Health and well-being in cities

Michèle Hipwell, 18th November 2018

By leaves we live. Some people have strange ideas that they live by money. They think energy is generated by the circulation of coins. But the world is mainly a vast leaf-colony, growing on and forming a leafy soil, not a mere mineral mass: and we live not by the jingling of our coins, but by the fullness of our harvest.

Geddes, P. (1918) Farewell lecture to Dundee students

Apples, nuts, cones and berries, Ashley Ainslie, Photo: S. Stevenson

The restorative effects of architecture and landscape

There have been examples, in Edinburgh, of spaces that were designed according to the principles that a pleasant and varied environment, contributes to mental and physical well-being. A pattern was emerging in the late 19th and early 20th century in South Edinburgh about the importance of restorative environments for the recuperation and long term recovery of people with physical and mental health problems. These environments usually included both pleasant scenery and varied architecture.

This view was certainly held by Dr Thomas Clouston, the physician superintendent of the Royal Edinburgh Asylum in Morningside when he encouraged the board to purchase the well-wooded 60-acres Old Craig estate in 1878 for the treatment of ‘the insanes’. Obviously impressed by the estate which he described as ‘the most beautiful site I have ever seen’, he believed that interesting buildings and open spaces should be made bright and as pleasant as possible for his patients (Journal of Decorative Art, 1894). Dr. Clouston worked closely with Arthur Mitchell, official architect to the General Board of Lunacy in Scotland to make sure that any change made to the existing estate would enhance the restorative effects of the architecture and landscape.

Similar views were held by David Ainslie, a wealthy farmer who lived near Haddington and when he died in 1900, left most of his money ‘for erecting, endowing and maintaining a Hospital or Institution for the relief and behood (benefit) of the convalescents in the Royal Infirmary of Edinburgh, a hospital open to the distressed from whatever corner of the world they come, without restriction.’ The trustees of his estate bought the land now known as the Astley Ainslie hospital, a protected south facing site with gardens, several nineteenth century house and a ladies’ golf course, described as ‘one of the most beautiful sites in the South Side of the city’. They employed the architects Auldjo Jamieson and Arnott to design appropriate buildings and open spaces and it was reported that ‘no better could be wished for as residence for the convalescents.’

Astley Ainslie Hospital, Photo: M. Surawski

Lily Bernheimer, an environmental psychologist who works with architects, designers and organisations considers that it is crucial to make every space truly work for the people and purpose they serve. She quotes Winston Churchill (himself no stranger to depression) in agreeing that ‘we shape our buildings, and afterwards our buildings shape us’, saying that humans have been around far longer than buildings, and that, before buildings, the natural environment of our evolution played a foundational role in shaping us to be the creatures we still are today (Benheimer, 2017).

She is concerned that we have somehow lost sight of the critical role that the built and natural environments play in shaping well-being and communities and believes that enabling people to take an active role in shaping the everyday spaces of their lives is critical to restoring a natural biophilic quality (focus on our connection with the natural world) to our built- in environment.

Is it that simple? Yes and no says Bernheimer, because the way we act and behave is often quite counter-intuitive. We assume that traffic lights and curbs protect pedestrians, but people actually drive more safely when they are forced to pay attention to their surroundings. Similarly, promising parks can become magnets for antisocial activity! However, evidence has shown that when people are involved in shaping their own streets, homes and work places, there is an increase in the level of well-being, trust and cohesion. Informal social control increases and crime rates decrease.

We like spaces that flirt with us

Bernheimer argues that we like space that flirt with us. The spaces we love most, she says, ‘balance order with complexity’, ‘comfort with awe’ and ‘we are equally drawn to spectacular views and cosy nooks like window seats or sheltered courtyards’. She explains that the built environment supports our well-being best when it echoes the natural world in some ways, through its patterns, dimensions and shape. This is also the case when the natural world is an integral part of it, such as roof gardens or green walls. Evidence has also shown that our environmental preferences deeply impact our health and it is when we are at our most vulnerable that we most need the support of a protective, life enhancing environment.

Why natural scenes reduce blood pressure and circulating stress hormones

In her article in the Psychologist, Bernheimer also remarked that ‘natural scenes are marked by fractal geometry, which involves a specific recipe of order and complexity. We see fractals shapes most obviously in trees and coastlines, which repeat self-similar forms on smaller and smaller scales. Because our perceptual system evolved to function in this fractal world, we find the environment calming and pleasing’. This anticipates another article in this section in due course, when I plan to tell you a little about forest bathing but it is interesting to note here that gazing at a tree can swiftly reduce blood pressure and the circulating stress hormones…

For many years now, I have been interested in botanical drawings and fascinated by the infinite beauty and regularity of the natural world so started taking close up photographs of the plants in my back garden, see two enclosed, just taken with my mobile phone, not like the wonderful photographs taken by Maciej Zurawski and Sara Stevenson for AACT. These patterns go on and on, down to the molecular level and beyond, I suspect. It was also interesting to hear from Maciej that after taking some tree photographs for us, he became fascinated by nature and is now taking many more photographs of nature! Watch this space.

Back Garden, Woodburn Terrace, Photo: Michele Hipwell

Designing urban spaces fit for all to live in

On a more practical note, Alastair Parvin, architect and WikiHouse co-founder is quoted to have said ‘what most people call bad design isn’t bad design. It’s really good design for a totally different set of economic outcomes, which is producing real estate’. Bernheimer argues that ‘to repair our dysfunctional streets and cities, we need to re-work the underlying economic and social structures we have created as well’. Relying on a small number of profit-driven developers to develop the majority of our housing – is rigged to prioritise profit rather than well-being, community or beauty, and that shows (Bernheimer, 2018).

The beliefs of Dr. Clouston and David Ainsley survive and are even enjoying a revival, although often only paid lip-service to nowadays. Increasingly, consideration of ‘design-thinking’ or ‘human-centred design approach’ is being considered when designing new products, consulting potential users to make sure that their preferences may be incorporated into the design and the designed products are fit for purpose and easy to use. Environmental psychologists use a similar type of ‘user experience’ for buildings and open spaces. In-depth consultation with local residents is essential to any new development or re-development in urban areas so that buildings are designed with sufficient open spaces and that, as well as being functional, they are pleasant for all to live in and promote health and well-being.


Bermheimer, L. (2017). The shaping of us. How every spaces structure our lives, behaviour and well-being. Little Brown Book group.

Bermheimer, L. (2018). The shaping of us. The Psychologist, 31, 67-68.

Useful information from NHS Health Scotland

For some information on how to find those aspects of a place that need to be targeted to improve people’s health, well-being and quality of life, follow the link to the NHS health Scotland website for the Place Standard tool.

You might wish to try it out for your local area. Can you identify the areas that are fine and those where improvement is needed?

How could you improve its rating if the Astley Ainslie was re-developed, create spaces and buildings that were pleasant to live in and life enhancing? Could some also serve a useful function for the community and contribute to the improvement of health, well-being and quality of life for all?



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