...of urban life in cities worldwide. The course will combine practical hands-on experience directly in cities alongside academic inputs from the network of foundation experts, politicians, consultants, professors, developers.
They'll learn how to interpret data using the most up-to-date digital tools in the quest to improve a sustainable quality of urban life.
Good evening, everybody, and welcome to this public debate on healthy cities, organized by the Norman Foster Foundation and supported by Sanitas, part of the International Health Care Trust Bupa. What brings us here today is a very simple question: Can architects and urban designers help to keep people healthy? Can they be, as Dr. Maria Neira from the World Health Organization suggested in our first debate, part of a team of preventative health professionals that can keep us healthier into the 21st century? My name is Catherine Cummings. I am fortunate to be the sustainability director with Sanitas, and we got involved with this question because it links directly to sustainability and to the issue of how we keep people healthy and promote good health and well-being.
My company's objective when we first started collaborating with the Norman Foster Foundation was to look beyond traditional healthcare and think about how we really do go about not waiting for people to get sick, but keeping them healthy. And we knew that to do that, we needed to do it working with many other professionals from different sectors. This is the only way that we can achieve better health for all, understanding that there is only one health and our health is inextricably linked to the health of the environments where we live. So this is what led us to create the cycle of Healthy Cities debates. And in this third of our debates today, we will shine a spotlight on healthy buildings, especially healthy hospitals. Because as we also say in sustainability, we want to make sure that we're part of the solution to climate change, not part of the problem.
So let me share with you today how tonight's event will unfurl. First, we will hear from three amazing experts who will share with us different aspects related to the topic of healthy buildings in healthy cities: Dr. Marina Romanello, executive director of the Lancet Countdown, specialist in global health and climate change research; followed by Mario Cucinella, founder of Mario Cucinella Architects in Italy; and Nigel Dancey, senior executive partner at Foster + Partners in the UK, with a wide range of expertise in education, research, and medical facilities.
Each of our three speakers will share a short presentation. Then we'll have a roundtable discussion when we'll also be inviting questions from the audience. So, please do not hesitate to put your hand up and ask any of those juicy questions that you've always wanted to ask. After this, we will then pass the baton to Joseph Allen. Joseph will give us information on how his work is developing at Harvard University as director of the Healthy Buildings Program. After that, Sir Norman Foster and Yolanda Erburu, Chief Sustainability Officer at Sanitas, will join him on stage to talk about how this first cycle of debates has developed, if we have achieved the change and the awareness that we intended, and how we can collaborate working together.
What we can already say is that our collaboration to date has helped us anchor an important sustainability program that we've been running in Sanitas since 2015. Our program, like these debates, is called Healthy Cities, and every year we challenge everyone in Spain to take up a physical activity challenge—pretty standard for a healthcare company, but what we do is we promise to invest in urban regeneration for every person who completes that challenge. We often work with local councils to help them plant more trees and support them in creating more green spaces. So if you want to join the challenge, now you know: the more you walk, the more we can plant. Participation is free because we know we have to go beyond conversations, beyond debates, and also deliver access to everyone to participate in making a change for healthier cities. And we also know that tree planting is only one part of the solution. And that is precisely why we come together today to learn from and to work with others. So that said, without further ado, I will now invite our first speaker, Marina, to come on stage and to help us understand the importance of healthier buildings for healthier cities. Thank you.
Hi everyone. What an enormous honor it is to be here, and thank you so much for inviting me, both to the Foster Foundation and to Sanitas. I'm delighted to be here. I'm delighted to be here in Madrid as well, which is a city I absolutely adore. So as you've heard, I'm the executive director for the Lancet Countdown on Health and Climate Change, and hopefully once the slides show up—maybe I have to pass on. There you go. I'm going to tell you a bit about the work that we do at the Lancet Countdown and who we are.
