• December 14, 2022

By Antoine Buisseret

Hospitals reflect the times in which they exist. As chronic illnesses, aging populations and health crises continue to rise, hospitals are finding that they must become far more humanistic and integrated within the urban fabric around them, making their relationships to their environment more pertinent than ever.

Natural environments have historically been connected to hospitals, but those connections have faded over time. Just as agricultural systems first began with local and smaller-scale producers, they became industrialized over time; hospitals have faced a similar industrialization, where they became factories for treatment and lost their more basic, natural components such as access to sunlight and natural ventilation methods.

Today, the climate footprint of the health sector is equivalent to 5% of the world’s net carbon emissions; to put that into perspective, if the healthcare industry were its own country, it would be the fifth-largest emitter globally. With environmental designs, however, tomorrow’s climate positive hospitals can be an active player in mitigating the impacts of climate change with deeply beneficial relationships to cities. This paradigm shift would give an opportunity to reconcile ecology and healthcare, making healthcare infrastructure more desirable for both professionals and their patients.

Environmental factors are social factors

Currently, hospitals’ massive emissions result from a perfect storm of operations: They’re teeming with technical equipment, computers and lighting running 24/7, single-use medical waste per patient can add up to as much as 43 pounds per patient a day, hospitals’ food’s quality and consumption factor in heavily, and massive amount of energy and transportation is required for supply chains.

All of these create a deeply set environmental footprint at a time when mitigating the effects of climate change has never been more urgent. I believe that by turning focus to their pollution, waste, emissions and impacts on health and well-being of not only patients but greater populations, design can respond in beneficial ways.

What is good for a city is also good for hospitals: Healthcare can’t be seen as a sector isolated from our daily lives but a part of our cities, designed sustainably in future-oriented ways. My work in hospital design over the years has led me to see that we must critically rethink our approach to hospitals, seeing them as interconnected to greater ecosystems that takes everything—from urban systems to the locals its everyday activities impact—into consideration alongside aspects such as biodiversity, urban agriculture, energy production and consumption when designing them. This way, hospitals and other healthcare environments can be precursors to integrating more vulnerability into their design process, all with the goal of creating more adaptable, integrated and inclusive cities.

Hospitals cannot be constructed as finite and standalone structures, but as open and ongoing spaces that are socially-focused to have greater and more positive environmental impacts on the world they are a part of. Even by building lower and in ways that integrate with landscape can create more opportunities ranging from lowering urban heat island effects while increasing therapeutic qualities with access to nature, gardens and large urban promenades that are accessible to all.

The green hospital: A radical shift in perception

Healthcare and the environment do not need to be at odds with one another. Sustainability and energy-efficiency are now at the forefront of built environment design, and hospitals are part of this shift. As older healthcare infrastructure is becoming increasingly obsolete as technological advancements improve, new and greener hospital designs, the recycling of existing structures, and adaptive reuse to reduce embodied carbon are all avenues which present new possibilities that combine environmental protection with saving human lives.

What’s most beneficial for a green hospital’s design is what can be the most beneficial for patients, from increasing access to daylight to improve sleep, natural ventilation methods for air quality, and the presence of nature through biophilia, landscaping and interior design—something which, alone, contributes substantially to physical well-being by reducing blood pressure and heart rates, easing muscle tension, and offsetting the production of stress hormones that are all too common in healthcare environments.

Sustainable design principles and material choices may present unattractive upfront costs, but those investments can offset long-term expenditures such as operations. This presents an avenue for reduced impacts on the environment and increased efficiency while leaving room to improve emissions in more high-impact areas such as equipment, products used, maintenance and purchasing practices—altogether creating a more healthy work environment for patients, healthcare practitioners, and the planet.

Buildings with greater integration of biophilia, green roofs and beyond have already been shown to contribute to improvements in mental health, healing and productivity, and hospitals are no exception. Plants can scrub the air, reducing respiratory illnesses and pollution removal, and even their presence has been shown to help hospitalized patients heal faster with reduced infections and lowered needs for pain medication while energizing staff with their esthetic, acoustic and air quality benefits.

Our built environments have everything to do with our well-being and health

We have the studies, methodologies and designs to prove it: Ecologically-minded and environmentally sustainable hospitals are beneficial not only for their patients, doctors, nurses and staff, but for the greater urban contexts which they serve.

As I look forward to new generations of hospitals, I see boundless opportunities in the architecture of care, where health and wellness are reconciled with the planet through innovative practices. Inside-out and outside-in, hospitals must go beyond themselves, explored form perspectives that reconfigure their coexistence with today’s new urban conditions.

No healthcare institution should be limited to its own operational framework; the most innovative and beneficial projects of our shared future should explore not only immediate needs, but needs to come—and environmental design presents a wide-open pathway for rethinking our built healthcare environments in all the forms they take.

Learn more about how the physical and social built environments we create are central to our health and well-being by exploring sustainable strategies in design with Lemay’s Net Positive framework.


Antoine Buisseret, Portrait, Architecte, Lemay

Antoine Buisseret is a design director and Lemay’s Director of Market Intelligence in Healthcare. A university professor, author and co-founder of the #hôpitaldufutur research platform, he has spent 18 years of his life leading the design and development of major hospital projects internationally as well as major mixed-use, office and research projects. His design process focuses on combining exploratory research, sustainability, collective well-being and user health.