By: Scott Habjan
“He who has health, has hope; and he who has hope, has everything”- Thomas Carlyle
According to the World Bank Group, by 2050, 70% of the world’s population will live in cities.1 With urban health facilities representing a key pillar of urban society, the need to better align their character with their mission is essential. How can these facilities better embody their critical role within our societies and cities? And, importantly, how can more consciously designed urban health centers enhance the health, wellness and outcomes of both individuals and communities while integrating with neighborhoods and enhancing the public realm?
These questions touch on the emerging science of neuroaesthetics—how our brains respond to and are shaped by art, music and the spaces around us.
Like many solutions to complex challenges, the answers may be simple. Sound urban design principles, a holistic approach to health and wellness and an understanding of how people inherently respond to the built environment comprise the roadmap to transformational change for urban health centers.
Understanding inherent challenges
A range of inherent challenges conspire to misalign the identity and presence of urban health facilities with their mission and hinder their ability to be successfully woven into the broader urban fabric. For large medical centers, those challenges begin with scale. Often at odds with their surrounding context, these imposing structures can dwarf adjacent buildings with their bulk.
Other challenges can be found on the ground floor. A good city street should be designed so that the average walker, moving at a rate of 3 miles per hour, sees something new and interesting about once every five seconds.2 Since a large medical center may consume an entire city block, this can equate to walking along a characterless urban void for a full minute.
Where what might otherwise be retail shops, restaurants or other pedestrian-friendly uses, the street frontage is largely given over to emergency rooms, ambulance queuing, medical gas tank “farms” and large, active loading docks. Though lobbies would seem to present opportunity for differentiation, they’re often modest in size and typically offer little in the way of transparency or visual interest. Further exacerbating the situation, parking lots or garages are sometimes adjacent to their facilities, amplifying the disconnection of these buildings from their neighborhoods.
With its origins in the 1980s, new urbanism continues to evolve as a movement. A response to suburban sprawl and the decline of cities, it was founded on ideas of place, community, local history and a responsiveness to ecology. The following guidelines suggest a powerful framework for better integrating healthcare facilities into the urban environment.
Understanding easy wins
Increasingly, there are calls for those in healthcare design to reimagine the role a building can play in the health of its inhabitants and the locale in which it is situated. While the programming and design of a new, ground-up urban medical facility affords the opportunity to address common challenges in a sweeping, wholesale manner, available funding is most often the obstacle between institutions and their aspirations. There are, nonetheless, opportunities to achieve some easy wins.
Transparency. By designing for greater transparency on the ground floor, new build or renovated urban medical center can be more welcoming for patients and more engaging and interesting for pedestrians. From the reverse perspective, author and urban design activist Jane Jacobs noted the value that “eyes on the street” offer in making neighborhoods safer — an added benefit.
Local aesthetic inspiration. A low-cost, high-impact idea for mitigating the generic, institutional aesthetic of most medical centers is installing works by local artists. After all, a wealth of research indicates artwork decreases patient stress, and views to windows improve patient outcomes and improve recovery times. Interventions like these, as well as interior design inspired by its context, can help root a facility in its place and connect with patients and staff in an authentic way.
Community engagement. A multipurpose room or outdoor open space can facilitate a wide range of community engagement. Farmers markets (particularly in “food deserts”), health fairs, educational events and youth activities, such as those related to sports or general socialization, can all go a long way to bolster wellness. When healthcare designers seize opportunities to foster community by reimagining the built environment, the potential for healing increases exponentially.
Urban panacea: case study in the making
Building upon its impactful work in taking on the social determinants of health throughout New York City, the Morris Heights Health Center is in the early stages of planning a new transformational facility within an underserved Bronx neighborhood. Plans envision a holistic community health center within a neighborhood where a third of the population falls below the poverty line.
Beyond the foundational components of primary care and dental, its Be Well program will offer mental health and adolescent care services, as well as a pharmacy, testing lab, teaching kitchen, yoga studio and a career center. A multipurpose room will accommodate activities from community board meetings, health fairs and health education sessions to movie nights and youth sports. Community partner organizations will run select programs. Consistent with their previous projects and on-going initiatives, the design of this urban panacea will address and cultivate all aspects of health and wellness.
At approximately 60,000 square feet and six stories, the scale of the building will fit very comfortably in its dense, urban, residential neighborhood. The facility will borrow from the street art of the city to animate its interiors and connect to community and place in an authentic way. By engaging local artists, MHHC has identified yet another way to give back to the community while at the same time celebrating it. To further its mission, the design will introduce an element of biophilia through its rooftop garden — a place of respite for patients, staff and visitors that offers the opportunity to decompress and engage with nature.
The façade’s underlying grid provides “coherence,” the interplay of opaque and transparent panels offers “fascination,” and its community murals connect to culture and place, offering “hominess.” From a modest footprint in its bustling urban neighborhood, Morris Heights Health Center’s new holistic care facility promises to have an outsized impact on the health and wellness of its community.
Moving toward new generation of urban health centers
With the world’s population increasingly becoming more urban, the urgency to better align the architectural character, urban design and offerings of urban medical centers is only becoming more heightened. Fortunately, the solutions are all around us. By applying principles from holistic health, new urbanism and neuroaesthetics, we can treat society’s health more holistically, in buildings people connect with more intuitively, ones which feel rooted in their cities and communities.
Scott Habjan, AIA, is director of design at E4h Environments for Health Architecture.
BeWell@MHHC concept renderings courtesy of E4h Environments for Health Architecture
1 “Urban Development: Overview.” World Bank Group. Accessed July 30, 2024. https://www.worldbank.org/en/topic/urbandevelopment/overview
2 Gehl, Jan, Lotte Johansen Kaefer, and Solvejg Reigstad. “Close encounters with buildings.” Urban Design International 11 (2006): 29-47. doi: 10.1057/palgrave.udi.9000162
