HEALTH FACILIITIES SHANNON BUNSEN – SUSTAINABILITY PROJECT MANAGER, MAZZETTI+GBA
Factors that influence public health outcomes
The world needs people who can work at the intersection of technology, biology, sociology, operations and building design. We will always need healthcare buildings designed to facilitate effective clinical treatments, but we will increasingly need to deliver healthcare in a proactive, preventive way, to keep people out of hospital.
On 2 June 2017, the Centers for Medicare & Medicaid Services announced a “requirement to reduce Legionella risk in healthcare facility water systems to prevent cases and outbreaks of Legionnaires’ disease”. Healthcare facilities must comply with this requirement with documented water management plans to protect the health and safety of building occupants. Approximately 6000 cases of Legionnaires’ disease (LD) were reported to the United States Centers for Disease Control and Prevention (CDC) in 2015 and about one in every 10 are fatal.1 On 6 July 2017, the New England Journal of Medicine published a study on the health effects of overweight and obesity in 195 countries over 25 years, which found that one in 10 people around the world (107.7 million children and 603.7 million adults) are considered obese.2
It also found that excess weight
was responsible for approximately four million deaths in 2015, primarily from cardiovascular disease and diabetes. Pathogenesis studies the causes of
disease, while salutogenesis studies factors that promote health and wellbeing. Medical sociologist Aaron Antonovsky coined the latter term as part of his theory that challenged the traditional medical model of illness and disease, instead concentrating on human capacity to leverage available resources for health and wellness.3
in focus from nature to nurture, reactive to proactive, treatment to prevention and sick to healthy. When we expand this
approach from the individual to a population of people and consider the various determinants influencing health outcomes for the group, we are studying the health of the population. Determinants of health include biological (eg age), socioeconomic (eg income), physical (eg air quality)
IFHE DIGEST 2018 Health factors
Social and economic factors (40%)
Policies and programmes It involves a shift Social determinants of health. Shannon Bunsen
Shannon Bunsen joined Mazzetti+GBA, a global provider of healthcare engineering and technology consulting, in 2017 as sustainability project
manager. She also leads The Sextant Foundation, a sustainable development not for profit organisation that works in healthcare settings in the developing world. She brings over five years’ experience in sustainability programme management. She was the University of Wisconsin Health’s first sustainability
co-ordinator, a position she created. Shannon holds a BS from the University of Wisconsin-Madison, with continuing education certificates in process improvement and change management.
79
Physical environment (10%)
Public health
PubH SD PopH
Population health
Salutogenic design
What is population health?
and behavioural (eg smoking) factors, as well as access to health services (eg access to quality care and having insurance).4 Healthcare policy makers around the globe are struggling with similar problems.
Health outcomes
What is becoming increasingly clear is that there is a need to identify ways to eliminate the needless cost of preventable illness (usually related to lifestyle and social indicators), needless (low or negative value) healthcare activities and expenses, and ways to improve the quality of necessary services (through elimination of error and improved outcomes measured in terms of patient quality of life changes). What is not so clear is how policy makers can move organisations and cultures towards these new ideals, and more important to designers, how healthcare organisations are moving towards solutions that include the built environment.
Length of life (50%) Quality of life (50%)
Quality behaviours (30%)
Clinical care (20%)
Tobacco use Diet and exercise Alcohol and drug use Sexual activity
Access to care Quality of care
Education Employment Income
Family and social support Community safety
Air and water quality Housing and transit
©2014UWPHI Country Health Ranking model
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