Long gone are the days when hospitals needed to focus exclusively on infectious diseases. The new pandemics are related to a stunning lack of exercise in most countries around the world – even, for example, in Scandinavia, where we like to think impressive lifestyle choices reign. In Denmark, more than 25 per cent of the population is overweight.

When Farrow imagines the ideal future, he sees a new kind of health ministry: one that seamlessly integrates health issues and their deep connections with education and municipal planning. That way, Canadian cities could be designed to invigorate the public into taking a rigorous walk; and schoolchildren could be educated about the benefits of regular exercise and healthy eating.

Women's College Hospital will be a pioneer in demonstrating clearheaded thinking about new ways to focus on health – rather than insisting on continuing with the same old models while seeing the world through rose-tinted glasses.