Providence Food Labeling Policy Memo

“Organic”, “All-Natural”, and “Locally Produced” are all great initiatives in the momentum of sustainable food and agriculture, but they will all remain buzz words unless standards are set in place. These standards are currently out of reach due to the lack of transparency within the industry. Right now, there seems to be a deliberate veil between us and where our food comes from, rendering us powerless. We need an ideal label not from the perspective of marketers, but from consumers.

Current Laws and Regulations:

We are proposing this policy memo that aims to establish a transparent labeling system for all food products beginning with raw fruits, vegetables, and fish. Currently, food labeling for raw products are not required within Providence and the United States. According to Chapter 1 Sec. 101.45 of the FDA guidelines, nutrition labeling of raw fruits, vegetables, and fish are voluntary. No other kind of labeling is mentioned nor required. Food safety relies on the FDA's importation laws and local production laws, which are harder to trace and therefore traditionally have not been transparent either.

U.S. Government intervention in labeling began in 1906 with the Federal Pure Food and Drugs Act and the Federal Meat Inspection Act, which authorized Federal regulation of the safety and quality of food and prohibited sales of misbranded or adulterated foods. Lawmakers’ primary objective in passing the acts’ labeling regulations was to enhance fair competition by cracking down on deceptive marketing practices. Enhancing fair competition and market efficiency has remained the primary motivation behind food labeling regulation for the past 100 years.

Current Problems:

The current law only mentions voluntary labeling or health- and nutrition-related (HNR) claims which are most often "Low Fat", "Sodium Free", "Organic", "All-Natural", and "Locally Produced". Since they are voluntary however, these are not held to stringent standards. This kind of labeling just leads to consumer confusion. Companies that produce food that is anything but natural can use loopholes and vague language in current laws to label their food as natural.

Even within the required packaged food labeling, there are issues regarding transparency. Ingredients are all placed under an umbrella. If a product is using corn, it does not matter what type of corn it is.

One snapshot of this crisis is the debate over GMO products. Unlike strict safety evaluations required for the approval of new drugs, the safety of genetically engineered foods for human consumption is not adequately tested. Drugs are also labeled with possible side effects, which certain types of food has on the human body as well. As seen from a public health point of view, this lack of transparency in Providence can lead to an untraceable epidemic that can have sever adverse effects on sustainability. More than 60 countries including the EU, Japan and China already label GMO products.

This kind of lack of control and limited labeling is a sustainability problem. Our current "normal" agricultural industrial model that we rely on and its distribution has a lot of negative impacts on all sectors of sustainability including environment, equity, and economy. Lack of food sourcing transparency leads to nutritional issues and foodborne-illnesses but most importantly it creates an inefficient distribution of power through manipulation. Empowerment and choice are stifled when there is a lack of transparency.

Figure 1.1 Map with Farmers’ Markets, Grocery Retail Locations (2013) and Low Income and Low Access Tracts, as of 2010

Figure 1.1 Map with Farmers’ Markets, Grocery Retail Locations (2013) and Low Income and Low Access Tracts, as of 2010

Figure 1.2 Map with Farmers’ Markets, Grocery Retail Locations (2013) and Estimated percent of adults reporting to be obese (a body mass index of 30 or greater) in 2013.

Figure 1.2 Map with Farmers’ Markets, Grocery Retail Locations (2013) and Estimated percent of adults reporting to be obese (a body mass index of 30 or greater) in 2013.

As seen with Figure 1.1, location of farmers markets and grocery retail locations are abundant. Yet, there is still a lack of access to food especially for low income groups. The next map Figure 1.2 shows us that there is a moderately high case load of adults reporting to be obese (BMI of 30 or greater). There also seems to be a correlation between lower obesity and the proximity of a farmers market. One cause of this health issue is lack of both access to nutritional food and proper food education.

Figure 2.1 Food at home ($000), 2015 by Census Tracts of Providence

Figure 2.1 Food at home ($000), 2015 by Census Tracts of Providence

Figure 2.2 Food at home ($000), 2015 by Census Tracts of United States

Figure 2.2 Food at home ($000), 2015 by Census Tracts of United States

According to Figure 2.1, citizens in Providence pay an average of $5,797 per year for food at home. This is very high when compared to the American average of $2,273 per year for food at home according to the USDA. As seen in Figure 2.2, expenditure for food is much lower in central America, where food production is higher. Cost is decreased due to transportation and processing.

