ARCHITECTURE AND DESIGN


The Al Jalila Research Centre in Dubai, of which Arcadis IBI says: “The design of the new mixed-use building innovatively works with the existing substructure and structural grid to produce an arrangement for laboratory, healthcare, and office accommodation, that is flexible and adaptable to future change.”


they are sustainable and energy-efficient for their entire lifecycles, and make a positive impact on their surroundings, as well as create healing, safe spaces.


Improving health in the community Design interventions at the building, healthcare campus, and indeed city level, can all make a significant difference, all while having the wider benefit of improving health within the community, and taking pressure off an NHS in crisis. Healthcare facilities designed today will experience dramatically different climate conditions to such buildings developed in the past. It comes down to incorporating forward-thinking measures to ensure the long-term adaptability of facilities that will benefit both people and the planet. For continuity of services, even at times of extreme weather events, we must consider design decisions from a macro as well as a micro perspective, from masterplanning and urban greening, to optimising infrastructure, right down to the position of everything in the streetscape, including bus stops or trees. In healthcare buildings, a host of measures can be considered – from the use of water for cooling purposes, to ‘smart technology’ and much more. This is all crucial for the safeguarding of communities and urban health.


Principal challenges faced by healthcare facilities Healthcare buildings are perhaps uniquely complex, as they are designed to accommodate a vast array of services in one place to meet various medical needs – from waiting areas and patient rooms, to critical-care units and operating rooms, many of which hold intricate specialist equipment. It is important to understand and effectively prepare for the various additional challenges emerging from climate change, not just in terms of the environment and its health impacts, but


40 Health Estate Journal March 2023


also as regards organising healthcare facilities themselves to avoid disruption to critical services, costly damage, and any trickle-down effects on patients, employees, and communities. One of the biggest climate-associated risks is heat, which brings with it the threat of heat exhaustion, heatstroke, dehydration, overheating, and other complications for buildings’ occupants. In 2020 and 2021, NHS Digital records reveal that more than 4,000 overheating incidents occurred. For some, excessive heat can be life-threatening. Within a clinical setting, it is imperative for patients to have a temperature-controlled, stable environment to aid rest and recovery to the maximum, as well as support the wellbeing of everyone in the building (including in terms of better comfort and productivity for staff). However, regulating temperatures in a sustainable way will be almost impossible unless we design facilities based on the future, rather than the past or present. Warming weather and increased


temperature fluctuations lead to higher operational costs in the form of rising energy costs, along with increased pressure on mechanical equipment, or the need to acquire additional equipment to supplement cooling requirements. Without proper ventilation, these factors can also increase the chances of airborne transmission of infections or contaminants.


Higher than usual demand for cooling Higher than usual demand for cooling during periods of extreme heat can also overwhelm the grid, and interrupt the provision of services and patient care – a risk that can not only affect the ability to maintain an appropriately comfortable interior temperature, but also lead to severe ramifications in a fast-paced healthcare setting. One way to counteract this, and to avoid dangerous outages, is to have a reliable back-up source of power,


ideally from renewable energy such as wind or solar. Renewable energy has the extra advantage of helping to reduce the operational energy usage of the building and boost energy efficiency. In addition, it is a great way to utilise extreme weather (heat or wind), and transform it into a positive for the environment. Global temperature changes can


lead to weather pattern changes of all types. Prolonged extreme winds and rainfall can cause extensive damage to a building’s foundation or structural integrity. Insufficient capacity in local stormwater drainage systems can cause rainwater to overflow, adding to the impacts felt by the healthcare system, with flooding threatening the sanitation of healthcare environments, not to mention the negative impact on expensive equipment, as well as the mental health of patients and staff.


Combating the urban ‘heat island’ effect If we look at the issues through a wider lens, at a city level, it’s clear that population growth and rising urbanisation present difficulties of their own. WHO estimates show that over 55% of the population worldwide lives in urban areas, a percentage that is forecast to grow to 68% by as soon as 2050 and not stop there. Urban locations are likely to experience hotter temperatures, given their high density of buildings and people, and a higher ratio of paved roads, leading to the so-called ‘urban heat island effect’ – whereby major cities are warmer than their surrounding regions due to their predisposition to heat retention. The shift towards harder road surfaces in the typical city streetscape leads to more reflectivity, and consequently amplifies the heat further.


Courtesy of Alex Jeffries


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