THE HOLISTIC HEALTH HOUSE A Typology for Preventive Healthcare Program
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“Health is not valued till sickness comes.� Thomas Fuller
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Andy Minchev Stud 4685 KADK School of Architecture Urbanism and Societal Change Thesis, Spring 2016 Tutor: Charles Bessard 4
CONTENTS
Abstract ...................................................................................... 06
I - THE HEALTHCARE SECTOR The Danish Health Sector ........................................................ 10 Health and Lifestyle .................................................................. 12 The Most Common Chronic Illnesses ................................... 14 Healthcare Sector Priorities .................................................... 18 Discourse on Preventive Healthcare ...................................... 20
II - PROJECT SITE Project Site Area: Kongens Lyngby ........................................ 24 Situation Plan ............................................................................ 26 Bird’s Eye Photo ........................................................................ 28 Site Scale Comparisons ............................................................ 30 Site Imagery ............................................................................... 32
III - ARCHITECTURAL INTENTION A Brief History of Medical Typologies .................................. 38 Holistic Healthcare ................................................................... 40 The Holistic Health House ...................................................... 42 Spatial Program ........................................................................ 44 Delivery Material ...................................................................... 46 References .................................................................................. 47 Résumé ....................................................................................... 48
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Abstract
Denmark is currently experiencing a rapid growth in health-related public expenditures. This is due to a general growth in lifestyle-related illnesses and an increasingly ageing population. Politicians and experts alike are endlessly optimizing the current pressured healthcare sector so it can barely maintain the same level of service and efficiency, but how far can we push the limit. Do we simply accept that our society is growing more and more mentally and physically ill? Shouldn’t we focus more on the root of the problem and concentrate on preventing the great increase of illnesses, instead of waiting for our population to grow more and more ill? Situated in Lyngby, a suburban city north of Copenhagen, this architectural project focuses on creating a new typology that promotes preventive healthcare. Located directly in the commercial heart of Lyngby, it is located at a very central location, inviting local adult citizens to use the building and its facilities as a natural part of their everyday lives. The proposed project attempts at de-institutionalizing a healthcare institution by treating it more like a public health-culture house for the healthy rather than the ill. This allows for a warmer, more personal spatial experience than the clinical hygenic architecture of medical institutions. The project furthermore merges social, physical and mental programs into an open and inviting public building, where preventive healthcare is supported through recreational, leisurely and informative activities, making the switch to a healthier lifestyle easier and more attractive for local adult citizens.
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I THE HEALTHCARE SECTOR
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The Danish Health Sector - The Status Quo
Like many other Western European nations, Denmark is currently experiencing a spike in lifestyle-related illnesses, a rapidly growing elderly population and at the same time, historically high public demand on quality and technology in the public healthcare sector. Public spending on healthcare has increased by 30 mia. kr from 2000 to 2013 alone (an increase of 43%) and is expected to increase further in the coming years. Our expenses on medication alone are expected to nearly double from 7,5 mia. kr in 2014, to 14,3 mia. kr in 2020! Furthermore, more citizens than ever are seaking extensive treatments each year, creating an unprecedented encumberment on the healthcare sector and a historical pressure on the Danish welfare state. As the needs and demands for the healthcare sector grow, the means to fund its future grow ever more challenging. At the same time, political parties proudly boast on the matter of how they can make the healthcare sector evermore efficient and thereby save money. While the numbers may speak the truth, medical experts are losing their jobs in the process and local healthcare facilities are being closed down in order to make way for strongly centralized medical facilities.
Source: ‘Sundhedsvæsnet i tal’, Danske Regioner 10
2014: 7,5 Mia. Kr
2007: 4,3 Mia. Kr
2020: 14,3
Mia. Kr
Source: http://politiken.dk/indland/politik/folketingsvalg2015/ECE2695574/sf-og-alternativet-vi-er-noedt-til-at-prioritere-i-sundheden/
Public spending on medication alone.