So in essence, the Lancet Countdown is a big research collaboration. We are an academic collaboration funded by the Wellcome Trust, and we bring together in our global network 57 contributing organizations, but worldwide something about 100 organizations with about 300 researchers that contribute to our work. So we pull in experts from all disciplines: from public health experts, physicians, physicists, engineers, and architects to understand the interconnections between health and climate change and to produce a series of indicators where we track that evolving nexus between climate change and health.
The report that we published last November, published just ahead of COP, had perhaps the most concerning finding of our almost 10 years of monitoring, in that it found that we're facing already today record health risks and record health impacts from climate change. Across the 15 indicators in which we're monitoring the health impacts of climate change, 10 reached new record high levels of hazards or impacts in the latest year of data. And we're seeing things like record high levels of exposures of vulnerable populations to heatwaves that are threatening their health and their lives. We're seeing record environmental suitability for the transmission of deadly infectious diseases like dengue or malaria. We're also seeing record exposure to droughts and floods. And we're seeing that these impacts are occurring all at once, and these risks are compounding one another to generate a bit of a perfect storm for health.
But we know that there's a lot that we can do about this. We know that there's a lot that we can still do, firstly, to reduce our greenhouse gas emissions and prevent these hazards and these risks from rising further. But there's also a lot that we can do today to already prevent those risks transforming into health impacts, and that's what adaptation looks like. We know that by building better cities, ensuring that our buildings are built around this changing environment, we can prevent much of that heat exposure. We can ensure that we avoid floods in urban centers. We can prevent exposure to these infectious diseases.
The good news that we found in the report—and there weren't many—is precisely coming from cities and from urban authorities. We see that cities, perhaps as opposed to what often happens at the national level, are taking the lead in understanding and evaluating the risk that people are facing from climate change, with record high levels of cities responding to the survey done by what was known before as the Carbon Disclosure Project (CDP). And we're seeing that more and more cities all around the world are starting to assess the risk and to start to respond to climate change in ways that are health-centered.
However, we still see big delays in action, and there's an example that I really like: What are we doing about urban green spaces, and particularly how we respond to heat, which is one of the most pressing issues from climate change? We've seen that in the latest year of data, our heat-related mortality of vulnerable populations has increased by about 147% with respect to the 1990s. So heat is becoming an increasingly pressing issue, particularly in cities, particularly in urban centers that become really hot during heat events because of the urban heat island effect. And we know that there's a lot that we can do in terms of cooling cities through means that are sustainable, including increasing the green and the blue space surfaces in cities. And we know that urban green spaces offer huge co-benefits for health. We know that they don't only offer local cooling and local shading, but we have very good data from epidemiological studies showing that exposure to urban green spaces decreases all-cause mortality, improves mental health, provides spaces for recreation, makes cities more livable, reduces air pollution, and improves quality of life altogether.
So they're generally cost-effective interventions. Obviously, that depends a bit on the location, but generally they're quite cost-effective interventions and good for the planet, good for our health. However, we're seeing that there's not enough action being taken by urban centers in terms of greening our cities, and urban greenness has remained practically static since we started monitoring in 2015. And what happens on the flip side of this is that people are starting to self-adapt to the higher temperature. So, we're oftentimes going towards maladaptive responses, like increasing our use of air conditioning to shield ourselves from the heat. Air conditioning is super effective in terms of preventing heat exposure and preventing the worst health impacts of heat, but obviously it increases enormously the demands on our energy systems. It puts pressure on energy systems, which often means that it increases energy poverty or increases energy bills. It also means that it increases the urban heat island effect through the waste heat that it generates. So, a maladaptive response that is increasingly being taken up because of the lack of good adaptation on other fronts.
The bad news is that with these health impacts that we're seeing and with these delays in adaptation, we're probably heading towards a very dangerous future. We're currently at about 1.3 degrees of global mean temperature rise, and we're currently headed towards 2.7 degrees given current policies and actions. And even if we managed to limit global mean heating to two degrees by the end of the century, in 20 years we would already see sharp increases in every one of the risks that we would be facing. So this tells us that adaptation is urgent but is absolutely insufficient to prevent the worst health impacts of climate change, and we absolutely need to mitigate to reduce greenhouse gas emissions and ensure that we keep our planet within safety boundaries.
