From moods to microbes: designing better indoor spaces w/ Emily Anthes

Jen Hancock: 

It’s a big world out there, but we spend most of our time inside.

Ninety per cent of it, if you live in Europe or North America. 

So wouldn’t you want the environment where you’re spending ninety per cent of your time to be designed with your best interests in mind? 

Instead of planning cities to prioritize economic growth or urban revitalization, what if we looked at the built environment through the lens of something much smaller?

Like the four walls right in front of us.

Emily Anthes is a science reporter at The New York Times and the author of The Great Indoors: The Surprising Science of How Buildings Shape Our Behavior, Health, and Happiness. 

Emily Anthes: 

I am a science journalist, and one of the reasons that I love this job and I gravitated towards science journalism rather than actually being a scientist, you know, “proper,” is because my interests have always been really broad and wide-ranging and I would much rather learn twenty things about twenty different topics than go really deep on one topic. 

Jen Hancock: 

For the past few years, Emily’s been spending a lot of time thinking about the indoors and how it affects us. 

Sights, smells, and sounds can impact just about everything; our mental health, nutrition, creativity — even mortality.

Take layout, for example. 

Open offices are beautiful to look at, but they can derail the focus and productivity of introverts. They can also contribute to disease transmission; a 2011 Danish study found that people who worked in open offices took sixty-two more sick days than those in private rooms.

But the impacts of a bad floorplan can go beyond the annoyance of working in a noisy room, or smelling a coworker’s microwaved fish for lunch.

A poorly-planned hospital can transform from a place of recuperation into a dangerous maze for those with memory loss or cognitive decline. 

An awkwardly-tight operating room can force surgical staff to walk further than necessary, causing delays, breaks, or even mistakes during critical operations.

Jen Hancock: 

And sometimes, the tiniest contributors have the biggest impact. 

Emily Anthes: 

I saw several studies come out that were about the microbiome of the home. And it just sort of blew my mind that that was even a thing. I was like, “What do you mean the microbiome of the home?” And so that was sort of what made me start thinking about our indoor environments in a new way that like, “Oh, there's all this hidden complexity there that we don't appreciate.” 

Jen Hancock: 

It’s not just our homes; every indoor environment contains microbes: hospitals, schools, prisons, offices… you name it. 

Emily Anthes:  

A lot of it comes from our body. You know, there are all these microbes that live on and in us. And as we walk around, they're, you know, flowing off us. But some are coming in from outdoors. So, you know, what kind of plants and soil do you have in your geographical area. All those things sort of combine to give your home a unique microbial fingerprint.

Jen Hancock: 

Many of the bacteria we coexist with are relatively harmless. 

Emily Anthes: 

These are normal microbes part of healthy ecosystems. 

Jen Hancock: 

But when conditions change — for example,  with flooding, and rainfall from unpredictable climate change events — things can wake up.

Emily Anthes: 

There was this study of commercial drywall and it turns out that there were dried, desiccated, basically inactivated fungal spores hiding in the drywall, and it posed no health threat as long as it stayed dry. But when the researchers got it wet, these fungal spores basically reanimated or resurrected, and suddenly they can begin replicating and causing mold and the health problems we associate with it. 

Jen Hancock: 

I’m Jen Hancock, and today on Building Good, our producer Katie sits down with Emily to get the inside scoop. And they started with a place that many of us never want to go: the hospital.

Katie Jensen:

Can you talk about what you learned about hospital design when you were writing the book?

Emily Anthes: 

Yeah. So obviously when you're talking about a place that is serving sick patients and very sick patients, considerations can be different.

And especially when you're talking about, like, an ICU, an OR, there are absolutely places in a hospital that you want to be sterile, for sure. But that said, this sort of general idea of connection between indoors and outdoors is a theme that comes up again and again, regardless of what kind of building you're talking about.

And it's not necessarily microbes. Maybe it's, you know, giving all hospital patients visual access to the outdoors, making sure that they can see trees and greenery. There's a lot of research that that doesn't just, you know, boost mood, but it literally speeds healing time. People get discharged sooner. So a lot of this research and recommendations come back to, “How can we make our buildings feel less like these hermetically sealed, sci-fi, high tech environments, and how can we restore some of the connection with the outdoors?”

