The Future of Healthy Communities

The Future of Healthy Communities: Humanism in our Design Environments

This is a guest blog from American urbanist David Kamp, who is the founding principal of New York-based Dirtworks Landscape Architecture, PC, whose projects span healthcare, academic, civic, cultural and residential.

A stronger concept of place can lead to a stronger concept of health. Individual health, community health, and environmental health often face similar challenges. They can also share similar benefits.

The following is taken from an article I wrote for World Health Design magazine, "The future of healthy communities: Humanism in our Designed Environments." A salutogenic approach to design and urban regeneration can help bridge the gap between creating sustainable environments and providing resources that strengthen a sense of community and improve individual health and well-being.

Rockefeller Center Channel Gardens, New York. Garden design by Dirtworks, PC. Sustainability and salutogenesis are two concepts that can provide a link between a healthy environment and wider community goals. Photo by Dirtworks, PC.

Our capacity and potential as a collective society and the technological, scientific, and educational resources we have at our disposal are unprecedented. Yet so are the threats to the basic health of the planet and its inhabitants. Biodiversity declines while greenhouse gas emissions increase. The balance between resource depletion and regeneration grows more precarious as the Earth’s climate grows more erratic. Population soars in developing countries, concentrated in unprepared mega-urban centers. Vast portions of the world’s fastest growing cities are built on ecologically sensitive, unstable landscapes; dense quarters in poverty and environmental degradation that lack the support systems to provide a basic quality of life for its inhabitants. In both developed and under-developed countries, large migrations of people have lead to significant strains on the economic, social and environmental fabric of urban communities.

This is, indeed, the best of times and the worst of times. Although we have advanced technology at our disposal, it will do no long-term benefit unless we also take into account ideas of a healthy environment that tie individual wellbeing to larger community goals. The following two concepts, I believe, will help make a bridge between individual and larger concepts of health: first, sustainability – creating and maintaining the conditions for life to thrive in balance with its environment; and second, salutogenesis – the promotion of health and the role of individual perception and motivation in making choices towards health.

Sustainable development is based upon a sense of connectedness - the interrelationship between societies, the environment, and its resources. Originally framed to balance resource use and environmental preservation, the concept has expanded to encompass a larger responsibility: to not only accommodate but improve the life of future generations by restoring and repairing natural systems and preventing future ecosystem damage. It is concerned with the carrying capacity of natural systems and the stress placed on the environment by the social challenges of humanity.

Salutogenesis, on the other hand, is a perspective of personal health proposed by Aaron Antonovsky. Rejecting the long-standing medical model of dichotomy, which separates health and illness, Antonovsky proposed that these extremes be understood as a continuum. In addition, salutogenesis describes an approach that looks at the factors that promote health rather than factors that cause disease, focusing on the relationship between health and stress. At its core is his Sense of Coherence construct, which describes the role of stress in human functioning, and the need to maintain an orientation towards the world that is comprehensible, manageable and meaningful. In essence, a fortified sense of coherence - comprehending a situation, managing effective actions, and finding meaning or purpose - better prepares us for life’s challenges. Antonovsky’s construct emphasizes the importance of a personal definition of life's quality and how that quality influences behavior and choices.

It is not too much of a stretch to claim that all design aims to be salutogenic. If not explicit, then by implication, design is the art (and sometimes science) of rendering the elements of the designed environment comprehensible, manageable, and meaningful. Our quality of life is directly influenced by the quality of the designed relationship between the built and natural environments. Design is an expression of personal and social values. It is an expression of our hopes and aspirations in what we choose to build. Unfortunately, trouble in designing today’s environment begins with the complex and often conflicting goals various essential and peripheral agencies impose on the process and demand from the results.

It has become a struggle for designers to understand and balance the myriad physical systems that need to be accommodated with the political forces that influence a societies’ ability to manage natural, technical, economic, and human resources. No wonder finding personal meaning in urban settings can be daunting. But if Antonovsky’s sense of coherence is to be strong in individuals living in these complex circumstances, it is essential for designers to try and lay bare the threads that tie individual experiences to larger social and environmental needs. Trusting that this theory has merit, the future of personal health may well depend upon it: each of us must not be hampered by the environment in finding meaning in our lives or else we will not care enough to find the strength to persevere.

The western medical model has been altered from a reductionist one of treating isolated symptoms to seeing patient care holistically. It has embraced complexity. Design must follow a similar path in order to address the complex social, economic, and environmental issues we face in rebuilding identity, strengthening resilience, and offering hope and health to future generations.

Resilience must be thought of in terms of environmental and human systems. Salutogenesis draws our focus towards human and social systems - creating design solutions that can guide individual and collective interactions and choices in times of crisis. Salutogenetic design allows us to reconsider the design of our infrastructure and communities to better equip people with the resources to adapt. Working together designers, planners, scientists, civic leaders and citizens can better understand the factors shaping these choices and their influence on our communities and the environment we share.

All built environments, both urban and rural, are complex living systems with inter-dependent social, biological and technological components. Salutogenic concepts can be extrapolated to inform design choices, enhancing individual experiences and health-promoting outlooks within the framework of large-scale sustainable development initiatives. A holistic design methodology incorporating salutogenesis, natural systems and technology with physical and social infrastructure can help create a healthy, vibrant, resilient and equitable future.

Read the original article on World Health Design.