Positive health: which levers for buildings, work spaces, regions and healthcare facilities?
Multiple societal transitions (demographic, epidemiological, urban, digital) are influencing the field of health and generating new challenges: how can we extend the healthy life expectancy of an ageing society?
How can we transform our lifestyles to improve health and reduce the burden of chronic diseases? How can we calm anxieties in a multi-risk society and rebalance the psychological state of the French, which has deteriorated due to the health crisis? These are all questions explored by Fabrique Spinoza, a think-tank dedicated to citizens’ happiness, in its study “Positive health. A guide to scientific determinants for citizens, professionals and institutions”, in which Bouygues Construction is a partner.
De-monopolise health from the purely medical in favour of a comprehensive approach to health and an ethic of care (“taking care”). Based on this conviction, the study proposes several avenues: mobilising under-used health determinants (or factors), enhancing mental health, re-enchanting health centres and re-engaging the patient.
Emotions and relationships are essential to our well-being
They influence our physical, psychological, behavioural and social health. For example, “positive“” emotions strengthen the immune system, protect against stress and improve the quality of relationships. The Harvard Study, one of the largest studies of adult life1, bears this out. It reveals that strong social relationships are better predictors of long and happy lives than social class, IQ and genetics. Therefore, relationships have real power for health, whether it is the relationship with oneself, with others or with carers.
The relationship with carers is changing at the same time as the beginnings of an evolution from medicine that heals to medicine that cares. This involves putting care and humanity back at the heart of the work and taking care of carers. In the Netherlands, the Buurtzorg home nursing company has chosen autonomy and an easier work/life balance for its nursing and home care teams, far from the models of excessive rationalisation of nursing work. Thanks to this change, absenteeism has fallen sharply, and professionals have gained more pride in their work and are more available to their patients. Similar schemes are emerging in the public hospital sector, such as the HoptiSoins platform, which offers wellness packages to all AP-HP professionals and has set up a decompression “bubble” at the Cochin Hospital in Paris.
Determinants of healthy living: adjusting lifestyles
Diet, physical activity, sleep and sex life are well-known health factors that are often neglected. The associated benefits are significant and encourage us to review our habits to adjust our lifestyles towards a healthier existence. The figures speak for themselves: in 40 years, young people have lost 25% of their cardiovascular capacity; it is currently estimated that one out of two French people is overweight; 80% of French people say they are tired during the day.
What action can be taken? Numerous measures are being developed at the regional, corporate, medical and hospital levels. To encourage physical activity and sports, some cities are developing pedestrian plans to improve their walkability. This is the case in Strasbourg, the first city to adopt a pedestrian plan, and in Sceaux (Hauts-de-Seine), which, after having completely pedestrianised one of its neighbourhoods, is now working on creating pedestrian continuity between the RER station and the city centre. Regional planning also enables action with respect to food. In 2018, the London City Council decided to ban the establishment of fast food restaurants within a 400-metre radius of schools and to offer a more balanced food landscape to students after school.
In addition to local authorities, a number of other players can help to promote changes in lifestyles. Treatment through sport: this is the principle of sport-health on prescription. Since 2016, the law has authorised doctors to prescribe physical and/or sporting activity to patients with long-term conditions (type 2 diabetes, obesity, breast and colon cancers in remission, stabilised cardiovascular diseases, etc.). Like Sète, several cities are initiating this type of programme and coordinating action between health professionals and sports clubs, accompanied by specialised sports educators within their departments.
Moving and being in motion contributes to physical but also mental well-being, by appealing to our sensoriality through proprioception (the perception, either conscious or not, of the position of our body in space, which can be considered a sixth sense). Companies are reconfiguring their premises using active design, i.e. making users want to choose an active way of moving around. It is in this spirit/with this in mind that 100Architects worked to reconfigure the hall of a company’s headquarters by introducing playful elements (slide, swing), graphic elements inciting movement (mirror arrow, bright colours) and by inviting a mixture of uses in the same space (relaxation and movement).
Occupational health: a renewed imperative
Occupational health is an imperative reinforced by the health crisis. The pandemic has been accompanied by a deterioration in workers’ health, both mental (doubling of the burn out rate, psychosocial risks the 2nd cause of work stoppage after the coronavirus in 2020) and physical (when working from home, 42% of workers move around little or not at all and 54% have lower back pain when working at home). The work environment can contribute to health and well-being through a few simple principles of action: material and social ergonomics, suitable workspace, biophilia, good digital practices, etc.
The benefits of proximity to natural elements (outdoor air, natural light, water, vegetation, etc.) has been demonstrated in numerous studies. Researchers estimate that absenteeism can be reduced by 6% just by having access to natural light and a view of the outdoors.
Work influences cognitive health through the design and layout of functional offices. Workspaces are organised based on an ergonomic principle via the concept of Activity Based Working. This concept is based on the choice of users to decide on the environment in which they wish to work according to their different activities throughout the day. The layout has been redesigned to offer a variety of spaces: common spaces designed as public squares, spaces for small groups of workers who work together for long periods of time, spaces for one-off collaborative projects, alcoves for relaxing, individual spaces for telephoning or taking part in a video conference, indoor or outdoor wellness areas (standing workstations, outdoor offices, meditation areas, etc.).
The work also takes into account social ergonomics in order to encourage human relationships. It is a question of organising the friendly flow of people, favouring small work units, creating friendly spaces, and animating interstices and circulation areas through nudging. Non-spatial arrangements can also be considered, such as the introduction of a Chief Happiness Officer to boost social ties.
A sensitive life: Art, a source of health
In all its various forms, art can heal, give relief, liberate, and contribute to both fulfilment and healing. While art therapy approaches (a creative process of self-transformation that proposes multiple practices of art as an act of care) are relatively well known, other similar practices are emerging, such as museum therapy, which takes a cultural approach to art as a source of health, bringing the museum closer to the medical field. French-speaking member physicians in Canada are prescribing museum visits in partnership with the Montreal Museum of Fine Arts. The practice has arrived in France, where doctors from the Pitié Salpêtrière Heart Institute can prescribe visits to the Château de Compiègne.
In hospitals and medical-social institutions, art is also used in the form of murals, artistic activities or in corridors, offering artistic and cultural routes through the heart of the hospital. The Lyon University Hospital offers patients the opportunity to choose a work of art for their room and has observed an improvement in mood and a reduction in the use of analgesics and antidepressants.
These different levers can only be fully expressed if individuals are involved and committed. In a comprehensive approach to health, this commitment can be expressed in all areas of daily life: living environment, food, mobility, social relations, sleep, etc. Health care facilities are being reinvented, with a focus on hyper-proximity and positive health, and a strong emphasis on prevention and well-being, following the example of multi-professional health centres or third place health care facilities open to the city and accessible to all.