PROJECT Inuusirvik Community Wellness Hub

ARCHITECTS Lateral Office Inc. (Design Architect); Verne Reimer Architecture Inc. (Prime Consultant)

TEXT Adele Weder

PHOTOS Andrew Latreille

As I entered the Inuusirvik Community Wellness Hub in Iqaluit last fall, it seemed like I was walking through a door into another universe. Aside from the hemispherical St. Jude’s Cathedral down the road, the building is mostly surrounded by starkly orthogonal edifices that relay no urban logic nor sense of place. Next door to the Wellness Hub is the windowless concrete hulk of NorthMart, one of the town’s main grocery stores. Beyond that are scores of former military housing units and recently built shoeboxes. But upon stepping into the Wellness Hub, a visitor is met with curves, birch plywood, and soft daylight seeping in from above. 

The building opened late last year in Iqaluit’s downtown core and was instantly beloved. In a community that struggles with social and geographic isolation, the Wellness Hub could turn out to be the town’s most important new building in years. Spearheaded by Qaujigiartiit Health Research Centre director Gwen Healey Akearok, and designed by Toronto-based Lateral Office with Winnipeg’s Verne Reimer Architects as prime consultant, the project offers a refreshing approach for designing in Arctic communities.

The Wellness Hub is a compact multi-purpose community centre that brings together many sorely needed services: counselling, daycare, wellness research centre, research library, food preparation, and gathering spaces. Iqaluit, the capital of Nunavut, is a fast-growing town of 8,000 residents, and such programs have been underserved for years. Equally important, it offers something more: a visceral connection to the rich local culture. 

Over a decade ago, Healey Akearok and other community members had begun conceiving of a place that would provide more of the essential community services necessary to local residents. At a serendipitous moment, she met Lateral Office partners Lola Sheppard and Mason White in 2012 while all three were researching health architecture in the Arctic. They then enlisted her as a collaborator for Arctic Adaptations, Lateral Office’s exhibition at the 2014 Venice Biennale of Architecture. Healey Akearok saw Sheppard and White as the logical choice of designers to help realize her vision. 

The next part of the puzzle came into place when the Research Centre acquired the abandoned house next door to its office in downtown Iqaluit.  The two lots, joined together, became the site for the project. 

From the start, Healey Akearok and the architects worked in an intensely collaborative manner, discussing form, program, cultural expression, and seasonality. In the course of their research prior to and after receiving the commission, White and Sheppard have made numerous treks to the region to understand its culture and geography. (Their observations and analyses of the North are the basis of their 2016 book Many Norths: Spatial Practice in a Polar Territory.) 

“The Arctic has always been like building on another planet,” says White. Or on planet Earth, he clarifies, it’s like building in a climate as extreme as the tropics, or the desert. “In Canada, this is our extreme environment.” 

The extended winters of sub-zero temperatures, permafrost that precludes subgrade construction, high windspeeds with no trees to break the wind, and the sheer remoteness of the place require a completely different mindset and building approach, he explains. Take the usual challenges of construction—budget restraints, labour shortages, unexpected shipping delays—and multiply each one by five or six. There is no road route to Iqaluit: every object, person, and piece of material must be flown in or barged in—or sealifted in, in northern parlance. Both modes of transportation are enormously costly. Air transportation limits the size of construction components to be transported. Sealifts allow for larger components, but pose other difficulties: Frobisher Bay’s sometimes-unpredictable schedule of spring thaw and winter freeze delayed this particular project—among others—by half a year when one shipment of materials missed the delivery-schedule window. 

In recent years, the response to Iqaluit’s surging demand for housing has been the construction of subdivisions and sprawl. In contrast, the Wellness Hub has been constructed on two adjacent single-family house lots in the downtown core. Although it might seem like land is endless in the Arctic compared with the metropolises of the south, the imperative for density is arguably greater in such a community. Densification of the downtown core makes better use of the area’s limited infrastructure, it reduces the carbon emissions from inner-city travel, and it makes for mercifully shorter pedestrian journeys in the biting cold of winter. 

Both Healey Akearok and the Lateral Office principals caution against the stereotype of the region as buried in snow year-round. On one hand, Iqaluit is undeniably colder: average winter temperatures fall to minus 45 Celsius and rise to an average of just nine degrees in summer. On the other hand, the local Inuit who live and work on the land are intensely attuned to richly variegated annual cycles, and recognize six distinctive seasons over the course of the year, rather than the standard four.  

I spent most of last January in this town, when walking to a building a few hundred metres away required gearing up in head-to-toe Arc’teryx. On my second visit last fall, the earth was bare and raw, dusted with frost on colder mornings, but perfectly hospitable for walking around downtown or hiking the nearby Apex Trail. “Our seasons are different here, and they determine what people are doing throughout the year,” says Healey Akearok. “There are different hunting and harvesting seasons, and we wanted our building to support all those activities that happen throughout the year.” 

Part of that support is a recognition of the different ways that space is used by the local community. The hunters’ bounty must be brought into the building’s food-preparation room, where the carcasses are butchered right on the floor. The option of dragging freshly harvested seals, caribou, and beluga through the common spaces of the building is a non-starter, so in starkly practical design terms, a large, separate ingress point was required. The opening started out as a hatch and evolved into a full-size door at the unloading level of a vehicle, once the design team had figured out how to resolve the related code requirements. 

The relationship of the Inuit people to the land is central to their culture, notes Healey Akearok. She worked with the architects to find contemporary ways to express that relationship visually and address it pragmatically. The syncopated corrugated-metal cladding is evocative of the shimmering sea, she notes. It’s also light on the land, in keeping with the values of contemporary environmentalists and age-old Indigenous traditions, and it’s less expensive to bring in than heavier cladding materials. 

Many Indigenous cultures favour circular forms, reflecting the historic rationality of domed structures. The iglu is the most widely known of those forms, but as Healey Akearok points out, there are other curvilinear forms that remain contemporary and are familiar to Inuit residents: the qammaq (a temporal structure, like a tent) or the qaggig (a very large iglu, built on four smaller ones to form a large gathering space). Even the iconic iglu, which I took to be anachronistic as a housing type, is still in use, albeit more as a secondary dwelling. 

