What would a Transition hospital look like?
Our theme for May is 'Transition and Health'. This month we’ll be looking at how public health professionals are already responding to challenges of climate change and resource depletion and at how a more Transition-inspired approach might help to deepen that. We’ll be talking to nurses and doctors, to those responsible for sustainability within the National Health Service and to one of the authors behind The Lancet’s extraordinary recent ‘Manifesto for Planetary Health’. We’ll hear from people involved in Transition who are doing great work in their communities to make them healthier places, from the author of the first Health Impact Assessment of a Transition town, and from the people working to make whole cities healthier places. We’ll start by hearing from Clive Hamilton, author of ‘Earthmasters’, about the public health impacts of that most extreme response to climate change, geoengineering.
For my opening piece this month, I want to ask the question “what would a Transition hospital look like?” In many communities, the hospital is one of the largest employers, the largest procurer of food and energy, and a key focal point for many people in the community. A good place to start is with a report from the World Health Organisation called Healthy Hospitals, Healthy Planet, Healthy People: Addressing climate change in health care settings. It sets out '7 Elements of a Climate-Friendly Hospital':
- Energy efficiency: reduce hospital energy consumption and costs through efficiency and conservation measures.
- Green building design: build hospitals that are responsive to local climate conditions and optimized for reduced energy and resource demands.
- Alternative energy generation: produce and/or consume clean, renewable energy onsite to ensure reliable and resilient operation.
- Transportation: use alternative fuels for hospital vehicle fleets; encourage walking and cycling to the facility; promote staff, patient and community use of public transport; site health-care buildings to minimize the need for staff and patient transportation.
- Food: provide sustainably grown local food for staff and patients.
- Waste: reduce, re-use, recycle, compost; employ alternatives to waste incineration.
- Water: conserve water; avoid bottled water when safe alternatives exist.
As I argued in my recent piece in the Coop News, institutions can gain a great deal by collaborating and working with local community organisations, and seeing that as being central to their health and wellbeing agenda. Let’s see what we might be able to add to the WHO’s list.
Design for beauty: most hospitals, let's face it, are pretty soulless and uninspired buildings. As Christopher Alexander puts it in The Battle for the Life and Beauty of the Earth (2012):
"If we examine ... newly built environments during the period from 1900 to 2010, and judge their human quality from the point of view of our psychology, our emotional states, our social and mental well-being, our happiness, our joy in life, then we shall reluctantly be forced to acknowledge that the contemporary efforts we (as a people) are making to build living environments, are becoming less and less successful with each decade that goes by".
While introducing the work of local artists to hospitals can help a bit, it really is no replacement for creating new buildings which embody healthy design, in terms of materials used, access to daylight, busy areas and quiet corners. It need not cost more, when rebuilding is to take place, to create a hospital which is beautiful, life-affirming and nourishing, but the benefits would be huge.
Create a new economy: A recent report by the Landscape Institute on the role landscapes can play in promoting public health began:
"We are under no illusion that spending cuts in the UK are constraining public health budgets, as well as putting pressure on the NHS. But, if responded to imaginatively, this pressure has the potential to generate both positive results for the health and wellbeing of communities across all the UK’s administrations and, as a result, reduce NHS spending".
There is huge scope, as the Evergreen Cooperatives in the US demonstrate, to reimagine how the economy of a hospital work. It need not follow the neo-liberal model of out-sourcing everything which is being so pushed by the current UK government. Subcontract the cleaning to Serco, the catering to Serco, the cafe franchise to Costa, the security to G4S etc. While many in the current government look to the US for inspiration in terms of how to design and run a healthcare system, they are looking at the wrong models there. Have a look at this:
Here's an approach which offers a way of procuring services which keeps money local, builds jobs, ownership, training and so on. Given the choice between promoting that, and the current approach which results in minimum wages and zero hour contracts, a strong argument can be made that the public health, financial health and mental health of the local community are far better served by taking a different approach.
Kick out the Costas, and get in a locally owned cafe, serving local produce, indeed produce grown in the hospital grounds (see below). Kick out Serco, and let a thousand co-ops bloom. Place the hospital at the centre of the web of the new local economy. Procure locally like they do in Nottinghamshire Healthcare Trust.
In an inspiring story that could be replicated anywhere, catering manager John Hughes shifted their procurement so they now source 90% of their fresh red meat and all of their vegetables, salad and fruit in season from within a 30-mile radius. Now they have created a 'super kitchen' and have taken on to provide all the meals that Nottingham City Council provide to people who use the Meals at Homes service. As Hughes said in a recent interview "we can continually change with the seasons". Anywhere else interested in such an approach can get great support from the Soil Association, who have been doing amazing work on this.
Hospital as Market Garden: Why not take a look at the grounds of the hospital and reimagine them in a different way? Gardens have been shown to have great benefits to peoples' health. A 2003 study from the Netherlands, based on interviews with 10,000 people, showed that the greener peoples' environments, the better their general health and the less symptoms they report, and the better their mental health too.
