The Salutogenic Approach on Healthcare and Policy

Alan Dilani
Ph.D.
Architect / Public Health
Professor
AIA- Awarded 2010
The Salutogenic Approach on
Healthcare and Policy
info@designandhealth.com
www.designandhealth.com
Agenda
THEORETICAL BACKGROUND
 SALUTOGENIC DESIGN PRINCIPAL
SALUTOGENIC HOSPITAL DESIGN
 CONCLUSION
Design for a sustainable healthy and productive society requires ecological
/Salutogenic design approach to infrastructure and built environment.
Ecological
Design
Eco
Geographical Infrastructure
position/
Urban Design
Climate Healthy Lifestyle
clean air,
landscape from
clean water, transportation
clean food routes
clean land clean Tech. /IT
Energy
Salutogenic
Design
Environment
architecture,
public health,
psychology,
engineering
culture,
art, music
Healthcare
Services/Policy
Bio- Genetic
Factors
Emotion/
Experience
Health/
Wellbeing
Lifestyle
Psycho- social
Factors
Productive
Healthy
Society
Process of Disease
Psychosocial
Factors
LIFE
Katabolic
Health
Anabolic
Life-style
Emotions
& Experience
Biological
Factors
Emotions
& Experience
Life-style
Illness
DEATH
Psychosocial
Factors
Process of Health
Sickness <<<<< Factors
Factors >>>>> Health
Pathogenic
State of Well-being
Salutogenic
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.
Aaron Antonovsky
‘Sense of Coherence’
• comprehensibility
• manageability
• meaningfulness
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
Salutogenic design elements (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 20082009, p. 32-37.
Translating Salutogenic Theory into Environmental Design Factors
Preception
Comprehensibility
Way-finding
pleasure
Nature
Landmark
Colors
Interio
r
Manageability
Aesthetic
elements
Natural
light
Green
environments
Music
Meaningfulness
Art
View
Gym
Restor
ation
Com
fort
Pet
Cultu
re
Social
support
ergon
omic
Stimuli
positive
Distracti
on
Application of Salutogenic Design Approach
Salutogenic
Theory
Gap
Between
Theory
and
Application
Wellness factor
by design
The lack of interdisciplinary approach;
Psychology, Sociology, Neuroscience, Design , Public health
医疗计讨论会
Linda Porter Bishop
Linda Porter Bishop
Salutogenic Design is important to demands from
Google/ knowledge Society, because of brain exposure!
Left side:
-Rational & logical
functions
-Mathematical
thinking
-Language
Right side:
-Holistic functions
-Ideas & creativity
-Emotion
-Experience of
art, music, nature
LEFT BRAIN FUNCTIONS
-uses logic
-detail oriented
-facts rule
-words and language
-present and past
-math and science
-can comprehend
-knowing
-acknowledges
-order/pattern perception
-knows object name
-reality based
-forms strategies
-practical
-safe
RIGHT BRAIN FUNCTIONS
-uses feeling
-"big picture" oriented
-imagination rules
-symbols and images
-present and future
-philosophy & religion
-can "get it" (i.e. meaning)
-believes
-appreciates
-spatial perception
-knows object function
-fantasy based
-presents possibilities
-spontaneous
-risk taking
“Whole brained”
Brain Exposure and the need for Stimuli
Attentional Restorative Theory (ART), Kaplan and Kaplan (1989) identified two
attention systems and how they are related. Direct and Indirect attention
Indirect attention does not demand any energy/effort from the person and it is
activated when something exciting suddenly happens or when one does not
have to focus on something in particular.
Direct attention is activated as soon as a person needs to concentrate and focus
on a task and simultaneously block other distracting stimuli, like now!
After an intense period of direct attention, a person requires restoration;
otherwise they will become mentally exhausted.
Dilani, 2008, International reference book, IHF 2008-2009
Brain Exposure and Time for Restoration
People, who have been using their direct attention without resting, often
become impatient and irritated.
It has been shown that a mentally exhausted person often commits “human
errors”.