Source: ‘Den Nationale Sundhedsprofil 2013’, Sundhedsstyrelsen 2014 11
‘Feeling Material XIV’ - Antony Gormley, 2008 12
Health and Lifestyle in the Contemporary Danish Society
Increasing expectations from people’s professional and educational performances and achievements are pressuring Danes to new levels. Physical inactivity due to desktop work and commuting, stressful workdays and pressure from care and parenting has created a great rise in lifestyle illnesses. The modern Dane is at once expected to perform exceptionally within work and education, while also being able to care for family and friends. This pressure from work and family has lead to many adults being over-encumbered from their everydays, leaving little time and space for actual rest and time to nurture and care for the body. This tense pressure of personal time and priorities has led to many Danes living inactive lives with quick, unhealthy diets as well as increasing stress. In recent years, the toll from this societal pressure on the individual has started to appear - currently about half of the adult Danish population is overweight. To many, such lifestyle issues may seam somewhat harmless, but in truth, it is exactly these personal problems that are truely taking their cost on society. What may start out as simple obesety often over the years tends to evolve into chronic lifestyle illnesses, that not only further pressure individuals, but also pressure our healthcare system.
Source: http://politiken.dk/forbrugogliv/livsstil/ECE1178378/skraemmende-tal-nu-er-der-flere-overvaegtige-end-slanke/ 13
The Most Common Chronic Illnesses
The radial diagram to the right illustrates the 20 most common chronic illnesses. The lines extruding from the middle ring show the percentage value of how much treatment resources each unique illness accounts for.
Legend This diagram roughly illustrates the relation between preventable and non-preventable illnesses. While painting a picture of the extent of medical prevention, the reality is always more complex, and the illustrated illnesses may vary greatly in treatment and prevention based on different individuals and their genetic history. Preventable Illnesses Non-Preventable Illnesses 14
... And Which Ones can be Prevented
Source: http://www.dsr.dk/Sygeplejersken/Sider/SY-2013-02-22-1-Patientkultur-i-historisk-perspektiv.aspx 15
60%
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of the illnesses we treat today can be prevented...
That means, in a healthcare budget of 25 billion kroner,
15 BILLION KR
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CAN BE SAVED ...if municipalities become better at promoting preventive healthcare. And this is just for the Capital Region.�
Source: http://politiken.dk/indland/ECE228710/forskere-60-procent-af-alle-sygdomme-kan-forebygges/ 17
‘Der Mensch als Industriepalast’ - Fritz Khan, 1926 18
Healthcare Sector Priorities - Efficiency and Savings
In 2007 the former name of ‘Indenrigs- og Sundhedsministeriet’ (Translated: The Ministry of Internal Affairs and Healthcare), renamed itself ‘Ministeriet for sundhed og forebyggelse’ (The Ministry of Heealtchare and Prevention) marking a new agenda in the government’s healthcare ministry. The name indicated a switch towards a healthcare sector that would put preventive medicine and rehabilitation much higher in its priorities. Decades of treatment of the ill and frail would now include the priority of informing the general public of how to lead a healthy lifestyle, creating a new unofficial ‘contract’ with citizens, that it was no longer just the healthcare sectors responsibility to heal and care for the ill, but also the responsibility of the individual to take care of one’s health and wellbeing - for one’s own best, but also as a responsibility to society. Despite the many good intentions and progressive directions that have started to influence contemporary healthcare policies, there is still a long way to go before preventive measures are turned into permanent, highly-prioritized tools and strategies in the healthcare sector. The current primary agenda for the public healthcare sector is furthering technology and optimizing effiency, so that we can continue to roughly receive the same quality of treatment as the current status-quo, while attempting to limit the spendings involved in doing so. This current priority is basically following the idea of continuing business-as-usual. Due to factors such as bureaucracy and limited political will to attempt to challenge the medicinal industry and its institutions, it seams that furthering preventive healthcare into the established healthcare system is still a distant, but fortunately also growingly prioritized vision.
Source: http://www.altinget.dk/sundhed/artikel/regering-saetter-gang-i-sundheds-prioritering 19
The Government’s Discourse on Preventive Healthcare
Preventive healthcare is one of the very few political subjects that all Danish political parties agree upon. As a matter of fact, the only point of disagreement within the Danish political spectrum, is how much preventive healthcare we should promote. The issue than lies in the way preventive healthcare is implemented upon the Danish society. Currently, it is promoted through top-down initiatives that mainly consist of ‘infomercial’ campaigns as well as regulatory measures, such as increasing the taxes of unhealthy products such as cigarettes.
