Tuesday, June 3, 2025
Although many people enjoy living in a city, it can also be an unhealthy environment, due to factors such as air pollution, lack of safety, and loneliness. Especially in vulnerable neighbourhoods, people have shorter life expectancies and fewer healthy years. Prof. Dr. Ir. Machiel van Dorst is committed to developing knowledge that helps reduce these health disparities. “The way we shape, design, and manage our spatial environment affects people's well-being in many different ways.”
Machiel van Dorst is Professor of Environment, Behaviour and Design at the Faculty of Architecture and the Built Environment at TU Delft. In addition, he has now been appointed as a Medical Delta Professor with a position at the Faculty of Social and Behavioural Sciences at Leiden University. He is involved in the Healthy Society program.
What does the appointment as a Medical Delta Professor mean to you?
“I feel honoured. To me, it means that I can contribute to the growing focus on prevention in healthcare and help bridge the gap between social, technical, and design sciences.
Within the Faculty of Architecture, where I work, quite a lot is already happening in the field of health. Still, this faculty wasn’t yet strongly connected to Medical Delta. That’s now changing. Together with Dr. Deepti Adlakha, I’m responsible within the faculty for BK Health — the program in which we explore how to design the built and natural environment in ways that promote health and well-being for everyone. In that sense, I also see my appointment as a logical next step.”
Can you briefly describe your area of expertise?
“My background is in environmental psychology and urban design. I’m interested in the behaviour and interaction of people with and within their living environment, both socially and physically.
The way we shape, design, and manage our spatial environment affects people’s well-being in many ways. Think of the impact of microclimates, such as heat stress on public squares, air quality, noise, and traffic safety — all of these are aspects of urban design. The same applies within buildings: indoor climate and safety have a direct effect on our health. The built environment also plays an important role in prevention. A green environment, for instance, reduces stress and has measurable effects on well-being.
In my work, I mainly focus on vulnerable groups, such as children and the elderly. They are highly dependent on their immediate surroundings. There is a clear link between the neighbourhood someone lives in and their life expectancy and number of healthy years. We study that connection — and there is much that can be improved.”
What is the link with healthcare?
“That link lies partly in prevention, but also in the direct care pathway. People living in less healthy environments are more likely to end up needing healthcare. They are patched up there, but then return to the same conditions. Someone who’s had lung surgery might just light up a cigarette again at home.
It’s about behaviour and both the social and physical environment — and that’s complex. As urban designers, we naturally deal with that complexity. Urban design is not a standalone discipline; it’s always multidisciplinary. That’s exactly why I find collaborations like Medical Delta so interesting: no single discipline can solve these kinds of complex issues on its own.
Ultimately, residents know their environment best and choose for themselves whether or not to live a healthy lifestyle.
The next step is not just to work in a multidisciplinary way, but transdisciplinarily. That means working together with organizations like the public health service (GGD), municipalities, the province, and with residents themselves. Ultimately, they know their environment best and choose for themselves whether or not to live a healthy lifestyle.
There’s an incredible amount of knowledge outside of academia. You can already see this in universities of applied sciences: they are closer to practice and to residents, and they gather different kinds of knowledge. Then comes working with people who are fully embedded in practice. Co-creation with end users — with residents — is essential. They are the experts of their own neighbourhood.”
What can you do or contribute from your discipline?
“From my discipline, I can primarily help build connections between different fields and contribute to transdisciplinary collaboration. But also: closely observe people’s living conditions. When people feel more part of a community, a greater sense of collective resilience emerges — they do things together and support one another. The way we design our living environment has a major influence on that.”
What is the collaboration like with fellow Medical Delta Professor Ineke van der Ham, who is taking the reverse path with an appointment at TU Delft?
“That collaboration is very pleasant and enriching. She is an expert in wayfinding — how people find their way in their environment — and she specifically focuses on groups for whom that’s a challenge. We design environments and their variations, while she brings neurological expertise and the tools to measure brain activity. That combination helps both of us move forward.
The official appointment in Leiden through Medical Delta supports that. It also makes me feel like a kind of ambassador, and I try to encourage people from my own group or network to explore collaboration with Leiden. For example, I connected Ineke with landscape architects on our side, and for me, gaining access to the social sciences in Leiden has become easier. Within my faculty, I’m the only environmental psychologist, but in Leiden, more people are working in that field. That’s incredibly valuable.”
The healthcare system is increasingly under pressure. What kind of transition do we (as a society) need to undergo, and how can your research contribute to that?
“The biggest transition we need to make is the shift toward prevention. Healthcare is becoming overwhelmed because we often intervene too late when it comes to people’s well-being. Think of obesity caused by growing up in an environment full of fast food and limited opportunities for physical activity. Or stress due to an unsafe neighbourhood, or sleepless nights caused by noise pollution. If you don’t address those issues, people become dependent on healthcare much sooner.
A second important change is that, as a society, we need to focus more on collective resilience. We live in a welfare state that is heavily centered on the individual. In a speech, the king once spoke of ‘self-reliance’ as a way to ease the burden on the system, but in reality, no one is fully self-reliant. You always need others. That’s why it would be beneficial for people to look out for one another and be engaged in their neighbourhood. No one needs to be forced to put on their neighbour’s compression stockings — but it starts with paying attention. If you notice in time that someone is struggling, many problems can be prevented. And that ultimately helps reduce the pressure on the healthcare system. The design of the living environment can either support or hinder this kind of essential social interaction.”