Katie Jensen: 

And I also think it's important to mention the studies that have been done on pain management, too. It's not just about getting discharged faster. It's also about the quality of stay when they're there, too, where they're not just completely miserable.

Emily Anthes: 

Yeah. It's one of the most consistently-replicated and oldest findings in the literature. And I think one of the few things that I would basically universally recommend to anyone, in any environment, is incorporating nature in some way, whether that's you know, actual plants, a view of trees, some sort of incorporation of nature. It seems like it just has huge benefits.

Katie Jensen: 

I want to throw a quote from the book at you, which really stopped me in my tracks. From Dr. Magda Mostafa: “Everyone has a basic right to good design. And design standards only cater to six-foot tall, perfect male individuals that have good visual capacity, good hearing capacity, and a statistically-typical sensory profile.”

Emily Anthes: 

I mean, the idea of what we usually call, like, accessible design is not going to be new to anyone. That's an old idea, but it's also sort of an outdated idea. It's a limiting idea. It's typically been defined as, you know, giving people literal quote unquote “access” and has been very focused on people with physical disabilities.

There are a lot of designers now thinking much more expansively and it's not just about giving people access to buildings, but what do people need to be safe and comfortable and thrive in these environments? And it's not just limited to people with physical disabilities, it's encompassing people with all sorts of invisible disabilities; neurodivergence.

There's a growing understanding of the fact that you know, there's a lot of talk about user needs and catering to the user. Well, users and occupants are all different. There is no one user. And I think for a lot of time, it's been optimized for this one user. And there's a lot more thinking now about, “How do we serve the diversity of people that use this building?”

Katie Jensen: 

Something that I was thinking a lot about with respect to this is the fact that we're all temporarily able-bodied and that our built environments are static when we need them to be dynamic and change with us throughout our lifetime. Did you come across anything where people were thinking about this?

Emily Anthes: 

Yeah, I mean, it's definitely part of sort of like the underlying, how the underlying discussion around disability and accessibility and design has changed is exactly what you said. We're dynamic. All of our bodies are dynamic. A lot of us, if not all of us are going to flow in and out of different degrees of ability and disability throughout our lives.

So it's pretty shortsighted for someone to sit here and say, “Oh, you know, because I don't have a movement disorder right now, I'll always be able to move fine.” I mean, just natural aging, we know, is a problem. And in terms of what that means for design, it's tricky because here I've just listed all these different types of ways people might experience the world differently or how their abilities might change.

And a natural question might be, well, how do you design for all those people? And I think one sort of generally good principle is variety and choice. So providing whatever it is that your building does, like, providing different ways to navigate to a destination or, you know, easily accessible stairs and elevators, rooms for big gatherings and smaller spaces where people can retreat when they're overwhelmed that maybe have fewer sensory stimuli.

The idea is that people can sort of seek out what they need and buildings can sort of make it possible for people to find what they need, if that makes sense.

Katie Jensen: 

What did you learn about patients within hospitals and the transition away from wards to individual rooms? Why is it useful and why do patients have better health outcomes when they're alone?

Emily Anthes: 

Yeah, that has been absolutely a trend in health care design and I talked to a lot of people who complained about trends in health care design that were bothering them, but this is sort of one of the trends that people say has definitely been a good thing. There's a lot more private rooms in health care now in hospitals than there used to be, and that can benefit patients for a whole bunch of reasons.

I mean, one, there's simply the infectious disease reason, you know, sharing a room with someone increases the odds that you transmit, if you have an infectious disease, that you transmit whatever it is to your roommate. So that's a big one. But then we also know that things like noise, for instance, is a huge stressor in general, but also in hospitals.

Hospitals can already be noisy. You know, there's beeping machines and people in the hallways. But then if you have a roommate who has his or her own set of beeping machines and, you know, shuffling around. That noise can be a stressor. Also, just, you can't understate the importance, the psychological importance, just, of privacy.

