Might the buildings that surround us be worsening our health?

As a paediatrician, I spend most of my working life inside hospitals and clinics. But I’m starting to get curious about whether the built environment my patients walk through to reach us may also impact on their health as much as anything we can offer once they arrive.

We sense instinctively that a blank, featureless street feels different to walk along than one with texture, variation and life at eye level. What’s newer is the evidence for why. Humanise’s own global evidence review shows that long, blank facades trigger measurable stress responses – raised heart rate, skin conductance, visual fatigue – often before we’re consciously aware of it¹. Earlier work on “discomfort from urban scenes” found comparable metabolic changes simply from viewing monotonous architecture², and a proposed model of architecturally-mediated allostasis suggests repeated exposure to such environments may chronically dysregulate our stress systems.³

This matters clinically. Chronic activation of the stress response – sustained cortisol and sympathetic drive – is an established pathway to hypertension, cardiovascular disease, impaired immunity and poorer mental health. The environments which children grow up walking through and living in shape their developing stress-regulation systems at a formative stage.

Crucially, this burden is not evenly shared. We already know that access to green space narrows health inequalities: populations in the greenest areas show substantially smaller income-related gaps in all-cause and circulatory mortality than those in less green areas.⁴ And there’s good reason to think the same logic applies to buildings themselves. Poorer communities are disproportionately surrounded by blank, monotonous, poorly maintained streetscapes, compounding rather than offsetting the health penalty of deprivation. Humanise names this design inequality as a public health issue in its own right.¹

There’s a real cost to the health system too. Mental ill health alone costs England an estimated £300 billion a year – one and a half times the entire NHS budget – through lost productivity, care costs and diminished quality of life.⁵ If featureless streetscapes are even a modest contributor to that chronic stress burden, then investing in more human-centred building exteriors isn’t a cosmetic nicety; it’s a potential upstream lever for prevention and better health.

This connects to something Don Berwick, Maureen Bisognano and I argued recently in the BMJ: that modern systems, healthcare included, have become expert at optimising for efficiency and metrics while losing sight of the human, relational experience that actually sustains wellbeing.⁶ The same imbalance plays out in our cities. A street can be cheap to build and easy to maintain while quietly working against the people who live in and alongside it.

As clinicians, we’re trained to treat the consequences for each patient we see, not to redesign the causes. But population health and wellbeing depends on more than what happens inside our buildings. As we redesign our urban environments, including our much-needed new hospitals (like the one I work in at St Mary’s in London), we should be curious as to what upstream prevention could look like if we took the outsides of our buildings as seriously as what goes on inside them.

Bob Klaber is Consultant Paediatrician & Director of Strategy, Research & Innovation at Imperial College Healthcare NHS Trust, and Professor of Practice (Population Health) at School of Public Health, Imperial College London.

Image

Helmsley Cancer Centre by Farrow Partners (image: Harel Gilboa)

References

1. Anna Kim, Why the outsides of buildings matter to human health: a global evidence review (Humanise; 2025).
2. An T.D. Le, Jasmine Payne, Charlotte Clarke, Murphy A. Kelly, Francesca Prudenziati, Elise Armsby, Olivier Penacchio, Arnold J. Wilkins, ‘Discomfort from urban scenes: metabolic consequences’ (Landscape and Urban Planning, 2017).
3. Cleo Valentine, Heather Mitcheltree, Isabelle A. K. Sjövall, Mohamed Hesham Khalil, ‘Architecturally mediated allostasis and neurosustainability: a proposed theoretical framework for the impact of the built environment on neurocognitive health’ (Brain Sciences, 2025) 
4. Richard Mitchell and Frank Popham, ‘Effect of exposure to natural environment on health inequalities: an observational population study’ (The Lancet, 2008) 
5. Frederico Cardoso and Zoë McHayle, The economic and social costs of mental ill health (Centre for Mental Health, 2024)
6. Robert Klaber, Donald Berwick, Maureen Bisognano, ‘Healthcare’s moral emergency: reconnecting healthcare with its mission and purpose’ (The BMJ,  2026)