Healthy Homes

Designing with light and air for sustainability and wellbeing

Nick Baker, Koen Steemers

• Publisher: RIBA Publishing
• Year: 2019
• ISBN:
  9781000705294
• Edition: 1
• Topic: Arquitectura
• Subtopic: Arquitectura general

It is widely acknowledged that there is an urgent need to transform our housing stock to a better energy performance level. However, improving energy performance should not result in a negative impact on the health, wellbeing and the comfort of building occupants. There are many energy-neutral features that can be incorporated at small or zero cost which have a positive effect on wellbeing. This book aims to outline and discuss these aspects of building design. The issue of health and wellbeing has already entered into design advice for the workplace, where productivity and absenteeism are often used as indicators. This book concentrates on residential buildings, notably mass housing and affordable strategies, for which new, more socially and health-oriented indicators are being developed. Provides practical design guidance based on scientific evidence Explores both physical and psychological wellbeing Focuses on the home and immediate domestic environment Structured in an accessible way for architects and designers.

Part One:
The background and growing body of research

Chapter 1
The context

Introduction

A house near Paris is to exploit natural light and ventilation well beyond the usual standards. The aim was to deliver an energy-efficient and comfortable home for the Pastours, a ‘test’ family of four. But it did more than that.

‘The house had a positive impact on health. My son had asthma before living in the house, and during the year he didn’t have any crises and didn’t take any medication. That was the most positive impact that I didn’t believe possible … We spent a wonderful year in that house.’ Samantha Pastour, mother of the family residing at Maison Air et Lumière (Figure 1.1).¹

Seventy years ago, with the establishment of the World Health Organization (WHO), health was defined as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity.’² In the same year the National Health Service (NHS) was launched in the UK. Today the NHS can barely keep pace with the increasing demands associated with the physical-health challenges of an aging and overweight population, let alone effectively address mental and social wellbeing.

The design of our built environment affects our health and wellbeing, and can have vital implications for quality of life. We spend up to 90% of our time in buildings (about 70% in our homes), so it is inevitable that this environment can create significant opportunities for and threats to our health.

A recent WHO report on housing and health confirms that ‘Improved housing conditions can save lives, prevent disease, increase quality of life, reduce poverty …’ and that ‘Housing is becoming increasingly important to health due to demographic and climate changes.’³ The report provides compelling evidence at a global level of health threats ranging from crowding to hazards in housing, but merely lists concerns associated with ventilation and lighting – themes addressed in this book. It provides an excellent overview, policy guidelines, references to standards and research recommendations but relatively little in the way of design-related advice – one purpose of the current volume.

This book addresses key environmental factors that are associated with architectural design and that impinge on health and wellbeing. It does not address health-and-safety hazards, such as those associated with electrical, gas, water or waste systems; or causes of burns, trips and falls.

In this introductory chapter we describe the context with respect to health conditions in homes, the healthcare system and the historical role of medical science in the built environment.

History

There is a long history of science and research related to how our health and wellbeing is affected by housing conditions – most notably, with regard to environmental characteristics. Access to fresh air and sunlight is a recurring theme. Related to this are thermal and humidity conditions, and the spread or triggering of ill health caused by lack of ventilation, poor air quality and overcrowding. More recently research has highlighted housing-design parameters affecting mental wellbeing (discussed in detail in chapter 2). As it is increasingly accepted that mental and physical health are intimately connected,⁴ this book addresses both.

Sun worshippers

More than four-and-a-half millennia ago the designs for the great Egyptian cities and pyramids were informed in detail and with astonishing

Figure 1.1:Maison Air et Lumière, Paris.

accuracy by the path of the sun. The sun god Ra was believed to be the source of creation and, after emerging victorious from conquering evil during the night, his morning appearance in the east represented the triumph of life over death. In a most fundamental way, sun and life were linked and embodied in architecture. The Maya civilisation, a thousand years later on a different continent, reflected similar beliefs through the design of its edifices.

Such beliefs and mythologies are underpinned by an evolutionary link between our biology and the rising and setting sun – known today as circadian rhythms – that give cues to diurnal physiological processes. Upsetting these processes can result in ill health (as discussed in more detail later in the book). As we spend approximately 70% of our lives in our homes, ensuring that their architecture embraces the use of natural light continues to be a key design principle to enhance health.