I think that's something that is important to people. I mean, hospitals already can be a place where one can feel like their dignity is stripped from them a little bit. And so I think restoring some of that with a private space can be really beneficial.

Katie Jensen: 

Another thing that came to mind was the concept of zoochosis and the fact that, you know, any mammal trapped inside of a sterile, very same-same environment will start to go a bit nutty. Can you talk about being presented with visually-stimulating and mentally-stimulating built environments and why that's good for the brain?

Emily Anthes: 

You know, I'm starting to sound like a broken record, but it's true. Like there's a balance here. So our brains don't like just tons of stimuli being overwhelmed, bombarded with, you know, sound and color and stuff.

But at the same time, you know, there's research showing that our brains crave novelty and variety and interesting sensory experiences. You know, you can imagine at the most extreme end of it, things like solitary confinement or even something like a sensory deprivation tank, which is literally right there in the name, people start to hallucinate when they're in there because their brain, sort of given no external stimuli, starts to sort of manufacture the stimuli internally. 

So we know that our brains need some sort of visual interest, basic visual interest, and this has been one critique of the trend in urban design where you're seeing like all these big box stores that sort of take up a whole city block and for a pedestrian walking down that sidewalk, it is a lot less interesting if it's just, you know, the side of a Target for the whole block than, you know, like ten different stores and different businesses. And so, there's some thinking that putting variety back into our environments would be good for our wellbeing, even at the urban scale.

Katie Jensen: 

What are some examples of things in the built environment that can make it really challenging for people?

Emily Anthes: 

Some of the basic ones people will be familiar with are the ones that have been regulated the most. So like, providing alternatives to stairs and elevators and things like that. But out of design choices that can be challenging that are less obvious, you know, PTSD is something that can make people hypervigilant out in public, and it can be stressful for people with PTSD to take blind corners or walk down very narrow halls that feel confining.

Lighting is a big one. You know, a lot of institutional buildings have fluorescent lighting, and those lights can flicker, and that can be a problem for people with migraines. I am a migraine sufferer myself, and those lights drive me crazy. They could be distracting and a problem for people with autism, for people with epilepsy. Some of these design, I guess, “flaws,” if you want to call them that, can be problematic for people with a wide range of conditions and experiences.

There's a whole field of designing for aging and dementia and, you know, one big challenge for people that are suffering with cognitive decline is navigation. And so, you know, you see sometimes people in retirement homes and there are all these halls and gathering spaces and cafeterias and those environments can be more complex than are needed and that they are hard to navigate.

So there are principles and recommendations to do things like make sure that there are intersections in halls where you can see around you and you can see all the possible destinations. Like, “Oh, the music room's over here. The cafeteria is over here.” So you don't have to remember, like, is it right or left and where am I?

Katie Jensen: 

My sister works in a long term care home on the dementia floor and they have tons of murals. And I think it's so good because a mural can be a really easy landmark for folks to see, to locate where they are, and then go left or right and not have to remember those directions. Even people who don't have dementia can't always remember left from right.

Emily Anthes: 

Yeah, things like that can also serve more than one purpose. You know, walls with murals maybe make it easier to navigate and also provide that visual interest we were talking about, and, you know, add more to the environment.

Jen Hancock: 

We’ll be back with Emily Anthes after this.

[music]

Jen Hancock:

At Chandos, building is about more than concrete and steel, drywall and windows. It’s how we build, and who we build with, that determines the legacy we leave behind.

Our commitment to a more diverse and sustainable future is built into every aspect of our business: the people, the processes, the projects, and every community we’re part of.

Let’s build better together.

Find out more, or join our team, at Chandos.com, that’s c-h-a-n-d-o-s-dot-com.

Katie Jensen: 

This kind of reminds me of First Place Phoenix, which you described in the book, because it kind of synthesizes everything we've just been talking about. Can you tell me the story of meeting Denise Resnick and how you came to learn about her?

Emily Anthes: 

Denise Resnick is a woman in Arizona, and she had a son who was diagnosed with autism when he was young, and she was basically told when he was two or three, like, “Prepare to love him and eventually institutionalize him.”