What will a Dutch citizen eventually notice from your work and this collaboration? What do you hope to have achieved for them in 5 or 10 years?
“What I hope people will notice in a few years is that science feels less like an ivory tower. That we, as specialists, work less in isolation and collaborate more.
Because an average Dutch citizen doesn’t think in disciplines. In fact, they suffer from being sent from one specialist to another. Imagine someone has complaints due to noise pollution at home. They go to their GP and might be referred to an ENT specialist or a psychologist. But no one asks: what’s the insulation quality of your home?
What we need are people — including scientists — who dare to think and look more broadly. Who work in an integrated and holistic way. A great example is a general practice in Rotterdam South, where they’ve hired a debt counsellor. Headaches and stomach-aches can sometimes stem from stress caused by debt. In that case, sending someone to a medical specialist doesn’t help — but mapping out their financial situation together does.”
How do you involve practical partners in your research?
“In various ways. It starts with being visible, so that questions from practice reach you. It is very valuable when a research question or goal arises from what is happening in a neighbourhood or organization.
You really have to connect with residents, stand alongside them. That provides so much inspiration.A good example is a project in Dordrecht, part of the Regioplan. It was set up with many involved actors, including municipalities. They bring their own questions and problems. This requires not only scientific expertise but also practical skills. You really have to connect with residents, stand alongside them. That provides so much inspiration. And it also keeps you grounded. In a project by one of my PhD students in Bospolder-Tussendijken, a resident said very strikingly: ‘All the knowledge is already here, but just listen to us for once.’
Of course, it’s different in more high-tech medical sciences, but for the type of research I do, collaborating with residents and practice partners from the start is essential.”
Do you have an example where input from practice completely changed the research?
“Fortunately, practice has never drastically changed my research; precisely for that reason, it’s important to always start by listening and making contact. If I want to study physical inactivity among the elderly, but I enter a neighbourhood where hardly any elderly live, or where they say, ‘Why are you interfering?’ it won’t work. You have to be very specific about who you approach and how you do it.
For example, in a project about the child-friendly city, we wanted to study children’s play behaviour in public spaces. The initial research question was quite broadly formulated. Then we made contact with primary schools and parents of young children even before starting the research. By talking with them, the research question became more specific and aligned with what’s really going on.”
Do you see a role for collaboration with vocational education (MBO)?
“Certainly, although I don’t have much experience with it myself yet. But when it comes to training people, education can be very well combined with research. For a project around Zuidplein in Rotterdam, I studied the experience and usage values of that place. I developed a research method that others could also use. First, university students worked with it, and later also MBO students. What was interesting about that: the MBO students often had a much more direct connection with the neighbourhood. They lived there, went to school there, and therefore brought very different perspectives and reflections than the university students. That provided valuable, additional insights for the research. So the link with MBO definitely deserves further development.”
You’re probably meeting more scientists but also practice partners now from different disciplines and institutions. Whose work has truly surprised you, and why?
“I’ve been working in this field for quite a while now, so that’s quite a few people. Recently, for example, I really enjoyed being approached by Andrea Evers for the Medical Delta theme program Healthy Society. What I truly appreciate about her is the way she brings the team together and gets people genuinely committed.
If I look further back in my career, someone who has stayed with me is the Indonesian architect Yusuf Bilyarta Mangunwijaya. I once went to Indonesia as a student and spoke with him a few times. He made a strong impression on me, partly because of the clear stance he took. He said to me, “I speak Dutch, but let’s speak English, because Dutch was the language of the former occupier.” He explained to me that it all starts with respecting the residents. Then they can develop self-respect, and only then can you collaborate well.
Yusuf won the prestigious Aga Khan Award for Architecture for a project in Yogyakarta. He first went to live in a neighbourhood himself, gained the trust of the residents, and only then began working together with them to improve the area. He really took the time to get to know the residents and the situation. He has always continued to inspire me.”
What do you need from others, what do you still miss in your collaboration to be able to achieve your goals? What call to action would you like to make?
“We have organized universities to be as efficient as possible. As a result, most of our time goes to teaching and research, including applying for funding and setting up consortia. And in that, I actually miss two things. First, I see that there is a lot of focus on international collaboration. Of course, this is good, but at the same time, it makes it difficult to start a consortium with a colleague from the department next door. While that collaboration can also be very valuable.
One group decided to bake pancakes in a booth for elderly people in the area. That worked very well, both as an interview method and as a form of education.
Second, transdisciplinary collaboration is very important for valorization, but it does require time. Time to sit for afternoons in a community center, to really listen to fellow human beings. Such activities are not part of the schedule for teaching and supervising PhD students. That time is not valued as such.
Less pressure to publish would help. And more flexibility in education. Right now, it’s all tightly structured with learning objectives, final terms, and course goals. Of course, those are important. Students need to graduate with certain skills, but besides that, we also need to create room for inspiration and personal engagement.
Last year, I had an elective where students went into the neighbourhood and could choose their own methods to get in touch with residents. One group decided to bake pancakes in a booth for elderly people in the area. That worked very well, both as an interview method and as a form of education. But that requires freedom and creativity within all the systems that are now so tightly organized.”