Body and mind

The link between sun and health is not only circadian. In ancient Greece, Hippocrates, the father of medicine, expounded the value of ‘heliotherapy’ – using the sun to treat patients and support passive, natural recovery (Figure 1.2). Such ideas about health were interpreted in the Roman architectural treatise of Vitruvius, who states,

‘The architect should also have a knowledge of the study of medicine on account of the questions of climates, air, the healthiness and unhealthiness of sites … For without these considerations the healthiness of a dwelling cannot be assured.’⁵

Vitruvius goes on to describe, in the context of health, how to orient spaces and design homes in order to create the most favourable conditions.

Four hundred years ago, René Descartes discussed the distinction of mind and body – Cartesian dualism – describing the body as merely mechanical and the mind or soul as irrational, not following the laws of nature. He proposed a two-way link between mind and body – thus, the physical influences the emotional and vice versa.

Today this relationship between mind and body is seen as far more integrated, although in our health service we continue to treat the two as somewhat independent. This is discussed in Jo Marchant’s book, Cure: A journey into the science of mind over body.⁶ The author reveals, through scientific literature as well as case studies, how our physical health (or ill health) is influenced and even determined by a range of interventions and contexts that shape our mental state. These clearly include the built environment and our homes, and the environmental and social conditions that they enable. Marchant presents numerous examples of how the perception of the world around us influences our physical condition. She concludes that

‘ignoring subjective experience is great when you’re trying to eliminate bias from your scientific experiments but is not always helpful in caring for your patients [i.e. in our case, occupants], when psychological and physical wellbeing are inextricably intertwined’.⁷

There is limited conventional medical evidence to address mind–body health effects – Marchant points out that only 0.2% of National Institute for Health Research (NIHR) funding is allocated to this topic – notably, in relation to the built environment. However, there is some acknowledgement from, for example, the British Medical Journal of the role of architecture (Figure 1.3), as exemplified in this quote about the design of Maggie’s Centres that support cancer patients:

Figure 1.2:The Greek notion of heliotherapy suggests that letting sunlight into our homes has health benefits.

“If any of these buildings contributes to a pleasantly thoughtful or reflective moment for any of its users, a moment with friends or relatives, or a moment of hope and calm that they otherwise wouldn’t have had then they have already achieved something wonderful.”⁸

Subjective and objective experiences of our homes both impact on our mental wellbeing and physical health. Much of the scientific research has historically focused on physical parameters and physiological health (as outlined in the brief overview below). However, increasingly there is evidence that the qualitative and social conditions that our built environment creates also affect our mental wellbeing.

The development of health science

This section focuses on the developments of medical research in relation to domestic architecture in the 19th and 20th centuries. The history of sanitation (particularly regarding sewage) is a fascinating story that highlights the rising dominance of medical specialists in domestic design. This story is expertly relayed by Dr Annmarie Adams in her book Architecture in the Family Way⁹ (notably, the chapter ‘Doctors as Architects’), in which she states,

‘The consequences [of the dominance of the medical specialist in domestic design] for the architectural profession in England were devastating. A “systematic” view of the house professed by the medical doctors was embraced by the middle class, with the result that there was a widespread wariness of building professionals. Design based on scientific principles … informed much material culture of the period.’¹⁰

Adams goes on to add the following:

‘Many of those [physicians] associated with the Domestic Sanitation Movement became, in a sense, “building-doctors”, called on to diagnose, treat, and heal architecture, much as they might a patient.’¹¹

The current section does not reprise this history of sanitation, but provides some highlights of the development of medical research in relation to broader design considerations of fresh air and good lighting.

Sunlight

Inspired by the writings of ancient thinkers such as Vitruvius, the medic Bernhard Christoph Faust (1755–1842) developed his solar theory related to urban planning – Sonnenbaulehre. Through the orientation and arrangement of buildings he sought to ensure increased access to sunlight and air flow in order to create healthy living conditions. He also considered the social benefits of street access, gardens and playgrounds. By 1825, the Munich architect, Gustav Vorherr (1778–1847), recognised Faust’s expertise and had put his principles into practice in planning the aptly named Sonnenstrasse (Sun Street) in the centre of that city.

The theory of phototherapy, harking back to Hippocrates’ heliotherapy, was further refined by Niels Ryberg Finsen (1860–1904), who demonstrated that specific wavelengths of light (notably ultraviolet – UV) can be shown to have medical benefits. As the sun is the most abundant natural source of UV light, Finsen’s research provided the scientific evidence for the benefits of solar access. He won the Nobel Prize in 1903 for his ...