Why design for health: beyond design for disability

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Recently in a talk on Building Biology, I was asked to how it relates to Universal Design (UD). UD grew out of a disability rights movement and is growing in popularity among homeowners and designers as accessibility products also become more available and attractive. Building Biology specifically address ecological and biological health in buildings. How do the two relate, if they do at all?

How did Universal Design start?

Architect and researcher Ron Mace is credited for coining the term “universal design” in 1985. He is known for his advocacy work for people with disabilities. He himself developed polio at age nine and was constrained to a wheelchair. As a student at North Carolina State University, he was carried up and down stairs as a student and could not fit in some of the rooms.

Later in his career, he was involved in projects that led to the first accessible building code in the U.S., including Section 504 of The Rehabilitation Act (1973), the Fair Housing Act Amendments (1988), and the Americans with Disabilities Act (1990) that establish minimum requirements that protect people with disabilities from discrimination in the built environment. [1]

"The design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialised design." (Mace, 1985)

After his death, the 7 Principles of UD were developed in 1997 by his team including researchers, architects and designers, at North Carolina State University. [2]

Current Perspectives on Universal Design

Much of the focus UD has been on disability and age, for example:

  • making doorways wide enough for wheelchairs

  • Braille signages in lifts

  • tools that fit left-handers for low muscle strength

  • captioning videos

UD came from the recognition that more people may be living longer, be living more of their lifespan with various disabilities, and that they are being excluded from public spaces socially because of these specialised needs. We saw this during World War II for example, as soldiers returned home with disabling injuries.

More recent perspectives expanded towards the scope of inclusive design, which extends the definition of UD by including users who have been excluded by rapidly changing technology. The proliferation of terms in this field include: inclusive design, design for all, or life span design, human-centred design, user-centred design, design for a broader average.

The broad spectrum range of ideas in UD is based on issues of diversity, inclusivity, and accessibility; on the flip side, its applications imply the homogeneity of many. There may be times when UD limits other facets of socio-cultural life [3]:

• Adapting a building can be limiting when the focus is on its authentic preservation.

• UD can be seen as an imposition of certain values.

• Design shouldn’t be restricted to a particular market.

• Inaccessibility can be productive.

Designing Beyond Disability

Two quotes reflect the reductionism interpretations of UD can fall into as well as hint at the need for a broader consideration for the human condition in design:

By right everything in the Malaysian standard should be followed and not just a cursory – carpark, ramp and toilet. The education of the built environment professionals, including contractors and property developers need to be prioritised in order for us to create a more accessible, safe and usable environment. The content of the training for this education to happen should strive for the concept of independent living and designing with empathy as part of the process of being educated. [4]

Naziaty Mohd Yaacob, Assoc Prof, University of Malaya


Universal design is "a process that enables and empowers a diverse population by improving human performance, health and wellness, and social participation".

Edward Steinfeld and Jordana Maisel, 2012

Disability Can Come in Many Forms

Much of the conversation around UD remain around the knowledge and know-how in interpreting Universal Design (UD) principles. However, disability today no longer refer to only physical constraints, just as illnesses today are not the infectious diseases of yesteryear.

Here are just a few related shifts and ideas that we face as communities. They speak to how design could address various sensitivities that may be disabling, or at the very least, prohibitive to their participation and productivity in spaces:

  • · Deadly allergies. Some cities debate banning peanuts for people who severely allergic and limited on where they can go. [5]

  • · Epidemic of "lifestyle diseases". Asia has the highest rates for "lifestyle diseases", or non-communicable diseases. An ever broader segment of the population has at least one chronic disease.

  • · Disability discrimination laws. Countries include Taiwan, Hong Kong and Australia. [6]

  • · SBS regulations. More government agencies recognise SBS (sick building syndrome), especially for poorly designed workplaces.

  • · Government zoning areas for health reasons. Governments enact policies to guide building zoning areas for health. [

  • · Medical recognition of EHS. ICD (International Classification of Diseases) now has codes for health effects caused by non-ionizing radiation. This was a request from the 2015 EHS Resolution adopted in Belgium. [9]

  • · Proliferation of green building specifications and industry.

  • · Multiple chemical sensitivities. As urban developments continue, we are seeing more evidence of how built environments can not only exclude people with various disabilities, but contribute to it.

What is Multiple Chemical Sensitivities and How is it Disabling?

Multiple Chemical Sensitivities (MCS) as a chronic condition involving multiple organ systems in which low-level exposures to multiple chemically unrelated substances cause symptoms. These symptoms improve or resolve when a person is no longer exposed to these substances.

