Alan Dilani Ph.D.

Architect / Public Health

Professor
AIA- Awarded 2010

Introduction of WCDH2015 and

Salutogenic Approach on Healthcare and Health Policy

info@designandhealth.com
w w w. d e s i g n a n d h e a l t h . c o m
 DESIGN FOR HEALTH PROMOTION
In 1997, the World Health Organization identified the
health “arena”,
including priority settings and frequently used spaces such as;
 workplace,
 schools,
 hospitals,
 correctional institutions,
 commercial offices,
 public spaces within our towns and cities,
 and indeed our homes,
should be at the centre of health promotion activities in the 21st century.

 During the 66th meeting of the General Assembly of the United Nations in
September 2011 the global challenges of non –communicable disease was
discussed for the first time.
 Academy believes strongly that quality of built environment could reduce the
causes of life style related diseases!
D&H World Congress is a Global Perspective on Healthy built environment!

1st Trondheim 1997

2nd Stockholm 2000

3rd Montreal 2003

4th Frankfurt 2005

5th Glasgow 2007

6th Singapore 2009

6th Singapore 2009

7th Boston 2011

8th Kuala Lumpur

9th Brisbane 2013

10th Toronto 2014

11th Hong Kong 2015

9th World Congress on Design and Health , 2013 July 10-14
 A generally accepted definition of Health
according to WHO:
”Health is a state of complete physical,
psychological and social well being; not only the
absence of illness!”
 Process of Disease

Psychosocial
LIFE
Factors
Katabolic Health

Anabolic

Emotions Biological Emotions

Life-style & Experience Factors & Experience
Life-style

Illness
Psychosocial
DEATH Factors

Process of Health

Sickness<<< Risk factors

Wellness factors>>> Health
Pathogenic State of Well-being Salutogenic
Aaron Antonovsky

Theory of Health and

Salutogenesis
 Theory of Salutogenesis

Aaron Antonovsky’s health theory of Salutogenesis

in contrast to the Pathogenic orientation of
Healthcare, suggests that we shall look for wellness
factors instead of risk factors.

Health care and medical science has been focused

for factors that cure diseases and factors that lead
to disease.
 Studies on "SALUTOGENESIS“ primarily
addressed the fields of health psychology,
behavioral medicine, and the sociology of
health.

"SALUTOGENESIS“ has also been adopted

in the medical fields for preventive healthcare
services delivery and healthcare architecture.

The meaning of this concept was a dominant concern of Antonovsky (1976)

 Salutogenic Design
Salutogenesis
A proactive approach to health promotion and
prevention (1)
Characteristic conditions that determine a person’s
abilities to cope is the Sense of Coherence (2):
• Comprehensibility: world is understandable
• Manageability: resources to meet situations
• Meaningfulness: life makes sense

1 Viravong, Khamphira, “Salutogenic community building,” International

Journal of Web Based Communities, Vol. 3, No. 1, May 2007,p 32-43.
2 Antonovsky, Aaron, Health, Stress and Coping, Jossey-Bass, San
Francisco, 1982, p 14.
 Salutogenic Design
‘Sense of Coherence’
• comprehensibility
• manageability
• meaningfulness

Comprehensibility

Meaningfulness

Manageability
 Translating Salutogenic Theory into Environmental Design Factors

Perception
Comprehensibility Way-finding Nature Pleasure

Colors Landmark

Interior
Natural Restoration Ergonomic
Aesthetic light Green
Manageability environments Stimuli
elements

Music Pet Comfort

positive Social
Meaningfulness Distraction Culture support
Art Gym View
 light
The Gap of Application of Salutogenic Theory
Pleasure
Aesthetic
Landmark elements

Perception Interior

Colors Gym
Culture
Gap
Way-finding
Between
Theory positive Environmental
Salutogenic Natural Distraction
Design Factors
Ergonomic
and light
Theory Application
Green
environments

Restoration Music Art

Nature Stimuli

Pet Comfort
Social
support

The lack of interdisciplinary approach; View

Psychology, Sociology, Neuroscience, Design , Public health
 医疗计讨论会

Linda Porter Bishop

Linda Porter Bishop
Salutogenic Design

Salutogenic design factors(Dilani,

others)…
Research suggests that the following have a positive or salutogenic
effect on individuals:

