Standpoint: The broader view
Designers need to take a more proactive role in helping the health world understand the real impact of design on health, urges Jacques Mizan.
‘Prevention’ must be the most popular word flying around the world’s corridors of power right now. Faced with the volatile mixture of ageing communities, cutbacks in public funding, reduced access to capital and an ever-increasing demand for the latest and best healthcare provision, there is a frantic need to find something to stem the tide – and prevention is it.
To some prevention means improving access, longer clinic opening times, more information for patients, choice, ‘better’ training for doctors, incentives to get doctors to do prevention. Prevention is also about changing behaviour. Significant resources are being ploughed into understanding behaviour change and then designing tools to shape it.
One can only imagine the sums of money that have been ploughed into marketing campaigns aimed at stopping smoking, for example. In the UK, the NHS Choices website has been developed at a cost of some £22m to date. None of this seems to be making any significant difference.
What confuses me as a clinician is why all of this goes on in blissful ignorance of the impact of design on health. There is now a growing body of evidence demonstrating how the design of environments can shape behaviour, perhaps more so than any of the aforementioned interventions.
A well-designed urban landscape, shaped with and by the community, which provides solutions for exercise, social connections and support, access to nature and fresh food, enabling opportunities for employment and education, these are the true shapers of health and wellbeing.
These are the social and environmental determinants of health. And design is core to all of them. However, shaping environments through design is much more complex than the straightforward solutions presented in the first paragraph. Many within health see such an approach as too costly and simply impossible to do.
So the default tends to resort back to the quick fixes of improved access, choice, new buildings, more technology etc. This is short-termism in its worst form and unlikely to do anything that remotely fits the definition of ‘prevention’. These interventions are wasteful of taxpayers’ money, wasteful of my time as a clinician, and wasteful of the time of designers.
How can such waste be justified in such frugal times? The design world needs to come to the fore now. There is a desperate need to educate the health world about the potential for design to shape health, and how ‘savvy’ such an investment can and will be. Looking inward, design and architecture fraternities need to widen their focus – to zoom out from the focus on developing spaces and places in isolation.
Of course, it is easier to just go along with what has been requested in the design brief. But if design really wants to play a part in health, then it needs to discourage quick fixes. Design needs to swim against the tide and push for – insist on – what might best be described as total-place design. Crucially, design can, and should be, the driving force to get the remaining stakeholders to do the same.
Dr Jacques Mizan is a senior associate with the Young Foundation’s Health Launchpad, a practising GP and an honorary research fellow in the Department of General Practice and Primary Care at Kings College London.