Second interlude: on the house from all sorts of angles

The planning and design of environments for healthcare is complex and at times contradictory. Research and critical discourse have been fragmented and have not provided the degree of support required by the architectural profession. This dilemma is compounded by the enormous capital investment countries around the globe expend annually to promote the health status of their citizens. To help rectify this situation, landmark international developments in the relationship between architecture and health are outlined within a dualistic conceptual framework that is part historical and part futurist. Prognostications for the year 2050 are offered on issues concerning the rise of alternative care settings to the traditional acute care hospital. This portion of the discussion examines the rising importance of home- and community-based care, the functions of nature as a therapeutic modality, patient empowerment, the critical need for socially equitable and sustainable environments for healthcare, and the need for new paradigms in the planning and design of therapeutically supportive care and treatment settings. Two developments in particular, functional deconstruction and residentialism, are described in some detail as is the critical role of interdisciplinary approaches in meeting the global research and practice challenges which lie ahead in this century.