The energy system is the biggest single contributor to climate change, and the vast majority of our greenhouse gas emissions comes from the energy system. Despite the availability of green energy solutions, still about 80% of our global energy comes from fossil fuels, which are highly polluting and obviously the main contributors to climate change. And cities contribute the vast majority of those emissions: about 70% of all greenhouse gas emissions comes from the consumption of energy in cities. So there's a lot that at the city level we can do to stop emissions and to transition rapidly towards a health-promoting future.
Now, the implications of energy are not only for climate change, but also the direct health impacts of our unhealthy energy consumption patterns. We estimate about 2.1 million deaths occurring every year due to exposure to outdoor air pollution coming from fossil fuel consumptions, with increasingly high burdens of disease, particularly in areas that are still heavily dependent on fossil fuels. Road transportation still dependent heavily on liquid fossil fuels being one of the main contributors to this air pollution.
And something that is slightly, perhaps, unrelated, but I think it runs at the core of this, is that we're still so absolutely dependent on fossil fuels to meet our energy needs, which we need to meet to hold healthy lives, that our energy systems depend on fossil fuels even under sharp fossil fuel fluctuations and sharp energy price fluctuations. And the reason why this is important was clearly exemplified in the last couple of years following the war in Ukraine. As you will all know, energy prices rocketed, mostly because of the changes in fossil fuel markets globally. And what that meant is that our governments had to allocate enormous amounts of funds to keeping energy affordable because we still depend on fossil fuels primarily. As a result, we spent $1.4 trillion globally in 2022 in net fossil fuel subsidies. This is often taxpayers' money that goes to subsidizing fossil fuels.
And the interesting thing is that in 55% of those countries that we monitored, we allocated more than 10% of our health budget to fossil fuel subsidies. And in 27% of countries, we allocated more to subsidizing fossil fuels than to healthcare. So we're fueling the addiction to fossil fuels, and this is costing our budgets and undermining our capacity to enable a sustainable future as well. So at this point, we have the technology to respond to climate change. We know how to build healthier cities. We know how to build healthier energy systems. We have the technology and we have the budget. So at this point, it's pretty clear that whether we respond or not to climate change, whether we deliver a healthy future or not, is not a technical or financial issue; it's entirely a political issue. So with that, I thank you very much for your attention.
Hello, and I just want to thank you for this invitation. Always a pleasure to come to have this kind of conversation. Well, I just want to show you some detail of this problem, healthy, in two projects. One is a large hospital in Cremona, which is south of Milan, and is about to design a hospital as also a landmark for the city, but the opportunity also to create a public space. So, you know, historically, a hospital was pavilions in a park, and the park was part of the city, that people can enjoy that park. So I thought the idea was: I'm going to the hospital not only for the cure and not only because I'm a patient, because maybe someday I'm going walking in the park of the hospital. So it becomes a public destination, not hostile, not something against people, but a part of life, a civic part of the life of people. And also take care not only of the people or the patients, but also of the people working in the hospital.
This hospital is 500 beds, 2,300 people working there, plus visitors. So I think in that case, we designed the ground floor as a sort of gallery where you can have your shops, a restaurant, a bar, a supermarket. For people working for 10 hours, they maybe need to do some shopping before going home. And on the other side of the hospital is a kindergarten, residential for families. So it's a sort of facilities for the community; it's not only a technical building, it's about creating something around the building. But what is a detail, but it's so important in the hospital—it's not only about architecture, okay, and then we discuss about many issues—one issue is managing the room of the patient.
