Health and Technology

UNSKnowledge on the responsive technologies of social health: part of an on going knowledge sharing series on health.

By Ben van Berkel, Wael Batal and Filippo Lodi

‘Stress’ and Social Determinants of Health

“We need a new economic model.  By that, I don’t mean capitalism versus communism.  What I’m talking about is a shift in the system [of neoliberalism of free markets and getting governments out of the way]…[to one] that will be focused, as its key goal, not on growth, per se, but on maximizing human well-being.”– Stewart Wallis, New Economics Foundation, UK (2016)

When one takes into consideration two of history’s most prominent urban city planners, Baron Haussmann and Le Corbusier, health supported universal/generic solutions with a particularly normalizing effect on society.

In 1854, Baron Haussmann - commissioned by Napoleon III - imposed the principles of sanitation and hygiene upon the city dweller by carving large avenues through the city, widening the streets and clearing off the “unfavorables” and providing great chances for the leisure of the bourgeoisie. During the early to mid-nineteen-hundreds, Le Corbusier’s obsession with health led to the enforcement of running tracks, pools and sun terraces, encouraged a reconnection with nature and promoted the value of exercise. In Villa Savoye, this obsession is clearly evident on the first floor where the sink occupies a central location in the plan and is the first element that a person encounters so that they can cleanse themselves before beginning the promenade through the villa to the verdant rooftop. Ostensibly, the central location of the sink asserts that hygiene - in the hierarchies of domesticity - replaced the construct of the family surrounding the fireplace.

Today, our interest in health stands in clear contrast to Modernist interest in hygiene, purity and the myth of the ideal man. Whereas Modernism supported a universal & generic understanding of well-being - such that it could be stretched and imposed upon any society in an effort to Modernize the world - the focus of Health enabled by the technologies of machine sensing allows for particular & specific accommodation to the individual, and therefore has widely different effects on society.  Living in a twenty-first century world, where almost every sort of necessity is available at one’s fingertips, technological innovations and public policies that enable healthy environments are of particular interest in our design strategies.

 

To dig deeper into the definition of health, as outlined by the World Health Organization (WHO), it is based on many combined factors beyond ‘healthcare’ and are centered on the “social determinants of health” which fall under two categories:

Structural determinants such as socioeconomic and political context, governance, policies, values, or socioeconomic status, income, occupation, education, social class, gender and ethnicity

Intermediary determinants, such as material circumstances, the work environment, psycho-social factors, stressful living situations, behavioral, biological factors, social connectedness, and health systems which vary with regards to people’s access to different types and quality of healthcare.

Previously these were shaped by money, power and distribution of resources through policy.  The issue today is not only about access to healthcare or quality of healthcare systems as they only make up 11% of the determinants of health [6].  Now, through the medium of architectural and urban design enabled by integrated machine vision, we can engage with many other aspects that define social health and allow people to participate in the determination of their own health. Today, stress is a major factor and key intermediary determinant of health, as is linked to heart disease, hypertension, obesity, addiction, anxiety and depression.  According to a WHO report citation of Professor Jean-Pierre Brun, on Occupational Health , the impact of stress induced absenteeism, turn-over and reduced productivity can be estimated to cost U.S. enterprises 300 million dollars per year since 2006.

Over the past 12 years, technological advancement in the smart phone sector has exacerbated this condition for a large percentage of people. 

“New smartphones, tablets, aps and sophisticated enterprise wide systems promised cost savings, efficiency and finally work-life balance via the connected world. Doing more with less was now possible with a click of a button, but yet workplace stress continued to rise. People found themselves connected to their work 24/7 while a new societal addiction crept into homes and businesses throughout the country. As people spent more time with their heads down looking at their phones, checking email and texting around the clock, online gaming, and living through social media their lives shifted to overload and interpersonal relationships suffered. Work-life balance continued to feel like a pipe dream.” Gina Soleil. 2018. Workplace Stress: The Health Epidemic of the 21st Century

A second crucial intermediary determinant of health that is of particular importance to today’s relationship between an individual and the constructs of a given social collectivity is, ostensibly, Social Connectedness. It is no surprise that social ties are central to what makes us human.  Furthermore, research shows that social connection more often leads to mental health than the opposite; if you are mentally healthy it does not always follow that you will be more socially connected, however if you are more socially connected then the chances are you will have better mental health and public well-being. Edges, barriers, walls and other hard lines drawn within cities and between nation states contradict social connectedness as they divide and separate citizens of a common area. They also restrict the free movement of people between territories.  In a world where we are increasingly reliant on social media platforms to overcome this, we aim for new strategies to dissolve these physical barriers.