 

Figure 3.1 Map with Estimated percent of people age 16 years or older who were employed in Agriculture, Forestry, Fishing and Hunting Industry between 2009-2013

Figure 3.1 Map with Estimated percent of people age 16 years or older who were employed in Agriculture, Forestry, Fishing and Hunting Industry between 2009-2013

Currently as seen with Figure 3.1, percent of agriculture, forestry, fishing and hunting industry is quite small compared to other industries within Providence. This showcases the lack of local production of food, which is correlated to higher food prices and lack of access.

Figure 4.1 Trend of Vegetables: Per Capita Availability in the US

Figure 4.1 Trend of Vegetables: Per Capita Availability in the US

Figure 4.2 Trend of Fruits: Per Capita Availability in the US

Figure 4.2 Trend of Fruits: Per Capita Availability in the US

This lack of access is not only a Providence issue but a nationwide one as well, according to information provided by the USDA. As seen in Figure 4.1 there is a clear decrease in vegetable availability in the US. Fruits on the other hand has been more stable but also shows dips in availability according to Figure 4.2.

Policy Memo:

This new policy memo provides all the necessary information to completely inform the consumer and aid their choices. The information provided will include but is not limited to:

  • Type of Seed Used (GMO or not)
  • Type of Fertilizer Used
  • Location of Farm
  • Location of Processing
  • Type of Processing
  • Additives Used
  • Date of Planting
  • Date of Harvest
  • Recommended Shelf Life

Alongside the aforementioned information, food will also be required to include a "stoplight" label that is based on a standardized 15-point scale. The color of the product will be determined by where it falls in this scale: 0 to 5 is red, 6 to 10 is yellow, and 11 to 15 is green. The scale is based on three key factors including nutrition and health benefits, how close the product is to real food, and production. The last metric involves quality of treatment of workers, animals, and the earth. According to a study done by the American Journal of Public Health, sales of red-lighted soda fell by 16.5% in only three months of implementation.

One factor of a successful memo is its scalability. This labeling system can be applied to all different sectors of the industry and start with a few products first. For the test pilot, this label will be first applied to apples in Providence supermarkets. Once successful, it can trickle down to all other raw food and even packaged food.

Supermarkets were chosen as the initial target because most of the parties involved in the food system converge here in where food is collected, distributed, and consumers vote with their dollars. Without transparent food systems, accountability is impossible, and the industry will be continuously motivated by inefficient market forces. By providing more information, consumers are able to make decisions that are based on facts rather than in marketing.

Impact:

This policy memo tackles the issue in where most impact can be made, by changing market forces through educating the public and increasing access. By improving access to healthy produce, Providence could reduce rates of nutrition-related disease, like diabetes and heart disease. Since many diseases are caused by - or at the very least, correlated with - poverty, improving access to healthy food for low-income communities in Providence leads to a healthier city overall.

According to a study done by the Economic Research Service as seen with Figure 5.1, a large amount of people surveyed would use nutrition information in fast-food/pizza place in deciding what to order.

Figure 5.1 Survey of Who Would Use Nutrition Information in Full-Service Restaurants in Deciding What to Order

Figure 5.1 Survey of Who Would Use Nutrition Information in Full-Service Restaurants in Deciding What to Order

As seen with Figure 5.2, availability of labels and guidelines have proved to be effective in affecting consumer choice. In a study conducted by the USDA, the whole-grain industry grew significantly when the 2005 dietary guidelines were released. This further supports the need for a new kind of transparent label.

Figure 5.2 Trend on Whole-Grain Product Introduction by Manufacturers

Figure 5.2 Trend on Whole-Grain Product Introduction by Manufacturers

Aside from health, this policy memo improves all sectors of sustainability. Environmentally, local food is better because it decreases transportation, processing, and shipping costs. Reversing industrial agriculture into a more ecological practice would decrease carbon emission, water run-off, and increase soil productivity. Economically, local food is cheaper and stimulates the local economy. It gives the state more financial independence and more resilient over nationwide financial fluctuations. With regard to equity, the information provided will highlight local farming and more ecological agricultural practices that are more beneficial to health. This would increase local food production. When food is sourced locally, it becomes more affordable and thus more accessible for more people. It also provides more jobs within the region.

