RESTRUCTURING


spend of $2,500 bn ($7,140 per person). It is clear to see which direction spend is driven by Western societal consumption. If the increase in ageing population is


combined with the increase in GDP, it is estimated that Australia’s spend on healthcare will exceed 20% of its GDP or $500 bn by 2050. This level of spending for treating illnesses


is unsustainable and will impose a huge financial strain on the economy of a country. The potential scale of the problem is so large that it is necessary to think outside of the box if we are to find a solution. For example, what if 1% of that spend annually was pushed towards wellness rather than illness?


Healthier cities: by design A group consisting of Australia’s leading healthcare practitioners, providers and designers were gathered together within a design charrette to discuss what could be possible if 1% of the annual national healthcare spend was transferred to the provision of wellness rather than the treatment of illness. The focus was to develop a sustainable solution, working towards the year 2050. The current estimated total spend on


healthcare between now and 2050 is $12.3 trillion. 1% of this would be $123 bn. Any solutions proposed had to be flexible enough to cater for a range of scenarios from an existing city with historic hospital infrastructure to a new build acute hospital on a green-field site, to a remote town in far north Queensland where there is a high proportion of indigenous communities. For each scenario, the group worked


through what could be achieved, within the available ‘budget’ of 1% of annual health spend. Four key challenges were addressed: • Culture • Masterplanning • Healthcare facility design • Low carbon solutions


Cultural change Lifestyle and cultural changes in Western society is adding to the problem. Again, we can turn to Australia as our indicator. Australians pride themselves on their sporting prowess. This is well deserved as they have consistently punched above their weight in most sports. Historically, the image of a typical Aussie is a healthy sun-kissed being. In fact, in 2007, Australia had the third highest life expectancy in the world. However, the average Australian is now overweight and it is estimated that 5% of the population will be diabetic by 2020. New arrivals to Australian shores are often


astonished by the high cost of fresh foods compared to other areas such as Europe and America. These high costs prohibit some lower income families from providing their children with a healthy balanced diet and this is an issue that needs to be addressed. The average Australian child (between 2-16 years) eats a paltry 15% of their


80


7,000 6,000 5,000 4,000 3,000 2,000 1,000 0


Urban population Rural population


1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 Figure 2: We are experiencing a transition from rural to urban communities.


recommended daily fruit and vegetable intake. It is imperative that this is reversed and that children and young adults are educated in the benefits to their future health by eating fruit and vegetables. Recent research suggests that there can be up to 45% reduction in risk from some cancers due to eating a good daily quota of ‘five-a-day’. Further research indicates that encouraging young children to get involved with growing their own vegetables can have a large influence on them actually eating them. Developing a culture where each person


has ownership of their wellness is also critical. People need to be informed on the implications of poor behaviour patterns. We need to move towards a future where people are aware of their wellness and illnesses and have easy access to the data for their own use and quick transfer to healthcare professionals. The technology is now available – all that’s missing is the willpower!


Healthcare facilities are generally thought


of as places you go to when you are ill, not places to help you stay healthy and this is a perception that needs to change. Hospital estates could be rebranded as ‘Wellness Centers’ which include public gyms, swimming pools, healthy food stores, community gardening schemes and wellbeing awareness centers. If these facilities are to be a success they also have to be freely available to all.


‘It is envisaged that hospitals of the future will be co-located with universities and research institutes.’


Investment in the provision of such


facilities would pay dividends with the long- term health of the nation and as such will reduce the cost of healthcare overall. How the community is engaged with the


Wellness facility is a key issue. The public need to see the hospital as a good place to visit and spend time. This would mean a radical rethink in how these buildings are designed and what other facilities are included within them. There would have to be a dramatic improvement in the design of the buildings to make them more welcoming places to spend time. This may include bringing in retail and recreational outlets. Faith, which is often overlooked in the


healthcare industry, also has a role to play. Research carried out by Blue Zones (www.bluezones.com) suggests that faith- based communities tend to have a longer life expectancy. This is thought to be due to having a


sense of purpose and of belonging. Again, this would be another aspect which we could bring to our Wellness Centers. It sounds like a cliché, however the centers could be beneficial for the body as well as the soul.


Masterplanning Historically, cities have evolved with healthcare facilities in and around the centre. In addition, the cities have evolved somewhat separately to suit the needs of business, largely ignoring the impact of the city’s design on the wellbeing of its occupants. In most cities, people movement occurs


via car or public transport. The roads are generally so congested that people would not feel safe cycling. In addition, most places of work do not have end of trip cycling facilities. Surveys indicate that the vast majority of people would prefer to live and work in a city which has an exclusion zone for vehicles, only permiting people on foot or by bicycle. If we could get people to build in natural movement and exercise into their daily


IFHE DIGEST 2013


Population (Millions)


© Peter Head, Entering the Ecological Age – 2008.


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