Urban Afflictions. An Interview with Hilary Sample (Part Two)

Urban outbreaks: SARS 2003

Urban outbreaks: A/H1N1 2009

Following up on our interview with Hilary Sample on the subject of global health crises in urban contexts, we've moved from the backdrop of her research and the specific responses she's studied to a more speculative perspective on the issue. If you haven't read the first part, scroll down or click here.

Where: You've identified a combined research/corporate drive behind the Biomed City phenomenon (those of you who haven’t, go download and read Hilary’s short essay on the BMC here). Due to current political and economic events, we see a tendency towards a heavier and more direct government involvement (particularly in the U.S., but in other places as well) in the different areas that are the backdrop for BMCs: economic policy, health care and infrastructural development. Do you see this affecting the nature of the BMC? For the good or for the bad?

Hilary Sample: We can look to Singapore as an example of the government-driven development, specifically in the Biopolis project. The masterplan was designed by Zaha Hadid, which had an extensive landscape and programmatically included a lot of public functions, along with connection to the subway system-extending it into the Biopolis. Subsequently not much of the public components have been built, but the project continues to grow with frequent announcements of new corporations renting space. It is a private interest project supported by the government. Singapore’s government does not place any restrictions on scientists working with stem cells, and this is one factor driving the brain gain and science boom in Singapore. Interestingly, universities such as Johns Hopkins, which have space problems at their campus rent space in the Biopolis. In this case, we see branding of health taking on new structures.

In the United States, it seems difficult to think that the private sector would begin to support innovation in terms of adopting a clear social agenda with respect to urban health development, even though there are tremendous needs and opportunities to rethink the way our cities could function with respect to health. The current moment does seem like an opportunity for government action, not only in terms of providing access to a better health care system, but for a complete reframing of the idea of health, at least in this country.

I think this could be supported by both Federal and city governments and inspire private developments. In my opinion, we need radical change in the way health care is promoted and in the physical spaces in which treatments and care are given. I’m interested in how architects and designers can rethink the city as we know it and develop new systems and forms that are civic, not just expanding the existing hospital building by adding to it. The image of the hospital from what it used to be has become unrecognizable. Hospitals are often referred to as cities in their own right, but in my opinion, they take the worst situations from cities as their examples. We need new paradigms, especially with the super hospital being developed as a mega-scaled building.

Biopolis, Singapore

W: Another revealing aspect here is the geoeconomic breach one perceives between "prepared" and "unprepared" cities. With the exception of China, maybe, BMCs are apparently limited to developed countries. At the same time, the cities that are most vulnerable and more exposed to health threats of this nature are those in underdeveloped countries. What do you think?

HS: Largely, I believe this is true; we have a huge division between prepared and unprepared cities. But the idea that Third-World cities are always unprepared or that First-World cities are prepared isn’t always the case. The SARS outbreaks showed us this exact problem. For instance, Hanoi — one of the poorest and least developed cities in terms of urban health developments — actually had one of the best responses to the SARS epidemic. It was the first city to get a hold on the spread of the virus. They basically did this by isolating all SARS patients to two hospitals on the outskirts of the city. In Beijing we saw the construction of a hospital in 8 days.

I wouldn’t say it is a regional trend, but in this one instance it shows that at a local level spatial practices worked well. I don’t think we can say it is an either or situation. The SARS virus was identified through the collaboration between many scientists in many different countries. The virus itself spread quickly, but so did the effort of scientists to find an answer, which relied on a spatial network of laboratories and governing agencies. The spatial organization of both are extremely important.

W: Do you think a different version of the BMC could arise in cities that don't have the funds or the resources to build huge hospitals and research centers? Maybe one that opts for networked, flexible, mobile infrastructures that could be deployed whenever and wherever needed, including the poorer cities of the South?

HS: This has been the subject of a graduate research seminar I taught at Yale called Design and Disease. An amazing feature of our interconnected world is that we are learning more and more about situations of impoverishment, poor health, and the lack of establishing life-sustaining infrastructures.

In the seminar, the students made a kind of index of building types in cities around the world, looking at hospitals from Hong Kong to Soweto, pharmaceutical companies (Roche vs. Novartis in Zurich) and the performance of architecture.

One of the most surprising instances we learned about is in Soweto. The Bara Hospital sees more than 2000 patients a day, with a large population of AIDS/HIV patients. It claims to be the largest hospital in the world, but this is a hospital that has been built within an aging British Army barracks, and in the context of limited access to resources, including electricity. Here a complementary support system would be a good option to support what little infrastructure and physically working buildings there are. So maybe flexible and mobile structures are more economical or efficient when you have nothing better, but really what all cities need are both permanent and mobile health support.

New York City is an example that has both some of the leading hospitals in the world, but also significant mobile infrastructures, from asthma vans to PODS (points of dispensing systems in the event of an epidemic). It’s significant that cities with permanent, large-scale buildings also have equally and burgeoning mobile systems, suggesting that both are truly needed. But how can we make these decisions as designers? In my opinion, it all comes back to the practice of understanding how cities perform at the most detailed level, and examining the diseased city is essential. Mapping activities of urban disease is essential.