For two of our projects, ‘The Reset Pods’ and the ‘Lelylaan A10 Ring’ projects, these issues are at the core of their ambition.

Infrastructure of Embedded Technologies

Axonometric View, ©UNStudio

RESET Stress Reduction Pods

Exhibited at the Salone del Mobile in Milan in 2017, the RESET Stress Reduction Pods are designed in collaboration with SCAPE as a working prototype and proof of concept pavilion.  The project is a series of pods, proposed as break rooms within an office space, and invites individuals to have a relief from a stressful working environment.  Three environments are designed to measure and react to individual’s stress levels by changing projections on the walls, sounds, tones and music.  Its spatial qualities change based on human movements and biometric data including brain signals and heart rate intervals. Sensors are integrated into the pod and worn on the human body to create a network of data points with a single mission: decreasing stress and eventually increasing human health.

2.2.1 Health.
The mission of RESET is being realized not only because lights and music change based on user’s stress level, but also because the existence of such a physical space as a part of the architectural program, integrates a work break within the culture of work. It raises and challenges public awareness regarding one of the overlooked problems of our working spaces. Health in RESET is considered as a very personal factor and not merely a general quality of an office.

Firstly, it directly interacts with individuals as their biometric data are distinct; rather than to treat everyone in the same way and to provide a generic solution to a stress-free environment.  Each user’s experience of the space is customized to their needs and is not the same experience as that of another individual. 

Secondly, an employee can track the pods’ effects on herself during multiple uses of the pod during weeks. While human health in the RESET pods is being measured individually, its effects are transformative not only for each individual but also for the productivity of the whole office and reduce the economic impact of stress upon an organization. Scaled up, the RESET pod project aims to influence the economy and productivity of cities through a bottom up approach on social health in the workplace on a national and global scale.                                                 

2.2.2 Integrated Technology.
To allow for the interaction between the architecture, the media projections, sounds, and the people experiencing the pods, various sensory technologies were integrated to measure and collect data about the inhabitants.  Kinect devices were embedded into the walls to track people’s proximity to the walls, which allowed the projections to modulate and react if the wall was directly touched.  Wearable monitors collected heart beat intervals and EEG data which were combined in a proprietary algorithm - The Reset Index™ - to analyze an individual’s psychophysiological stress state.  With this information, a percentage was assigned to a user’s profile based on their resilience to stress, which was then translated to personalized projections, colors and sounds to accommodate their emotional state.

2.2.3 Transparency.
RESET is not a “black box” that can improve health without user participation and transparency. It is important to consider that sensors’ data only show a portion of the complex matter of human stress. A user’s behavior and biometric data is being monitored by wearable devices which send data to the pod’s core software. Then, the software modifies the space through light and sound modifications in real-time. Visitors are also encouraged to follow up on their experience by looking at personal recommendations on the RESET website, where they can access ongoing management tools, give feedback and participate in shaping the positive development of RESET.

Transparency of the pod’s use of sensors is essential as the data allows the user to be aware of how their data is being translated to stress level.  Rather than to make the effects of technology invisible, familiar and unconscious, RESET mobilizes the transparent interaction between human & machine, to produce intense atmospheric effects that engage with social health.

Smart Cities do not always equal Healthy Cities

The term ‘Smart’ – along with the buzz that surrounds it - in today’s development of cities is all but bankrupt as a Positivist concept reminiscent of the Corbusian or Hausmannian ideologies. It recalls ‘Modern’ attempts to outline a universal set of criteria through which any city could be deemed ‘Smart’ by default if it complies with a prescriptive manual for development.

For certain, a ‘Smart’ city does not always produce a Healthy city.  Cities that are simply connected/wired/embedded with technologies of measurement and surveillance without being deployed to solve a particular problem, or to pose a critical question, is symptomatic of the retrograde ideologies of universal solutions.  While many smart city initiatives are well intentioned and attempt to do public good, the accumulation of these efforts become problematic.  Furthermore, it suggests a de facto form of ‘quality’ in the definition of the urban fabric that negates the possibility that complexity, diversity and the accidental, are essential to the development of socially healthy cities.