“Those round forms are out on the land; they are what’s familiar to people here,” says Healey Akearok. “You just don’t see them in the towns.” For Lateral Office, the design directive to visually reinterpret the cultural norm required a creative approach. “We told them: ‘You’re not going to get a dome; we just don’t have the budget for that,” recalls White. “And, by the way, we do love rectangles!” 

Although Iqaluit is filled with rectangular buildings, that standard is strongly associated with its years as a colonial military outpost, as well as with expeditiously built government housing. “We all agreed that a rectangle wasn’t an acceptable form,” says Healey Akearok. “So they came back with five different concepts, and everyone let them know which one was their favourite.” 

The final design resolution involved rethinking the conventional mode of architectural curvilinearity, seeing the challenge more in conceptual terms. “We didn’t take the iglu as a form,” says White. “The iglu as a form would be a cartoon building. Instead, we took elements of an iglu, the spirit and aspects of an iglu, and used them selectively.” Instead of configuring the massing as a dome or tacking on rounded shapes, the design team embedded curves as subtractions rather than additions. 

The footprint is orthogonal, and the basic massing is close to cubic, but the subtractions—which read as five “scoops”—break the orthogonality of the volume and transform it into a different form altogether. These curved, indented spaces on the corners and front entrance help deflect wind in the harsher months, offer outdoor space in the milder seasons, and provide access to the green roof decks of tundra and moss. Snow will collect in the scooped-out spaces in the winter, but that’s all right, says White: “The snow will insulate the building: this the Inuit have taught us.” 

The design also embodies the concept of an iglu in its treatment of light. Iqaluit receives as little as four hours of daylight in the winter, but up to a full 22 hours of daylight in high summer. That cyclical shift required the architects to favour indirect glazing, in order to shield the occupants from being flooded by light in June, while still allowing light in during the dark months of winter. 

The rotunda at the centre of the building embeds curvilinearity into the entire sequence of interior spaces that surround it. The tundra roof and clerestory glazing atop the rotunda bring landscape, light, and views into the building in an indirect manner, acting in a similar manner to the fenestration pattern of an iglu. The rotunda itself—a wood-sheathed cylinder embedded with Inuit art—serves as a performance hall and social hub of the building. “At the top of this cylinder of space at the heart of the building is a full ring of windows, which is one of the ways you’d bring light into an iglu,” says White.  

Iqaluit is now one of the fastest-growing cities in Canada and will need a profusion of new buildings in the years to come. For Sheppard and White, this burgeoning demand is both an architectural opportunity and an imperative to design responsibly in a locale with a starkly different climate and way of living within it. 

For all their years of research, the Wellness Hub is the first completed building for Lateral Office, whose principals hold academic positions at the architecture schools at the universities of Toronto and Waterloo. Their practice has long been more focused on raising questions than chasing commissions. “There is a wider conversation about circumpolar architectural typology: What is an arctic vernacular today?” says White. “This building is a response to that question, but it is not the response. We’re just happy that this building can contribute to the wider conversation.”

Adele Weder is a contributing editor to Canadian Architect.

CLIENT Qaujigiartiit Health Research Centre | ARCHITECT TEAM Lateral Office Inc.—Mason White (FRAIC), Lola Sheppard, Kearon Roy Taylor. Verne Reimer Architecture Inc.—Verne Reimer (FRAIC), Jeff Penner (MRAIC), Daryl Holloway, Stephen Meijer, Youchen Wang. | STRUCTURAL/MECHANICAL/ELECTRICAL WSP Canada Inc. | LANDSCAPE Lateral Office Inc. with Roxanne Miller, Sopranature (green roof); and WSP Canada Inc. (civil) | INTERIORS Lateral Office Inc. | CONTRACTOR NCC Development Ltd. | PROJECT MANAGEMENT Colliers Project Leaders and MLPM Inc. |  AREA 883 m2 | BUDGET $10.2 M | COMPLETION November 2023

ENERGY USE INTENSITY (PROJECTED) 553 kWh/m2/year

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PROJECT Galt Health, Cambridge, Ontario

ARCHITECT Jaliya Fonseka Studio

TEXT David T. Fortin

PHOTOS Riley Snelling

Spaces for healthcare present, in many ways, the ideal opportunity to explore an ethos of care through design—an approach that is grounded in being mindful of one’s intuitions and individual well-being, but also based in empathy and compassion for others. Since Tommy Douglas first introduced medicare to Saskatchewan in the 1950s, the idea of universal healthcare has arguably remained one of the most broadly embraced Canadian values. A society that sees access to basic health services as a human right is one that, ultimately, believes in a collective responsibility to care for each other. 

Yet the bedrock of universal healthcare—the family physician’s office—is often an uninspired space, wedged above pharmacies and into strip malls. It is rare for the designers of such clinics to earnestly embrace an ideology of care. Many, if not the majority, of family health clinics across the country have a bare minimum of design thinking invested into them, offering a series of sterilized and compartmentalized windowless patient rooms flanking equally utilitarian corridors. These kinds of spaces hardly inspire optimism for someone who is likely feeling vulnerable, or in at least somewhat of a compromised state. 

Jaliya Fonseka has designed a clinic for Galt Health Centre in downtown Cambridge, Ontario, that is clearly an exception. Upon entering the space, there is immediately a sense of warmth, framed by its humble material palette and careful attention to light. But as one spends more time in the clinic, its carefully composed arrangements become increasingly evident. Everything about the project is modest: its budget, its size, its location off the atrium of a standard office building, its materiality. And yet, its thoughtful design skillfully creates a place where one instantly feels uplifted. 