Normally, in this first slide you see, it is like this: a corridor and a toilet, and then the bed is behind. You can't see the patient. You need to open the door, get inside, check in. Normally, okay, there's a lot of digital tools around the patient, but also the visual is still important. So, we tilted the room, and then you can see the position of the toilets and the bed. So the nurse can see the patient without opening the door, or if they open the door, they don't need to disturb, but they can see. And also, you can transform from one single bed to a two-bedroom or intensive care, which is one of the problems we get in Italy, and I'm sure in many countries: not enough room for intensive care. Normally, in Italian hospitals, they have 10 intensive care beds, but in that case, COVID was needed for hundreds. So the way you transform the unit is very important to adapt to different solutions.
So that was the key of the competition. We won that competition. Now we are starting the final drawings. But one of the things that was really appreciated is the attention to the patient room, the way you organize it, and the public space around, and that's what the people see from the room, which I think was very important. You can sit and watch the park and watch greenery. As you said previously, this visual relationship with plants is very important for people psychologically. We did another hospital in Milan with courtyards; every courtyard has different plants, and then there's a window above. So the patient can almost go out onto the garden, and this relationship with life is quite important. But also, we made a little analysis about how much daylight gets through the building and what the people in the beds see outside. We tested these things because we want to give you values and numbers about this, and that's what I think was very appreciated for the way you design new facilities.
And then the hospital is a park. This is the main entrance, but at the same time it is integrating into this landscape. And Cremona is very well known for Stradivarius violins. You go to Cremona, you go into the street, and people are singing and music is playing. In the middle of the town is the highest tower built in Italy, or maybe one of the highest in Europe. So they have a landmark, but they're looking for a new hospital that can also be a new landmark for the city, close to the countryside, almost close to the city.
I just made a very short presentation, but just to give you the elements: also when designing a school, one is the environment, the space, and the city community. If you put these indicators together and measure your building, you really get a chart to understand how much you're working on the environment, how much you're working on the flexibility of the space, how much this building is connecting with the city community. I think this goes beyond architecture; it's the way you really approach buildings. It's not only an aesthetic approach; it's how we connect things. But I want just to show this very small project. I like being an architect. When you work for a long time, you like big projects; it's nice, but sometimes we work with non-profit organizations on very small projects because, in the end, all the philosophy we have about sustainability, you need to put it down on the ground, and also a small thing can change the lives of people.
So we worked, and we just opened two weeks ago, with an association that provides food for poor people, like a canteen. They are serving 700 meals every day to people who can't afford it. But now the problem is that it's not only people who don't work; now the new poor people are people who have a job with very low income. So you find this kind of change in society. It's not only people who don't have anything; there are people who work, get very bad pay, and they go to this place. But there are people who go to this place and don't have teeth to eat, and kids who have sickness in their teeth. What can you do? You can provide food, but you need to provide a dental clinic.
So we opened this place for kids in a very underprivileged area of Bologna, a very difficult suburb. It is thanks to Dottor Sorriso and volunteer dentists from the university—the students in their last years of dental school—and professionals who just give one day a month, two days a month. Students work there and provide free service for kids and people who need care for that. What happened there is we designed something very nice. We are always thinking that whatever the budget is, the best thing we can do is design the best architecture we can, because cheap doesn't mean it cannot be nice. And I think also when you bring kids to a place like this, it needs to be nice: nice curving walls, simple, and all the rooms are very well-equipped with support by companies who donated this.
I think this is a little thing inside of a very large neighborhood that has difficult problems, but the fact is there is a sign that maybe something can change. One of the points I'm more and more working on—I like to say, okay, sustainability is an issue, and we know how to do it, we have the knowledge, we have information, everything. What is missing? I still wonder. But I feel it's not only about technology; the problem is the human being. How can we transform this into a sustainable city? For me, I was working in many different places in the world with the United Nations in Gaza; we did things for refugees with little things. But I think we save our cities by generosity—you know, generosity. We lost contact with people. Generosity, understanding people, gratitude—these kinds of things are the basis of how we can change our life in the city. It's not only about data and information; if you're not changing our attitude with people, it will be very difficult to make the change. So I think this little work is a nice sign of generosity inside of a city that is trying to make things better and help other people. If you don't help each other, it will be very difficult to sustain the transformation. Okay. Thank you very much.
