Context

Today’s healthcare systems in Europe and the United States have become an echo from history, from a period of rapid economic and demographic growth. They were part of the social networks that evolved as part of the Welfare State (and in Central and Eastern Europe of its communist counterpart). Their administrative structures were inspired by modern management procedures in the world of largescale private companies and their main function was the top-down redistribution of money and public facilities. Health promotion was synonymous with the creation of huge networks of medical institutions – fostering healthy lifestyles only played a marginal role. Buildings – hospitals, psychiatric clinics – represented the frontlines of public health. By now they have become relics of the past. The networks created in the heydays of the Welfare State, the Great Society and communism have become obsolete. Economic growth no longer results in higher wages. Social security networks are shrinking. Jobs for life have become exceptional. The emerging sharing economy replaces traditional forms of ownership. Social media destroyed the notion of homogenous social classes and created a fluent field of mostly digital communities based on shared interests. Advanced ICT-technologies redefine the traditional client/provider relations and allow for an unprecedented level of personalized consumerism. Yesterday’s public health systems cannot cope with these changes and have become unaffordable. New realities emerge that make it imperative to shift the focus in public health to non-medical policies. Architecture and urbanism will once again play a crucial role.