The attached figures shown are just a few of the metrics that can gauge the success of this policy memo. With our current data, there is a clear need for this policy but it can have many more positive externalities. It has the ability to really impact and improve lives through creating a sustainable environment that enables smarter growth.

Sources:

 

"A 2-Phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices." American Public Health Association -. Accessed October 22, 2015.

Law, Alex. "The DARK Act Makes Absolutely No Sense, And Here's Why." The Huffington Post. Accessed October 22, 2015. 

"Food Policy: Check the List of Ingredients." USDA ERS -. Accessed October 22, 2015. 

Gregory, C., T.A. Smith, and M. Wendt. 2011. How Americans Rate Their Diet Quality: An Increasingly Realistic Perspective. U.S. Department of Agriculture, Economic Research Service, EIB-83, September.

Kim, S.Y., R.M. Nayga, and O. Capps. 2001. “Food Label Use, Self-Selectivity, and Diet Quality,” Journal of Consumer Affairs 35(2):346-63. 

"Obesity and Other Health Concerns Lead Food Companies to Step up Health and Nutrient Claims." USDA ERS -. Accessed October 22, 2015.

"USDA ERS - Food Expenditures." USDA ERS - Food Expenditures. Accessed October 22, 2015.

Seiders, K., and R.D. Petty. 2004. “Obesity and the Role of Food Marketing: A Policy Analysis of Issues and Remedies,” Journal of Public Policy & Marketing 23(2):153-69.

 

Impacts of Western Philosophy on Modern Agriculture

Let's lay down some facts. Currently, chronic hunger and its related preventable diseases kill as many as eight thousand children under the age of five.[1] From 1990 to 2010, “most of the key causes” of non-communicable diseases are diet-related and predicted by 2020 to account for nearly 75 deaths worldwide.[2] Lastly, according to WHO, UNICEF, and the Worldbank, nearly 800 million people worldwide were “stunted”.[3] Most often, we see this image of hunger as just that, statistics. Yet chronic hunger is more. According to Frances Moore Lappe who wrote World Hunger: 10 Myths, it is anguish, grief, humiliation, and fear. As a society, how did we get here?

This paper is an investigation of the relationship between the philosophy of modern hunger, philosophy of modern agriculture, and the philosophy that drove us to our current state. It can be argued that there is a direct relationship between the three; cause and effect. As a cyclical causal relationship, these topics are paramount concerns that shape our sustainability as a race. After only investigating these causal relationships can we then decide philosophically which paths are ethically right to pursue.

Within traditional philosophy fathered by Plato, the stomach is but a manger for the ravening appetitive soul, that part of the soul whose job it is to sustain the bodily creature. Appetite is a powerful, relentless force that must be kept chained like a wild animal lest it overtake the whole being.[4] In Making Sense of Taste, Carolyn Korsmeyer interprets this as food being a functional good. It is just needed for health and maintenance of energy and sickness. The bodily senses are “lower” in part because of the necessary closeness of the object of perception to the physical body. Therefore, quality of information received from vision is superior as “form” is available.

We can clearly see the divide between mind and body creating a duality which shapes our perception of value. Korsmeyer mentions Socrates and his remarks that a philosopher must be concerned with neither food, drink, nor sex. Through the lens of this rationality, we began to value food less, but even within food, we had created hierarchy. The impact of this philosophy is evident with our current obsession toward the ideal visual perception of produce in where those that do not meet visual standards are discarded.

It is interesting to note that as philosophers denounce the senses related to food and the action of eating, they simultaneously place it in high regard due to acknowledgement and repetition. Why is it such a central theme with philosophers? No matter the answer, it is a central theme, one that has evolved through different eras. Aristotle emphasizes the concept of food when he talks about the mean of virtue. Since he believes food to be measurable, we can find the right quantity of food that is “good” for a person. He also notes that this is not always the same for all people.

This train of thought arguably drove “nutritionism” which was brought upon by the era of science: the scientific revolution. In Firtjob Capra’s The Newtonian World-Machine”, our current scientific and rational world view and value system was essentially formulated in the 16th and 17th century. Prior to that, the dominant world view was organic[5]. Inspired by the previously mentioned philosophers, modern philosophers such as Descartes and Francis Bacon replaced organic world view with that of a machine with their methods of inquiry and analytic reasoning.