And that, you know, did not sit well with her for a variety of reasons. She is a real go-getter. She runs with ideas. So, when her son was young, she started this autism research center and care center in Phoenix that turned into a huge community organization that provides all sorts of services. 

But her ideas grew, I guess, as her son Matt got older and his needs changed and she could tell that, you know, he wasn't going to be able to live entirely independently. But she also thought that what doctors told her initially, that, “Oh just institutionalize him,” not only was that something she didn't want to consider, but that that wasn’t necessary. And that she thought there was really a lack of other options for autistic young adults, for a place they could carve out a bit of independence but have a support system in place to help them with the things they needed help with.

So that was the genesis of what she called First Place. It's an apartment building in Phoenix. It was designed with the input of autistic young adults and design experts and is mostly occupied by autistic young adults, but is sort of, you know, designed to be friendly to anyone with any sort of neurodivergence.

There is a resident there with a traumatic brain injury, and there are social supports built into the building. So there is a staff there to help people with what they need, but everyone gets their own apartment. You rent an apartment. It's a market apartment, on the market. But they've also thought really carefully about the design.

How can we make an apartment building that meets their needs physically, environmentally, beyond just what service providers can provide? So that was the impetus of it. And there are a bunch of pretty thoughtful and interesting features in the building that range from small, so small that I wouldn't have noticed to, you know, fairly obvious.

Katie Jensen: 

It's fairly obvious, like in the layout of the apartments? Or how so?

Emily Anthes: 

Like, some of that is social spaces, gathering spaces — there's sort of a common misconception about people with autism that they don't want social connections or friendships or romantic relationships. And that is not at all the case, or certainly it's not the case for many people. 

And so some of it was about how can we provide spaces that will allow people to get together in sort of slightly more structured ways? So rather than just having open lounges, it's, you know, a video game room, there's a kitchen that offers public cooking classes, a garden, a grill — places where people can get together.

They've also deliberately designed social spaces in a variety of sizes. So there are like big lounges and meeting rooms and places where two dozen people can watch a movie, but they've also designed these little pocket lounges, which is maybe a space where like one person can play a card game with a friend. So if that's more comfortable for somebody, that option's available too.

Katie Jensen: 

One thing I loved is when you described the concept of universal design and designing for people with higher needs, but benefiting everybody.

Emily Anthes: 

Yeah. Well, so a lot of, I talked about how the idea of “accessible design,” quote unquote, access is sort of outdated.

And one concept that's replaced it is actually called universal design, because the idea is that not only does it make a building accessible to anyone, but that it benefits everyone. There's sort of a classic example, which is very much from the old school accessibility train of thought, which is curb cuts, you know, the ramps that are cut into the sort of side of the sidewalk and were initially put in in many cities so wheelchair users could cross the street.

But think about all the other people that benefit from that now. People pushing strollers, people pushing grocery carts, all sorts of other people beyond wheelchair users benefit from having that option. And so actually, I loved Denise Resnick talks about in First Place, she said, “What we're doing is building neurological curb cuts.”

So the idea is a lot of autistic people are quite sensitive to sound. So they put a lot of resources into really soundproofing these apartments. And I can say, as a New York city resident, that's something that anyone would appreciate. We would all like to hear less of our neighbors, but even things like fluorescent lights, which we know like are a specific trigger for me as a migraine haver. I don't think there are a lot of people out there, whether they have migraines or not, that say like, “Yes, I love being in a building with flickering fluorescent lights.” 

So a lot of this is about when you sort of tailor a building to your most sensitive users, you are raising the bar for everyone. There are a few examples of design features that I did not notice and would not have noticed until they were pointed out to me. One was in the shower at First Place. It was a very simple reversal, but even when I was in the bathroom taking a tour, I missed it. The dial or the controls for the shower in most bathrooms are right underneath the shower head. They're sort of all in a vertical line. 

