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Review of Related Literature

The redevelopment and modernization of the Baguio General Hospital and Medical Center at present is facing
conflict with its 115-year old facilities being declared as a heritage cultural structure. Further understanding of
Modernization, Greening and Conversion of Historic Hospitals as a part of sustainable redevelopment is vital in the
study. Another points in the study to understand was the principles and creation of outdoor and indoor healing

This part is about a review of existing literature related to the conservation of heritage, green design and
healing environment to set the theoretical framework and planning strategies for conservation of Built heritage and
creating a healing environment for Baguio General Hospital and Medical Center.

The Importance of Cultural Heritage

Culture is a term used by social scientists for a way of life. Every human society has a culture. Culture
includes a society’s arts, beliefs, customs, institutions, inventions, language, technology, and values. Culture
produces similar behavior and thought among most people in a particular society (Encyclopedia, 2007). Also,
UNESCO (2007) defines that culture “is a set of shared attitudes, values, goals and practices, the integrated pattern
of human knowledge, belief and behavior that depends on the capacity for learning and transmitting knowledge to
succeeding generations, including not only arts and letters, but also modes of life.

Cultural Heritage is an expression of the ways of living developed by a community and passed on from
generation to generation, including customs, practices, places, objects, artistic expressions and values. Cultural
Heritage is often expressed as either Intangible or Tangible Cultural Heritage (Ippolito, 2016). Also, According to
the United Nations Educational, Scientific and Cultural Organization, heritage is “our legacy from the past, what
we live with today, and what we pass on to future generations. Our cultural and natural heritages are both
irreplaceable sources of life and inspiration (UNESCO, 2002).

Built heritage value can be best expressed as a cultural resource. Architecture is a product of culture and
encapsulates the attitudes and values of the past times. These are valuables as they are documents with knowledge
of the evolution of society and are an important entity for the development of society (Worthing and Bond, 2008).

Historic Environment and Heritage Buildings

Historic environment contains a unique and dynamic record of human activity. It has been shaped by
people responding to the surroundings they inherit, and embodies the aspirations, skills and investment of
successive generations (Lockhart, 2014). Some parts of the historic environment are important to society as a
whole or to a group within it and merit some level of protection or consideration. These are called our heritage
assets. They are the elements of the historic environment that we value for more than their money’s worth. The
generations that follow us are most likely to value them. It has therefore long been accepted that we have a
responsibility to look after them (Lockhart, 2014).

Heritage buildings possess architectural, aesthetic, historic or cultural values and are declared as heritage
buildings by the planning authority, heritage conservation committees or any other competent authority in whose
jurisdiction such buildings are situated. Historical significance, architectural style, design, technology and material
use and aesthetic are the main parameters to identify the heritage buildings/precincts. Heritage can be
environmental, architectural, and archaeological or culture and crafts related (Chairatananonda, 2009).

Contemporary Issues in Urban Heritage Conservation

Urbanization in many developing economies has been rapid, incessant, excessive, and often uncontrolled.
Widespread growth of cities has resulted in deteriorating urban environments. Such modes of urbanization have
also been damaging to natural resources including land and water bodies, and cultural resources including built
heritage, building crafts, traditional knowledge and creative industries.

The globalization processes have resulted in increasing homogenization and standardization across the
world. This in turn hassled to a growing search for identity. These have posed persistent threats to the heritage
assets and values and the identity of historic urban area. In previous decades, urbanization resulted in vast
destruction of built cultural heritage in order to create a ‘tabula rasa’ and restructure the city. Places assume a key
role in the urbanization processes as they satisfy the need for identity. Cultural heritage plays a key role in the
establishing the identity of places and their regeneration.

Heritage Conservation

Heritage conservation is defined as all actions or processes aimed at safeguarding the character-defining
Elements of a historic place to retain its heritage value and extend its physical life (Fan, 2014). Fan also defined
conservation as the process of managing change to a significant place in its setting in ways that will best sustain its
heritage values, while recognizing opportunities to reveal or reinforce those values for present and future
generations. In the sphere of cultural heritage, the preservation values are critical deciding what to preserve and
how. Even making a typical preservation decision reveals many different and sometimes divergent values: artistic,
aesthetic and historic values, plus economic values tied with the use of building or other structure under

Cultural Heritage in the Context of Sustainable Development

Traditional approaches of environment protection were concentrated on limiting the impacts on the natural
and, to some extent on social and cultural environment. The main concern of such approaches was repair, and the
perspective was short time orientated. However, over the recent decades the concept of sustainable development
has evolved. Gro Harlem Brundtland, the former Prime Minister of Norway, in Brundtland Commission Report
describes that a sustainable heritage development is that development which meets the needs of the present without
compromising the ability of the future generation to meet its own needs (Lafferty, Knudsen and Larsen, 2007).
Moreover, Cohen (2002) suggests that the aim of conservation should be promoting life characterized by a strong
sense of continuity and aesthetic qualities are not sufficient to achieve this aim. The focus should not be only on
the monuments, but everyday urban activities should also be rediscovered. According to D. Rypkema (2007),

thinking in a broader context, the role of heritage striving for sustainable development is absolutely clear:
preserving cultural heritage provides environmental sustainability, cultural sustainability and economic

Sustainable Healthcare Architecture

With numerous hospitals and medical centers affecting the quality of life and the people’s living
conditions, it is very important to escalate the quality of services provided by these healthcare institutions. In order
to become a leader in healthcare, training and research in Northern Luzon, The Baguio General Hospital and
Medical Center strives to provide quality healthcare and exercise social and environmental sustainability in its
spaces. With the Department of Health’s mandate in modernizing and greening hospitals, it is very import to
understand the roles played hospitals and the principles for a healthcare architecture to be considered sustainable
and eco-effective.