The organization of the project emerged from Fonseka’s consultations with the clinic’s medical professionals and staff, as well as community members, to ensure their insights were foundational to the design. This led to a focus on access to daylight, views, and a sense of openness. Despite the efficient and compact use of space, the exposed wood-fin ceiling, with utilities set between and behind the slats, allows for a surprisingly generous sense of volume. The plan, resulting from a thorough study of the users’ daily activities and movement patterns, positions the patient rooms in a central block, accessed along the building’s exterior wall. This allows daylight to flood the hall, extending into the reception and waiting areas through carefully arranged openings. A circulation loop links the patient corridor to the staff working areas, allowing for a certain fluidity and ease of movement. Strategic curved walls and arches allow natural light to softly guide movement throughout the project. Inside the patient rooms, simple pitched roof ceilings bring a sense of domestic familiarity and added volume, while translucent glazing creates planes of natural daylight.

Perhaps the most defining attribute of the project is its wood millwork. Vertical wood fins, made of standard dimensional lumber, are positioned thoughtfully to maximize light while offering a sense of enclosure and privacy from certain angles. They are composed to strategically break up and contain spaces at the same time. Meanwhile, wood ceiling fins and a custom-built 35-metre-long plywood bench tie the clinic’s various areas together at the perimeter. 

In this project, the use of wood is about more than just its composition. All of the wood was locally sourced and milled on-site. It was finished with natural and renewable raw materials—a mix of soybean oil, sunflower oil, thistle oil, carnauba wax, and candelilla wax. Perhaps most impressively, Fonseka constructed the millwork himself, by hand, acting also as the general contractor for the project. The personal commitment to craft can be sensed at all levels. In a profession that seems like it is constantly challenged by diminishing budgets and timelines, it is easy—and most often necessary—to prioritize efficiency in billable hours, material sourcing, and constructability. But in the frenzy of such means of production, it is easy to forget the importance of sometimes slowing down and taking care of the process.

Nowadays, whenever I am forced to slow down and sit with my family in the waiting room at the Galt Health Centre, I can’t help but sense the personal investment and careful intentions for the project. Despite the discomfort that we may be feeling, the clinic offers a sense of respite, with the sun filtering through Fonseka’s hand-crafted wood fins. It serves as an important reminder of how a quiet and empathetic approach to design can indeed be powerful and uplifting, even in the most humble of places.

David T. Fortin is a Professor at the University of Waterloo and Principal Architect of David T Fortin Architect. His research and practice focus on concepts of home and alienation, and the structural impact that colonization and commodification have on these conditions, with particular interest in how design can instead embed relationality—between humans and more-than-humans—as its first priority.

CLIENT Gheriani Medicine Professional | ARCHITECT TEAM Jaliya Fonseka, Walter Bettio, Deni Papetti | STRUCTURAL | MECHANICAL CONSULTANT Sopes Engineering | MECHANICAL CONTRACTOR Sharpline HVAC | ELECTRICAL CONTRACTOR Spark Power Corp.  | BUILDING SUPERVISOR / GENERAL CONTRACTOR  Jaliya Fonseka | CUSTOM MILLWORK AND FABRICATION Jaliya Fonseka, Bradley Paddock, Carrie Paddock | METAL FABRICATION Rees Metal Design and Fabrication | AREA 246 m2 | BUDGET Withheld | COMPLETION Fall 2023

As appeared in the June 2024 issue of Canadian Architect magazine

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PROJECT Renew Sinai – Phase 3A Emergency Department Renovation, Toronto, Ontario

ARCHITECT Stantec

TEXT Naomi Kriss

PHOTOS Tom Arban

As my parents’ health slid into serious decline over the past few years, I have become a regular visitor to a handful of downtown Toronto’s hospitals and emergency departments. I’ve built a career immersed in understanding and developing narratives about how design contributes to creating a better world. So during those long visits, I became curious about healthcare environments and their impact on visitors—as well as on the staff for whom these are daily workplaces. Unfortunately, many of Toronto’s hospitals feel less than great. Soaring atriums lack human scale. Infantile colours and inelegant signage make a feeble attempt to deliver warmth. There’s a corporate stiffness. What happened to the idea that hospitals can heal through human-centred design? 

But when I took my critically ill father to the new Schwartz/Reisman Emergency Centre at Mount Sinai Hospital, I encountered a highly considered environment. We arrived by ambulance, were swiftly processed through triage, and shown into a spacious private examination room. As we rolled my father’s gurney through the emergency department, I noticed how clean and fresh it was and how the ceilings—an often-overlooked plane, but one a person notices so often in hospitals—was thoughtfully designed with seamlessly integrated lights and vents, and canopies clad with a wood-look laminate. In lieu of standard blue privacy curtains, we entered through an acoustically separating, sliding glass door. An unexpected clerestory window brought in rays of sunlight while still maintaining our sense of shelter and privacy. The room was quietly neutral with more of the wood-like panelling which emitted warmth and reassurance. Equipment offered pops of colour. The room had its own sink. A headwall panel above the bed neatly organized equipment and switches. For the first time in months, I exhaled.

Mount Sinai Hospital plays a vital role in the lives of many Torontonians, while also conducting world-class research and training. To do so effectively, its facilities need to feel fresh and exemplify leading standards. Since 2009, Stantec Architecture’s Gail Hannah and Michael Moxam have been collaborating with a close-knit team of seasoned Mount Sinai administrative and clinical staff on renovations throughout the hospital’s 1953 building. This effort has required nothing short of military-style planning, with over 150 sequenced phases and temporary “decants and relocates” to upgrade the hospital while maintaining ongoing 24/7 operations. According to Dr. David Dushenski, Chief of Emergency Medicine at Sinai Health, following a renovation in 2000, the hospital had exceeded the emergency department’s capabilities within only four years. The new emergency department (ED) is now nearing completion, after seven years of phased construction. 

