How architecture can save lives

{"text":[[{"start":5.35,"text":"The writer is a science commentator"}],[{"start":7.85,"text":"When outsiders began building odd-looking houses in rural Tanzania and offering them to families by lottery, lurid rumours started to swirl."}],[{"start":16.75,"text":"Were the boxy new-builds designed to lure villagers to their deaths? Why did these strangers want photo IDs of their children? Given the Makonde proverb, Cha bure cha kudoroja, which warns of no such thing as a free lunch — let alone a free home — freemasonry, witchcraft or supernatural forces were variously suspected to be at play. "}],[{"start":38.75,"text":"In fact, it was part of an unusual experiment: to test architecture as a health intervention. A group of researchers has since found that children living in these purpose-built two-storey “Star Homes” showed more robust health on average than peers living in traditional one-storey mud-and-thatch huts. Youngsters in the homes, who had their health measured over three years, saw fewer cases of malaria, diarrhoea and acute respiratory infections, which are among the major killers of children in sub-Saharan Africa. Under-fives in the homes were also taller for their age. "}],[{"start":73.25,"text":"Lorenz von Seidlein, an Oxford University global health academic based at the Mahidol Oxford Tropical Medicine Research Unit in Bangkok, helped to lead the study, funded by the Singapore-based Hanako Foundation and published last month in Nature Medicine. He singled out the increase in height as a crucial win. “I can’t overestimate the importance of reduced stunting over a lifetime,” he told me. Stunting, which affects around 62mn children in sub-Saharan Africa, according to Unicef, can hamper brain development, school attainment, adult earnings and later health. It is a reminder that health interventions are economic interventions, too."}],[{"start":112.4,"text":"The homes — designed by medic-turned-architect Jakob Knudsen, from the Royal Danish Academy — are paragons of passive engineering, pulling together features that have been tested at smaller scale in Tanzania and the Gambia. The houses are positioned to maximise shade through the day so the house is cool at night, with perforated screens on the first floor rather than walls. Self-closing doors keep insects out."}],[{"start":null,"text":"

"}],[{"start":138.70000000000002,"text":"A raised, easy-to-clean concrete floor, together with lockable rat-proof storage, improves kitchen hygiene; there is a ventilated, fly-proof toilet. A vented stove avoids the need for cooking inside on open fires, stopping the build-up of harmful gases linked to respiratory illnesses. A rooftop system collects and filters rainwater. Much of the health benefit was designed to come from separating out the cooking, sleeping and toilet areas."}],[{"start":166.45000000000002,"text":"But the only way to find out for sure was to conduct a randomised controlled trial. Across 60 villages in the southern Mtwara region of Tanzania, the researchers used lotteries to randomly allocate families to 110 Star Homes. The lottery excluded families living in houses with electricity and piped water, reducing the chances of skewing the results from the start."}],[{"start":189.45000000000002,"text":"Over the three years up to the end of December 2024, researchers compared Star Home children with their peers living in 513 mud-and-thatch buildings — and found 44 per cent fewer malaria cases, 30 per cent less diarrhoea and an 18 per cent drop in respiratory infections. The figures are significant, though one malaria researcher who was not involved in the study told Science it was like comparing the worst housing in Tanzania to the best."}],[{"start":218.4,"text":"The steel-framed, solar-panelled Star Homes cost around $8,800. That is much more than a $500 mud hut, von Seidlein said, but the team estimates huts can cost $5,000 in repairs over a 50-year lifetime. It is, though, comparable to the cost of widely popular one-storey concrete houses; using timber and bamboo instead of steel, the study claims, would make them cheaper. Star Homes use passive cooling; concrete bungalows, in contrast, tend to retain heat, fuelling the need for air-conditioning."}],[{"start":252.8,"text":"The experiment is not about plastering these homes across Africa, von Seidlein said. It is about finding ideas that make a real difference: “If more people incorporate the design principles . . . [maximising airflow, building two storeys] into their next home construction, that would be a major public health benefit.”"}],[{"start":271.15000000000003,"text":"Only, of course, if people accept them. It took many months for data collection to start, partly because some were fearful about sleeping in the new houses. Field scientists, led by Tanzania-based co-author Salum Mshamu, won the trust of locals and elders by organising social events and football matches. Sometimes, scoring a win in public health starts with genuinely turning up on the pitch. "}],[{"start":301.55,"text":""}]],"url":"https://audio.ftcn.net.cn/album/a_1778899009_8270.mp3"}