Healthcare’s “Modern Movement”

For most of my childhood our next door neighbor, Nick, ran a niche sports magazine from his home.  Trained as an architect at the University of Toronto, Nick went on to work (for only a couple of miserable years) as an municipal architect with the city before dedicating himself full-time to sports.

One of Nick’s most memorable stories involved the Regent Park housing project near our home, which he had helped design.  Build in the 1950’s, Regent Park was an experiment in social engineering.  Always a tough area, after the War the City made big plans to raze Victorian era homes and install multi-story apartments instead.

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Regent Park, Toronto,  in the 1950’s, rising behind existing housing

By all accounts the attempt to improve living conditions gradually failed: only a few years later, the new apartment blocks quickly became run-down and I remember the area being hardscrabble through the 70’s and 80’s when I was a kid.

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Nick often commented on how Regent Park stood as an example of a profound disconnect between the social/ architectural engineer’s ambitions and the grim realities of poverty.

For him, nothing symbolized this disconnect more than the pass-through windows that the architects designed into each new apartment in the early 1950s.   The architects gamely imagined that the windows would allow hot roasts to be passed from the kitchen to the dining room during large family Sunday dinners. The reality of life in the “social housing” apartments was something quite different.

 


A lot has been written about the Regent Park development.  It stands (much like Chicago’s public housing projects) as an example of architecture’s “modern movement”.  This post-war urban planning philosophy arose in response to dreadful urban living conditions, and proposed orderly complexes as a way of “renewing” neighborhoods.

Urban designer Ken Greenberg writes about history of the “modern movement”.   Jann Pill, commenting on Greenberg’s work, notes:

The modern movement was motivated by what Greenberg calls “a sincere humanist urge” to address the substandard housing, overcrowding, pollution, noise, soot, disease, and other features of industrial cities that emerged after the Industrial Revolution. The modern movement was based on the premise that the methodical logic that had successfully applied inventive engineering to industry could also be applied to how people lived their lives.

The “modern movement” looked at housing as a technological and engineering challenge.

The early modernists believed that the primary roles of a city could be identified, in the same way as the mechanical operations of industrial processes can be identified. The belief was that after the roles would be identified, they could then be simplified, separated, and made to work more efficiently.

In a proposed scenario advanced by prewar and postwar modernist architects, people would be housed in “towers in the park” – high, widely spaced apartment blocks, with lots of green space surrounding individual buildings. Work would be performed in modern factories and offices. Recreation would take place in sports complexes. Cars would move people between zones. Greenbelts would separate the zones.

In the interest of minimizing “friction” and maximizing “efficiency” in what was called the Functional City, there was to be no mixing of zones or of functions. The application of these principles gave rise to large numbers of postwar “urban renewal”  projects based on slum clearance and redevelopment.

The result was a predictable conflict between the “city as machine” and the behaviors, desires and decisions of the humans who lived within them.


Working in healthcare, I’m often reminded of Nick’s pass-through window anecdote.  When I was much younger I worked as a paramedic and spent a lot of time in the homes of all kinds of folks. It was always disheartening to find detailed hospital discharge papers (specifying wound care, medications, repeat visits, PT/OT and the like) on the table in a kitchen with no food.   No surprise that the paramedics were back.

In this era of so-called accountable care, are we living through healthcare’s modern movement?  As I contemplate “quality” metrics that require “compliance” with medications, and improvements in diabetes markers–  I wonder whether the health administrator’s perspective of the world is comparable to that of earlier urban architects.  We spend time building processes and institutions to standardize healthcare delivery, to then be disappointed when we find that complex human behavior is inherently resistant to process.  Our idealized systems are divorced from human calculus.

As we build the healthcare systems of the future, maybe we should stop to evaluate the number of pass-through windows implicit in our plans…

 


Photo:  City of Toronto Archives.