A person who does not take the opportunity for restoration reduces their
capacity to concentrate, often becoming
careless, less cooperative and less competent.
Therefore, in order to work effectively, it is vital to have a well
functioning attention system and find time for restoration.
Dilani, 2008, International reference book, IHF 2008-2009
Design to Improve Brain Performance!
Agenda
THEORETICAL BACKGROUND
 SALUTOGENIC DESIGN PRINCIPAL
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,
Shepley Bulfinch Architects
”access to nature”
FARROW Partnership,
Creditvalley Toronto
Place for ”senses”
and
”contemplation”
Stantec
A patient reads the morning paper on one of the many abundantly green spaces
of the Khoo Teck Puat Hospital in Singapore.
(Designed by CPG Consultants Pte Ltd and landscaped by Peridian Asia Pte Ltd – photo credit CPG Consultants Pte Ltd)
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
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
Art, Culture
and Health
Brisbane Robina Hospital OR BVN Architect
Brisbane Robina Hospital OR BVN Architect
Research Findings
Dr. Bruce Rabin, University of Pittsburgh, found surgery patient
recovering in rooms with ample natural light took less pain medication and
had drug costs 21% less than equally ill patients in darker rooms. (2004)
More Light Means Less Meds...
4.1
Dim Room
5.1
Total Stay
Day after Surgery
3.2
Sunny Room
3.7
0
1
2
3
4
5
6
Average Milligarams of Pain Reliver taken per hour by Surgery Patients
Swedish Cancer Center
NBBJ
daylighting
Restorative Environment
DESIGN&HEALTH
ACADEMY AWARDS
Academy Award winner
Bloorview Kids Rehab, Toronto, Ontario, CANADA
Montgomery Sisam/Stantec Architecture – Architects in Joint Venture
Music and
Health
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.
Our brain use architecture
as memory and our most
design
is
creativity!
strongest memory is related
to places and design!
Application of
Salutogenic
Design
School
Office
Healthcare
Elderly
Prison
Urban Design
Agenda
THEORETICAL BACKGROUND
 SALUTOGENIC DESIGN PRINCIPAL
SALUTOGENIC HOSPITAL DESIGN
 CONCLUSION
Salutogenic Hospital
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.
RiT - Existing Hospital 1989-2000
The concept
1995
78
KNOWLEDGE CENTRE
ST. OLAV’S HOSPITAL
FULLY INTEGRATED ARTWORK IN PASSIVE
INTELLIGENT FACADE
KNOWLEDGE CENTRE
ST. OLAV’S HOSPITAL
Laboratory Centre
Green Hospital
– Women and Children`s Centre
Integration with structure of City
St. Olavs Hospital 2013
Agenda
CONCLUSION
The pandemic of physical inactivity
causing 10 % of premature mortality
I-Min Lee et al, Lancet 2012; Published Online July 18
photo: Sharon VanderKaay
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
 Heart
Disease $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 Motorspaying more, getting less and going broke”
The White House, June 15, 2009. President Obama.
We need to come
out of the box and
ask a question!
What makes
people healthy?
The Salutogenic perspective
What creates health?
Why is a person well?
Which are the health
promoting factors?
How is it possible to feel quite well
even though a person has
experienced traumas?
Factors that affect health
Genetically (hereditary characteristic ethnic belonging)
Biological (sex, age, disease)
Social (profession, economy, sex, network)
Life style (food, exercise, smoking, alcohol)
Personality (attitudes, values, emotions, temperament)
Risk factors (life events, risk behavior, nature catastrophes, danger, violence)
Environment (geographic place, climate, pollutions, social
environment, physical environment, design)
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 Care – what are the
causes of disease?
-Health – what are the
causes of health
How to treat disease?
-What contributes to
good health?
How to prevent disease?
-What makes keeping
good health easier?
Pathogenic Approach
Salutogenic Approach
Organizing
International Competition
for Hospital Design
Ministry of Health
”Health Promoting
Lifestyle Center”
Dr. Aaron Motsoaledi
Health Minister, South Africa