Roles of Hospitals in an Emerging, Changing Environment

Emerging at different places, reflecting existing social and cultural contexts, hospitals as recognizable
institutions pose many challenges to those undertaking reform of the various healthcare systems. Hospitals are
immovable structures whose design was cast in concrete, many years previously in the past. The existing setup and
configuration often reflects the health care practice and the projected patient populations. Hospitals are institutions
providing healthcare services such as diagnosis, checkups, and medical operations. In the near future, hospitals
should be able to anticipate and adapt to emerging factors affecting human lives. Hospital design and clinical
practice need to consider existing and newly emerging diseases in order to provide for the people. Another role
that arises from the patients’ needs were the necessities of modernization and development in technologies,

opening up possibilities for new health investigations or new methodologies in the treatment of diseases.
Modernization and technology bring profound changes in what is possible to do in a hospital. Hospitals in the
future must be able to respond to challenges presented by issues that will arise. It must be able to balance
economies of scope with optimal access, drawing on technological advances. It should address the needs for
increasing bed capacity and it will need operating facilities and recovery areas, with purpose-built facilities
offering surgical operations and integrated healthcare for common disorders. Lastly, the hospital of the future
needs to be flexible, because todays’ way and methods of treatment will be different in the times to come. (McKee
and Healy, 2000)

Green Building Design

The hospitals and health facilities of the future has the capability of achieving environmental sustainability
by incorporating green building principles in their design, construction and in hospital retrofits or preservation.
Environmental sustainability is a powerful tool for the improvement of the quality of life and health of the people
of the hospitals and medical centers, patients and workers alike. Both existing and new healthcare facilities can
regulate climate footprint through design by incorporating components and features such as day lighting, natural
ventilation and green roofs. Planting trees and the use of local and regional materials were also green
methodologies used in achieving environmental sustainability. (Vittori, 2009)

Eco-Effective Design

Being coined by William McDonough and Michael Braungart, Eco-Effective Design is an approach that
has a huge impact in the design of healthcare architecture. It push to achieve increased or improved positive results
or outcomes in both human and environmental health. Eco-Effective Design gives rise to buildings that generates

or promote improves ecological health and indoor environmental quality. In addition to that, it is considered as the
strategy for designing human industy that is safe, profitable and regenerative, production, economic, ecological
and social value. (McDonough Braungart Design, 2008). Contrary to Eco-Efficient Design, Eco-Effective Design
focuses more on the good impacts of buildings rather than reducing negative impacts. The Eco-Effective approach
of creating positive environmental impact has a strong relationship to the goals of healthcare and it is a powerful
tool in achieve those objectives.

Greening and Modernizing Historic Hospitals and Healthcare Institutions

Understanding and addressing the redevelopment of historical structures without compromising is very
important. The concept intends to preserve and conserve the character-defining elements found in the structures.
Green retrofitting and redevelopment intends to measure reduce energy consumptions by buildings, thus reducing
electricity generation and the combustion of natural gas in a day-to-day basis. The greening of hospitals and
healthcare institutions intends to reduce emissions of greenhouse gases and to create environmental sustainability.
(Stein, 2009)

The Seven Elements of a Climate-Friendly Hospital

According to the World Health Organization (2009), climate change has the capacity and capability to produce
several consequences for the human health and quality of life. The heath sector has a vital and important role in
helping nations across the world to adapt to those severe consequences. In addition, the health sector also plays a

leadership role in the mitigation of climate change, reducing magnitude, impact and consequences of such changes.
There are seven elements that can contribute in mitigating the severe effects of climate change and are factors to
consider in the design of hospitals and other healthcare facilities:

1. Energy Efficiency
Reduce hospital energy consumption and costs through efficiency and conservation measures.
2. Green Building Design
Build hospitals that are responsive to local climate conditions and optimized for reduced energy and
resource demands.

3. Alternate Energy Regeneration

Produce and/or consume clean, renewable energy onsite to ensure reliable and resilient operation.
4. Transportation
Use alternative fuels for hospital vehicle fleets; encourage walking and cycling to the facility; promote
staff, patient and community use of public transport; site health-care buildings to minimize the need for
staff and patient transportation.

5. Food
Provide sustainably grown local food for staff and patients.
6. Waste
Reduce, re-use, recycle, and compost; employ alternatives to waste incineration.

7. Water
Conserve water; avoid bottled water when alternatives exist.