An evidence review for Community Food and Health (Scotland) showed how involvement in food growing is linked to improved mental health and wellbeing in a variety of ways, such as enabling people to learn new skills, have more physical exercise and relaxation. So why not bring the two things together, and put food growing on hospital grounds as being central to their public health work?
Instead of seeing hospital grounds as large areas of ornamental grass which no-one ever walks on, outsourced to a contractor who cuts the grass and plants annual bedding plants, rethink them instead as intensive market gardens, as food forests, as orchards undergrazed by chickens. Such spaces also serve a powerful role in creating stress-free environments for staff and patients, reducing sickness time in staff and hastening recovery for patients. As Christina Fox put it in her dissertation for her Landscape Architecture degree at Leeds Metropolitan University:
"In the current economic crisis, budgets should be re-addressed with the emphasis on volunteering, fundraising, shared services and changes of use of external landscapes and gardens. With a focus on educating staff and managers on health benefits of natural environments and links with external expertise such as universities and colleges should maximise the potential of hospitals landscapes and gardens".
Create a co-operative to manage them and to train local people to become growers. Create walkways through them for patients and their families. Focus on leafy greens, salads, and other high value crops which also introduce a healthy seasonal boost to the hospital meals.
Be ambitious in terms of scale. Work the ground like you would work a market garden. Redesign the menus around the seasonal produce. Grow produce that patients at the hospital who originate from oversees connect with home, and invite them out to see it, smell it, taste it. Design into the business plan a percentage of food distributed free to local families struggling to provide good food. Harness the healing power of food memories around food. Use the waste heat from the hospital air conditioning or from the incinerator to heat glasshouses to extend the season and the varieties that can be grown (NHS bananas anyone?).
Such an approach also tackles a range of other problems hospitals face. It can reduce crime (a study from Chicago showed that that the presence of vegetation can significantly reduce both property crime and violent crime). It can improve air quality and the problems associated with that. It can be a sink for water, stopping surges associated with heavy rainfall. It can reduce the heat island effect and therefore lead to reduced need for air conditioning. It can provide enjoyable occupational therapy for patients. Looked at in this way, although the 'contract-it-out-to-the-guys-with-the-sit-on-mowers' approach may be cheaper, in the longer run, the approach outlined above would make far more sense.
Hospital as community power station: Let’s take the WTO’s suggestion to “produce and/or consume clean, renewable energy onsite to ensure reliable and resilient operation”. How about the hospital reimagines itself as a community energy power station, and invite the local community to invest in and benefit from the energy? Hospitals often have some of the largest roofs in an area and the highest potential for installing renewables. For example, Totnes Renewable Energy Society (TRESOC) recently invested £39,000 of members' money in installing solar onto the local doctors' surgery.
This is an approach that could scale up. Hospitals could see the community investment that such an approach would enable as a public health strategy in itself.
Those are just a few thoughts. What's exciting is how the debate around public health and prevention opens up these conversations. What is a healthy community? Is it one surrounded by lawns and asphalt, or by food gardens, ponds and orchards? Is it one for whom services are contracted in at the lowest cost, or one able to provide them themselves, thereby creating sustainable employment? Is it one whose energy is generated miles away, or one that can see, and invest in, local energy generation?
Is it one where breastfeeding is encouraged or stigmatised? Where counselling and mentoring is available to young people in school? Where good local food is available on prescription for those who so clearly need it? Where the hospital hosts a Food Hub? Where the hospital is twinned with a farm, and patients for whom it would be beneficial are taken for trips to the countryside, while the farm's produce supplies the hospital?
As Michael Lewis & Pat Conaty put it in The Resilience Imperative:
The physical and emotional health of citizens and communities is reinforced by active physical and cultural engagement. Programming and support that makes such involvement possible can be an important platform from which to extend the opportunities for participation in other aspects of community life".
This should be a really fascinating month, and as it goes by we'll be adding new ideas to those above, hearing from people working within the NHS about what is already happening. The NHS is at the moment under the greatest risk it has yet faced from those who seek to privatise as much of it as can be privatised. The pressure is away from what we have described above, yet at the same time, the public health agenda opens the possibilities of much of what Transition seeks to do coming under that banner.
It's not an either/or choice. There is a different route forward for healthcare in the UK, one framed around an understanding that public health and increased community resilience can be seen as very much the same thing. A healthcare system recalibrated to that end could become a powerful and dynamic force, and, as we shall see, many of the building blocks for that, and examples to show that it is possible, are already in place. As we will hear though, it needs support from higher up, it needs government that has some degree of vision, that cares about more than the shareholders of private service companies. Perhaps the scale of change needed will come from us, as communities, supporting and working with our local health providers, and talking more explicitly about what we do in the context of public health (as, for example, Jamaica Plain New Economy Transition did recently)? It's going to be a fascinating month, we hope you enjoy the journey.
What do you think? Leave a comment below. See our commenting guidelines.
Sign up for regular Resilience bulletins direct to your email.