Sickness and Health and the Turn of Seasons

At his office, surrounded by books and nature, Pritzker Prize laureate Renzo Piano, the famous architect of the Parisian Centre Pompidou, weaves history, design and philosophy. “Hospitals in the 20th century became more intelligent, for sure, the clinical or medical side became fantastically better, but they lost their humanity,” he says. “If you go to hospitals of the 19th century, they were, I should say, less functional and not as clinically good, but they were more humane, with gardening and trees rather than immense blocks. In those hospitals you were able to see trees from your room, for example — and rooms were never taller than trees. It might sound like a stupid thing, but it is not that stupid. You look out, and in some way the foliage of the trees, nature changing — it is like a metaphor of illness and health, in some way.”

Lord Norman Foster, also a Pritzker Prize laureate, agrees. He led the design of Maggie’s centers, a home away from home for cancer patients. “The purpose of this building is a refuge where you are comforted and informed — particularly after your cancer diagnosis,” he says. “Before this you will have received the life-changing news in an institutional environment. Having been through that experience I believed that I should apply my skills as an architect to create hospitals and healthcare centers which put the interest of the customer first — to try and create a more humane place. From my experience with airports, I knew that it was possible without compromising workability.”

Thinking of the customer can be challenging, as Piano recounts his experience in designing the children’s hospice in Bologna, a suspended building surrounded by nature. “Making a hospice for children is the most terrible experience you can have,” he confesses. “Because, as an architect, you have to put your mind inside the mind of the user. Just like if you design a concert hall, you become a listener. It is a very complex and difficult experience; parents and children are living together when time is suspended. A hospital is, after all, a place of suspension, like being apneic, or between breaths. In this moment, we needed to inspire humanism. And humanism is a concept that ties together science and humanity. That's a humanism.”

But, in designing hospitals, another aspect of humanism is played out, Piano says — beauty. “I'm not talking about stupid beauty, but about real beauty, deep beauty. This quality that is in the nature of the space, the lighting, the rooms and the transparency of the building, the connection with the community and nature.”

Superficial beauty might be in the eyes of the beholder, but in Piano’s eyes, we were robbed of a most fundamental concept. “Beauty is a word that was stolen to good people like us by publicity people, flattened to pure aesthetics or empty and frivolous aesthetics,” he argues. “But beauty is one of the deepest emotions of human beings. It is not just visible beauty; as you say ‘beautiful mind,’ or a ‘beautiful person’, not just because they are aesthetically beautiful to watch, but because there is an invisible part of beauty. Beauty is applicable to human solidarity, and that is nothing to do with aesthetics. Scientists understand this too. And what is beauty? It is human curiosity, passion itself, finding and making a better world.”

“It is easy for an Italian to talk about beauty,” he smiles, “when you say ‘bello,’ it doesn’t just mean beautiful, but also ‘good,’ especially in the south of Italy. But the same is true for many other languages. The concept of being beautiful is the same as being good — you cannot have one without the other. So this idea that beauty is something that is deeply within us, a bit irrational, maybe. When you conceive beauty this way, you understand that hospital needs that beauty — and there is no frivolity here — it is essential. Actually, we should charge a battle to take back beauty to the good side of the world.”

This conviction — that beauty is not ornamental but essential to healing — also animates the work of architect Sir David Adjaye, who is designing the International Children’s Cancer Research Center in Ghana. “Beauty is not an added layer, it is part of how a building functions,” he says. “In healthcare environments especially, the quality of space has a direct impact on how people feel and behave. Light, proportion, material and connection to the outside world all contribute to reducing stress and supporting recovery. These are not luxuries. They are fundamental to care. In resource-constrained settings, the question is not whether you can afford beauty, but how you define it. It often comes from working intelligently with climate and local materials. There is a kind of quiet dignity in buildings that are well made and thoughtfully considered, even with limited means.”

Change

“Healthcare is one of the most immediate ways architecture can engage with social change, because the impact is direct and tangible,” says Adjaye. “You are dealing with vulnerability, with urgency and with systems that affect people’s lives in very real terms. But what architecture can contribute is often underestimated. It can’t replace medicine, but it can shape the conditions in which care is delivered. It can reduce stress, support dignity, improve efficiency and create environments where both patients and practitioners function better.”

Such a change can only be brought about, he believes, if we contextualize the hospital within its environment, from the patient and their family, to a larger ecosystem beyond the building itself, as part of a network of treatment, research, education and community. The Cancer Research Center in Ghana exemplifies this for Adjaye. “An understanding of what constitutes a healing environment inevitably expands when you work across different geographies,” he says. “You begin to see that care is not universal, but is shaped by climate, culture, social structures and belief systems. In some contexts, healing is inseparable from family presence, community and a sense of openness. In others, it is more private and isolated. Architecture needs to accommodate those differences rather than impose a singular model. Climate is also critical. In parts of West Africa, for example, the ability to access fresh air, shade and outdoor space is not a luxury, it is fundamental to comfort and well-being. Sealed, artificially lit environments can feel alienating. So the question is not just how a building functions clinically, but how it aligns with the lived experience of the people using it. A healing space must feel grounded in its context. That’s what allows it to support both physical recovery and emotional resilience.”

Social sensibility is at the heart of architecture, as design is inevitably linked to transformation. “Design starts with the social agenda and has power to improve and enhance the quality of our lives — materially and spiritually,” says Foster. “It also has the potential to address needs and create change for the better, to anticipate the future and to address inequality. It is about beauty, joy and optimism.”

His process always starts by thinking of change. “We always begin by asking whether the project has the power to improve the quality of life for those who will use it. When designing hospitals and healthcare facilities, it is crucial to consider not only the structures that hold them up; the services that allow them to function; but also the ecology; the quality of natural light; the symbolism of the form; the relationship between buildings and the skyline or the streetscape; the way you move through or around them; and last but not least their ability to lift the spirits, to reassure, to bring forth some joy.”

“In my profession,” adds Piano, “if you are lucky, or if you are in the right moment at the right place — you don't change the world, of course, but you build, you give a shape to the change of the world.”