Nutritionism is the spawn of both traditional philosophical concepts of duality and modern philosophical concepts of rationality. Michael Pollan writer of In Defense of Food, states that within nutritionism, food is essentially the sum of their nutrient parts and that the whole point of eating is to maintain and promote bodily health. This manifested in trends that organized most of its energies around an imperial nutrient such as protein in the 19th century, fat in the 20th, and now carbohydrate in the 21st. [6] Parts are then highlighted, as the system that it is within got lost in the background. This leads to the lack of causal links which leads to the lack of transparency and accountability.

This duality and hierarchal philosophy was further exacerbated during the industrial revolution in where the scientific revolution manifested itself as industrial agriculture also known as the “Green Revolution”. This was introduced in the developing world as the solution to hunger, only about 60 years ago. However, we now often refer to it as “conventional agriculture” creating the illusion of authenticity and longevity. With the aid of time, we can now look through its causal relationship with our current state (as mentioned in the introduction) and see that it was not the solution to hunger. Some argue, that it cannot end hunger because its narrow focus on producing more for short-term profit-sometimes called “productivism” can’t incorporate the interests of everyone.[7] However, this is merely a symptom of a larger problem, one that this paper explores, its philosophical roots.

To prove the inefficiencies of this “Green Revolution”, this paper will investigate two different case studies including CAFO’s (concentrated animal feeding operations) and GMO’s (genetically modified organisms).

As previously mentioned, nutritionism has created a culture obsessed with imperial nutrients such as protein which aided in our increased intake of animal products. Worldwide, three-fourths of all agricultural land go to producing animal products.[8] In terms of calorie efficiency, animal products are highly inefficient. About half of the world’s calories don’t go to people but instead go to feed livestock. Within this inefficiency, beef comes in last in where we only get a measly 3 percent. Therefore, it feeds fewer people per hectare.

Rather than to adapt our diet accordingly, we chose to mold our environment and agricultural methods which resulted to CAFOs or also known as “factory farms”. To increase beef production, we began isolating parts by separating production of feeds and the cows. This model is being replicated across the globe at fast rate. According to the Food and Agriculture Organization of the United Nations, 80% of growth in the livestock sector is in animal feeding operations not integrated into farms.[9] This in return, altered animal’s natural behavior, decreased water supplies, destroyed biodiversity, and created an ecological imbalance. Again, another proof of the impacts of Western philosophy on our current agricultural model.

The introduction of CAFOs also opened doors for the creation of GMOs to ensure that feed production was optimal changing traditional cropping patterns and resorting to high-input agriculture. GMOs were first created in the 70s by inserting specific genes from one organism into the DNA of another.[10] Proponents saw to this technique as a faster and more targeted form of traditional crossbreeding. The discovery of DNA promoted the Western philosophical concept of rationality and part to whole.

There are numerous ethical debates for and against GMO and within those, the most convincing are the systemic ecological externalities. Biologically speaking, unintended side effects such as mutations are common in genetic engineering practices. Genetic engineering can introduce a range of genes and traits, some never before present in our food supply or in plant ecosystems. Now from a social aspect, since only a handful of industries are distributing these GMOs, increase in dependency further exacerbates concentration of power. This in return, creates more hunger as a root cause.

In conclusion, there is a clear causal relationship between Western Philosophy and our current agricultural methods. With this, we can then project forward, creating an image of a world further divided into parts and separation due to its inherit philosophical hierarchies. This trajectory of our current agricultural model will continue to lead us to hunger due to its unsustainable fragmentation. Paradoxically, the same philosophy has also equipped us with the rationality and reasoning to reverse said trajectory. From what we have “learned”, we can no longer perceive the world through the lens of duality and senseless hierarchy if we are to sustain our existence on this planet. We need to look through a relational lens, one that focuses on the interaction of all elements, often described as “systems thinking”.[11] Ecological systems do not have isolated parts that function in a hierarchy as they are all integral to sustainability. Simply stated, one is not better than the other. Therefore, I do not propose that our current system is a mistake, but a necessary iteration for a more sustainable future. It has led us to where we are now. However, just like any iteration, we have to acknowledge its failures and learn when to move on.

 


[1] “Hunger Statistics,” World Food Programme, last updated 2013, accessed October 13, 2015, www.wfp.org/hunger/stats.