Here, they're on the opposite side of the shower. The idea is that someone can turn on the water and adjust the temperature and maybe stick a finger or a toe in and make sure the pressure and the temperature is what they would like before getting in.

You don't have to do that dance that I think we've all done, where, like, you turn it on and back up and you're dodging in and out to try and make sure you don't get wet until it's ready. 

Another one that I didn't notice, but that I really liked is, the entrances to each apartment are slightly recessed from the halls, so the doors aren't flush with the hall, so you're walking down the hall, your apartment's on the right, you turn right, and there's almost like a little shallow alcove, and then there's the door to your apartment.

And the idea is that it gives people a little bit of a transitional space. You know, they're coming out of their apartment and maybe getting ready to enter the hubbub of what's happening in the public spaces of the building and it gives them a moment to sort of like, catch their breath or prepare for whatever's next.

There was a lot of discussion about how much to use technology and monitoring. We are now in a place where they could have put Nest cams in every apartment. But that was sort of an idea that was eventually rejected because the idea was to give people some dignity and residents some dignity and independence, and that just felt too in your face, too much surveillance.

But there were other things that they could do to sort of try and keep people safe that felt less in your face, I guess. And so one obvious one is that there's an automatic shut off on the oven and stove. So if someone's cooking and forgets to turn it off, if the stove or oven is on for too long, it will shut off.

Even here though, there's wiggle room. You know, if someone is a real baker and they like to make cakes every weekend, the building can adjust for that and say, like, “Oh, we'll either turn this feature off in your apartment or we'll extend it to three hours from one hour.” It can be adjusted for needs, but it can be helpful for some people to have some automatic safety features like that.

Katie Jensen: 

So talking about some of the criticisms of designing like this, anything pioneering can be expensive, especially something that includes support systems, like in the form of on-call staff. But then, the other criticism I think is interesting is, why have just this one location? We should be able to fund housing that's accessible all over the city. What do you think about that kind of criticism with respect to First Place Phoenix?

Emily Anthes: 

I mean, I think they're both valid criticisms. First Place is not cheap, and it's explicitly not designed for people with certain very intensive needs, people who might act out in violent ways, which pose self harming behavior, things like that.

It's just not equipped to handle those people. So excludes some of the people that in theory it could be serving. So that's been one criticism and Denise acknowledges that, that's something we talked about. And she said, you know, I spent a lot of time trying to figure out how to create a building for everyone and I couldn't, and there's still a population that needs to be served here, so I'm going to build something for them.

And yeah, the other criticism comes from the autistic self-advocacy network, other autistic self-advocates from a couple of places. I mean, one is, I think there is naturally a reluctance anytime you encounter anything that sort of even remotely resembles sort of segregation, the idea of we're going to put everyone with this disability in a special building, I think, is a tough one.

Even though this building is downtown, it's meant to be integrated in the community, a lot of people sort of rightfully, I think, oppose the notion of that and what it represents. What they want is to be fully integrated into communities, into regular apartment buildings. And, yeah, I mean, it also gets to, there are a lot of problems here societally that design cannot solve and does not solve.

So affordability is a huge one. A lot of autistic adults have trouble finding jobs at all, let alone well-paying jobs. And there's just a lack of affordable housing, period, that is a huge problem for people, all people. Also, people with disabilities and that's not something that adding some recessed entrances can fix.

Katie Jensen: 

I mean, it's tricky, right? We have this problem of needing to have large scale housing immediately, like yesterday, but then also having the need to accommodate health. So it's kind of like we have two separate problems with conflicting goals: specialization, but then mass production. So, really tricky.

Emily Anthes: 

So this was something that, this is sort of where Denise came down in the end when I pushed her on some of these issues, is like, the answer is yes and yes. Like we need all of these things. We need more housing, period. We need more affordable housing. And we also need buildings, she believes, that are tailored to people who might need extra support or who might have different neurodivergences.

So I mean, and I think it's true that those goals don't have to conflict. But I do think it would be dangerous to think that like, “Oh, we'll just build an autism apartment building in every downtown and problem solved.” Like that is just the tip of the iceberg. 