Touring the ED with representatives from Stantec and Mount Sinai, I learned how this kind of project requires close partnerships, deep listening, and patience to combine clinical and design requirements. The team’s challenges are on par with a complex urban intervention: a deliberately protracted schedule, zero-downtime, multiple experts, stakeholders and sub-consultants, and additional code requirements, especially to meet Infection Prevention and Control Canada (IPAC) standards. This project also involved repurposing functional spaces. To double the ED footprint to 2,230 square metres, they absorbed areas previously occupied by elective surgery and administrative offices. Technological requirements add further complications, particularly when working within an existing floor slab. There’s no room for designers to take experimental risks nor make trendy choices that will quickly age the space. 

This is also the kind of project that requires a certain nimbleness. As Dr. Dushenski explained, healthcare design is both linear and non-linear: “We do our planning at a fixed point in time, but the protracted schedule doesn’t slow down for us to incorporate technical innovations and clinical technologies. So midstream during a project, we sometimes need to improve on best practices, add new and important features, or adjust for new requirements.” 

The project began with an exercise in research and development, in which Stantec’s team evaluated design concepts and considered future scenarios, such as evolving technologies. They developed full-scale mock-ups of critical spaces complete with materials and equipment—including the very room that my father and I were waiting in—so that users could experience what it would be like to manage and treat people there. “That exercise greatly informed a lot of the design outcomes,” Gail Hannah explained. “It also helped the clinical staff, who aren’t accustomed to reading architectural drawings, to understand what they were getting.” 

A key criterion for evaluating an ED is speed of service. When the final phase of the project is complete, ambulance and drop-off patients will arrive through a newly constructed emergency driveway, and enter through dedicated doors to help alleviate congestion. The triage waiting room is intentionally smaller than it was previously, part of an integrated process of guiding patients more quickly towards providers.
An overhead monitor outlines the check-in process—in which patients are registered in the hospital’s system, enabling care such as bloodwork or an intravenous drip to be ordered right away—and indicates where patients are in the queue. 

To help expedite service, Mount Sinai increased its examination rooms from 37 to 52, and there are now dedicated rooms for specialized services within the department such as ophthalmology and dentistry, and even CT scans and X-rays so that patients do not need to be transported elsewhere within the hospital, nor interrupt regularly scheduled services. I was told that with this renovation, Mount Sinai is Canada’s first ED to have dedicated in-house diagnostic services. Standardized examination rooms accelerate both service and safety, as staff are always familiar with the placement of equipment and other elements. And Mount Sinai’s “nobody owns a bed” philosophy means that between examinations or consultations, patients are directed to internal waiting areas, freeing rooms for other patients.

Another critical indicator of success is an ED’s ability to induce calm. With the new design, instead of being told to go to the perhaps stress-inducing “acute care waiting area,” patients wait in the “yellow zone”—indicated by yellow lines on the floor and a supersized photograph with yellow hues. These photographs, superimposed onto fibre-reinforced laminate (a durable material only recently approved by IPAC), multitask as wayfinding and stress-relieving distractions. 

Interestingly, the ED is not as laden with technology as I expected. Monitors similar to those in an airport indicate where everybody in the department is located, when a room needs to be cleaned, or if a patient needs assistance. The examination rooms are outfitted with computers, enabling a full-scale switch to digital charting. In some cases, there was a deliberate effort to reduce the presence of technology: for example, high-security staff phones substitute for overhead intercom pages to minimize extraneous noise pollution.

Over the past few years, mental health care has become an increasingly important aspect of emergency health. The final phase of Mount Sinai’s ED will reveal a dedicated pod for patients experiencing behavioural and substance issues. This contained unit is designed to help keep both patients and staff safe, and incorporates more soothing design elements. 

When I asked the team what they were particularly proud of, I was ushered into the resuscitation room—the most critical space within the ED. This operating room was almost completed when the Covid pandemic struck, and the team needed to reverse its approach. Previously, patient, clinicians and equipment were all within the room. But the IPAC requirements switched to allowing only essential people and equipment. It was challenging to quickly design a response that met the needs of both the clinicians and IPAC. The solution features an operating room with an anteroom and equipment room divided by glass partitions, so that a supporting team can feed the necessary equipment into the operating room as needed. The teams communicate via intercom, as well as via a whiteboard—the latter proved to offer the quickest and clearest form of communication when one is dressed in full PPE. According to Dr. Dushenski, “This space has fundamentally changed the way that we do critical care in emergency medicine.”

As my visits to the hospitals increased, I came to realize that when it comes to design, the primary users are the physicians, nurses, and allied health professionals for whom they are a regular workplace. While patient care is top of mind, in the hospital, design excellence is determined by how the space can support medical services to be delivered quickly, safely, and effectively, under what are often the most intense and life-changing circumstances. A clinician’s ability to cope, respond and perform effectively under pressure is deeply dependant on the design. So much is determined by clinical and code requirements that investment in more nuanced design details might otherwise fall to the wayside. However, the thoughtfulness applied to these areas has a subtle yet important impact on everyone’s wellbeing. This is why the Mount Sinai ED excels—much of its design is exceptional for both staff and patients.

Naomi Kriss is the founder of Kriss Communications, a consultancy that aims to broaden national and global awareness of contemporary Canadian architecture and design. Since 2020, Naomi has also been exploring ways to leverage her skills to improve the design of healthcare and wellness environments.

CLIENT Sinai Health System | ARCHITECT TEAM John Steven FRAIC, Michael Moxam, FRAIC, Gail Hannah MRAIC, Mark Pitman, Sylvia Kim MRAIC, Brian Moeller MRAIC, Norma Angel MRAIC, Nicolas Correa-Corrilla, Steve Moore, Arshad Siddiqui MRAIC, Anthony Lue, Baria Abu Ghoush, Damir Kusec, Ena Kenny, Jane Wigle, Jim McCullam, Ko Van Klaveren, Laurena Clark, Lloyd Hilgers, Nancy Lindsay, Richard Eaves, Sarah O’Connor-Hassan, Sylvina Jones-Noel | STRUCTURAL Entuitive | MECHANICAL/ELECTRICAL H.H.Angus & Associates | LANDSCAPE Stantec | INTERIORS Stantec | CONTRACTOR Ellis Don | AREA 2,468 m2 | BUDGET Withheld | COMPLETION Summer 2024

As appeared in the June 2024 issue of Canadian Architect magazine

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Constructing Health

Tye Farrow (University of Toronto Press, 2024)

REVIEW Laure Nolte

For a moment, recall a memory of when you felt instantly at ease when you entered a building. You may have felt your heart rate slow down as you took a deep breath. Perhaps your nervous system regulated as the stress and noise of the outside world faded, and your senses gradually attuned to the space. A glimmer of light and shadow may have brought a moment of delight, a turn of a corner revealing a compelling materiality you began to trace with your fingers. 