[2] Fumiaki Imamura et al., “Dietary quality among men and women in 187 countries in 1990 and 2010: a systemic assessment,” The Lancet 3 (March 2015): 132-142

[3] World Health Organization, Global Health Observatory Data Repository, Joint child malnutrition estimates (UNICEF-WHO-WB), “Global and regional trends by WHO Regions 1990-2013 Stunting”

[4] Korsmeyer, Carolyn. Making Sense of Taste: Food & Philosophy. Ithaca, NY: Cornell UP, 1999. Print.

[5] Capra, Fritjof. The Turning Point: Science, Society, and the Rising Culture. Toronto: Bantam, 1983. Print.

[6] Pollan, Michael. In Defense of Food: An Eater's Manifesto. New York: Penguin, 2008. Print.

[7] Oxfam-Solidarity and Stephani Parmentier, “Scaling Up Agroecological Approaches: What, Why, and How? Discussion Paper, January 2014,

[8] Hans Hurni et al., “Key Implications of Land Converseions in Agriculture,” in Wake Up Before It Is Too Late, Trade and Development Review 2013, United Nations Conference on Trade and Development 2013

[9] FAO, Agriculture and Consumer Protection Department, “Livestock impacts on the environment,” Spotlight, 2006

[10] Lappe, Frances Moore, and Joseph Collins. "Myth 3: Only Industrial Agriculture & GMOs Can Feed a Hungry World." World Hunger. Grove/Atlantic, 2015. Print.

[11] Lappe, Frances Moore, and Joseph Collins. "Myth 3: Only Industrial Agriculture & GMOs Can Feed a Hungry World." World Hunger. Grove/Atlantic, 2015. Print.

 

What constitutes sustainability? Are there multiple definitions of it? If yes, is this a problem?

According to the World Commission on Environment and Development, sustainability and its development is defined as the "development that meets the needs of the present without jeopardizing the ability of future generations to meet their own needs". This definition is hard to grasp in our current environment of what Herman Daly calls "Growthmania", in where needs have been replaced by wants. Therefore, our perception of what we need now may differ to what future generations may need. 

According to the New York Times article written by Andrew Zolli, we should be focusing our attention on "resiliency". Yet he fails to see that resiliency is just part of sustainability. If something is sustainable, it must then be resilient and vice versa. This misinterpretation of sustainability must have been caused by the previous definition.

This definition is also derived from a purely humanitarian point of view in where the human race is the epicenter. Within this, the environment only plays a secondary role in providing us the means to meet our needs and nothing more. Therefore, we can ignore the other aspects of nature than we don't perceive as "useful". 

In terms of defining sustainability, I myself lean towards ecological equilibrium as mentioned by Donella Meadows. When a system is in equilibrium, there is an equal balance of input and output. What we take from the environment, we have to give back in the same amount. This limits our capacity to grow but rightfully so. Limits exist throughout nature and we are not beyond that. These limits ensure our survival as a species because what we have now will be maintained for generations to come. However, I don't think that definition of sustainability can be used at our current state. It has to be more now. We have taken too much from the environment. 

There is a new genre of architecture that I believe surpasses previous sustainable design called "regenerative" architecture. It is buildings that give back more to the environment than what it takes from it. Within this discipline, a new definition of sustainability can be found. Ecological equilibrium must be met but only until we give back to the environment for generations of environmental abuse.

 

Second Week in Sagam, Kenya

It took me about a week to get accustomed to the culture here in Kenya but when I did, it made life much easier. The second week of my stay here started off really well. On Monday, I had the opportunity to meet Deborah Rogo, the daughter of Khama Rogo, who owned the hospital. Deborah is the acting General Manager of Sagam Hospital and was a great source of knowledge in terms of hospital operations. Seeing from her point of view gave me very useful insight of operations from the local context. I then presented my analytical findings and masterplanning to her. She had a few comments on things that I may have misunderstood due to the difference in context but overall she agreed with my analysis. From her feedback, I went back and worked on my traffic flow analysis of the hospital to prepare for my presentation with Khama Rogo.