Good afternoon. It's a real honor to be here, and I thank the Norman Foster Foundation and our friends from Bupa. I'm going to show you some things that we've been doing in the practice, Foster + Partners. I think there's a theme about: Can architects make situations and spaces better for patients in a hospital setting? Can you do things that are better by design? Ten years ago at one of our strategy board meetings, we decided to really think about hospitals in more detail, and we've been lucky enough to work around the world looking at hospital projects, developing things, and really trying to explore what the key elements are that you can think about.
I'm going to start off with Maggie's. This is a space in Manchester for Maggie's. It's a retreat for cancer patients, and most of the ingredients that we think are important are here: biophilia, plants, nature, natural ventilation, daylight, a sense of community, and a sense of support in a difficult situation. A very small project, but some of the key elements are something that we learned from and actually have influenced the projects we've done since. So we are firm believers the patient comes first as we think about hospitals, but we know it's important about the family members. It's an extremely stressful time for the patient and the family to visit the hospital. It's also important for the care team, under huge amounts of pressure. Why can't they have daylight? Why can't they be in a better work environment? Why can't they perform better and have a better situation to work in? So, we think about the patient first, and we think about the care team and the families all together as we start to think about our hospital projects.
This is the first project that we did. This is Iowa Children's Hospital. Somewhere in the Midwest, college football is like a religion. The stadium is packed; it's full. And with Norman, in some of the first meetings we said, "Well, surely we should build the new hospital away from the stadium, away from the noise, with better access for ambulances." And there was a conversation about: Is there a benefit perhaps to having the hospital overlooking the stadium? We designed a children's viewing platform at the very top so the children could watch the game. We worked through it, and obviously it's probably one of the most emotive things. A children's hospital for me is very difficult. And there's also this thing about the generosity of spirit. We built the hospital. Some of these kids have been here for months, and they don't know if or when they're coming home. At the end of the first quarter, everyone in Kinnick Stadium—70,000 plus—would turn and wave to the hospital.
What a simple concept, yet so powerful. Like a lot of the good things that happen in life, they are pretty simple in their nature, but the power and the meaning of it is really significant. Everyone up here had tears in their eyes, with 70,000 people just turning around and waving to us. They were all giving us that moment of, "Hey, we care about you, too." Architecture can make a difference. And it's incredible how that's really become a tradition in Iowa.
This is one of Norman's sketches, but we talk about change a lot. We talk about: How do you design a building that won't be finished for the next five years? How do you anticipate the technologies that are coming? We're seeing a huge change in healthcare at the moment. And we really try and think about: How do we design that hospital? How do we really embrace the patient? How do we really think about the care team? And how do we design for change? This is in Philadelphia, but this is an idea about designing a more flexible floor plate for patient rooms so that, effectively, if we overdesign the room slightly, every room can be an intensive care room.
Do they know how many intensive care rooms they want at the beginning of the project? No, they don't. Will they know later in the piece in the first build? Yes. Can they then change it in the future to have more rooms? Yes, they possibly can. In our research, we also find that patients prefer to be in the same room and not moved. It's not nice to be moved from room to room. For the care team, it takes 24 hours to change a room over from a cleaning point of view. And therefore, the idea is to have a building where this is the stack of the building: you've got the operating theaters at the base, and the rooms changing depending on the brief, depending on what the client would need as we got close to the time, and also trying to design a building that's relevant for the next 60 years and not something that becomes obsolete because it hasn't been able to adapt to the changes.
