Dr. Christine Jeffries-Stokes, right, conducts a checkup and diabetes screening with Beniah Brooks at a local community health centre in Leonora, Western Australia; Dr. Christine Jeffries-Stokes, right, conducts a checkup and diabetes screening with Beniah Brooks at a local community health centre in Leonora, Western Australia;

Designing culturally inclusive health facilities

Julian Soper, Arup Australasia Health Business Lead and Ros Moriarty, CEO Balarinji

New Zealand’s Māori heritage is entwined in modern life: the widespread integration of Maori culture is an inspiration for Australians as they work to deepen Indigenous cultural awareness and make positive change in design and infrastructure, especially in metropolitan areas.

Within government and industry - more specifically the construction sector - there is an increasing awareness and will to affect change to bridge the cultural gap.

Embracing inclusive principles in health design

With an ageing and growing population – and the growing demand for investment in new facilities - the Australian healthcare industry is shifting its thinking.

While health infrastructure was once designed just for clinical functionality, in recent years the industry has embraced changing expectations of how that infrastructure can also improve a person’s wellbeing.

How can we implement better, more inclusive systems to deliver capital works in our cities to support human wellbeing - where we think of cities as complex ‘living’ systems, with co-dependent parts?

We can learn from Aboriginal and Torres Strait Islander peoples how to design healthcare facilities that treat the whole person beyond the medical presentation.

The concepts of mindfulness, connection to nature, caring for Country and caring for family are important in achieving health and wellbeing. A connection to the outside environment, access to multi-level large green spaces that can embrace family groups, the orientation of buildings to face the sunrise or sunset, and a connection with smoke and fire offer potential for significant healing benefits when brought into a contemporary context and integrated into urban health facilities.

These are fundamental concepts which have been embedded within Aboriginal and Torres Strait Islander sensibility for millennia.

So, as well as green hospitals and resilient design to combat climate change, we now have opportunities for better integrated, culturally inclusive health facilities. A more culturally informed facility will maximise access to health services for all Australians.

The much-needed step change: collaboration

Creating culturally inclusive health facilities is not a new topic of discussion; regional areas of Australia have long acknowledged that local health facilities need to be culturally informed. 

The Office for Aboriginal and Torres Strait Islander Health (OATSIH Capital Works Programme) along with state and territory governments have funded the design and construction of culturally appropriate medical facilities for Aboriginal and Torres Strait Islander peoples around Australia for decades.

These facilities accommodate Aboriginal Medical Services (community-controlled organisations) to deliver holistic services to Aboriginal and Torres Strait Islander peoples incorporating social, cultural and emotional wellbeing.

To incorporate Aboriginal and Torres Strait Islander narratives into the urban health context, another change is needed – collaboration. 

A key aspect of this rethinking has focused on how to better engage with Aboriginal and Torres Strait Islander end-users to guide the design requirements and accommodate the functional and cultural needs to support wellbeing.

To do this more widely will rely on the industry to change processes more fundamentally.

For some years, Arup has been rethinking its approach to the design and delivery of major urban projects with a view to maximising the participation of Aboriginal and Torres Strait Islander peoples from the outset. ”

Julian Soper Julian Soper Principal | Health – Australasia Leader

The way forward

In the context of health infrastructure, there is no one-size-fits-all for embedding Aboriginal and Torres Strait Islander stories into design; it will differ between facilities and places. However, there are underlying principles which are important for decision makers to consider: focus on the process, think about the product, and think beyond the product.

Focus on the process: Make sure it’s culturally informed. Think about the process and engage Aboriginal and Torres Strait Islander peoples and consultants from the beginning to shape it in a meaningful way. When we focus on the process, on the way these facilities are designed, delivered, constructed, operated and maintained, we see significant benefits and efficiencies.

Think about the product: Wellness is an underlying constant – the end product should reflect not just the physical wellbeing of an individual, but also the social, emotional, and cultural wellbeing of the whole community. This may include linking spaces to outdoors, ensuring connection with Country, creating spaces that are accessible and not intimidating, and arranging the spaces to accommodate expanding and contracting family groups. Balancing these needs with clinical requirements is critical.

Think beyond the product: For facilities geared specifically to Aboriginal and Torres Strait Islander communities, it is crucial to go beyond the design of physical elements to include designing the process of delivery so Aboriginal and Torres Strait Islander peoples local to place tangibly benefit from the economic opportunity, as well as contribute knowledge and skills.

Rethinking the processes by which we plan, design and deliver

Organisations such as Balarinji are playing a critical role in the activation of the voices of Aboriginal and Torres Strait Islanders in the co-design of major projects.

Balarinji is helping in the shift to Indigenous partnerships, acting as an interface between the translation of Indigenous design and the delivery of the built environment.

It’s hard to understand why in 2019 our foundational narrative of Australia is invisible in much of our infrastructure. ” Ros Moriarty CEO of Balarinji

In an Australian first, it has developed cultural design principles to embed Aboriginal and Torres Strait Islander stories within large public infrastructure master planning and design projects, such as the Sydney Metro West (rail line) and M12 Motorway.

“We pursue deep collaboration with Indigenous communities to establish the stories that are important to them and significant to the local area. These stories then underpin design principles,” Ros said.

“We translate those themes and stories for master planning or project design teams, and work with those teams (and with local community) to bring visibility to Indigenous narratives in Australia’s public places, public architecture or public projects.”

For designers and design teams this means exploring a way of seeing the world they might not have ever considered before.

“It’s not simply about a painting on a wall; it may be the way the building is orientated to where the sun rises or sets, or it may be how it embraces the elements for a particular reason.

“Exploring those themes at the front end of projects is exciting for the sector.

“And we are finding that once these projects are underway, it’s a ‘lightbulb’ moment for the teams we work with - large engineering companies and prominent architectural firms. They ‘get it’ because they’re working in a different way and they see the value: the design sector is at the apex of the intent to bring the community along.”

Creating health spaces that embrace Aboriginal and Torres Strait Islander peoples requires new ways of thinking. But inclusive health facilities can bring wellbeing benefits for all people.

By reframing how we approach the design of our health infrastructure, we are also creating a more vibrant Australia that recognises its founding identity and embeds the values of Aboriginal and Torres Strait Islander cultures to achieve better outcomes for everyone.

By acknowledging Aboriginal and Torres Strait Islander peoples’ deep knowledge and culture, and developing inclusive partnerships for co-design of major urban capital works, we continue the journey to Reconciliation.

Download Arup’s Reconciliation Action Plan.