Deborah Rogo

Deborah Rogo

The next day, Deborah gave me a tour of the entire hospital and the sites for expansion. Sagam Hospital has a lot of plans for expansion including housing for their workers. They have been having a difficulty recruiting new members because of the hospital's remote location. I learned that provincial hospitals need to be built with housing in mind to encourage healthcare workers to work there. Since the housing were still under construction, I got a sneak preview of how they locally construct buildings. For most one story buildings, Kenyans use a combination of mud bricks and concrete to build load bearing walls, which are approximately 200mm in thickness. For every 4 layers of bricks, they use a metal bar or "wall pass" to add strength. The bricks are made by simply digging up their abundant soil, pouring that in a mold, then leaving it to dry in the sun. This makes their wall construction very affordable. After the tour, I got back to work on the designs for the 3rd level and the masterplan for the hospital including its expansion.

I then got a call from Khama who told me to observe some masons working on the flooring for the entrance of the ER to see if I can get inspired by local craftsmanship. They used the thin stone and placed it on top of cement mixed with rough sand. Their methods of making the path were simple and rudimentary but highly effective.

On Wednesday, Khama finally arrived and I was able to meet him for a quick update of what I was doing. I presented my analysis and designs. He agreed with me that the old building has poor access to natural light and air ventilation. After the discussion, he told me that he was going to be in Kenya for 5 straight weeks and that he wants a lot of construction done before he leaves. Apart from the 3rd level, he wants to implement what I had proposed for the OPD in class last semester. What I have noticed so far was that construction only really happens when Khama is present on site. He is very hands on with construction and spends a great deal amount of time to make sure everything is moving.

Khama then shared his plans for the second level of the hospital. He wants to add another level above the old building and asked me that if I was not working on the 3rd level, that I should be "dreaming about the 2nd level". I took that as a call to action that I should design the second level. Currently, the doctors in the hospital did not have their own office space. The expansion of the second level would provide them with just that. Designing the second level also gave me the opportunity to give the first level more access to natural light and improve passive ventilation.

Original Building First Level

Original Building First Level

I felt accomplished that Khama had asked me to help him design the second level and that he trusted me as a designer. It was not part of the initial responsibilities that I was tasked with but am happy to accept more work while I was there. Like I said in my last post, I want to make the most of my trip here. After conversing with Khama, my tasks now included helping implement the 3rd level of the ER, masterplanning the entire hospital, landscaping, redesigning the OPD, and now designing the second level of the old hospital.

Thursday started off really interesting because I volunteered to be a patient for a medical simulation. The MGH fellows hold simulations every Monday and Thursday to better equip the Sagam Hospital healthcare workers. My role for this simulation was a construction worker that had fallen off a ladder and was then unconscious. I was instructed to lay down at the waiting room. I was then transferred to a gurney and brought to the resuscitation room. I cannot recall the last time I was being transferred using a hospital bed. It was quite unnerving. After several physical exams, they then had to put a neck brace. Overall, the fellows and I were impressed with the performance of the doctors and nurses.

After the simulation, Khama called me asking me to meet a man named Werewn who was in charge of construction for the steel roof. I had to then explain to him what was happening for the second level. It was a strange feeling being depended on like that in spite of my recent arrival. On my way back to the house, I bumped into Khama who asked me if I could present all my work to him. I then proceeded to present my traffic flow analysis, masterplan, and landscaping.

Traffic Flow Analysis

Traffic Flow Analysis

Throughout the presentation, it was very exciting seeing his eyes light up and that my work resonated with him. He then went on approving my designs and saying that he will work on it within his 5 week stay to make them a reality. It left me in a state of both giddiness and fear because I am finally getting work out in the real world. I have designed quite a bit of built projects but all of them were personal work for my own business. This was the first time that it was for someone else.

On Friday, Tim Duchenness, my first teammate from RISD finally arrived. After giving Tim the tour of the hospital, we then got working on the 3rd level designs to make it ready for implementation. Now that Tim was present, I was able to spend more time on the other designs that needed doing. As per Khama's instructions, we needed to start construction. So Tim and I met the masons that were going to build the curved walls that's part of our 3rd level designs.

We spent the weekend working at the hospital. For Saturday, we were instructed to foresee the beginning of construction at 7:30 in the morning. When Tim and I arrived on time, we had to wait for a couple of hours until all of the workers had arrived. It turns out that just like the Philippines, Kenya had their own sense of time. When they actually started construction, it felt great because we were finally getting physical work done. We started with clearing the floor debris and then we started constructing the curved walls using brick.

On Sunday, I prepared a construction schedule for us. Another aspect of design that I had to learn on the spot. Thankfully, everyone seemed to be on board with the schedule that I had proposed. Overall, the week was a pretty productive one.

