ARCHITECTURE AND HEALTH 2.0 (audio)
September 23, 2011 – Listening to Esther Sternberg, MD, describe the exotic fragrance of jasmine and the quiet chirping of crickets carried by Washington’s humid summer air engenders restful nostalgia for idyllic landscapes. Her lyrical evocations of verdant gardenia are more rapid; an energy and enthusiasm for space underlies the tranquil scene. Enthralled in her narrative, one could easily forget that Sternberg, rheumatologist, medical researcher and author of Healing Spaces: The Science of Place and Wellbeing, is discussing research.
“We know that many aspects of the physical environment, perceived through all of your senses—what you see, hear, smell, touch—can trigger memories that then can trigger emotions,” explains Sternberg. “We know how those emotions cause nerve chemicals and brain hormones to be released from the brain, whether you’re stressed by the surroundings or whether you’re relaxed and put into a state of peace by them. What you perceive through all your senses, all those elements of the physical environment, trigger memories that trigger emotions that in turn cause release of nerve chemicals and hormones that have a very direct effect on how the immune system does its job in healing and in preventing disease.”
Equipped with this knowledge, Sternberg transformed her personal Washington garden into a restorative Mediterranean oasis. Her conscientious personal design undertaking, profiled in an accompanying commentary, parallels substantial industry shifts outlined in the 7th World Congress on Design and Health summary: evidence-based design, expanded scope, and economics.
What is meant by "Asclepian"?
The word “Asclepian” takes its cue from the Greek god of health, Ascelpius. The son of Apollo, Asclepius became celebrated for medicinal knowledge so great that he could restore life. Temples and shrines known as Asclepia were erected throughout Greece with the most beautiful vistas. Grecians would travel to these restorative spaces to worship and restore mind and body. Sternberg documents her experience at one such Asclepia in her documentary, The Science of Healing.
EVIDENCE-BASED DESIGN: RESEARCH
The value of space as a contributor to psychological well-being is not a young idea; however, the research validating these Asclepian ideas is. Prior to Roger Ulrich’s transformative 1984 research study, “View Through a Window May Influence Recovery from Surgery,” health-design was synonymous with healthcare design—clinics, hospitals, medical centers. Designers and medical practitioners gauged success on the ability of design to improve physical health and reduce infections. Ulrich’s study broadened established quantifiable metrics to demonstrate that design decisions have restorative psychological outcomes beyond known physical benefits, effectively setting the groundwork for evidence-based design.
“The reason that Roger Ulrich was able to get this beautiful data, which was published in Science Magazine, the top journal in science, was that he had the patients in-hospital hooked up to monitors,” explains Sternberg. Contemporary researchers are continuing Ulrich’s methods with cutting-edge technology. At the University of California San Diego’s Calit2, researchers have explored 3D virtual reality in design space using advanced electroencephalography (EEG) technology. One apparatus, which resembles a futuristic shower cap, uses 256 electrode receptors to monitor brainwaves in response to visual stimuli as they navigate through virtual space. EEG technology affords researchers a particularly high degree of temporal precision while monitoring brain activity. “You get the brainwaves right online in real time,” explains Sternberg, “and it gives you a lot of information about how people are feeling when they’re feeling lost or when they’re able to orient themselves in a given space.”
ECONOMICS: MEDICAL CARE V. HEALTH CARE
Health happens beyond the hospital. This is the new paradigm for health design championed by design and health leaders, who cite US annual healthcare spending in excess of $2.3 trillion. Researching and designing to remove stress elements in the built environment could drastically affect those numbers. Research indicates that when animals and people’s stress response is turned on, especially chronically—like caregivers who tend to aging parents, Alzheimer’s patients, or young children—the immune system becomes impaired. “People like that are more prone to more frequent and more severe viral infections, like the common cold and the flu. If they go out and get a flu shot, there’s going to be less of a take rate of that vaccine because their immune system isn’t able to mount a sufficient antibody response,” explains Sternberg. “Chronic stress also speeds aging, and it slows wound healing.”
Designing spaces with better views, access to nature, or clear organization won’t eliminate health afflictions, but it may contribute to reducing the stress levels that most affect the immune system. Similarly, research regarding vistas and crowding can be used to proactively create spaces that encourage low stress-levels and enhanced immunological performance. A recent article in Scientific American suggested that congestion in urban environments may generate increased activity in the brain region called the amygdala – the brain’s fear center. The impact of this neurological mapping is yet untold, but the implications for urban planning are substantial. It becomes the challenge of designers to work with researchers, medical practitioners and owners to interpret this data into cunning design solutions to lower stress. This is part of what Sternberg dubs, “Architecture and Health 2.0.”
EXPANDED SCOPE: OWNERSHIP
“I'll listen to the crickets out in the trees and just be in the moment. It's mindfulness meditation. It's being aware of your breathing. It's being aware of where you are. It's just focusing on every element of the place, of the space around you. That kind of mindfulness has been shown to immediately put people in a state of relaxation and reduce the stress response and turn on that positive, healthy relaxation response,” says Sternberg, connecting her personal garden to her research. "That led me to view my science in a different way, not as in a cold calculating way, which you need to do when you’re doing research, but also in a very personal way.”
The new health paradigm happens beyond the hospital, and beyond the traditional divisions between research, science and design. In the 7th World Congress on Design and Health summary, it was expressed that “health does not belong to practitioners, nor design to designers. Both belong to the client/patient.” By collaborating with architects, Sternberg transcended her professional role as researcher/physician to craft a meaningful spot where she can find solace from her stressful journey. Evoking the smells and textures of Asclepian practice with contemporary medical research about visions, Sternberg’s modern garden is a model for the broadened realm of health-design in the future.
In an accompanying podcast, Dr. Esther Sternberg discusses scientific evidence and transformative personal experiences to connect built space with the personal well-being. The podcast is available here. Additional resources and articles can be found at the ADHI webpage and www.esthersternberg.com.