Baragwanath Hospital, Soweto, South Africa

W: This last outbreak in Mexico generated an enormous amount of activity on the Web: everything that we’re starting to grow used to now (real-time reporting on Twitter, constant updates on Google News and recommendations delivered directly from institutional web pages) but also some fascinating tools we really hadn’t seen before (I’m thinking of the Google Flu Trends project). Do you think we will see more alert systems, diagnostic means, protocols, open-source and web-based strategies in the future, or, we could say, a “smarter” response strategy?

HS: We see scientists working with a kind of virtual epidemiology, and they’re doing this more than any designer or spatial planner. For instance, I have a case in mind in which researchers studied a hypothetical outbreak of smallpox in Portland, Oregon, trying to identify social trends in an urban disease situation. The study included specific maps of the transportation infrastructure, and looked at how people moved in the city. This is an extraordinary spatial analysis that would be a powerful tool for architects, planners, and designers. Portland is a city that has made interesting urban decisions tied with how to better access its health-care infrastructure, including the Portland Aerial Tram designed by AGPS.

By comparison, there are actually very few studies or projects that I have seen looking at the contagious disease in cities by designers. I can think of two important works that shed light on the SARS outbreaks. The first is the “SARS Atlas” by Fabrizio Gallanti and Francisca Insulza published by Domus in 2004, which indexically mapped disease hot spots in cities. The other is Julie Rose’s essay in Log, a description of the urban spatial shifts that SARS produced in Hong Kong.

The spatial and social consequences of a disease reveal the performance of a given city. With the recent 2009A/H1N1 outbreak, just five years after the SARS outbreak, it seems likely that we are going to see more frequent events of this kind. In the end, if hospitals fail in an actual emergency, then suddenly subways are empty, people are in their cars or at their family’s house in the suburb, the city fails, the economy fails and it takes years to recover. The way we design our buildings and cities should be rethought to include social spaces that work.

W: This last question is probably more abstract (even emotional), but I think it's just as relevant in terms of spatial effects. I would like to discuss this recurring issue of fear, not only in terms of the outbreaks themselves, but regarding measures taken to deal with crises as well. You mentioned something about this regarding the resistance some of these public health projects have met in cities. It’s interesting to see how these developments might generate suspicion in themselves and cause a stir, like a high-security prison or a nuclear plant probably would.

There is also a whiff of mid-century paranoia about the whole situation, the fear of the looming dangers of density and the city core (you mentioned that many of the projects are built in secluded and distant locations). In Mexico City lots of people actually fled for cities nearby over the weekend when the crisis was announced. What do you think of all this?

HS: There is no question that fear, like the virus, is an epidemic. And it does seem like urban disasters are on the rise, Katrina, SARS, 9/11. There are patterns that we can now begin to study and understand, which would in turn affect the way we design both buildings and cities. In general there are two trends emerging regarding what we’ve been discussing here:

First, the building-up of the urban core with super hospitals and biosafety labs, new transit connections between these centers, and the location of research laboratories within the city rather in remote suburban parks. In the U.S. many developers in the sector are abandoning the model of suburban corporate park in favor of building in the city. Some cities have begun to build their own biosafety labs. Some of these laboratories test deadly viruses, like the Boston case we mentioned before. Ultimately, it winds up being housed in a non-descript building sited within a hospital district, but the surrounding neighborhood is considered to be a low-income area. This raised many questions at the time of its construction.

The second trend, which we see mostly in South East Asia, is the building of remote hospitals, far from the city core, with architectural renderings that show them surrounded by green spaces.

In the end, both of these urban strategies are driven by fear.

It isn’t surprising that people fled from Mexico City; this was the same reaction in Beijing during the SARS outbreaks. How people react to crisis is unpredictable, and so, at least for designers, it seems we can only study what has already occurred. Again, here I think that the most significant spatial studies are being developed by scientists or artists, not architects or planners.

In 2005, researchers Nina Fefferman and Eric Lofgren, examined the video game "World of Warcraft” and the introduction of a virtual virus within a controlled environment. The virtual virus quickly and unexpectedly corrupted the virtual world, and learned that there were many similarities between the virtual and real life scenarios.

Christain Nold, an artist, has been working on a bio-mapping project that tests emotional responses of individuals in urban contexts. These studies result in maps that give us a whole new geographic perspective of the city. What I appreciate about this study is that we see a range of emotional responses that correspond directly to the built environment. Again here there are lessons to be learned about the performance of our constructed environments.

Protest against biosafety lab, Boston

W: Thank you so much Hilary, it’s been great talking to you! I think we’ve covered a pretty good spectrum. Now let’s hope our Where readers out there have more to add to the discussion.

(Maps courtesy of Hilary Sample. Photo from Flickr users askpang, srippon, and steph ps. The original full-sized color version can be viewed by clicking the photo.)

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