Social organization, personal control, quiet, soft

light, nature, art, music, architecture and building
proportion, social support, uncrowded spaces,
color, comfort, daylight, separation from daily
stimuli, need for fascinating stimuli, good sleep,
ergonomic form etc

Alan Dilani, Psychosocially supportive design: a salutogenic approach to the design

of the physical environment, International Hospital Federation Reference Book 2008-
2009, p. 32-37.
 Salutogenic Design is important to demands from
Google/ knowledge Society, because of brain exposure!
 Physical Environment
Structure and Function
Social Organization

Psycho- Mechanisms Precursors

Psycho-social
stimuli + biological
program
e.g.
Stress
of
disease
Disease

Earlier
Genetic
Environmental
factors
influences

Interacting variables

L. Levi, 1972
 Employees in three business sectors:
Information Technology - Services - Industry

60%

50%

40%
Knowledge/info
30% Services
20% Industry

10 %

0%

1970 1985 2010

Time
Design to Improve Brain Performance!
 INTRODUCTION OF DESIGN & HEALTH
THEORETICAL BACKGROUND
 SALUTOGENIC DESIGN APPLICATION
SALUTOGENIC HOSPITAL DESIGN
 CONCLUSION
Restorative
Environment
Nature and
Daylight
Restorative
design
Entrance
Astra Zeneca
Design for positive psychosocial stimuli and restoration
”access to green areas for recreation”
National goal for public health, Act 6
 University of Michigan, FARROW Partnership,
Shepley Bulfinch Architects Creditvalley Toronto

”access to nature”
copyright © Mikael Paatela / Sweco Paatela Architects Oy
Perception and
Way finding
Perception and Way finding Lyons Architects
BMJ Architects
University of Michigan, Shepley Bulfinch Architects
 Example of good design for high-tech
environment without access to daylight.
Salutogenic Design Application
Art, Culture
and Health
Pets stimulate
emotional development
 Being close to pets will;
- increase physical activities
- increase social support
- provide contact among people
- prevent stress
- affect pulse, cortisol level,
- create sense of control
Ingemar Norling,
Göteborg University
Brisbane Robina Hospital OR BVN Architect
Brisbane Robina Hospital OR BVN Architect
daylighting
Restorative
Environment
 DESIGN&HEALTH
ACADEMY AWARDS
Prof. Paul Robertson (2001)
suggests that music is human
richest language that expresses
complex, emotional insight and for
long time, it has been linked to
human well-being.

Robertson also suggests how

different music therapy program is
used instead of medicine at the
different treatments, where the
music rhythm and melody distracts
patients 'perceptions of pain and
also reduces patients' stress
hormones.
Music and
Health
Application of
Design & Health
Salutogenic
Approach

Healthcare
School
Elderly
Prison
Office
Health promoting
design for
Prison environment
INNOVATION AND FUTURE HEALTHCARE DESIGN
SALUTOGENIC HOSPITAL DESIGN
 CONCLUSION
RiT - Existing Hospital 1989-2000
The concept
1995
104
105
106
KNOWLEDGE CENTRE FULLY INTEGRATED ARTWORK IN PASSIVE
ST. OLAV’S HOSPITAL INTELLIGENT FACADE
KNOWLEDGE CENTRE
ST. OLAV’S HOSPITAL
Kunnskapsportalen unique interactive, medical education design
Green Hospital, Olav Kyrres gate
Neuro Centre
Laboratory Centre
Green Hospital
– Women and Children`s Centre
Integration with structure of City

St. Olavs Hospital 2013

Salutogenic Hospital or…………
The task of a Salutogenic Hospital is to deliver the most appropriate
medical services for patients in a very stimulating environment, that
supports the healing process for patients and is experienced by
staff as an enjoyable and efficient workplace.

A Salutogenic hospital furthermore provides services that actively

prevent people getting sick through the regular checkup to spot
diseases by identifying risk factors in early stage. The cost of
medical treatment reduces and supports healthier society.

