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market volume of EUR 27.2 billion in 2018. Still, is the average European any healt-
hier than previous generations? The times when infectious diseases were wiping
out Europe’s population are long gone; today our lives are ended by chronic disea-
ses like diabetes, heart diseases and cancer.
The Future of the Health Care Institutions

According to the World Health Organization, Europe is the region mostly affected,
with almost 90 percent of all deaths caused by noncommunicable diseases. Me-
anwhile, a quarter of its working age population lives with a chronic disease.
Roughly ten percent of Europeans suffer from diabetes, while one in two persons is
overweight. And, worryingly, Europe is running out of people to look after them.
By 2020, the European Union will be short of 230,000 doctors and 600,000 nurses,
equivalent to a shortfall of nearly 14 Percent. Various technological advances, in
combination with a partial privatization of patient care allow us to get by, but only
for so long. If living a long life no longer equates with living a life in good health,
one cannot help but wonder: What is the role of the health care institutions which
we have set in place to make us healthy, and what will they look like in the future?

The hospital as a machine for healing Ist das Krankenhaus der Zukunft ein Ort der Erholung? • Is the hospital of the future a place to rest?

Since Le Corbusier 1921 characterize the term „Living-machine“, architects have Orte des Austausches mit vielfältigen öffentlichen Räumen. • Place for exchange with manifold public spaces.
been fascinated by machines: the house as a machine for living, the hospital as a
machine for healing. For the last hundred and fifty years or so, hospitals were a
place we go to when we are sick, only to return to our normal life healed. “L’hôpi-
tal idéal serait pour nous celui où le malade ferait le séjour le plus bref du fait qu’il
aurait reçu les meilleurs soins et d’où il serait le plus vite rendu à sa vie normale,”
wrote Henry Bernard, one of the prominent French architects of the Trente Glorieu-
ses. With this ethos, an entire generation of hospitals has been built in Europe star-
ting from the early 1970s. Its architectural translation, known in the German spea-
king countries as Breitfuß, would consist of a low rise base surmounted by a high-
rise slab or tower, accommodating the inpatient wards – a much more efficient con-
figuration in terms of circulation than the pavilion type, which had been the stan-
dard practice for hospital design since the early 18th century. In Germany, the Breit-
fuß model found one of its most accurate implementations in the project for the As-
klepios Clinic Altona, designed by Kallmorgen und Karres Architects and built in
1971. However, what seemed to be revolutionary about its design turned out to be
its nemesis. The decline of the inpatient hospital brought about by increasingly
more effective surgical procedures rendered the clearly defined, un-expandable
high-rise building obsolete. Adding to that, the endless elevator waiting times put
patients’ lives at risk and the staff on the verge of mental breakdown. Just over 40
years after its opening, Asklepios Clinic Altona has been deemed unfit for today’s
healthcare requirements and is being proposed for demolition. If we look at the hi-
story of hospital design in general, a curious pattern emerges: the more recent the
project, the shorter it remains in use. In attempting to keep up with the frenetic Krankenhäuser als lebendige, gesellige Stadt in der Stadt. • Hospitals as a lively, sociable city in the city.
pace of research and development in medicine, any large hospital project, often ta-
king ten to 15 years from conception to delivery, is likely to be a casualty of its own
eagerness to innovate: obsolete upon completion.

The hospital of the future as an urban project

What, then, should the hospital of tomorrow be? An improved version of existing
hospitals? Or should it orient itself more widely and look at other buildings too –
being environments for people in general, irrespective of their medical condition?
The hospital remains one of the last truly public spaces, where people of all social
classes, ethnicities and occupations run into each other at any time of day. Derived
from the Latin ‘hospitale’ (guest house), the hospital’s implicit duty is also to be a
place of welcome. For many, today’s chronic diseases make a visit to the hospital a
routine, much like shopping, commuting to work or going to the gym. With that in
mind, the question arises how to make the hospital a place we actually enjoy going
to. Should the notion be expanded perhaps? What if we thought of the hospital of
the future not as a finite architectural solution but as an urban project: a perpetual
work in progress, a condition, much like the city itself – ubiquitous, ever-changing.

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