We then built a full-size mockup out of cardboard, and we took 450 people through it from the care team to see the rooms, to test spaces, to test the circulation, to listen to them, to listen to their comments, to see if we could improve what we were going to build. Lots of conversations about corridor widths, about the patient room sizes, about the location of the bathroom within the room. A lot of input from all these people—some are surgeons, some of the care team, some of the people that will be cleaning the building in the future. And this is the final hospital. Interestingly, it sits right next door to a museum, and we're able to link the two together so you can actually go to the museum from the hospital to explore their collection.
And then as we showed you with the markers before, this is the lobby space. An incredible Maya Lin sculptural piece inside the lobby, but also this link to the outside where we have biophilia and outside seating spaces for the care team, for the family members, and eventually for some of the patients, too. There's a hospitality conversation about making it more welcoming, making it more calm when you come into the building as you work your way through.
This is Lord Foster—I apologize. This is simulating a patient room. Norman's looking through an Apple Vision Pro goggle set, and he's seeing five or six different interior rooms, and we're measuring him and trying to figure out—and it wasn't just Norman; we actually used about 150 people from our office from different disciplines, and also some of our clients, and we tried to understand what makes you calmer within a patient room. Can you design a patient room which makes you calmer? The clues, obviously: daylight is important, color, nature, the awareness of outside, artwork, timber, curves, softness. And that led us to the idea of a room which we're developing at the moment for the Mayo Clinic, where we try and maximize the ability for the patient to control the environment they're in, but have the daylight, have the views, have the artwork, and really learn from the science that we have.
We're seeing a dramatic curve at the moment in terms of healthcare and research. AI is coming on stream. We talk about robotics, incredible technologies in terms of cures for cancer, algorithms for AI, linking up data across the whole world. Four years ago, we started working with the Mayo Clinic in Rochester, Minnesota. The whole conversation is about: they're the best hospital system in the world, and they want to build a hospital of the future that can adapt to change. And there's a very visionary CEO, Dr. Farrugia, who is inspirational, never satisfied, always wants to really think about the next steps in hospital planning. He phoned me up—and I haven't had many clients do this—and he said, "I'm worried that the building won't be relevant in 20 years' time. Have we thought enough about the interface between robots and drones within the building?" That's what he asked me to do.
And then we're thinking about distribution systems, flexibility, and again, a sketch we talked with Norman about: How do you design full flexibility? Can you have operating theaters that can go where patient rooms go? Can you move things around? This is a three-dimensional rendering to show a system that we've developed so that departments can change, the building can change over time. We can move operating theaters around, we can move patient rooms around. As the demand changes, we will be able to accommodate those changes within a very flexible building. And then finally, we talk about the technology, about the drones and the robots and how we're actually going to serve the building. This project just started on site a few weeks ago, working very closely with the Mayo team, embracing the technology, thinking about the systems, thinking about the patient, and putting the patient in a situation where they're calm, they're comfortable in a wonderful space, and behind the walls, above the ceiling, beneath the floor is this incredible technology that helps to support them as they go through their difficult times and hopefully have a better outcome. That's my last slide. Thank you very much indeed.
Thank you very much. There we go. Would you like to sit here? Marina, amazing presentations. Thank you very much. Marina, I'm sure everybody would love to have a hospital like Cremona or the Mayo Clinic, but that's not always possible. You shared a lot of data. What's the minimum that we should start with when we're thinking about new buildings in cities from now on?
Well, I think that the minimum is understanding that when we build buildings, we're building the most fundamental determinant of health. We have to understand that health does not happen in hospitals; health happens in the places that we spend most of our time—inside the buildings that we work, inside the buildings where we live, inside the hospitals once we are in hospitals. But it's determined mostly by the environments that we're exposed to most of our time, and for those living in urban environments, that's most of the time inside a building. So we have to understand that when we think about building design, we are not designing buildings to be pretty; we're not designing buildings only to be functional; we're designing buildings to be all of that while improving the health and well-being of those that are within them. So as in most of the things that you'll always hear me say, I'm a huge advocate of putting people's health and people's well-being at the center of every single one of our interventions. And I think in terms of designing our built environment, people's health, people's well-being has to be one of the core metrics of how we go about designing those buildings.
