Editorial: Designing for Health

The CAMH Village Family Health Team clinic, by Toronto-based firm ARK, exemplifies new design paradigms by bringing transparency and a gallery-like feel to a mental-health facility.
The CAMH Village Family Health Team clinic, by Toronto-based firm ARK, exemplifies new
design paradigms by bringing transparency and a gallery-like feel to a mental-health facility. Photo by Peter A. Sellar

Health-care spending consumes over 10% of Canada’s GDP. In 20 years, one in four Canadians will be over the age of 65—more than the current population of Quebec and Alberta combined. One in five Canadians will suffer from mental illness at some point in their lives.

These figures were top of mind at the Design & Health World Congress in Toronto this summer. In addition to the expected talk of hospital and health-care facility design, bigger-picture topics were on the table: how to build age-friendly communities, what evidence supports walkability, and how design might aid in the mental and physical health of people of all ages and backgrounds. Attendees came from around the globe, and much of the presented research was homegrown in Canada.

The designed environment can be the best of medicines—or the worst of poisons. One study by epidemiologist Gillian Booth dug into Toronto’s public health records from 2001-2009, and found that postal codes affect health more than genetic codes. After correcting for factors like income and education, she concluded that those living in the most car-centric areas of the city had higher rates of both obesity and diabetes. People that lived in more walkable neighbourhoods had a 15% reduced risk for diabetes. “We need to connect the dots between health and transport,” she advises, noting that investments in active transportation infrastructure could reduce occurrences of costly, debilitating chronic disease.

West Coast researcher Heather McKay pointed out how bikeways and sidewalks serve not only the young and robust, but also the elderly. In her pre- and post-construction evaluations of the Comox Greenway in Victoria, BC, she was surprised to discover a highly active population of older adults eager to stay active.

“I grew up on a bike,” declared one interviewee. Only safety concerns deterred seniors from keeping active—and those could be easily addressed with such design interventions as properly graded sidewalks, frequent benches for resting, and adequate street lighting.

As Dr. Samir Sinha, the newly appointed expert lead of Ontario’s Seniors Care Strategy points out, older adults typically give up driving in the last 10 years of their lives. He asks: “Does transit serve older riders?” It’s an especially pressing question in the suburbs, which continue to dominate residential development across North America. Glenn Miller, Vice President of the Canadian Urban Institute, believes that finding ways to retrofit Canada’s suburbs to allow ageing in place will be a crucial challenge for developers and designers alike. One key will be integrating apartments and mid-rises with assisted-living options into the suburbs. “Design for the young and you exclude the old; design for the old and you include everyone,” says Miller.

The discussion also addressed design for those with mental illness. In Toronto, the Centre for Addiction and Mental Health (CAMH) is leading the way in championing health equity for those with mental illness and addictions. Their newly redeveloped campus, along Queen Street West, breaks open a formerly walled asylum and continues the street grid, physically weaving treatment facilities into the urban fabric.

Toronto-based firm ARK described a recent CAMH clinic they designed—located not in a neglected corner of the city, but in bustling Liberty Village. From the street, the facility looks like a light-filled art gallery. Throughout, translucent screens create visibility while protecting the privacy of consumers. Designing for mental-health facilities, explains ARK’s Guela Solow-Ruda, involves following “good design” principles—but also addressing specialized needs such as infection control, real and perceived safety, and the need to avoid crowding and other stress triggers.

By and large, an optimistic attitude prevailed as attendees discussed the ability of design to promote good health. Pediatrician and public health researcher Richard Jackson says that over the past century, medical advancements have added five years to the average lifespan—while public health and environmental changes, such as reductions in industrial pollution, have added 25 years. Armed with an increasingly robust body of knowledge, designers and policy-makers working together may yet continue to improve the healthfulness of our living environments.