“We have a personal responsibility for our health, but we also have a common responsibility in empowering this responsibility. Municipalities are key actors here, since preventive healthcare is best when applied in a local context in close collaboration with its citizens.” Venstre Current Ruling Party Excerpt from party program on preventive healthcare.
Source: http://www.venstre.dk/politik/venstre-mener/sundhedspolitik 20
... And the Public Opinion
According to a report on the future of preventive healthcare by Mandag Morgen - an independent think-tank - the conclusions tell that the vast majority of the general Danish public are more than willing to take greater responsibility for their own health, but that they also long for an easier way to live a healthier life. Rather than top-down political intiatives, people wish for an easier and more accessible way towards a better lifestyle within the context of their everyday lives. This is where the project proposal comes in the picture.
“Danes are well aware of what is healthy and what isn’t, but they have difficulty finding time and means for this in their everyday lives. They are searching for a helping hand to make healthy living easier.” Lars Jannick Johansen Director of ‘Mandag Morgen’ Comment on the conclusion of ‘Fremtidens forebyggelse’ - a study on Danes’ opinions on preventive healthcare.
Source: http://www.trygfonden.dk/Bestil-materiale/Publikationer/Fremtidens-forebyggelse 21
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II PROJECT SITE
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Lyngby
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Project Site Area: Kongens Lyngby
Located in the municipality of Lyngby-Taarbæk, Kongens Lyngby is a historic suburban city that is known to be a vital trade center for the historic industrial ‘vein’ along the Mølleå river. Today it is an upper-middle class suburb, that still houses a very strong commercial center, attracting many diverse visitors from its neighbouring municipalities and beyond. Lyngby is home to large shopping centers such as ‘Lyngby Storcenter’ and ‘Magasin’ as well as other large-scale commercial buildings such as its cinema, ‘Kinopalæet’. Unlike many other suburban cities with large shopping centers that kill off local stores and street life, the vast amount of commercial offerings that Lyngby hosts still manage to attract daily visitors in the thousands (Lyngby Storcenter alone has an average of 15.000 daily visitors), allowing the city to maintain a very lively historic commercial street that houses Lyngby’s smaller boutiques and café life. The project site is located in the very heart of downtown Lyngby, roughly in the middle of the city’s historic merchant street, Lyngby Hovedgade. The site location is especially interesting because its central location allows it to reach out to a very broad segment of the local adult population, creating great potential for communicating and promoting preventive healthcare.
Legend Site Area Municipal Borders Sea and Lakes Nature Area Urban Area 25
Lyngby Church
Situation Plan of Downtown Lyngby
P The project site is located roughly in the middle of Lyngby Hovedgade, which is slightly less trafficated than the shopping center routes, but nevertheless still very central and lively. It is especially placed here in order to integrate itself into Lyngby Hovedgade’s café culture, merging it naturally into the character of the existing streetlife. The site’s current parking courtyard is enclosed enough to almost completely quell the noise from the main street, giving the oppurtunity to create a quiet courtyard atmosphere that relates to the architectural project. The backside of the site features a quiet small street, that leads directly up to Lyngby’s Assistentkirkegård (cemetery) - a public park cemetery that further connects to Lyngby’s larger nature areas, such as Lyngby Lake and Mølleåen. This close proximity to parks and nature creates the oppurtunity to connect the project to a larger network of green areas, almost directly from the city’s urban center.
Towards Lyngby Lake
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P P
Legend *All commercial and cultural landmarks are marked by text within the plan.
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Site
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Bus Terminal
Pedestrian Flow
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Car Parking
Rail Tracks
Commercial Street
Station
Public Park
Lyngby Cemetery
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Lyngby Storcenter
P KinopalĂŚet Cinema
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P Magasin
P P
Lyngby Cityhall
P P P
B S
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Site Scale Comparisons
A small selection of well-known Copenhagen squares and buildings for scale comparisons. The site is slightly smaller than the exterior area of the KADK cantine and Skt. Hans Square. It is roughly equal to the plot size of NORD Architects’ Center for Cancer and Health, but still larger than the historic Rosenborg in Kongens Have.