Alphabet’s Sidewalk Labs, for example, considers the city as a laboratory of urban life within which they are working “Towards a Standard for Smart Buildings” and are launching pilot programs such as “Model” which helps communities “build consensus on affordability, sustainability and transportation needs.”

To go through such effort only to achieve ‘consensus’, however, seems to miss the opportunity to leverage “high fidelity data” to map the diverse conditions and opinions of the city.  While building consensus may help to induce “faster policies”, it naively negates the importance of diversity as an essential factor of healthy cities. Further, even if the diverse properties of the city were mapped, they may only form a fixed, singular collective opinion; or some form of scientific truth, which of course does not support diversity of opinion. The discriminatory nature of ‘smart’ monitoring systems for ‘predictive policing’ being perhaps the most symptomatic of this.

As philosopher Etienne Turpin argues in his critique of the concept of ‘smart cities’, “We have to attend more closely to our differences and the inequalities and asymmetries of power that are at the core of some of those issues rather than trying to wish them away through a process of automation or computation”.  It is the imperative of this paper to extend this critique and differentiate between ‘smart’ and ‘Responsive’ cities; where ‘Smart’ shares the Positivist belief that society operates according to general laws which can be imposed from above, ‘Responsive’ cities are committed to interactive structures that enable both the individual and collective to evaluate and determine ‘well-being’ for themselves.  Through responsive architecture, infrastructure and urban environments, the potential for heightened social connectedness – another intermediary determinant of health – can be realized and can flourish in the ongoing development of cities.  For the city of Amsterdam, our Lelylaan A10 Ring proposal aimed to put this to action.

Diagram, ©UNStudio

A10 Ring Master Plan Diagram, ©UNStudio

Lelylaan A10 Ring and Social Connectedness

Commissioned by the The Royal Institute of Dutch Architects - in consultation with the Rijkswaterstraat and the Amsterdam City Council – UNStudio joined efforts with Goudappel Coffeng (mobility consultant), GeoPhy(data specialists) and 2getthere (automated systems), to examine the developing area of Lelylaan near the A10 highway in Amsterdam, and to offer a proposal to accommodate healthy future growth.  As the A10 “ring-road” is a major highway that circumscribes the city, urban transportation was fundamental to the approach,

In the early 17th century, Amsterdam grew exponentially due to the booming economy of shipbuilding, trade and industry which brought waves of immigrants to the city.  As the outer boundary of the city was inscribed into the ground by water filled canals, each expansion of the city resulted in the series of concentric canal rings that define the city today.  Although each new ring extended the boundary of the city outwards, when the A10 highway was paved, it did more than expand the territory of the city; it solidified into a dividing line with affluence on one side, and its opposite on the other.

The objective of the proposal was, therefore, to connect the two sides of the A10 and to smooth over the physical and social barrier of the highway.  New programs and amenities were injected into either side of the Lelylaan overpass, including two parking buildings on either side of the street.  Regional A10 commuters could enter the parking loop directly from either direction of the highway and continue their journey locally via the POD/Tram station between the two parking buildings.  Multiple modes of transit, such as bicycles, underground metro, and trams, combined to form a multifunctional transit hub.  The proposal also included a pickup point for a new autonomous transportation system called CityPods, which offer a direct line to the city center with a driverless system. Supplemented by automated communications from car to people, car to car and car to city, the efficient use of roads and parking would also reduce the stress of commuters.

Further reducing commuter stress, the project anticipates technologies of autonomous-drive that would be supported by a proposed ‘autonomous street edge’ which enables a real time living street grid that responsively changes based on user interaction such as circulation paths, events, noise, and weather.

Through the interaction between hardware (built environment) and software (responsive technologies), we can plan for healthier societies in which individuals can interact with a living version of what Frederick Jameson calls a cognitive map of the city: 

“a situational representation of the part of the individual subject to that vaster and properly unrepresentable totality which is the ensemble of society’s structures as a whole.” –Fredric Jameson

 

Presented at Media Architecture Biennale, 2018

Published in MAB18 proceedings: Ava Fatah gen. Schieck, Dave Colangelo, Chang Zhigang (Eds.). 2018. Proceedings of 4th Media Architecture Biennale Conference: Digital Infrastructure at the Scale of the Hybrid City, 13 - 16 November 2018, Beijing, China ACM Digital Library, USA.