People suffering with MCS have to make adjustments in their diets, home environment, type and location of work, clothing, and personal care products they use to remain productive and connected to the outside world. At its worst, however, MCS is a severe, disabling, and isolating disease that forces people to alter every aspect of their lives. [9]

MCS can be an "Invisible" Disability

The medical community has been slow to recognise, accept, or treat MCS as a “real illness”. There can remain a prevailing belief, as researcher and advocate Ann Campbell describes it:

"MCS has no definition, no objective findings, and no known prevalence, and is “only symptom-based,” a “belief system,” or “chemophobia.” People with MCS are also frequently dismissed as having an “unexplained illness,” as if they, rather than their physicians, were to blame for not adequately “explaining” it.” [10]

MCS is recognised as a potentially disabling condition by the Social Security Administration, the U.S. Department of Housing and Urban Development, and an increasing number of other federal, state, and local government agencies. People with MCS are covered under the Americans with Disabilities Act on a case-by-case basis, like all other people with disabilities.

“We believe it is the responsibility of health care providers to study emerging illnesses and disabilities and to contribute positively to the care of those who experience them. Koch et al would like rehabilitation counselors to challenge their own biases toward MCS, revise their understanding of universal design, accommodations, and accessibility, and learn to help clients to communicate with their work supervisors and erode their psychosocial isolation.”

Two Case Studies on Design and Health


Case study in Japan: 36 yo clerk, female, Japan

The first case study shows how building design can inadvertently create disability. This case was the first time in Japan someone had applied for payment under Workmen’s Accident Compensation Insurance due to sick building syndrome. She applied for compensation at the Osaka Labor Standards Bureau in December 2000 and her application was approved in June 2002.”[11]

Symptoms:

  • Headache, cough, nausea, dizziness and eczema while working in a refurbished office (May 2000)

  • Nettle rash, fever and pharyngeal pain (by June 2000)

  • Nose and pharyngeal mucous membranes were slightly inflamed

  • Total immunoglobulin (Ig) E level was 32 IU/mL (normal < 320 IU/mL)

  • Eye Tracking Test (ETT), vertical eye movement was saccadic. ETT is a test of equilibrium function and was used to diagnose “multiple chemical sensitivity

“The Bureau measured formaldehyde concentrations in her office as part of an environmental survey. The survey was performed more than one year after the onset of her symptoms and the formaldehyde concentrations were found to range from 0.017 to 0.053 ppm. The highest concentration was found in the meeting room, where this patient and her colleagues complained of headache and nausea. WHO reports that the safe level for formaldehyde is below 0.05 ppm.

In 2002, the Japanese Ministry of Health, Labour and Welfare recommended a guideline value for indoor formaldehyde concentration in workplaces of 0.08 ppm. The concentration in the air of the meeting room was higher than the level that WHO designates as safe, but was within the Japanese guideline level.

She underwent a physical check-up, routine tests and a check to identify any respiratory symptoms at the otorhinolaryngology department of a city hospital. Although there were no abnormal laboratory findings, she still complained of headache and nausea. The symptoms progressively worsened while working in the company’s meeting room and showroom. In late July, after she had been working in the showroom, severe cough and nausea appeared. From that time onward she took leave from work and her symptoms improved to some extent.

However, she then began to react to various smells from chemicals outside of the company building, such as exhaust and synthetic detergent. Following this experience, she consulted several doctors at a number of clinics and hospitals. Finally, she was referred to our hospital on February 7, 2001.”

Case study in KL, Malaysia: Sunway Putra Mall, Kuala Lumpur, Malaysia

The second case study shows how building interior design can accommodate neurological impairments and disability. People with autism often have numerous co-morbid medical conditions which may include: allergies, asthma, epilepsy, digestive disorders, persistent viral infections, feeding disorders, sensory integration dysfunction, sleeping disorders.

Sunway Putra Mall in Kuala Lumpur announced in January 2019 that they will alter certain aspects of the building that normal shoppers take for granted but are a major hurdle for people with autism such as bright lights and the type or volume of background music. The mall partnered with the Autism Behavioral Center and is supported by the National Autism Society of Malaysia. [12]

The interior spaces avoid sensory triggers such as:

  • Bright lights

  • ·Loud noises

  • Crowds

“When we first approached this initiative, we found one thing in common amongst our colleagues; a number of us knew at least one person with autism and the challenges they face in public places like shopping malls. Thus, this project is very close to our hearts. We decided to embark on this journey to advocate Autism Awareness.” Sunway Putra Mall, Ms. Phang Sau Lian, General Manager of Sunway Putra Mall.

“We’d never received a request for an autism-friendly shopping mall before,” says Phang. “But we know that there are more than 300,000 people in the country on the autism spectrum. We can also see autistic children in our midst. We’ve had requests to hold awareness programmes but this is a first in an initiative of this scale.”