Redesigning health care for people and planet

On the invitation of the Department of Health in January, we attended the annual National Health Sector Meeting, a gathering of health leaders from national agencies, DOH regional offices, and public hospitals.

We joined the panel on designing green and sustainable National Ambulatory and Urgent Care (Nauc) Facilities. DOH aims to establish 28 Naucs that will reach 28 million Filipinos by 2028. The hope is that these new facilities would help realize the long-held dream of achieving universal health care for all Filipinos.

It is not usual to bring together physicians and architects in a panel. But if you think about it, health care requires buildings, and their design needs architects.

As we face increasing threats to health systems—from future pandemics to climate disasters—there is an urgent need to break the silos and encourage transdisciplinary collaboration in health care. We can begin by bringing doctors and architects together.

The panel examined how health care is increasingly being affected by climate change and other environmental threats, which disrupt health services, cut off the supply of water, food, and electricity, and consequently widen health inequalities.

But we also explored how health care is contributing to climate change and environmental pollution, for one, through its reliance on fossil fuel-based energy and its consumption of many materials made of plastic which are now choking our rivers and flowing in our bloodstream.

Today’s health care cannot ignore the environment anymore and must address these pressing problems. This is not a consideration only for Nauc Facilities that are yet to be constructed, as existing hospitals and clinics must become climate-resilient and environmentally sustainable at the same time.

A 2017 World Bank report introduced a term that brings together these dual goals of resilience and sustainability: “climate-smart health care.”

How can health care be “climate-smart”? Architects prescribe the “Triple S” approach, a comprehensive strategy for designing, constructing, and operating environmentally conscious structures that prioritize both ecological sustainability and human well-being.

First is self-sufficiency—a building must generate its own resources and minimize reliance on external systems, whether it is food, water, or energy. Second is survivability—a building must withstand and recover from various environmental hazards and disasters, and ensure functionality even under adverse conditions. Last is sustainability, or focusing on long-term environmental responsibility, social equity, and economic viability. Sustainable buildings not only reduce their environmental impact but also enhance the quality of life for occupants, foster community engagement, and promote economic prosperity.

Where can we begin? The Philippine health sector must be “W.I.S.E.,” an acronym that represents the areas that need to be addressed. First is workforce. Health system leaders, hospital chiefs, and all health professionals must be equipped with knowledge, skills, and tools for implementing climate-smart health care. We suggest that the DOH Academy design a course on this topic and make it accessible to all Filipino health professionals.

Next is infrastructure, and this does not only pertain to the physical building but also the supply chains for food and medical supplies, as well as energy and water sources. Third is systems—the policies, protocols, and procedures that link the workforce and infrastructure together to deliver quality, sustainable, and resilient health care.

Last is enabling resources, especially financial resources, although there are many green and sustainable interventions that are zero- or low-cost but high in impact. For instance, the widely available bamboo—which bends without breaking—is hugely underutilized as a resilient building material, even in health care.One way to enable this mind shift in health care is to visualize the human body and its various organ systems. To enhance the hospital’s respiratory health, windows and corridors can be maximized for natural ventilation. Addressing how waste is being produced and disposed of helps prevent “constipation” in the hospital’s gastrointestinal system. Ensuring clean water access and safe disposal of chemicals will free the health facility’s circulatory system of “blood clots” and contaminants.

Health care today must be redesigned to not only serve people but also to preserve the planet. Diagnosing its ills and developing its cures require the combined expertise of multiple disciplines—such as medicine and architecture. We hope that this DOH initiative is just the beginning of greater transdisciplinary collaboration for human and planetary health.

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Renzo R. Guinto, MD, DrPH, is chair of the Committee on Environmental Health and Ecology of the Philippine Medical Association. Lui Daya-Garcia, an architect, is the former chair of the committee on environment and ecology of the United Architects of the Philippines.