Building a Healthy City
Benny Chan Chak Bun 陳澤斌
Anticipating a drastic demand increase for medical facilities in the coming decades due to the aging population, the Hong Kong SAR Government announced two ambitious Hospital Development Plans (HDP), in 2016 and 2018 respectively. Between them, these two plans earmark HK$470 billion for building new hospitals and revamping and expanding nearly all existing general hospitals. Among the schemes announced, the upcoming New Acute Hospital in Kai Tak will take over the duties of the existing Queen Elizabeth Hospital (QEH) upon its completion, allowing QEH to be vacated for redevelopment. Other existing general hospitals, including Queen Mary Hospital (QMH) and Prince of Wales Hospital (PWH), will be redeveloped to expand capacities.
Filling the gap in hospital quantity
After the two HDPs are completed in 2035, the total number of public hospital beds overseen by Hospital Authority will increase by more than 50% to around 43,000 beds. Outpatient service capacity will also increase proportionally. Although Hong Kong’s population is only expected to increase by 10.6% from 7.34 million people in 2016 to 8.12 million in 2036, the plan to increase hospital capacity in the same period by 50% should not be seen as an overreaction. It takes into account a forecast near doubling of Hong Kong’s elderly share of the total population from 16.6% to 31.1%. The mortality rate is also expected to increase steadily during this period, from around 47,000 deaths annually to around 70,000. As a person’s need for medical care rises with their age, especially during their final years, the expected increase in the elderly population will put an enormous strain on hospital resources. Because of the wide gap between existing hospital capacity and the anticipated increase in demand for medical services, the two HDPs are clearly necessary. As the same time, they present attractive work opportunities for local architects. The role of architects in the construction of these schemes, however, must be much more than perfunctory. Capable designers can strengthen the function of hospitals as a ‘medical instrument, a contributor to healing process’, as Alvar Aalto said of his famous Paimio Sanatorium.
Biophilic and salutogenic design optimises healing
QEH, QMH and PWH all operate as general hospitals with all major medical departments under one roof. The obvious advantage of this lies in their superb operational efficiency allowed. The drawback is the lack of intimacy and personal attention, which can create stress for elderly patients. However, due to Hong Kong’s limited land supply, the trend of building large-scale general hospitals is unavoidable. The in-situ redevelopment of existing hospitals will make them even bigger.
Even so, a hospital should not be a sterile and functional space devoted principally to housing sophisticated diagnostic equipment, operation theatres, patient wards and other treatment facilities. It should also provide a positive healing environment using intimate, warm, colorful and humane elements to create a home-like feeling that can put patients’ minds at ease. Innovative architectural design incorporating natural lighting and ventilation can provide relief measures not only for patients but also for busy and often stressed medical staff. A study conducted by Roger Ulrich in the 1980s found that patients staying in wards with a view of nature were discharged faster and required less painkillers than those in wards without such views. E.O. Wilson, with his ‘biophilia’ hypothesis, claimed that human beings have an inherent affiliation with living things. Because of this, he coined the term biophilic design for the idea that people can plan ways of connecting human beings and nature, and he also suggested that such design could facilitate the healing process for patients and create a relaxing environment for medical staff. Wilson’s theory was applied in the design of Khoo Tech Puat Hospital (KTPH) in Singapore. Nature is introduced into the building through garden courtyards, waterfalls, and roof and vertical greening using plants to attract birds and butterflies. This design strategy, with a total greenery area about four times that of the site’s footprint, gives the hospital a distinct visual, aural and olfactory character.
Hospitals in Hong Kong have also incorporated biophilic elements in their design, though to a much smaller extent. Sensory gardens with varieties of plants in all colours, textures and scents provide a positive stimulus for patients. Landscaped terraces also provide resting areas for hospital staff and visitors. Such features have been introduced in North Lantau Hospital and Tin Shui Wai Hospital as part of patient rehabilitation treatments.
