Designing buildings that promote health

For decades, the value of healthcare construction was measured at handover: on time, on budget, and to specification. Yet the real world now tells us something very different. Many of the illnesses filling hospital beds originate years earlier in the places people live, work, and grow up. With the NHS under unprecedented pressure — including over 2.8 million working-age adults now economically inactive due to ill health — healthcare construction has reached an inflection point: should buildings simply receive illness, or actively help prevent it?

This decline in population health is driving demand for NHS services, shrinking the workforce available to staff them, and weakening the national economy. Prevention cannot be delivered by the NHS alone; it depends on all public investment strengthening the social determinants of health (SDOH). Construction, which shapes the environments in which people live and work, faces similar workforce pressures to healthcare and has significant power to improve population health by shifting focus from treatment to prevention.

Social value as a lever for prevention

Health enables people to work, learn, and contribute to the economy, and a national rise in economic inactivity is a preventable one. And this is precisely where construction’s social value commitments can be transformative. In construction, social value refers to the wider benefits a project delivers for local people — such as employment, skills, education, support for local businesses, and community wellbeing — during delivery and beyond. But social value is not a tick box exercise — it is a framework through which the industry can actively counteract the drivers of ill health, inequalities, and economic inactivity.

The primary purpose in healthcare construction is to deliver high-quality, compliant, and safe facilities. That expectation from the NHS rightly remains. But the sector can no longer be defined only by the delivery of rooms, equipment, and compliant infrastructure. It should also be judged on its contribution to healthier communities, healthier workforces, and healthier futures — they must become assets for prevention.

This shift matters because prevention is now a clear priority for government and the NHS. A healthier population reduces pressure on services and boosts productivity. As a major delivery partner for government, construction has both a responsibility and an opportunity to support this focus through how projects are designed, procured, and delivered.

Construction as a driver of population health

Health does not begin in hospitals. It begins in the conditions that shape daily life: secure housing, stable income, supportive communities, access to nature, safe environments, and opportunities to learn and move. These social determinants of health account for the vast majority of our health outcomes.

Construction shapes the country on a huge scale. Public sector building programmes involve billions each year, and the CWAS3/P24 framework currently under procurement is worth up to £120bn over eight years. Ten per cent of its scoring, as with all public sector procurement owing to PPN/002, is linked to social value performance. With investment of this size, there is a major opportunity to improve public health through a joined-up approach to better places and stronger communities.

Prevention is not only good for people, but also for the economy. Evidence shows that each pound invested in prevention generates returns many times over through improved productivity, reduced welfare reliance, and stronger communities. As NHS Confederation chief executive Matthew Taylor has noted: “investing in prevention is not just good for patients and improving public health, but also the economy”. A 20 per cent reduction across major preventable disease categories could increase GDP by up to £26bn per year. Healthier populations participate more, earn more, spend more, and rely less on public services, creating a compounding cycle of economic benefit.

To reduce illness, we need to create places that help people move more, connect more and live healthier lives — not just receive treatment. Social value is how construction can influence these wider factors quickly and effectively, from before the first foundation has been laid, to well beyond opening.

Social value as upstream public health

Social value is often underestimated in its power to influence long-term health outcomes. Yet it can be one of the most powerful tools the construction sector has to address the root causes of illness.

Construction projects of all sizes can create employment opportunities that improve income security — one of the strongest predictors of health. Training programmes increase lifetime earnings and support economic mobility. Local supply chains strengthen community resilience and reduce deprivation. Youth engagement initiatives offer early-life interventions that deliver astonishing long-term returns. They demonstrate what happens when social value programmes directly target the conditions that underpin long-term health.

Kierriculum, an education programme designed by Kier to bring real-world STEM learning into schools through practical, curriculum linked activities, has supported pupils to build early confidence in science, technology, engineering, and maths. In parallel, the Hartlepool Literacy Taskforce sees our social value teams helping to tackle low literacy levels by making learning more accessible for both children and families — simplifying induction documents to a 10-12 year old reading age, redesigning student workbooks, reviewing feedback tools, and developing a ‘book supper club’ to encourage families to read together at home. Improving literacy and confidence at a young age is strongly linked to better health outcomes, higher educational attainment, and wider future opportunities.

At HS2, the Operator Skills Hubs have trained over 600 local people in just two weeks, giving many a route into secure employment. In Gloucester, the Learning Quarter at The Forum has provided a free space for training and employability events, helping more than 120 people return to work. These are practical routes into steady jobs — one of the strongest contributors to good health. And they work best when combined with other health promoting activities, such as workplace running clubs, healthy eating programmes, or regular health checks and wellbeing talks. Together, they help people stay healthier for longer by supporting both the conditions that shape health and the everyday choices that prevent illness.

This is prevention in action. By improving skills, confidence, education, employability, and community cohesion, social value helps people stay healthier for longer and reduces the pressures that lead to ill health in the first place. When aligned to local needs, social value becomes a practical and measurable way to prevent illness at scale. It stops being a requirement on a procurement form and becomes part of a project’s health legacy.

