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Ecology and Hospitals

Hospitals today are the least daylit of any regularly inhabited building type.


By Robin Guenther, FAIA

Often i am asked, “why is  it that health care seems ‘behind’ in embracing the design opportunities inherent in green buildings?” I typically reply that hospitals are 24/7 buildings in an overregulated sector, faced with tough economic challenges and huge operating costs. I want the world to recognize and applaud the incremental improvements that are the low-hanging fruit of sustainable design—using low-emitting materials or building on previously developed sites. I witness the health-care sector making the connection between healing the earth and healing people—accepting and acting on the core notion “that you can’t have healthy people on a sick planet.”

Ecology and Hospitals
Image: Brian Stauffer
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But increasingly, I suspect there is something more fundamentally sinister that holds us back from creating sustainable healing environments. I believe it is embedded in the concept of “Living Buildings.” It’s such a simple idea, it’s hard to imagine that we haven’t already seen the metaphor. Hospitals are buildings on life support, and they are in a deep coma. As surely as the electricity pumps into them at 60 cycles per second to provide a heartbeat with mechanical ventilation systems as their ventilators, these buildings hover near-death, awaiting the next inevitable interruption of their heart-lung machines to expire. Isn’t it ironic that we ask the staff within them to keep us alive, in moments of extreme crisis, when these environments are so profoundly lifeless?

Over two generations of medical and building technology advances, we have relinquished design ideas of long life, daylight and views, flexibility, and adaptability as we moved these buildings onto artificial life support. Realizing it, we excluded the fundamental building blocks of human resilience and growth—light, air, water, spirit—in our quest for medical progress. In fact, we have barely questioned what has been lost—namely, the essential connection between nature and healing.

We have created whole sub-industries to compensate for the inherent lack of passive survivability. Equipping hospitals with emergency lighting, diesel generators, double- and triple-backup systems, we brace ourselves against the natural and manmade threats to our buildings and the safety of those within them. However, we no longer view the natural world as a partner in healing and, with this, have lost our connection to the sacred. Less than a century ago, when hospitals needed fresh air, clean water, and light to flush away disease, they occupied amazing sites selected for their life-giving properties. Today, we focus on the convenience of automobile commuters.

Extreme weather events like Hurricane Katrina illustrate the price we pay for the lack of resilience of our medical infrastructure. The fact that health care has become the second most energy-intensive building sector enacts a societal price of a different, but no less important, kind—climate-change impacts, political disruption, and the rising cost of care.

Imagine if our hospitals adapted to climate challenges, used on-site renewable energy, harvested and recycled available water, and were filled with natural light, so that in extended periods of infrastructure crises, vital medical services could continue without interruption? Then, close your eyes and imagine how that building would feel to inhabit—perhaps restoring these vital connections to life would help the patients and staff within the walls reconnect to their own powers of healing and restoration.

I believe we stand at the threshold of this transformation; capturing it in bricks and mortar will be difficult, but possible. Around the world, there are amazing healing buildings appearing in both the developed and developing world. While we in the U.S. can and should applaud our incremental improvements, we must recognize and squarely accept this larger challenge. As poet, essayist, farmer, and novelist Wendell Berry so eloquently reminds us, “health” comes from the word “whole”—to heal is to make “whole.” Together, our work is to reinvent our hospitals as “whole buildings.” Maybe, after all, health care has been sleeping on life support, awaiting the “Living Building Challenge” www.cascadiagbc.org/lbc.

Robin Guenther, FAIA, is principal of Guenther 5 Architects in New York City, co-coordinator of the Green Guide for Healthcare, and coauthor of the forthcoming book, Sustainable Healthcare Architecture.

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This article appeared in the October 2007 print issue of GreenSource Magazine.

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