Whether we are aware of it or not, the environments we inhabit have an impact on the mind and body; on our cognition and physiology. For over two decades, architect and urban designer Tye Farrow, founder of Farrow Partners, has asked how meaningful, health-generating person-to-place relationships can be nurtured through the medium of architecture. His new book, Constructing Health, offers a touchstone for designers, clients, and others embarking on a similar journey. 

Farrow invites readers to reframe their understanding of what buildings can do by posing a series of questions, such as: “How do buildings make us feel, and how can they make us feel better?” A guiding concept is salutogenesis, a term proposed by sociologist Aaron Antonovsky to describe the factors and conditions that promote health and well-being, rather than focusing solely on the causes and treatment of disease. Farrow suggests that for most of the past 5,000 years, health was valued as an asset to be maintained through a holistic understanding of the intricate connections between mind, body, environment and community. Recently, however, many aspects of the built environment have been constructed in ways that deviate from these values. Farrow’s solution is to actively construct environments that enhance optimal health.

What exactly does this mean? Rather than offering prescriptive instructions, Constructing Health explores salutogenic possibilities in an open-ended way. The book’s first section is an overview of contributing theories, ideas and concepts that are part of the emerging field of salutogenic design, from thinking about environments as a source of enrichment to a deep dive into understanding beyond the five senses.

The next section offers case studies on themes of city-making, living places, educational spaces, and healthcare environments. These convincingly demonstrate how inhabited spaces can have a measurable impact on human health, performance, and experience. Take, for example, the radiation treatment rooms of Thunder Bay Regional Hospital (designed by Salter Farrow Pilon Architects, of which Farrow Partners is a successor firm), a space where natural light is rarely possible due to strict health and safety requirements. The design team delved into the dynamics of radiation energy dissipation, realizing that altering its trajectory could limit its spread. Taking cues from art galleries, where natural light is both ideal for viewing art and potentially damaging to it, they integrated a skylight into the treatment area, bathing an interior garden below in natural light. This resulting environment fosters a sense of hope and healing for patients and staff alike.

The final part of Constructing Health empowers designers with a reading list of fifty suggested books, as well as plans, sections, and perspective drawings of projects presented earlier in the book. 

The average Canadian spends 90% of their time indoors, and in the post-pandemic era anxiety, stress, and depression are at all-time highs. Now, more than ever, it is important to understand that as architects, designers and stewards of the built environment, we have an ethical responsibility to create environments that are restorative for the body and mind, activate optimal well-being, and are health-generating. As Farrow asserts, when it comes to whether a building causes health, the answer is either “yes” or “no,” never in-between—a building is never neutral. Comprehensive and compelling, this book is a guiding light towards design as a healing modality.

As appeared in the June 2024 issue of Canadian Architect magazine

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Located on Gouin Boulevard in the Ahuntsic-Cartierville borough, Hôpital du Sacré-Cœur-de-Montréal (HSCM) was first completed in 1927 and functioned as a sanitorium. Almost a century later, the hospital is now one of Montréal’s major ambulatory care centres, a highly specialized trauma centre, and a critical part of its healthcare infrastructure.

But, despite its prominence, its facilities suffered from decades of dilapidation. Over time, its physical and functional deficiencies impeded the hospital from delivering on its mission.

To solve this, the hospital commissioned architects’ Provencher_Roy and Yelle Maillé to design an expansion that would complement the heritage structure while creating cutting-edge spaces for healthcare. The design brings an L-shaped new wing that houses an integrated trauma centre, a mother-child unit, endoscopy and cardiology departments, and a medical device reprocessing unit. The addition is meticulously integrated with the existing facilities, expanding them while maintaining the sense of a single, unified hospital facility.

Patient treatment areas occupy the upper floors of the volume, clad with a curtain wall punctuated by vertical bands of a masonry block that relate to the historic hospital building and provide a sense of rhythm across the facade. These areas appear to float above the glass-enclosed lower levels, where waiting rooms, lounges, cafes, and other semi-public areas enjoy sweeping views over the grounds and the original building. The design maximizes natural light and views of nature at every turn, resulting in a calm, comfortable, and non-institutional patient experience.

The addition leverages one of the site’s distinctive advantages—its bucolic setting and access to natural light. First built as a sanitorium, the hospital was originally sited and designed to take advantage of sunlight as a fundamental component of patient treatment. Today, contemporary medicine still recognizes the power of natural light and nature views as critical to the patient experience and morale.

“The original building plan included the construction of two wings destined for tuberculosis patients, designed to transmit the therapeutic virtues of sunlight. Access to light and views was central to the design,” says Benoit Laforest, Principal Partner Architect and Project Manager at Provencher_Roy.

Clad in a glass curtain wall designed to stringent LEED environmental criteria, the building is designed to feel open to the surroundings and filled with natural light. The expansion takes a campus-style design, interweaving planted and built areas to incorporate landscape as central to the patient experience. New gardens allow patients, doctors, visitors, and staff to enjoy spaces for quiet contemplation and rest and boost exposure to natural light.

On the upper levels, the vertical alternation between masonry wall bands and curtain walls reinterprets the fenestration of the heritage structure in a contemporary architectural language. The approach integrates the new building with its built context, offers views out over the campus, maximizes natural light, and achieves optimal energy performance.