First Week in Sagam, Kenya

I have had the great opportunity to fly to Kenya as part of a fellowship program sponsored by Mass General Hospital (MGH) and Rhode Island School of Design. The purpose of the fellowship was to implement the designs we have been working on throughout the last semester for a hospital in Sagam, Kenya aptly named Sagam Hospital.

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Manifesto: A Nation Built on Wellness

It is clear that alternatives to our current state of capitalism has to be formulated due to major inefficiencies inherit within it. These inefficiencies manifest itself in inequality, inequity, and environmental unsustainability. We believe that we have progressed far from our ancestors and yet we still face the same issues that they have faced, if not worse. With all the technological and societal advancements we have achieved as a race, how have we not solved these issues? Is it part of our nature? I don't believe so. I believe that the root cause of these issues is how we perceive value and in parallel our commerce and economic system.

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DESINELab Student Lecture

I was recently invited to give a student lecture on healthcare as part of an ongoing series by DESINELab here in Rhode Island School of Design. I wanted to share what I talked about here in this blog to extend the conversation to a wider audience. Any kind of feedback or comments would be much appreciated.

My interest in healthcare was sparked in an advanced studio class I took with Nathan King and Olga Mesa called Future Health Systems. In this class, I realized that most of my personal efforts in trying to affect positive change, within systems like business, the food industry, agriculture, and education were all connected with healthcare, or at least my own vision of healthcare. For that studio, I proposed an ideal healthcare system for the Philippines through architecture, which you can find here. I am currently writing a manifesto for it, in the hopes of making it a reality. 

This narrow focus on a specific area of design has opened many doors for me. I recently did an internship in MASS Design Group, as one of the first RISD students to do so. I have been asked to start consulting with a group of doctors in Manila who are building about 40 hospitals and clinics across the country. The pace of my understanding and knowledge on the field has been increasingly fast due to my niche interest in specializing coupled with the demand of good designers in the field. 

Paradigm Shift in Healthcare

Healthcare has long been ignored by the majority design community. Yet, it is currently experiencing a paradigm shift in where designers are crucial components. This shift is in response to a universal effort of decentralizing and defragmentizing traditional healthcare: from reactive to preventive, from medicine to wellness, from the hospital to the home, from the wealthy to the masses. Therefore, the definition of healthcare is as complex as ever.

Traditionally it is defined as the diagnosis, treatment, and prevention of disease, illness, and other physical and mental impairments in human beings. However, a lot more attention has been focused on just diagnosis and treatment. It is traditionally delivered within primary, secondary, and tertiary care, as well as public health. 

However, projecting forward this definition, as I have mentioned, will change. Therefore, looking forward, my own definition of healthcare is the maintenance of a persons complete wellness system, which includes social, spiritual, physical, occupational, intellectual, emotional, and environmental.

For this lecture, I will be using the lens of architecture in talking about design in healthcare but I want to emphasize that any field of design is just as important. To help understand the current context of healthcare architecture, I want to quickly talk about its history. Just like design movements, healthcare has gone through several revolutions since its inception. 

Prehistory of Western Hospital Architecture

Prehistory of Western Hospital Architecture began in Ancient Greece where the concept of health was closely linked to religious rites and rituals. It emulated the model of their classical temples. In the middle ages, monastic hospitals were built that resembled monasteries like Hotel Dieu. Most hospitals until the 1700's were designed in parallel to the architecture style of their time. They were rarely designed with the pure intention of being a place for treatment. In the renaissance, hospitals were designed according to the geometrical principles that were popular at the time like the Ospedale Maggiore in Milan in 1468. Then in the 70's western countries started producing statistics that triggered the first revolution in hospital design

Ancient Greece

Ancient Greece

Middle Ages

Middle Ages

Renaissance

Renaissance

First Revolution: Built Natural Healing.

Hospitals were the first buildings that were completely determined by scientific and philosophical concepts. It was inspired by the poor outcomes of existing hospital designs that pushed designers to rethink hospital design. Two concepts were brought forth in Paris: the radial system and the pavilion system. Both systems believe that healing is not derived from medicine but from being in a purified, natural environment that provided clean air. The Hopital Lariboisiere by M.P. Gauthier built between 1839 and 1854 is credited as the first pavilion hospital. Pavilions maximized sunlight and windflow. Apart from designing hospitals using the beneficial effects of nature, architects designed hospitals to become iconic. By housing medicine in such a way, it influenced the public to believe that it was important and thus provided more investment, which drove medical science. 

