Some Philosophical Musings

In this post I thought I’d take a detour from the usual practical focus of this blog and discuss some of the deep background thinking that social scientists draw on when they study the built environment. The idea that health care delivery takes place within the built environment is the starting place for this blog's project, which is to bring insights from research in the social sciences to health improvement. Why the social sciences?  Because fields like architecture, geography, history and anthropology have been studying the way we interact with our environment for at least a century now.  And the same tools they've developed for looking at the macro-environment (cities, regions, and nations) can also be used to study the micro-environment (hospitals, clinics, and offices).

 It is an obvious truth that just as we affect our environment, it also affects us.  Yet, for much of the western intellectual tradition we have preferred to focus on our power to change the world, less on what it is doing to us. As far back as to Plato’s musings on the “just city,” the focus has been on the best way to do things.  In The Republic, Plato wrote about creating an environment with good laws and law-abiding citizens.  He didn’t dwell much on the physical aspects of the city.  He hardly touched on the fact that city life changes its inhabitants.  So even going as far back as the Socratic tradition we have been fascinated with what we can to our surroundings, less interested in what they do to us.

I picked up a slim little book I’ve had since grad school the other day, Manfredo Tafuri’s Architecture and Utopia, and it got me thinking about this topic.  While Tafuri was trying to explain his theories of modern architecture I was struck by something else.  Since the Renaissance there have been great treatises on how to arrange and design cities, but cities’ component parts, the buildings, roads, squares and gardens were thought of as a backdrop, a stage, as we all remember Shakespeare saying .  And as you thumb through the pages and get to Enlightenment thinkers like Thomas Jefferson, you see them carrying on the same way of thinking.  Jefferson believed that the Palladian-inspired architecture of Monticello (begun in 1769) promoted democratic values.  But the buildings did their job by being symbols of democracy, not by exerting any direct effect on the Virginians who might pass by.  Even when you come to a modernist like Baudelaire who recognized “the shock of the city,” and who wrote about  nineteenth-century Europeans’ angst at being thrust into the fast-paced world of the machine-aged metropolis, he tended to focus on the way it stimulated inhabitants to action rather than the way they themselves physically changed.
If you are thinking now that there is one area that I am skipping over here you are right.  There is one obvious sense in which people have been very concerned about the way the city affects us and that is in the realm of health or disease.