Philippe Mizutani, Partner Architect at Provencher_Roy and Design Lead for the envelope, affirms that the project constitutes “the integration of a gesture that remains faithful to the original intention of the architectural language.”

The upper-level block of patient treatment areas adopts materiality that evokes the building’s original masonry. The interiors are characterized by warm, calming materials like wood while accommodating the hygiene and cleaning facilities a hospital setting demands.

A long artery connects the historic buildings with the modern wing, ensuring the seamless circulation of patients and personnel. From this axis symbolizing interdisciplinarity, visitors can access the health care spaces of other pavilions via elevators visible from the entrance and signage facilitating orientation directly integrated into the architecture.

The artery opens onto a welcoming entryway bathed in light and designed to double as a casual meeting place for professionals from various departments, students, and patients. The area creates a dramatic sense of arrival and offers a much-needed place to relax and take breaks, improving the workplace experience of doctors, nurses, and other hospital staff.

The addition is designed to seamlessly accommodate future expansions as healthcare demands outstrip the facilities.

“The conceptual approach essentially masks the great complexity of exigencies involved in a hospital project under a veneer of simplicity. This complexity is distilled into a language of sobriety. We worked very hard to offer a foundation establishing a base for potentially building higher in the future”, says Philippe Mizutani, Partner at Provencher_Roy.

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Canada’s older adult population increased by nearly one million people over the last five years and is projected to grow exponentially more in the coming decades. This will leave support systems, and especially the long-term care sector, scrambling to keep up. Long-term care (LTC) facilities have faced extensive scrutiny following the pandemic, opening Canadians’ eyes to the importance of these spaces and the need to combat concerns including social isolation, physical accessibility and more. 

What can be done to make LTC facilities better suited to present and future needs? The following are some key considerations that designers should keep in mind when retrofitting existing spaces and creating new ones for aging Canadians.   

Age-appropriate biophilic elements 

Green space is often an after-thought in the development of LTC facilities, especially in urban contexts where designers feel pressure to maximize building heights and footprints, but the benefits of such spaces are immense. Even the ability to view a natural landscape from a roof terrace or smell fresh flowers in a communal garden can be therapeutic for residents. In a post-pandemic world, however, age-appropriate spaces must provide protection from the elements using canopied patios and cantilevers, while simultaneously ensuring proper social distancing. Consider spreading out seating and table areas to allow residents to meaningfully engage in social activity, as opposed to activity and programming space for games involving balls that could cause injuries to residents. 

Also consider exploring walkable zones. Walking is a preferred activity among the active elderly; it is a prime source of exercise, provides opportunities to socialize, and can be a psychological diversion—a positive distraction from daily routines. Model these spaces after preferred age-appropriate places for walking, such as parks, forests, neighborhoods with sidewalks, traditional town centres (such as Collingwood, Ontario) and suburban shopping malls in larger cities like Toronto. 

Horticultural therapy  

Landscaped gardens provide more benefits than simply beautification. They can include multipurpose elements that allow for stimulating programming for residents as well.  

Consider creating vegetable gardens to draw people together as a seasonal (or year-round, in greenhouses) activity. It can be part of an organized program, daily or less frequently, depending on the resident population. The act of gardening provides opportunity for purpose and teamwork, allowing residents and others to work together towards common goals.   

Create spaces both for mobile and immobile residents using raised platform beds for flower and vegetable gardening. Universally-designed raised platform gardens provide all residents with equal physical access and the ability to water plants from a stationary position. Remember to allocate storage space for equipment nearby, along with seating for periodic resting and interacting with others. 

Encourage building operators to get families and visitors involved with horticultural therapy as well. Intergenerational activities are few and far between in most eldercare facilities as it is, so it follows that friends and family should feel they are stakeholders. 

Family support spaces  

Residents should also feel comfortable spending lots of time with family and visitors in informal intermediary settings. Avoid creating excessive programming spaces – residents need room to interact with family and staff outside of their bedroom zones, in the semi-publicness of the dayroom, the main dining room and other places.

These support spaces should straddle the line between the semi-private and semi-public realms. Alcoves, window seats, terraces, balconies, patios, and informal break-out rooms can provide a welcoming environment that promotes both social interactions and reflective moments. Provide a kitchenette for family-visitor use, a We-Work-type workspace shared by residents’ family/visitors, and a dedicated washroom.  

Consider long-term visitors as well, especially in remote communities. In Australia, for instance, family sleepover rooms are provided for the families of Indigenous residents who travel great distances to visit loved ones. This strategy is equally applicable in Canada’s Far North.  Controlled wandering  

Aside from memory loss, wandering is perhaps the most well-known behavior exhibited by persons with Alzheimer’s and other types of dementia, which can be distressing and dangerous. LTC design should encourage and support mobility and freedom of movement in a safe, semi-independent physical setting. Wandering gardens and paths, for instance, are popular and prominent features of the most well-known LTC residences internationally. 

LTC homes with a memory care unit or Special Care Unit (SCU) for residents with cognitive disorders should feature at least one controlled wandering space—one indoors and one outdoors. Create a secure, gated architectural and exterior environment with locked doors. Provide a multi-faceted security system including visual monitoring and unobtrusive warning sounds to alert staff of unwanted movements. Ensure areas are well-lit and avoid steps with abrupt level changes. 

Consider programmable space for both indoor and outdoor activities to enrich and occupy the individual’s time, that include physical exercise and freedom to self-choose the degree of immersion in nature and landscape.  Multi-sensory stimulation  

There is growing empirical support for the inclusion of multi-sensory rooms for non-pharmaceutical behavioral treatment for dementia. This treatment modality revolves around music, massage and aromatherapy. Doll-, animal- and toy-assisted therapy can also help reduce agitation levels depending on the individual resident’s stage of dementia.  

Locate these rooms centrally but not at the heart of the most public area. Avoid potentially distracting external noise sources, such as adjacent busy corridors and active spaces, i.e. kitchen/dining areas. Pair a non-descript exterior with a blank canvas interior that can become highly activated with flowing, vibrating, contrasting colors and imagery, as well as sounds and sensations.  

