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Editorial 2/2023: Caring for People Needs Architecture
The architecture of care is a fitting symbol of the Finnish welfare state, both when it comes to the ideals and objectives and when it comes to a number of the problems. A network of care buildings covering the entire country should – at least in theory – guarantee equal access to social and health care services to all citizens, from child welfare clinics to hospice care. On the other hand, the aging complexes, pieced together little by little over time and riddled with indoor air issues, can be viewed as a metaphor for a system in need of a thorough overhaul.
The problems have been tackled by renewing the organisations providing social and health care services, as well as the care buildings themselves. Over the last decade, mind-boggling sums have been spent on new hospitals and welfare, health care and senior centres, as well as on renovating old buildings – the estimated costs of the Oulu University Hospital renewal programme alone are 1.6 billion euros. The investments are typically justified by savings in personnel costs that can be achieved by streamlining operations. Leafing through old volumes of the Finnish Architectural Review reveals that, while the start-up costs of a new hospital in the 1950s corresponded to the operating costs of four years, the start-up costs today are matched in just one year of running the hospital. Not even the substantial carbon emissions of construction seem to draw much discussion.
The previous great wave of care construction was seen in the 1950s–1970s with the creation of a nationwide network of central hospitals and health care centres. When the Finnish Architectural Review presented the results of this process in 1978, Editor-in-Chief Markku Komonen criticised the large care institutions for their bleak anonymity, citing developer organisations in which “holistic perspectives had become stuck in a thicket of partial views and unconnected pieces of information” as the main culprit.
The next wider review of hospital architecture was 36 years in the making. In 2014, we saw the dawn of a new construction boom and the general mood was hopeful: architects were developing more open, flexible and urban hospital concepts in which architectural quality would also play an important role.
Now is a good moment to examine whether the designs have delivered on the promises made nine years ago or whether we have become mired in the more technocratic mindset described by Komonen. In this issue, to provide an overall picture of the situation, we have compiled a selection of recently completed care buildings, as well as buildings that are still in the makings, with the scale spanning from health care centres to university hospitals. In several of the new buildings, commendable attention has been paid to the comfort of patients and staff, but at the same time, one has to ask whether a tall, deep-frame building really is the only feasible typology for today’s care buildings.
While the start-up costs of a new hospital in the 1950s corresponded to the operating costs of four years, the start-up costs today are matched in just one year of running the hospital.
One speed bump in the way of a care construction reform would appear to be the requirement of extensive references for the designers of these large projects. With newcomers having next to no chance of getting the commissions, the projects all fall in the hands of a few, albeit highly qualified, practices. Many of the most well-resolved hospitals from the 1950s–1970s were based on architectural competitions, but only a handful of competitions for hospitals have been arranged during the new millennium, some of which with not much to show for them by way of results. The Meilahti Bridge Hospital featured in this issue is based on an invited competition held in 2015, and the expansion of Lapland Central Hospital is being implemented based on the winning entry of an open competition arranged the same year.
There has been a significant shift over the last decade in attitudes towards the existing building stock. In the hospital issue of 2014, several writers brought up how much easier it would be to replace old hospitals with new construction instead of renovating and expanding the dinosaurs. At the time, experience in such radical measures chiefly came from abroad, but in just nine years, this has become standard practice in Finland as well, as you will find in the concise review of the disappearing built heritage of health care.
The other articles included in this issue study the concept of care from wider perspectives beyond construction. Hanna Tyvelä writes about care construction as part of the Finnish welfare state project, while Emilia Rönkkö and Helka-Liisa Hentilä outline the preconditions of urban design and planning that takes the health impacts into consideration.
The projects introduced in this issue describe the different premises of health care architecture. In Jyväskylä, a completely new hospital has been built next to the old one; in Helsinki’s Meilahti, the existing hospital complex has been filled in at the edges; and in Myllypuro, a 1970s hospital building has been revamped into a new-generation senior centre. Finally, the Serlachius Art Sauna transports the reader to the very fountain of the experience of wellbeing. ↙