Couldn't agree more. And Mario, you were talking about gratitude before, and if we could integrate that more, we could even have healthier buildings. Why aren't we integrating that more?
Well, it's about human nature, and I think we are really focused to make our better buildings, and we have much more knowledge about how to make them, and there's a lot of technology. A hospital means a lot of diagnostics, a lot of machines. So we really know how to cure people very precisely, but in the end you also need to train people to get this kind of human relation I always call empathy. Empathy is one of the fundamental keys to how to make a hospital work, because machines sometimes are scary—you go inside of a tube, you know. But then you really need to train people, and architecture needs to be in some way friendly and welcoming.
And I think especially when you design schools—schools are so important, as is a hospital, but you stay in school for a long time, five years or 11 years, whatever. But school, I always say, we need to design better schools because you create memories. People bring in their life the experience of school. And also, when you design a very good school, I think the message from who designed the school, but also from the government, is to say, "I take care of you." And I think this message is so important. That's why I sometimes go crazy to see terrible buildings. The message behind a bad building is, "We are not caring enough about you. We don't care about your memory. We don't care about your experiences." So that's why, as the question in the beginning asked, "Why are architects so important?" which I believe is very important.
And sometimes I feel the architects, in this case the work of foundations, do much more work than politicians. Politicians have disappeared a little bit sometimes; I'm not sure they have a very clear idea about the future. Well, I talk about my country—sorry, maybe there are better places than Italy, which is a fantastic country, but sometimes I feel they don't have a clue. They just do, "We'll do a hospital," but they don't know the major reason. And the distance between competence and politics is coming far, far away. So you really need—that's why I say architects are very important, politicians are very important too. And when politics is not strong enough, we are alone to try driving this force to make better buildings, take care of public spaces, and design hospitals and schools and public buildings to care about the community. Designing little things inside of a large neighborhood is the first step to make the change, because you can't change everything at one time. You need a lot of steps. So just putting something inside...
Creating a sort of contagious... Architecture is contagious as beauty. You know, beauty is contagious, which this time is a better world, not contagious in a bad way, but beauty is contagious, you know, to help people to make maybe another building better than you. That's it.
So Nigel, now turning to you, why are healthy buildings not the norm? Is it because people are scared if they're more expensive? And I'm sure it's a question maybe somebody's wondering: are they much more expensive?
Well, I mean, what we're finding, and certainly post-pandemic, is there's a huge demand for outside space. Every building we talk about, they want ideally the best quality air. They like external terraces, they like green spaces, they like the social interaction of people coming together. And I think that there's definitely a change in people trying to produce healthy buildings. At the end of the day, the productivity, the happiness of your team is reinforced if they're in a better working environment. You have less days sick, they're in a better environment, they can be more innovative, more creative, they can focus better, and ideally they've got better amenities, better quality food, they've got a gym, they've got health, and then that starts on kind of a roll of a better kind of quality of life. And I think that's really what we're seeing mostly.
There's obviously some tired buildings from the 1960s and '70s which are a challenge, and again there's opportunities to refit and repurpose those. But I think that the people we're seeing now are really looking at their team and their organization and really trying to put people in better quality space if they can.
So we can go ahead. I have many more questions here, but I'm sure a lot of people in the audience also have some questions. So, before continuing, I just wanted to ask if there are any questions from the audience that we would like to pose for our guest speakers? Everybody's shy tonight.
How would you... Oh, sorry, for Nigel. I just heard about the '60s buildings and I thought that was really interesting because, of course, coming from a country like Spain, we have so many buildings to repurpose. So I would like to know if you have any thoughts on how to approach a problem like this and make them healthier.
Okay. So, we're fortunate working with Norman that there's a building in New York on Madison Avenue which we're repurposing. We're able to refit the building and change its life, and it will become a much better office building in the future. We're able to replace the cladding, the glass, which is the performance, introduce more daylight, and put in better air systems within that building. That's an exception, perhaps.