While these recommendations would greatly improve LTC homes in Canada, there is so much more to do. Read more about LTC design considerations here.  

Stephen Verderber is a professor with the John H. Daniels Faculty of Architecture, Landscape, and Design, University of Toronto

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The Agora Maximus is a pedestrianization project inspired by Montreal’s Quartier Latin, designed by the LAAB collective in collaboration with Signature Design Communication.

The project proposes a durable, integrated, and heavily planted modular installation, in front of the St-Sulpice Library in 2022, then along the whole  Saint-Denis Street in 2023 and 2024.

Immersive and intriguing, the installation combines two landmarks of Latin culture: the Agora, a place for civic meetings, and the Circus Maximus, a linear amphitheater for live entertainment.

In this way, the concept pays homage to festivals, circuses, and experimental arts by transforming the urban space into a linear stage, with striking pixelated pop-up seating arrangements placed at intervals along the street.

The modular platforms offer accessible open spaces for pedestrians to socialize and take in the scenery. Their stepped profile evokes the main staircases of the cultural institutions of the Quartier Latin. Informal and playful, they take the form of colorful mounds of “pixels” filled with greenery, enhancing the tree coverage of St-Denis Street. The pixels’ colorful swatches use GREY to integrate into heritage surroundings, WHITE to evoke modernity, and ORANGE to deliver a playful nod to roadwork visual codes.

The various platforms are linked by a continuous street-art graphic intervention made of pixel patterns along the whole length of the street, providing an ever-changing visual journey for pedestrians.

A paired strategy of visual/graphic dressing of key commercial windows along the street enhances the immersive stroll and urban experience between de Maisonneuve and Sherbrooke streets.

Technical sheet

Project Name: Agora Maximus

Location: Montreal, Quebec, Canada

Client: SDC Quartier Latin and the Partenariat du Quartier des spectacles de Montréal

Architects/Designers: LAAB Collective in collaboration with Signature design communication

Design team: Michel Lauzon, Vincent Clarizio, Maëva Lonni, Frédérick Gagliolo, Adam Ghadi-Delgado, Margot Greenbaum.

Project type: Urban design, Tactical urbanism, Temporary & Events installations, Industrial design, Street furniture

Technical description: An assembly of pixels of 5 different heights in painted steel and wood. The pixels can be used as platforms, seats or planters.

Challenges: A modular system, easy to assemble, install, dismantle for summer use over 3 seasons. 

Installation: summer 2022 (2023 and 2024)

Photographer: Raphaël Thibodeau

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If there was any doubt as to the role the built environment plays in safeguarding public health, it’s surely been erased by now. Over the last two years, Canadians from coast to coast witnessed the devastating effects of ill-considered design regulations and a lack of building intelligence in residential eldercare facilities. 

The state of long-term care today is a direct result of its troublesome history and perpetual marginalization in policy making, in mainstream healthcare, and certainly in design discourse.  

This is not to throw our profession under the proverbial bus; many if not most architects have shifted from a pathogenic thinking to a salutogenic thinking in long-term care, designing homes that privilege the privacy, dignity, and wellbeing of residents.  

But these homes have also been tethered by a compliance mindset driven (in Ontario at least) by the systems and standards that have governed the design, development, and operations of long-term care homes since the late 90s.  

At Montgomery Sisam, we’ve always been at the forefront seniors supportive housing. Working with many of the most progressive thinkers and doers in the industry, our practice has been a proud partner to the quiet revolution in long-term care design.  

Now, in the wake of the COVID-19 pandemic, it behoves us to become not just passive allies but vocal advocates for more progressive, evidence-based models of care. One among many such model is small home.

Small home addresses many top-of-mind issues in long-term care today 

The concept is simple. Small homes are designed to be intimate, residentially scaled facilities with accommodations for a very limited number of residents, usually 8 to 12. Each resident has their own private space, and access to a shared living room, family kitchen and outdoor space, all of which are home-like, elder-friendly, and easy to navigate. And resident support is provided by multi-skilled workers responsible for cooking, cleaning, and caregiving.  

Small home design has many proven merits. Their intimate physical environment and operational structure privileges resident-caregiver relationships, social connectedness and a more familiar, more familial living and dining experiences [1]. What’s more, the compact, intelligible nature of a small home floor plan aids in wayfinding, fall prevention and staff workflow [2]. And the self sufficiency of each home along with their limited number of residents lends itself to better infection prevention and control and natural cohorting during an outbreak [3].  

Now, small home is by no means new to residential long-term care. Its origins can be traced back to the Green House model in the United States and similar projects around the globe [4]. It is, however, a challenging pursuit in Canada where the current climate favours larger, leaner buildings. 

Lean design aims to create the most effective buildings possible with the least amount of square footage. It allows architects to meet legislated standards while eliminating redundancies and optimizing the floor plan to help providers manage the effects of strict funding structures, rising capitals costs and major staffing shortages. And, when coupled with other important design qualities, it offers a sustainable balance between efficiency and experience for safe, healthy, dignified elder-friendly residences.  

The thing is these larger, leaner buildings simply don’t compute with our post-pandemic consciousness and the growing research favouring small living. 

So, how do we get the benefits of small home while maintaining the same operational integrity?  

We recalibrate our priorities. We find a better balance between experience and efficiency. We build big to live small.  

It starts with shifting our thinking from the macro to the micro, understanding the granularity of users’ day-to-day experiences and mapping out every decision in the context of resident life and staff workflows. 

Next, we have to embrace the operational differences that comes with this thinking, scaling down the traditional 32-bed Resident Home Area (RHA) as much as possible into smaller subclusters of interconnected, self-contained units with a limited number of bedrooms. Any degree of ‘smaller’ is better in the pursuit of living small. 

Then, we have to fight the lure of centralized services and create, in each of these clusters, a strong social heart complete with an open family-style kitchen, dining room, and den-like living area and we have to couple this social heart with accessible, purposeful outdoor space.  