If every public sector capital project applied a SDOH‑based framework — using real local data to understand what communities genuinely need, targeting those needs in a sustained and meaningful way, and measuring actual outcomes rather than theoretical financial proxies — the impact would be both significant and long‑lasting.

It would move social value away from short-term activity counts and toward interventions that genuinely shift the conditions that shape health in the long term: income, education, security, connection, and opportunity. And if that learning were openly shared across programmes and supply chains, each project would become part of a growing national evidence base, making it easier for others to adopt what works and avoid what does not. Instead of isolated success stories, we would see a consistent, system-wide approach to prevention built into every investment.

The result would be healthier, more resilient communities — not just for the duration of a build, but for generations afterwards.

Designing buildings that promote health — not just treat illness

A healthcare building can also influence behaviour — often in subtle ways that shape wellbeing long before a patient enters a clinic room. Access to nature, which has previously been seen as optional in healthcare builds, is proven to reduce stress, support immunity, and aid recovery, while outdoor spaces can promote gentle movement and connection for staff and visitors alike.

Intuitive layouts that encourage walking, visible stairs, and inviting circulation spaces help normalise activity as part of daily routines. Co-locating preventive and community services — such as financial wellbeing support, employment advice, or health coaching — brings practical, upstream interventions into the heart of care pathways. At the same time, trauma-informed design principles create calm, legible environments that reduce anxiety and make services more accessible. These choices are far from being ‘extras,’ they help position healthcare buildings as community health anchors that actively support prevention as part of their everyday function.

Digital estates as prevention engines during use

Digital systems from sensors to data platforms are now essential to creating environments that actively prevent harm and, crucially, support staff wellbeing; the value is not in the technology itself, but in how it reduces stress, friction, and unnecessary workload so staff can focus on care.

Digital twins exemplify this approach by providing a real-time view of the estate, allowing teams to predict failures and optimise performance. In an A&E setting, for example, a digital twin can combine data on occupancy, temperature, and movement to identify environmental factors that may increase agitation, enabling adjustments before tensions escalate and helping protect staff from avoidable conflict.

This represents preventive design for psychological safety, reducing the environmental triggers that make healthcare settings harder to work in. Alongside digital twins, day-to-day digital systems — such as automated water safety management, location tracking tools, and digital wayfinding — support calmer, more efficient, and safer environments.

At a time when ill health is pushing record numbers of people out of the workforce, these systems play a vital role in helping staff stay well, avoid burnout, and continue doing the jobs they love. And as digital twins evolve, they could also help track broader wellbeing patterns across buildings or services, opening new possibilities for prevention in the future.

Bold leadership and capital project reform

To make prevention the key principle of healthcare construction, we need leadership willing to shift the narrative from ‘buildings as assets’ to ‘buildings as health interventions’. This is the time to ask bold questions. What if we treated buildings as health interventions? Why do we not design every project around SDOH principles?

Achieving this vision requires:

• Procurement frameworks that reward achieving measurable long-term health outcomes rather than short term interventions.
• Alliancing models that align contractors, designers, clinicians, and communities to push together around shared preventive goals, not siloed pockets of excellence.
• Investment in digital capability, to support safer, more adaptive buildings that allow the workforce to not just get by, but to flourish.
• A cultural and contractual shift towards measuring success years into a building’s life, not just at handover.
• Commissioning teams embedding prevention requirements in briefs from the earliest concept stage.
• Estates leaders demanding outdoor spaces, digital infrastructure, and co-located community services as core requirements, not optional extras.

This is not about spending more. It is about spending differently — on elements that compound in value over decades.

If we build with prevention at the centre, the benefits extend far beyond healthcare:

• Populations stay healthier and remain economically active for longer, reducing welfare pressures and strengthening national productivity.
• Communities rely less on acute NHS services and more on local preventive assets, shifting activity from hospital to community settings.
• NHS staff experience less stress and deliver better care in environments that support their wellbeing, helping improve retention, and patient experience.
• Estates run more efficiently and sustainably, boosting productivity and supporting progress toward Net Zero.

Construction, in partnership with the NHS, holds one of the most powerful levers for shaping the long-term health of the nation. Not through clinical activity, but through the environments, opportunities and connections created around every project.

Leaving a legacy

The purpose of healthcare construction is evolving. The question is no longer simply what are we building, but what are we building for?

If prevention is central to improving the UK’s health and prosperity, our estates must reflect that — encouraging movement, integrating nature, co-locating preventive services, strengthening community connection, supporting staff wellbeing, and using digital systems intelligently. Buildings shape health every day, not only at the point of care, and capital projects offer a powerful opportunity to influence those outcomes at scale.

This cannot remain aspiration. Prevention must be embedded in delivery — through social value, design choices, and digital integration. If every project took this approach, the collective impact on population health, communities, and productivity would be profound. This is the legacy now required, and one the construction sector is uniquely placed to deliver.