Katie Jensen: 

Well, yeah, especially because I know you mentioned the statistic from the U.S., that fifty-five thousand young people with autism come of age every year. That's a huge volume of people with varying needs. So, even if we were able to do that, it still probably wouldn't be feasible.

Emily Anthes: 

Right. And of course, autism is just one specific example. We're talking about a whole bunch of different neurodivergences; physical disabilities.

I mean, the solution cannot be to build a special building for every micro population. But that is where this idea of universal design comes in, in that there are thoughtful things we can do in any building that would improve life for everyone.

Katie Jensen: 

Before we wrap up, I just wanted to ask you about prisons, which you delve into in the book. How are prisons great at showing us what kind of design is bad for our health?

Emily Anthes: 

I mean, so prisons are, if you're using a place like First Place or a well-designed modern hospital or a great building as a “Here's what to do,” guide, prisons are a, “Here's what not to do,” guide. These are deliberately designed to be punitive environments, and they deprive people of many of the things that research has shown is important for basic human functioning.

And so, that can be everything from social connection to sunlight to feelings of safety and security. I mean, obviously, that's one of the huge ironies of prisons is that we put people in them so that we out in the community can feel safe, but for the people who are in prison, these are not safe places to be.

These are not places of basic physical safety for people. And so, I mean, you can start to take the elements of design one by one and, you know, break through, like, there's often no daylight, there's not much access to the outdoors or to nature and you can do it that way and you basically want to do the opposite of whatever a prison is doing.

But I think the larger idea and the one that I found so compelling about prisons is that buildings sort of communicate our values or like our society's values. And prisons basically are designed to say that like, “You are being punished. You don't matter. This building and this environment is not one that would be created for someone who matters.”

And that's something that some designers are starting to push back on. Again, it's tricky in a prison, which is always going to be a punitive place, but whether it's a prison or a hospital or a retirement home, people get messages from their environments about their worth and their value, depending on how these places are designed.

So everything about a prison is sort of designed to be dehumanizing. If you want one more beat on that, I mean, there's an example that probably would be more familiar and accessible to people than prisons. I mean, you don't have to go to prisons to think about it. 

But if you think about schools, there have been studies showing that kids at schools that are well-maintained and get basic upkeep tend to believe in themselves more, have higher self esteem and self confidence, sort of get this message from the environment that, like, “School matters, I matter.” 

And kids in schools that are run-down and not well-maintained can get the opposite message. And so it's something that sort of applies to even if you're not talking just about prisons.

Katie Jensen: 

Did you make any changes to your indoor environment after you finished writing the book or while you were writing?

Emily Anthes: 

That's a question I've gotten before. I wish I had more dramatic things to say, though. I guess in my defense, I'm a renter, so there's only so much I can do in my Brooklyn apartment.

But, I absolutely got more plants. We have plants everywhere in our apartment. I mean, that is something that obviously even a renter can do. And it was sort of inspired, sure, by the data, but it's also just been really nice, I guess that's what the data says anyway, that it's nice to have plants. 

But it really changes the space and I feel I don't have the best green thumb; not everything I get survives; but we've put plants everywhere. In some ways, the animals are easier, because they're not going to let you forget to feed them, but you might forget to water a plant.

Katie Jensen: 

It's true. Or fertilize it. Like I know real green thumbs are like, “I have a fertilization schedule and I fertilize these two days a week and this season it changes,” and all that stuff. And I don't do that. I just kind of let whoever survives, survives. It's kind of like a round robin and whoever makes it to the next year is like the survivor.

Emily Anthes: 

It's Darwinian.

[music]

Jen Hancock: 

That was Emily Anthes, science journalist and author of The Great Indoors. 

Thanks for listening to Building Good. We’re having conversations about changing construction for the better, so if you want to be part of those conversations, stay subscribed on any podcast app.

Building Good is a Vocal Fry Studios production in partnership with Bird Construction and Chandos Construction.

The producers are Jay Cockburn and Katie Jensen, with production assistance from Jessica Loughlin and Joanne Hignett.

I’m Jen Hancock. Thanks for listening.