Health by design: How design can impact lifestyle and promote health, via healthcare facilities in Middle East

Public health research for many years has held that unhealthy behaviours are really a consequence of unhealthy environments and unhealthy prompts within these environments.

October 02, 2019 Upali Nanda and Ben Gonzalez, HKS

An obesity epidemic

In 2015, a news article in CNN Abu Dhabi proclaimed an obesity epidemic in the Middle East showcasing a young boy who weighed more than 600 kgs and had to be forklifted from his apartment to get medical help. The article announced that obesity and diabetes rates in the Middle East are staggering, particularly in the Gulf region – Kuwait, Saudi Arabia, Bahrain, and the United Arab Emirates. The article went on to suggest that perhaps the luxurious lifestyle and the abundant availability of food without an equal focus on physical activity could be at the heart of the problem.

The United States has also struggled with the obesity epidemic for many years. More than one-third of American adults are now obese, which has nearly doubled since the 1960’s, and another third are overweight (National Center for Health Statistics, 2016). The issue is urgent because we know that physical health can impact mental well-being as well. Depressed and obese people are far more likely to become obese or depressed, respectively, over time (Luppino et al., 2010). Many initiatives are being supported nationwide to focus on health and well-being and encourage a healthier lifestyle. What if our environments, and the buildings we live in, are the hurdle towards this goal?

A design opportunity

Public health research for many years has held that unhealthy behaviours are really a consequence of unhealthy environments and unhealthy prompts within these environments. In 2016, the AIA supported the Center for Advanced Design Research and Evaluation, Planning4Solutions and HKS architects to study how design could influence people to make healthier decisions. The team concluded that while there were many design strategies that could create a healthy environment, we need to focus on the “points of decision” where people make choices about their physical activity or diet and influence the decision at that point.

The following are some of the design strategies this study found that can nudge people to make healthier physical activity and diet choices in college settings:

Increase visibility of healthy choices
—– A well-placed staircase in lieu of elevators.
— – A smartphone app that prompts us when there is a park or a health food store.
— – Signage.

Enhance walkability
—– Well-maintained walkways.
— – Greenery, gardens, multi-use fields, sheltered picnic areas, public plazas.
—– Quality street lighting.
—– Mixed-use development that includes appealing and accessible healthy food options and other amenities.

Improve transportation infrastructure
— – Bike lanes and bike share/parking facilities.
— – Easy access to public transportation system.

Increase availability of healthy food options
—– Easy access to fresh produce such as supermarkets, farmer’s markets, and community gardens.
—– Healthy “grab ‘n go” options in vending machines and cafeterias.

These strategies involve various scales of environmental design ranging from information design to urban realm. The research recommends a detailed analysis of the users and different personas to assess how to create better point of decision design. Given the unique culture in the Middle East, for example, perhaps a compelling point of decision prompt would be to have healthy lifestyle options in places where there are large social and family gatherings. Large Middle East families tend to visit patients in hospitals. Perhaps developing educational programmes in the main lobby that teach healthy cooking options or exercising will allow them to spend time in the hospital while learning. Given that more than half of the population is in school, a similar programme can be developed for schools in order to educate and improve the health of the population now and in future generations. The unique climate needs to be taken into account to ensure that activity and hydration options are planned together, while remaining culturally sensitive.

Given that more than half of the population is in school, a similar programme can be developed for schools in order to educate and improve the health of the population now and in future generations.

A new paradigm: Healthcare facilities as health destinations

In conclusion, there is a need for healthier environments, but there is also a growing awareness and expectation from the patients to live healthy and be treated in health promoting environments.

As designers we can keep the following tenets in mind, while designing any healthcare facility:

  • During master planning, ensure planning for pedestrian friendly environments that promote engagement with nature.
  • Consider creating a “health neighbourhood” around healthcare facilities, especially those in the community so they can become a health destination rather than a “sickness” destination
  • Carefully consider diet choices and health food availability in designs. Create appealing environments around healthier options and provide sensory cues at key points of decision.
  • Promote stair use for ambulatory patients by creating attractive, accessible stairs that are strategically positioned at key points of decision.
  • Make health and well-being a core focus of healthcare facilities by designing facilities that are warm, environment-friendly, well-lit, integrated with nature and actively promote healthier choices.