Can We Build Better Health?
After an earthquake, we often hear the expression, "Earthquakes don't kill people, buildings do." When it comes to beating infectious diseases such as tuberculosis, the focus has historically been placed on developing better drugs and perhaps one day finding a vaccine. But for people at risk of catching infectious diseases, what if homes built with disease prevention in mind were an equally valid solution?
Currently 1 billion people around the world live in city slums, and according to the WHO this figure is projected to double over the next 25 years. Those living in conditions of urban deprivation are at far greater risk of opportunistic illness, particularly if their immune systems are already weakened by HIV/AIDS. We know that poor heating and ventilation cause mold and fungus, allowing bacteria to thrive, all of which compromise the respiratory system. Yet there is a solution: Improve ventilation and reduce indoor humidity and you significantly reduce the risk of an HIV-positive individual contracting tuberculosis.
One-third of people living with HIV/AIDS are co-infected with TB. In fact, without proper treatment, 90 percent of people with this condition die within months of contracting the illness. But it is not just those whose immune systems are compromised who are at risk. Respiratory diseases in children under five claim more than 2 million lives annually.An open innovation design competition in Haiti has yielded housing prototypes that can potentially reduce disease transmission.
At the nonprofit organization ARCHIVE (Architecture for Health In Vulnerable Environments), we believe that many of these deaths are preventable by simple design solutions. ARCHIVE is the only international development organization to concentrate on improving health through innovative housing design and improvement.
I was born into a low-income Jamaican community where I was exposed to many of the same cultural, climatic, and socioeconomic challenges faced by people in vulnerable communities today. This left a deep impression on me when I went on to study architecture at Columbia University. While there, a three-year Kinne research fellowship set me on a path to discover more about the links between architecture and health.
My research initially focused on the association between architecture and HIV in South Africa, and was later broadened to include infectious diseases generally. I realized that it was an under-researched area of architecture, and I looked for ways to share and discuss my ideas with a wider audience. This open-source approach still underpins my work as founder and director of ARCHIVE today.
ARCHIVE identified Haiti as a suitable country to pilot its first major project in May 2009. According to World Health Organization statistics, Haiti has the highest TB rate in the Americas. Our Kay e Sante nan Ayiti project (Creole for housing and health in Haiti) began with thorough research and consultation with local organizations and community groups to gather baseline data for the second phase of the project—an open innovation, global design competition calling on architects, engineers, health specialists, and the general public to pool their knowledge and submit housing designs to help tackle TB transmission.
A design brief was issued by ARCHIVE after consultation with the target community, and it was informed by the latest public health recommendations. The designs were required to be sensitive to the economic and cultural environment; be replicable and inexpensive; utilize local building materials; and employ indigenous construction techniques and practices wherever possible.
Based on these and other criteria, an interdisciplinary panel of judges and community members chose five winning designs for construction. These designs will be deployed in an integrated community development and healthcare pilot project in the coastal port town of Saint-Marc in western Haiti, an hour's drive from the capital Port-au-Prince.
The overall winner was Breathe House. The use of local materials and the simplicity of construction made Breathe House a strong proposal. The judges were particularly impressed with the "user's guide" to construction and the possibility of employing local, less-skilled though supervised construction workers. The addition of composting toilets, creation of excellent ventilation, and a design that considers the landscape were stand-out features that made this health- and environment-conscious design a winner.
Judges described Maison Canopy as "a low-tech, user-friendly design" using "recognizable and familiar building technologies." In this design, cooking and communal areas are separated, maximizing cross ventilation, and insect screens acknowledge the prevalence of vector-borne diseases. Additionally, the rainwater harvesting and storage facility and the sanitation and waste management technologies can be easily managed.
Cycle House revolves around the idea of open and closed spaces that promote and facilitate a healthy lifestyle. The judges were impressed by the innovative application of this simple but effective theme. The design defines two types of spaces: solid spaces (rooms and bathrooms), which are the only completely closed structures and independent of the house, and open spaces, which are lined with blinds and sliding screen doors. Additionally four green spaces are to be planted with medicinal herbs to help patients with the preparation of tisanas or aromatherapy. Stationary bicycles in the Cycle House generate electricity and can be detached for use as local transportation.
In order to measure project effectiveness, baseline data will be collected from existing structures in the vicinity. This involves measuring indoor environmental conditions including temperature, humidity, C02 levels, and airflow. Once the new houses have been completed, similar tests will be carried out, as well as a post-occupancy evaluation. This will assess the ways in which occupants utilized the design features. Key performance indicators will be monitored at six-month intervals for up to three years to compare environmental conditions in the new structures versus preexisting ones.
Through this pilot project, ARCHIVE seeks to demonstrate that housing can be designed to minimize airborne disease infection. For example, adjusting the material composition of walls, floors, and roofs can lower humidity, improve ventilation, and increase levels of direct sunlight, which in turn reduces the presence of indoor pathogens.
While the physical design innovations are crucial to the project's success, of equal importance is the level of community involvement at each stage of the process. Kay e Sante nan Ayiti continues to engage local communities on the topic of housing as a vital component of holistic public health, by holding on-site training sessions, workshops, and community-led seminars. Construction of the five winning designs is now well under way.
Looking to the future, multidrug-resistant tuberculosis is on the rise. The WHO estimates that there will be more than 2 million new cases of MDR-TB between 2011 and 2015. It is therefore vital to reexamine housing if we are to combat and ultimately defeat TB and other infectious diseases. This is particularly so in an age when our world is urbanizing at a rate much faster than ever before.
With conventional disease control measures losing ground to new strains of infectious disease, it is time to rethink our strategies for dealing with this growing problem. ARCHIVE's pioneering project is an important first step along the road. By submitting designs to Kay e Sante nan Ayiti, the global community has taken part in an innovative public health project that makes housing a critical component of disease prevention.
We hope Kay e Sante nan Ayiti will help people see the health potential of housing, and in the longer term encourage organizations around the world to design and build more healthful homes.
ARCHIVE Communications Manager Greg McCardell helped develop this article.
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