Salutogenesis: Urban Health


Crystal Cheng

A multiscale salutogenetic symbiosis is an ultimate investment in the people

Khoo Teck Puat Hospital (Image courtesy of

Sociologist Aaron Antonovsky’s Theory of Salutogenesis (1979) advanced the concept of salutogenesis as a juxtaposition to the concept of pathogenesis. The former focuses on factors that promote human health and well-being, while the latter focuses on what causes disease. It was found that people who find their environments manageable, develop a “Sense of Coherence” and are better able to sustain health as the World Health Organization defines it: “A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity (1948). The central idea of a personal sense of coherence integrates the meaningfulness, comprehensibility and manageability of an experience or disease. Which means the more a person can make sense of (meaningfulness), understand (comprehensibility) and handle (manageability) an experience or disease, the greater the potential to successfully cope with it.


And at an age where urbanisation and technology advances faster than ever before, humans are living longer. Unsurprisingly, the turn of phrase “Salutogenic Design” was pioneered, which refer to design solutions that keep people healthy throughout their lifetime. (Dilani, 2006) According to Antonosky, this measurable aspect of design can help people operate at peak performance and maintain physical and mental wellbeing. This establishes the need for salutogenic design operating beyond biophilia, on multiple scales, as an “ultimate investment in people”.


“The Salutogenic City” (Marcus, Sachs, 2014) described how neighbourhoods can include safe and interactive pedestrian and cyclist-friendly sidewalks, making physical activity an easy choice rather than an out-of-the way recreational option. Congested arterial roads can also be replaced with more walkable, heterogenous street grids. In encouraging active living, we will also be creating spaces that allow people to age in place. Buildings can accomplish salutogenic design via passive environmental design, creative wayfinding, welcoming spaces and even staircases that encourages walking over the use of elevators. Interiors can do so by using biophilic elements like healthy plants and natural materials. Although these strategies are not new or groundbreaking on their own, they provide the sort of novelty and variety our evolutionary memory craves. More importantly, salutogenic design laid out in enriched environments will redefine and unify concepts of green communities, eco-towns and smart cities. 


In a case study, Khoo Teck Puat Hospital in Singapore was conceptualised as a “hospital in a garden, a garden in a hospital”. By ‘adopting’ the adjacent Yishun Pond Park, KTPH expanded their green-blue footprint and resulted in a salutogenic continuity that goes beyond the hospital’s premises, with its healing effects felt in the park and nearby residential estates. This shows us that by striving to interweave different scales of healing spaces, the unbroken continuum between different administrative spaces enjoys the potential and benefits of a new salutogenic symbiosis.

KTPH’s natural extension of Yishun Pond. (Image courtesy of Green in Future Pte Ltd., 2018)

Landscape architects, in making nature visually and physically accessible, are likened to environmental justice and public health advocates of the industry. Designing spaces that benefit human comfort and long-term environmental health is not foreign to us. However, we should also practice salutogenic design by integrating the dynamics of health and experience with our landscape, and transition from healthy spaces to healing spaces. Hence, it will be important to assess our projects not only in terms of biophilia, biodiversity, sustainability, recreation potential and maintenance, but also under salutogenic principles. Overall, a multiscale salutogenic design not only allows for a wider reach to more user types, but also improves population health, which makes for a healthier and happier society.



About the Author


Crystal is an aspiring landscape architect and urban designer at the National University of Singapore. She is passionate about designing cities for high levels of liveability and understanding how cities interact with their environment at the macro and micro scale. In an ideal world, Crystal believes that all systems should be concerned with achieving a sustainable balance and resilient design in the face of climate change.