The positive reception towards biophilic design in creating an optimal physical, mental, social and spiritual healing environment suggests that there is potential for using it in hospitals under development. Aaron Antonovsky in the 1970s first advocated the idea of an optimal healing environment in his ‘theory of salutogenesis’ developed in the 1970s. Since then, many others have taken up his ideas and developed them further. The two HDPs could allow architects opportunities to apply biophilic and salutogenic design in local hospitals. Professionals from other design areas could also be involved, along with experts in plant maintenance and pest management.
Promoting a healthy lifestyle through universal design
As the well-known saying has it, ‘prevention is better than cure.’ On a pragmatic level, helping the elderly remain in better health with shorter periods of illness can relieve pressure on hospital capacity. Due to this, the government actively encourages old people to adopt a healthy lifestyle. Initiatives such as free seasonal influenza vaccination, colorectal cancer screening and dementia care service have all been made available in recent years.
Architects can also play a role in promoting a healthy and independent lifestyle for the elderly by designing environments that meet the needs of older people. Even though the deterioration of their freedom to move, their sensory capacities and their cognitive skills hinder people’s ability to live independently as they age, a community with good accessibility in buildings and public areas can accommodate older populations with different movement abilities. Small details like drop-curbs, ramps and handrails facilitate not only wheelchair users but also people with walking difficulties. Escalators and elevators can be installed in strategic locations on hilly terrains to improve walkability. Those suffering from visual and hearing impairments benefit from having the tactile guided paths, braille information and assertive listening systems stipulated in the Building Department’s ‘Design Manual: Barrier Free Access 2008.’ As ageing tends to lead to a decrease in visual ability to manage glare and differentiate texture, contrast and patterns, special attention should also be paid to the design and use of signage, artificial lighting, fenestration, floor patterns, and materials. Introducing more natural lighting in buildings and allowing for a gradual transition from bright to dark zones should be encouraged, while creating a good acoustic environment can improve communication capabilities, especially for those with hearing aids.
Memory loss and orientation difficulties can hinder the elderly’s ability to navigate in a city. Straightforward urban patterns and building circulations are easier to comprehend and remember. Landmark buildings, sculptures and innovative landscape elements at strategic points can provide useful visual cues to improve orientation. Spatial permeability in an urban setting can be further improved by eliminating unnecessary barriers, such as boundary fences, and adopting step-free podiums, as is the case in Jardine House and in the elevated section of Tamar Park running from Admiralty MTR Station through to the Central Government Complex – a scheme which also allows improved pedestrian access to the waterfront. Good accessibility also encourages the elderly to use public spaces for social activities and exercise, thus helping them maintain their health and reduce the risks of getting Alzheimer’s disease or other causes of dementia. Apart from public parks, Hong Kong has redeveloped some former commercial berths and piers as waterfront promenades in order to providing quality public space for residents. An example of such a project is the Kwun Tong Waterfront Promenade.
Adopting biophilic and salutogenic designs in hospitals and other public infrastructure may involve additional spending and recurrent costs. But such investment is worthwhile as it can help the elderly maintain their health and prolong the period in which they can live independently, in turn reducing demand for chronic medical care. Schemes such as the Pier Improvement Programme, which is upgrading over a hundred public piers to include barrier-free access, will enable the elderly, even those with walking difficulties, to visit natural areas in Hong Kong’s outlying islands that they could not previously enjoy, so improving their quality of life. Such public works not only benefit Hong Kong residents, they can also help relieve the long-term strain on medical services. Keeping the elderly in good health cannot be achieved only by having more hospitals. It also requires effort to take care of their physical, mental, social, and spiritual well-being. Good architectural design that improves accessibility and liveability is an important tool to realising these goals.
Benny Chan Chak Bun is former Assistant Director of Architectural Services Department, current Chairman of Architects Registration Board and Vice President of Hong Kong Institute of Urban Design.
Fig.1 Tamar Park, Central, improved walkability
Fig.2 Khoo Teck Puat Hospital, Singapore (Credit: RMJM)
Fig.3 Tin Shui Wai Hospital rehabilitation garden
Fig.4 Shatin Green Station Landmark building for visual clue
Fig.5 Kwun Tong Promenade
Fig.6 Tin Shui Wai Hospital biophilic elements
(Credit for images 1,3,4,5,6: ArchSD)