10m 10m
Lyngby Site Plot Area: 1300m
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KADK Cantine Outdoor Space, Holmen
* The comparisons are guiding since they are baesd on satelite orthophotography. The imagery may not fulfill exact measurements. 30
Skt. Hans Square, Nørrebro
Center for Cancer and Health, Nørrebro
Rosenborg Castle, Copenhagen City
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Project Site Imagery
Building site and opposite context.
Site edge looking towards Lyngby Hovedgade south.
Zoom of building gap.
Context buildings and courtyard fence.
Look towards Lyngby Hovedgade north.
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View of alley from the backside.
View towards Lyngby Hovedgade from the parking courtyard.
Panorama of the parking couryard looking towards north.
Panorama of the parking courtyard looking towards south.
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III ARCHITECTURAL INTENTION
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A Brief History of Danish Medical Typologies
Middleages (1000-1700)
Enlightenment (1700-1920’ies)
Modernism (1930-00’s)
For centuries, medical treatment was a thing exclusively for royalty and nobility, but along with the rise of christianity in Denmark, came the first organized medical institutions that would serve the general public. Churches and monasteries would occasionally aid the poor and the frail, but resources were few and the medical expertise was limited to the skill of local munks.
New political ideas born out of The Enlightenment created an interest for the health and wellbeing of the general public. In Denmark, the birth of the modern hospital began its journey during this time, but it would take more than a century before large-scale hospitals such as ‘Kommunehospitalet’ (1858-63) were built, setting the standard for future medical institutions.
The rapid growth of the welfare state and the rise of the Danish middle-class created a great demand for better healthcare for citizens. New modern hospitals were planned for maximum efficiency, concentrating heavily specialized personale, as well as using the latest medical technologies and treatments - the hospital turns into a ‘healing machine’.
Based on various sources, but most notably ‘The Architecture of Hospitals’ by Cor Wagenaar (2006). 38
? Super-Hospitals (2000’s-)
‘Sundhedshuse’ (2010’s-)
The Holistic Health House
Lifestyle diseases, an ageing population and growing pressure on the welfare state and its health sector have given birth to regional-scale super-hospitals at the scale of small towns. The ‘healing-machine’ mentality of the 60’ies and 70’ies has been taken to new heights and every measure of effiency has been taken to squeeze value out of every single kroner invested in healthcare.
The ‘sundhedshus’ is a local polyclinic that focuses on a local demographic, providing the most common medical facilities and specialists. It is in a way a by-product of the super-hospitals - a down-scaled version of the services provided by the former municipal hospitals. The sundhedshus usually houses preventive healthcare, but this is very unwelcoming and institutional since it is still intended for the ill.
The holistic health house is a proposal for a typology that is dedicated to preventive healthcare. Detached from existing medical institutions and their focus on the ill, this new typology gains the freedom of a new aesthetic that doesn’t follow strict medical standards, turning it into a local culture house rather than a medical institution. This allows it to be open and inviting to a broader segment of citizens, who merely seak to improve their health lifestyles.
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Preventive Healthcare - Holistic Ideas of the Body and Mind
In recent years, the field of medicine has experienced a revived interest in the ancient ideas of holistic health. Where the traditional medical school focuses on treating and caring for the body by separately specializing in different organs and systems as well as isolating the mind as a discipline in its own, the school of holistic health defines true wellbeing as a strong, healthy relation between the physical, mental and spirtual as one deeply connected and intertwined system.
Specialized Healthcare
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This view of wellbeing is vital in the sphere of preventive healthcare, since it covers all areas of preventive healthcare treatment and can even do so in majority through the use of recreational and non-treative programs. In other words, the diagram below illustrates how the interconnection between the six criteria for holistic wellbeing are closely related to the individuals lifestyle and the choices connected to this, rather than the wellbeing of separate organs and bodily systems.