Finally, we have to strategically and mindfully connect subclusters to a central service hub to achieve the essential efficiencies that come from a larger care structure. 

In the build big, live small model, every element related to the resident experience, from the hearth to the table to the garden, is scaled down to recreate the comfort and intimacy of home and day-to-day living. As evidenced by small house research, it has the capacity to yield tremendous gains, including improvements in the overall delivery and quality of care [5]; improved relationships between residents and staff [6]; lower incident rates [6] and higher resident satisfaction and self-reported wellbeing [7]; and increased staff recruitment, retention, and satisfaction [8, 9]; and, in all of these things, a higher quality of life for residents. What’s more these gains exist within a larger building structure so as not to impact the efficiencies of its back-of-house operations.

If it’s that easy why isn’t everyone already doing it? 

Systemic challenges in long-term care development persist, aggravated in recent months by supply chain issues, excruciating inflation, and the scarcity of trades.  

You cannot operate the build big, live small model for the same cost as a traditional home. Subclustering resident homes areas requires duplicating some program elements, and duplication requires more money and more staff, inherently working against lean design gains from a tighter floor plan and smaller square footage.  

Moreover, build big, live small isn’t just a design approach but a model of care, one that requires a fundamentally different philosophical outlook at every organizational level to be successful. And in the wake of the pandemic, staff morale is low and staffing shortages persist. 

But a radical culture change is possible; the willingness is there, and financial help is coming with more investment being made in the long-term care sector than every before. We can only hope that with the promise of a better future, the workforce will come and come inspired.  

So, what’s the takeaway? 

We are at crossroads.  

Residential long-term care in Canada has and continues to suffer from many competing challenges. In response to the public and political awakening to these challenges, a new national standard is set to be released. But standards traditionally limit lateral thinking. And those of us who have been working in this sector for years know compliance isn’t the answer here. Creativity is. 

The build big, live small model is one way to incite real, substantive change now.  

Building big to live small, however, is not without its challenges. It relies heavily on the human factor, from financiers to the front lines. In such a politically charged atmosphere, where many discussions and decisions are dominated by dollars and cents, it is our professional responsibility to advocate for these evidence-based design solutions, how they can be implemented, and the policy alternatives needed to support them.  

With a more forward-thinking dialogue in place, organization-led innovation and sector-wide transformation becomes not only possible but achievable. What follows will chart the course of history for generations to come.  

Alexandra Boissonneault, Associate, Research and Communications & Tony Ross, Principal Montgomery Sisam Architects

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The RIBA has announced the winner of the world’s best new building. The Friendship Hospital in Bangladesh designed by Kashef Chowdhury/URBANA will be awarded the RIBA International Prize, the global accolade for design excellence and social impact.

The remote community hospital was commissioned by the NGO, Friendship, and provides a medical lifeline for thousands of people from Satkhira, an area of the coast that was heavily affected by a major cyclone in 2007.

Winning this global accolade, the hospital was described by the Grand Jury as embodying an “architecture of humanity” and as an “exemplar of innovative architecture that addresses critical global issues – unequal access to healthcare and the crushing impact of climate breakdown on vulnerable communities.”

Situated in the southern region of Bangladesh, the project faced demanding environmental conditions due to rising sea levels impacted by climate change.

“In a sublimely important moment, RIBA and the jurors have identified a project from the global periphery to bring to the centre of architectural discourse and be the subject of one of the most important global awards. I am encouraged that this may inspire more of us to commit, not in spite of, but because of limitations of resources and means, to an architecture of care both for humanity and for nature, to rise collectively to the urgencies that we face today on a planetary scale,” says  Chowdhury .

“Having worked with communities most impacted by climate change over the last 20 years, I have seen, time and time again, proof of my belief that ‘The poor cannot afford poor solutions’! Friendship Hospital brings new hope of a better tomorrow to some of the most climate impacted people on this planet,”  says Runa Khan, Founder and Executive Director of Friendship.

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Stantec has been selected as the prime consultant to provide architectural, interior design, and building and civil engineering services for the new Queensway Health Centre.
Part of Trillium Health Partners (THP), the nine-story, 600,000-square-foot patient tower will offer over 350 beds in a modern, dedicated centre for complex care and rehabilitation services. 

The building design creates a healing environment with access to daylight and views supporting patients and their families throughout the patient journey, while offering intuitive wayfinding that minimizes patient travel within the facility. Landscaped outdoor spaces will serve as natural extensions of indoor patient and public spaces providing amenity space for patients, families, and staff. The building design brings a strong sense of connection to the community and reinforces the urban fabric.

The state-of-the-art hospital building will connect to the existing hospital complex via a pedestrian corridor. The new nine-storey patient tower will define the northern edge of the Queensway campus, with the primary hospital building visible from the north and northwest entrances, and H-shaped floor plates.

On the ground floor, public entrances will greet patients, families, and their visitors with check-in services, waiting areas, administration support, and retail amenities.

Two courtyards, one open to the east and one to the west, offer a place for respite and connection to nature. The east courtyard will be shared between the public and patients, with the north half providing a landscaped amenity that respects the privacy of patient bedrooms with a mix of low stone walls and planting. The south half is an open landscaped public space with a pedestrian entrance in the southeast public lobby area. 

“In designing Queensway Health Centre, our team is embracing THP’s values of Compassion, Excellence, and Courage to create a dynamic, welcoming, and sustainable facility for the community,” said George Bitsakakis, project principal for Stantec. “We believe that facility design plays a vital role in optimizing patient care and clinical services while creating positive spaces for patients, staff, and the neighboring community. We’re excited to continue our work with THP to support the health and well-being of the community.”

As part of the redevelopment at Queensway, Stantec is also designing a new central utility plant  to the existing hospital. In addition to the firm’s work at the Queensway campus, Stantec is providing planning, design, and conformance (PDC) services for THP’s new Mississauga Hospital project. 

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