Description

The planning of new facilities as well as the large-scale reconstruction of existing ones requires a clear view of future needs. To a remarkable extent, these needs can be predicted: ‘Prognoses can be based on the basis of the length of time between causation and the appearance of disease.’[1] Given adequate information about the composition of the population, including both basic demographic facts and data on lifestyles, jobs, education and wealth, as well as on consistent trends among these factors, one can safely assume, for instance, that regions experiencing economic growth will adopt lifestyles that typically promote obesity; and where this occurs, the period of time it takes before the diseases associated with obesity manifest themselves can easily be forecasted.

Hospitals typically draw people with diseases that cannot be treated without the high level of professional skills and the advanced medical technology only they can offer. The great majority of their patients suffer from disorders that are not contagious. Although the far more common, so-called non-communicable diseases (NCDs) usually lack the spectacular and frightening aspects of, for instance, Ebola, they account for 75 % of deaths worldwide and as much as 86 % in Europe. Whereas not a lot can be done to prevent epidemics, it is estimated that 80 % of cardiovascular diseases and 40 % of all cancers could be avoided. Likewise, changes in the relative incidence of illnesses must be taken into account. Some afflictions that were widespread in the past have virtually disappeared, while others have taken their place. For those charged with preparing hospitals to cope with future needs, statistical data on demographic trends and the occurrence of diseases is indispensable.

In 1796, Edward Jenner ushered in a whole new branch of medicine when he introduced a vaccine against smallpox, and thanks to vaccination campaigns some diseases have virtually disappeared. However, the emergence of SARS (severe acute respiratory syndrome) in 2002, the chicken flu caused by the N5N1 virus that unleashed a pandemic in 2009, and subsequently the swine flu and Ebola all serve to demonstrate that new contagious diseases and epidemics can occur at any time.

In the treatment of non-communicable diseases medical progress has been impressive owing in large measure to the pharmaceutical industry’s continuous development of new drugs. Equally crucial has been the introduction of new imaging technologies — magnetic resonance imaging, positron emission tomography — which has revolutionized diagnostic procedures. And thanks to highly sophisticated surgical procedures (sometimes using robotics), minimally invasive operations have become an everyday reality that was unthinkable only a decade ago. Undoubtedly the most impressive advance in the last decade has been the development of gene technology.

The promotion of healthy lifestyles is another development in public health. Social stratification also has a bearing on health issues. In some European countries, the difference in life expectancy between the upper classes and lower classes is eight years.[2] If unhealthy lifestyles prevail, this will lead to an increase in the demand for healthcare services. However, unhealthy lifestyles do not shorten the time during which people need medical assistance. Architects and urbanists can play a vital role in providing environments conducive to health. ‘Healthy cities’ should provide clean air and limit automobile use while favoring pedestrian and bicycle mobility.

Aging populations are an important factor in public health. The need for medical treatment correlates closely with age and reaches a peak in the last years of our lives: the larger the number of elderly people, the higher the demand for medical assistance. However, the age when medical problems first manifest themselves remains about the same, at around 40. The growing number of the elderly combined with the prolongation of the period when they require medical attention is expected to result in a steep rise in the need for healthcare. ‘Healthy aging’ has become a well-known concept all over the world. Strategies to support healthy lifestyles will also contribute to better integrate the hospital in society.[3]

Footnotes