Preventive Healthcare Source: http://ahha.org/rosen.htm 41
The Holistic Health House
My vision for the holistic health house is to create a model for a local social gathering place, where the adult population can come and experience preventive healthcare first-hand in an informal setting. Inspired by holistic medical ideas, it can perhaps best be described as a culture house that relates to the body and mind. The building will include an open-kitchen where citizens can learn new, easy healthy dishes to make at home, activity halls where you can enter and join along on light physical activities such as yoga and aerobics. And should you not have interest in the physical activities and you would rather relax and contemplate in a quiet and peaceful environment, there will be spaces for contemplation and meditation. Should you have some doubts about your wellbeing, but hesitate to get a check-up at your doctor, you can enter the holistic health house for an informal consultation and hear whether there is reason to worry or perhaps just receive tips on how to avoid a certain illness in the first place, should it be the case. For those who simply wish for a social place to hang out to avoid loneliness, the holistic house can also act as an open social lounge, open to free use by the citizens.
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Harriet Lee-Merrion - Illustration Work 43
Spatial Program
Social Programs - 530m2 - Open-Kitchen (Folkekøkken) / CafÊ - 300m2 - Public Lounge - 100m2 - Event Hall - 80m2 - Group Consultation Room - 50m2
Physical Programs - 200m2 - Physical Activity Hall - 100m2 - Outdoor Activities Base - 40m2 - Physical Consultation Rooms - 30m2 - Screening Rooms - 30m2
Mental Programs - 100m2 - Contemplative Activity Space - 50m2 - Mental Consultation Rooms - 30m2 - Information Kiosk - 20m2 - Contemplative Garden (Exterior) Other - 220m2 - Staff Office Space - ~100m2 - Functional (Toilets, Maintenance, Storage, Etc.) - 120m2
Total: 1050m2
* The mentioned areas and programs may be altered during the design process. 44
Programs in Relation to the Holistic Aspects
Public Lounge ‘Open-Kitchen’ Café
Group Consultation Room
Outdoor Activities Base
Event Hall
Physical Activity Hall
Social
Mental
Physical
Mental Consultation Rooms
Physical Consultation Rooms
Contemplative Garden
Screening Room
Contemplative Activity Space Information Kiosk
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Delivery Material
Graphic Material Situation Plan - 1:1000 Site & Building Plans - 1:100 Section & Elevation - 1:100 Spatial Visualisations Diagrammatic Material Facade Detail Misc. Visualisation Material
Physical Material Situation Model - 1:1000 Site Model - 1:100 Detail Models
* The mentioned material may be altered for the final delivery, should it present the project more clearly. 46
References
Literature Anne Kathrine Frandsen et. al., Helende arkitektur. Danske Regioner, 2009 Cor Wagenaar, The Architecture of Hospitals. NAi Publishers, 2006 Lars Heslet, Sansernes hospital. Arkitekternes Forlag, 2007
Reports De fremtidige sundhedsudgifter. Økonomisk Institut - University of Copenhagen, 2011 Den nationale sundhedsprofil 2013. Sundhedsstyrelsen, 2014 Det kommende hospital. Danske Regioner, 2010 Forebyggelse er fremtiden. Dansk Sygeplejeråd, 2009 Fremtidens forebyggelse. Mandag Morgen, 2008 Kultur og sundhedsfremme. Hans Knudsen Instituttet, 2015 Skal overvægtige voksne tabe sige?. Vidensråd for Forebyggelse, 2013 Sundhedsprofil 2013. Region Hovedstaden - Center for Sundhed, 2015 Sustania Guide to Co-Creating Health. Sustania, 2011
Journals Arkitekten, 07/2011, vol. 113 Arkitekten, 07/2014, vol. 116
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Résumé
Education 09.2014 -
KADK School of Architecture Urbanism and Societal Change Master of Architecture (M.Arch) 09.2010 - 07.2013
KADK School of Architecture Department 10: Architecture, Terms and Vision Bachelor of Architecture (B.Arch) 09.2006 - 07.2009
Nørre Gymnasium STX - High School
Work 11.2014 - 08.2015
Model Workshop Manager COBE Architects 04.2015
Guest Lecturer The Scandinavian Design College 09.2013 - 07.2014
Architectural Internship COBE Architects
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Andy Minchev Stud 4685 KADK School of Architecture Urbanism and Societal Change Thesis, Spring 2016 50