With the ever-growing costs of global health care, investigating ways to pre-empt and prevent illnesses (both physical and mental) has never been more important. In this fascinating article, Gayle Souter-Brown, author of Landscape and Urban Design for Health and Well-Being, explains how salutogenic landscape design, that is design for health and well-being as a health promotion tool, can be used to improve and enhance social, economic and environmental outcomes in communities.
If you’re keen to further your understanding on the topic, watch a recording of our webinar from 2015 where Gayle and two other experts in the field provide their thoughts.
Rapid urbanisation requires a new approach to offset and mitigate the impact. Communities in these fast-growing urban areas face 5 challenges of interest: stress, obesity, climate change, economic constraint and environmental degradation. Are these adversities linked? Overwhelming research supports the thought that yes, they are. If that is the case, what then is the potential of landscape design to alleviate the situation? Standard healthcare treats people when they are ill. Standard architecture treats people as if they are well. Standard economics assumes growth is the only way forward. Climate scientists assume people will understand the need for action in the face of the enormity of the challenge. While the focus attends to standard thinking, the interaction of inhabitants with and within the built environment, it misses the natural environment in which a city is set. Multi-disciplinary research now unequivocally shows what has been long suspected; a dose of nature is good for us. Salutogenic landscape design, that is design for health and well-being as a health promotion tool, can be used to improve and enhance social, economic and environmental outcomes. The new U.K Health and Horticulture Charter formally acknowledges the health-promoting potential of connecting with nature. The U.S Robert Woods Johnson Foundation supports research into landscape, design and child health outcomes. Asian academics and policy advisors are investigating landscape as a tool for healthy, active ageing. Scandinavia noted the link between nature / landscape and health / well-being at the turn of the century. However, the mainstream public health field still views the natural environment with ambivalence.
1000 years ago, Europe’s monastic gardens provided the setting for education, welfare and community healthcare. Monks taught the importance of gardens and gardening. Some of this landscape design has endured as healing, sensory and therapeutic gardens, interpreted to suit local culture and conditions. Notable historic gardens remain, restored, such as at Fishbourne, England and Prieuré d’Orsan, France, showing modern day scholars the ability of a well-designed garden to feed mind, body and spirit. Modern healing gardens are seen in hospitals across five continents. Their use in wider settings is still limited by constrained thinking. Early Landscape Designers were highly educated and well-travelled. They understood the importance of ecological health for human health and well-being, that a kitchen garden could do more than simply provide food for the local inhabitants. They were early proponents of the triple bottom line: social, environmental and economic benefit, achieved through a landscape design intervention.
Early examples of inclusive and accessible gardens are seen in historic records. With no welfare provided by the State it was left to the Church to tend to the physical and spiritual needs of the people. This is significant in urban planning and social housing today as we strive to provide more with less. Landscape designers reference historic and cultural interfaces between public and private spaces to provide design solutions for modern lifestyle-related problems.
Social isolation, the silent killer of modern times, was banished through meaningful, co-operative activity. Lay priests worked in the gardens to be able to enjoy the welfare and protection of the church. An early form of ‘community garden’, a typical kitchen garden had raised beds to allow easy access for intensive cultivation by even the elderly and infirm monks and lay brothers. To reduce risk from pests the monks grew companion flowers between the vegetables. Appropriately designed and managed contemporary therapeutic horticulture programmes and community gardens use this idea to provide vulnerable people meaningful activity.
Stress and depression, and a lack of fresh healthy food was mitigated by plantings of orchards with varieties of fruits and nuts. Trees were positioned to provide fragrant, seasonal shade over walkways. Space-saving Espalier techniques, developed in France as a way of training trees along a flat surface such as a wall, were introduced into English monasteries. It meant that an orchard could be planted anywhere where the blossom and fruit could be appreciated. Hop vines for medicinal use (sleep, tension, digestion) as well as beer were also grown using the vertical plane, and provided welcome shade. “Thus, in the full enjoyment of peace and protection, the monks busied themselves very diligently with the gentle art of gardening, and so reaped calm happiness and the useful fruits of the earth” (Gothein, 1928).
The monastic physic garden was where medicinal herbs grew. As the plants tended to be invasive, and to aid monks with failing eyesight, the garden contained one bed for each herb. As then, in the contemporary setting, landscape designers specify planting the herbs in neat rows to allow weeds to be easily identified and removed by touch where sight impairment is profound.
The Abbey garden of Clairvaux, France, is described by a contemporary of St. Bernard in the early 12th Century "Behind the abbey, and within the wall of the cloister, there is a wide level ground: here there is an orchard, with a great many different fruit-trees… It is close to the infirmary, and is very comforting to the brothers, providing a wide promenade for those who want to walk, and a pleasant resting-place for those who prefer to rest. Where the orchard leaves off, the garden begins, divided into several beds, … cut up by little canals,.... The water fulfils the double purpose of nourishing the fish and watering the vegetables” (Hobhouse, 2004).
Resilience is a buzz word in these times of political and geophysical stress. Storms, water shortages, droughts, plant pests and pollution of our food supply by products destined originally for chemical warfare but redirected to agriculture all affect our communities. While salutogenic landscape design is not a panacea for all ills, it acknowledges that without ecological health there can be no human health and well-being. Historic abbey gardens could be used as a template for modern resilient communities. By moving healthcare upstream we focus on the people. Landscape design deals in the essentials of life. Healing gardens, designed to be accessible, equitable, practical and beautiful, could heal our towns and cities.
Christopher Coutts, Gayle Souter-Brown, and Catharine Ward Thompson discuss the prime importance of landscape design on health and the ways that you can change this dynamic through effective design and specific interventions.
Hear their thoughts as to why this key issue is still being largely ignored in mainstream public health research and practice. With rising costs, deleterious mental and physical health stats, and an ageing population, learn what you can do as a practical response.
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