The role of modern architecture in the definition of the Portuguese Health System

Being health a fundamental right, the healthcare system and infrastructures are essential for society’s wellbeing and progress. Specially in the context we face since last year with the Covid-19 Pandemic, this is once again in the fore. As the relationship between illness and the built environment is undoubtedly a critical topic, architecture and medicine have always been tightly interlinked. Investigation into healthcare buildings involves dealing with multiple spheres beyond the technological, physical, and psychological. Nowadays, the growing emphasis on wellbeing goes beyond the seminal ideas of the hospital as a “healing machine”, or that modern architecture and urbanism were shaped by bacteria, influenced by discoveries by physicians as Pasteur or Röntgen. By responding to the specific health necessities of their time, healthcare buildings are subject to continuous transformation, frequently not planned in a middle-long term and without sufficiently considering comfort and space quality. Consequently, in many hospitals the existing environment is not welcoming and “human”, hindering the upcoming of a feeling of comfort and the doctor patient approach. Also functionality becomes affected as interventions are not undertaken within a general middle-long term maintenance plan. Considering the health facilities network, central and regional hospitals deal more with this kind of interventions as they must provide health assistance in a wider spectrum of services and to a larger population. Saying this, the aim of this paper is to highlight the relation between architecture and health, based on the development of 20th century Modern Movement health facilities in Portugal within the definition of the Portuguese Health System [Sistema Nacional de Saúde, SNS]. Two particular cases with different programmes and roles in the Portuguese health policy and importance on national level will be studied: the teaching hospital – São João Hospital in Porto (1939-1959) by Hermann Distel – and the regional hospital – Santa Luzia District Hospital in Viana do Castelo (1970-1984), by Raúl Chorão Ramalho. Therefore, starting with the study of the original project of the hospitals, from the urban scale to the scale of the patient’s room, will be highlighted the main transformations and challenges driven by developments in technology and medicine, as well as actual problems. Hereby some possible future needs can be inferred, which is essential for an integrated intervention that values the healthcare architectural heritage, and prevent its deconfiguration, deactivated or even demolished, ensuring a sustainable built environment focused on adaptative, reuse, renovation, and rehabilitation intervention measures