This international edition of HEALTHCARE DESIGN couldn't be timelier. The United States is squarely in the middle of much contention surrounding the future of healthcare and advocates on all sides of the deliberations are pointing to healthcare systems and health outcomes in other parts of the world to support their arguments. It has long been obvious that there is not always a direct correlation between the cost per capita of a nation's healthcare spending and the quality of life and longevity of its citizens. Countries with public healthcare plans are being both held up as models for a new American system, as well as being demonized.

No matter where the healthcare debate lands, the one constant will always be that healthcare happens in an environment of care. Whether the environment is a large acute care hospital or an individual's living room, care cannot happen outside of physical space. Access to natural light, clean and fresh air, environments that help to reduce the spread of infection, that do not hamper the caregivers, the absence of environmental toxins, and environments that are friendly to the earth are universal concepts that are important considerations for the future of healthcare no matter where you live. There is much the United States can learn from our international neighbors and unique solutions from around the world are seen throughout the pages of this issue.

As we debate the future of the American healthcare system, I know I personally look at the examples in this issue with fresh eyes; seeing them through the filter of not just the aesthetic of the environment and the solutions applied to issues surrounding quality of care, but also in the context of each respective nation's healthcare system and how patient care is covered financially. I try to understand how the challenges and solutions of their healthcare system have played out in the design of the environment and understand how the environment is supportive of their particular healthcare system. I'm looking for clues as to how the United States may have evolved 5 or 10 years from today.

As The Center for Health Design matures and grows, we strive to be a global facilitator of these discussions. Through various initiatives such as EDAC, the Pebble Program, and our partnerships with Vendome, we strive to create an international learning community that explores and champions an evidence-based process and evidence-based design solutions to the challenges that healthcare faces throughout the world.

Over the next few years we will continue to launch new tools and conversations to facilitate a global discussion around the role the built environment plays in quality healthcare and in improving quality of life.

As Dickens said in the opening of A Tale of Two Cities, “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us….”

Judging from the televised reactions of people attending recent Town Hall meetings across the United States, it is apparent that there is great passion and public debate surrounding healthcare. The debate is both appropriate and relevant, and of such importance to America's future that I am hopeful people will find a way to stay open to explore any number of options until we find the right set of solutions for a future that provides quality healthcare to all and focuses on health outcomes and quality of life as the benchmark and not solely on the financial bottom line.

Only time will tell exactly where we are in history, but we do have great opportunity before us to work together-design professionals, clinicians, researchers and product manufacturers, politicians, and private citizens-to provide optimal solutions to these significant challenges. HD

Healthcare Design 2009 October;9(10):8