There are other buildings. Office buildings have a higher floor-to-ceiling height than residential buildings. They can be converted into hospital space; they can be converted into more residential spaces. There's a lot of effort really thinking about those buildings, and sometimes we're keeping the structure. We have another building in London where we're keeping the structure of the building and then we're recladding, which is a building on Bond Street. So there's things that you can do, and I think you just need to be creative as you do it.
Any more questions? Marina, I did want to ask you: what key policy changes are we needing in our regulations to bring all these factors that we've been talking about to make it happen on a more day-to-day occurrence?
Yeah. So I think going back to what you were mentioning, the sad reality is that we should not need regulation to do things that are better for the environment or better for people. But the sad truth is that without sometimes political measures, change doesn't happen as it should.
So we see very, very few countries with really robust regulations in climate performance. You have a lot of plans for decarbonization in many countries, but they're not really tied to really robust regulations when it comes to determining the built environment. Europe performs fairly well in that sense, but that's not a norm globally.
So the first thing is ensuring that those standards, those plans at the national level are translated to robust regulations, because we're not just talking about an environmental issue; we're talking about ensuring that we keep our planet inhabitable. So it should not be optional. It's perceived as something optional, perceived as an extra benefit, but it should be the fundamental baseline ensuring that whatever we do, and particularly when it comes to buildings, they're there for the long run. We still have buildings that are centuries and centuries old that are fully operational. So buildings are there for the long run. So we have to ensure that they're what we say 'future-proofed.'
And future-proofing means ensuring they're resilient to the impacts of climate change, that they can withstand a changing climate, and that they're zero emissions—and really zero emissions. And within all of that, that obviously they support cleaner indoor air, improved exposure to natural light, improved exposure to greenness, and all of those determinants that we know are fundamental to health and well-being.
So thinking about that, Mario, in Cremona, I understand the hospital is a local council building.
Yeah, it is a public building.
How were they so enlightened with that tender?
Well, I think this project was one of the first projects in Italy where they made a very good brief. They had a very clear idea of what they want. That's why you can make a good building, because it depends on the quality of the brief. And I think they really worked hard to make questions and studies, and they're using a lot of consultancy. Sometimes competitions like this are not good enough to give a very good answer. That's the problem, and then it's difficult to make a decision because it's too vague, you know.
So I think there was high ambition to make something very nice. And it was international. There were big companies that participated, and they were really looking... It's always a difficult moment when you're looking for a landmark, but you want to see something working well, and at the same time it needs to be sustainable, and at the same time it needs to be for the community. Putting the ambition of the program very high, I think it was very good. So I think they were very courageous to make that choice. But it's nice to work with competent people from the government, because this is a public building and they really made an effort to make a new generation of public buildings, especially in Italy, because the last period of building was in 1980–1985, so it's out of the rules of energy performance and earthquake security. So this is a big change; it's a huge program of changing hospitals everywhere in Italy. And that is a sign of something good, this ambition of the government to really improve the quality of service for healthcare people.
And so I think we need to take the challenge and push a little bit more, transforming that opportunity of this building, which is a service building, into a civic opportunity. It's something more than a hospital; it is mainly a destination for everybody, and it needs to be something more than only a cure. That's why this idea of a park, a place where people really... My ambition is they say, 'Oh, this Sunday we go to the restaurant at the hospital.' I find it fantastic, because it's a beautiful restaurant, and then, 'I go jogging in the park of the hospital.' So you just reduce the idea that a hospital is something nasty or difficult. It is really very close to people, and then you need to join by design things in a special way. That's why it is amazing and beautiful to design public buildings. You see you can really make the change. I tell you, a lot of people in our company have seen that hospital and it's an inspiration, definitely.
And Nigel, with all the work you've been doing on hospital buildings, what is your vision now for future designs in future hospitals? Where is it going to go?
