The Ultimate Test for Design: Does it Cause Health?


How can we ignite a worldwide movement to achieve total health in our built environment? How can we channel our highest aspirations toward reversing nearly a century of constructed habitat degradation?

This degree of change will require fundamentally new design questions. In order to incite a campaign for design that actively makes us feel and do better, two questions must be planted in the mind of every politician, every decision‐maker and every citizen: “Does this place cause health?” and “How does it make me feel?”

As a society, we can no longer afford to tolerate places that fail to ensure we thrive. 

Three generations of constructing environments that deny our deeply rooted biological needs have yielded not only a surge of lifestyle‐related diseases, but also a plague on the human spirit.

The design of every public space, building, campus, community and every home must be judged in terms of its capacity to cause total health, not simply to stop doing physical harm. 

We must be able to thrive and prosper; to do more than survive and sustain ourselves. The full range of design factors that influence our total health extend beyond the state of our physical well being, such as air quality, to include qualities of place that affect our state of mind.

In other words, environmentally responsible design today cannot be isolated, placeless, careless and rootless. The time has come to take the next leap forward by assessing factors that affect social, neural and spiritual regeneration.


Does this place cause health? How does it make me feel?

These new design questions transcend traditional concerns for style, taste and the creation of isolated built objects. They expand the traditional meaning of “design excellence” beyond standards of pure aesthetics to include impact on human health. The fundamental question, “How does it make me feel?” looks beyond dense planning jargon and arcane theories to expose the most telling, bottom line effects on our psyche.

Moreover, these simple questions instill the habit of paying conscious attention to the effect of every built or proposed habitat. In this way, the power of analysis becomes accessible to the people who benefit from—or suffer the health consequences of—countless design choices. When these questions become the definitive test that guides each and every design decision, they have the potential to raise expectations for design worldwide.

“The design of every public space, building, campus, community and every home must be judged in terms of its capacity to cause total health, not simply to stop doing physical harm.”

There is no such thing as neutral space in terms of the impact of design on our health. Every element in every space serves to either enhance or erode our capacity to thrive. In combination, these design ingredients have positive or negative consequences for our state of mind and neurological nourishment.

Ultimately, these elements result in places people love, or at least feel are worth caring for, while other places have detrimental effects.

Over the past century, people have become numb to the harmful effects of denatured, disconnected and dismal design. In recent decades, environmental sustainability initiatives have focused primarily physical resource damage control rather than on the full spectrum of human and natural environmental health needs. The state of our mental and physical health is an essential element of a strategy for regeneration that enables us to thrive and prosper rather than merely survive.

Instead of turning a blind eye to detrimental design, people can develop a visceral reaction to dismal places that drain their energy. 

Most of us today would have a strong emotional reaction if we saw a mother smoking while holding a baby. Not long ago, smoking mothers were accepted as a societal norm, along with smoking on airplanes. Major changes in sensitivity to such health issues have developed over one or two generations. Vastly reduced tolerance for these threats indicates that expectations can change quickly and dramatically.


A global Cause Health movement aims higher than current efforts focused on disease prevention and wellness. We have been conditioned by the media and medical business interests to rarely think further than avoiding ill‐health. In many ways, we live in a pathology-centric society where medical fears and phobias are fed, while research is mainly directed at finding cures for causes of disease. Very little attention is paid to discovering the causes of health.

For evidence of this imbalance, consider the term pathogenic, which is widely understood to mean “causing disease.” A corresponding term for “causing health,” salutogenic, is relatively unknown. If causing total health became the basis for judging every building and every public space, it would raise public aspirations beyond mere coping and prevention.

“Instead of turning a blind eye to detrimental design, people can develop a visceral reaction to dismal places that drain their energy.”

To fill this gap, we can look to the pioneering research developed by medical sociologist Aaron Antonovsky whose books Health, Stress and Coping (1979) and Unraveling the Mystery of Health (1987) formed the basis of understanding the relationship between health and illness.

Antonovsky focused on the personal characteristics of individuals who were more resilient to the stressors of daily life. He claimed these qualities helped a person cope and remain healthy by providing a “sense of coherence” about life and its challenges. He coined the term salutogenesis, a concept which reframes health as a positive force rather than a collection of deficiencies. Salutogenesis is derived from salus, a Latin word meaning health, and the Greek word genesis, meaning origin.

The distinction between causing health and preventing degradation is crucial. The cause health view is focused on leveraging human assets and capabilities—regardless of their current state— and engages us in building on these strengths to optimize health.

Originally presented at:

Healthy Environments, Healthy Spaces Conference, University of Virginia Center for Design and Health

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