Second Revolution: Medical Science and Technology.

At this time period, we begin to see the shift from using nature to using technology. This shift in balance began with the invention of the x-ray. Pavilion type hospitals were replaced with block hospitals because they thought long corridors made it more inefficient. Block hospitals were good for centralizing common utilities like the x-ray which was too expensive to place in every building/pavilion. The first of this block type was the Columbia-Presbyterian Medical Center in New York by James Gamble Rogers built in 1930. However, with the introduction of the block type, we lost an essential architectural feature: the ambition to create healing environments that emulated nature.

Third Revolution: Hospital for the Masses.

This revolution was the product of WWII and the 'social revolution' which fostered the idea of the Welfare State. Social Security Systems were set up in most countries to safeguard the public from unemployment, disability, old age, and illness. Due to the influx of new patients, technology was focused on treatment facilities and outpatient wards. Hospital architecture became synthetic and a new type of hospitals emerged called Matchbox on a Muffin Type. The idea with this new type was that it is much easier to rebuild and redesign the ground floor than to make changes in high-rise buildings. It combines a flat spreadout building and a high rise building containing the patient ward on top. It allowed changes to occur without disturbing the patient wards. The first of this type was the Hopital Memorial France-Etats-Unis in Saint-Lo by Nelson in 1956. Since hospitals were now open to a larger population patients stopped being treated as people but collection of possible diseases or just data. This ran parallel with the capitalistic trend of the Western culture and the rise of bureaucracy. 

Fourth Revolution: Empowering the Patient.

Hospital embodies conflict between the individual, and the needs of the medical staff and equipment. This led to the invention of a neutral, industrially-built, unexpressive structure that was no longer recognizable as an individual building. An example of this would be the Medical Center of Groningen in the Netherlands which emulated the city by introducing covered streets, a huge hall, and many shops and restaurants. Unfortunately, The transition from a medicine-dominated to a management-dominated hospital has not curbed the process of institutionalization. It failed to return the hospital to the people. Technology and science that was once the main justification for hospital architecture and design is now what is driving it to the opposite direction. 

Fifth Revolution: Returning the Hospital to the People.

This revolution should initiate the return to the basic principles of decent management, empowerment of the patient, de-institutionalization, and the courage to re-conceptualize healthcare and to let it go back to its core business. We are the generation currently undergoing this paradigm shift. Healthcare is shifting from being purely reactive to preventive, but we still have a long way to go. 

Designing Forward

How can we design for this new shift towards preventive healthcare, or what we can even call responsible design? I believe the answer lies in research and evidence-based design. When I interned in MASS Design Group, I learned that there should be 4 stages in design. Traditionally especially in architecture, there are two that we mostly focus on: Design and Construction or Manufacturing. However, there should be two more stages to make design more efficient and effective. 

Prior to the design phase, there should be a pre-design phase in where you research the context holistically. RISD design students are very aware of this and most of us approach projects this way anyways. However, where I think we are lacking are looking at things from a systemic point of view. Here is where ID students do better than architecture students in my opinion. In architecture, we often use the pre-design phase as basis of form and program making, which I think is still very shallow. Pre-design must be thought of from the scale of systems all the way to the people that use the system. 

The fourth phase goes after construction or manufacturing called Impact Analysis. This is often very difficult to do because it costs money outside the traditional budgets that are given by clients. However, it is one of the most important phases because it teaches the designer what actually works and what doesn't outside the theoretical realm. Without Impact Analysis, we cannot achieve a complete feedback loop and that is why history of design has been so inefficient and ineffective. We are currently designing objects and buildings without considering what kind of futures they will create both environmentally and socially. This is a manifestation due to the lack of impact analysis of our designs. 

With all 4 phases completing a feedback loop, designers can truly achieve research and evidence-based design. This means that your design is an efficient use of resources because your design meets a real need and demand rather than a theoretical one. From this we can start designing an environment that actually suits our human needs and prevent us from being unwell and getting sick. We cannot use money anymore as an effective way to gauge the flow of resources. Why not try using wellness as a metric of developing a project and as a way to see its following success?