The Salutogenic Hospital serves its local community, its patient

population and its own staff through the application of a holistic,
knowledge-based approach to the delivery of medical treatment and
clinical services, provided in combination with preventative
measures and public health information that promotes health,
wellbeing and quality of life.
INNOVATION AND FUTURE HEALTHCARE DESIGN
SALUTOGENIC HOSPITAL DESIGN
 CONCLUSION
photo: Sharon VanderKaay
The pandemic of physical inactivity
causing 10 % of premature mortality

I-Min Lee et al, Lancet 2012; Published Online July 18

3four50 message
1. 3 risk factors (tobacco, lack of activity, Unhealthy
diet)
2. Four chronic diseases (cardiovascular, type 2
diabetes, many cancers, chronic lung disease)
3. Over 50% of deaths worldwide

“Architects, urban planners and transport

engineers (among many others) can create
environments in which healthy choices are easy
choices.”
Christine Hancock, Founder, C3 Collaborating for Health, : Design and Health conference, May 2010
Photo used under Creative Commons from Willie Lunchmeat

Obese people pay

$1429 (42%) more in
healthcare costs
than normal weight
individuals. (1)

1 Finkelstein EA, Trogdon JG, Cohen

JW, Dietz W. Annual Medical Spending
Attributable To Obesity: Payer- And
Service-Specific Estimates. Health
Affairs. 2009; 28(5): w822–w831.
 US “Health Care” Expenditures:
78% is spent on diseases of
lifestyle
 HeartDisease $501,000,000/DAY
Cancer $430,000,000/DAY
Digestive Disorders $337,000,000/DAY
Obesity $320,000,000/DAY
Diabetes $273,000,000/DAY
RAND corp./ US NIH 2000
 Pharmacy
 Over $5 billion spent each year on medication
advertising
 76% of Americans regularly take prescription drugs
 Total number of prescriptions increased 39% between
1999 and 2009
 33.5 prescriptions per person per year
 Americans now consume 25 million pills per HOUR.

Medicare Current Beneficiary Survey/Families USA Foundation

What USA getting for $?
 39th Healthcare Quality Index (WHO)
 46th infant mortality
 50th Life Expectancy
 73rd in Wellness
 Last in a comparison of 19 industrialized
nations for preventable deaths
”If we do not fix our healthcare system
the US may go the way of General Motors-
paying more, getting less and going broke”

The White House, June 15, 2009. President Obama.

What makes
people healthy?
Exercise and Health
 Exercise
 Prevent 91% of cases of type 2 diabetes
 Prevent 50% of all cases of heart disease
 Prevent 50% of all stroke deaths
 Reduce site specific cancers by 50-72%

Journal of Applied Physiology 2005

 Exercise
 Decrease all cause mortality by 67%
 Prevent up to 47% of cognitive damage
 Decrease depression by 20%
 All accomplished with 30 minutes/day of
moderate activity.

Journal of Applied Physiology 2005

Exercise and Health

Nordkarelia project and FINMONICA 1449 indiv, 65-79 years,

followed 20 years

Physical activity, at least 2 times per week

during middle-age

reduced risk dementia 52 %

reduced risk Alzheimer´s disease 62 %
Adjusted for age, sex, education, osteoarthritis,
APOE genotype, smoking, alcohol
Rovio S et al. Lancet 2005;4;705
RCT, 120 elderly, mod-intens aerobic excerise 3 days/w
compared to control (stretching). MR. Cognitive tests.
Erickson KI, et al. PNAS 2011;108:3017-22.
Designed by
BVN
 Questions get modified and improved
Health =
Health Care =
 what are the
 what are the
causes of health
causes of
disease?
 What contributes to
 How to treat good health?
disease?  What makes keeping
 How to good health easier?
prevent
disease?
Pathogenic Approach Salutogenic Approach
 The Economic Benefits of Salutogenic Design

Salutogenic Improve Building performance

Approach = Reduce Running cost

Better design Improve Bio-Psycho - Social

and construction Performance =Superior Work
and Productivity

Improved Health Less Absenteeism =

& wellbeing more production and
less healthcare cost

User sattisfaction Reduce Staff turnover

Create image for org.

Alan Dilani, International Hospital Federation Reference Book 2008-2009, p. 32-37.