A Friendly Rest Room: Developing Toilets of the Future for Disabled and Elderly People 7 J.F.M. Molenbroek et al. (Eds.) IOS Press, 2011 © 2011 The authors. All rights reserved. doi:10.3233/978-1-60750-752-9-7 for All: Not Excluded by Design

Johan F.M. MOLENBROEKa,1, Theo J.J. GROOTHUIZENb, R. DE BRUINc a Faculty of – Delft University of Technology, Delft, The Netherlands b Design Consultant – Groothuizen Beheer bv, Rotterdam, The Netherlands c Erin Ergonomics and Industrial Design, Nijmegen, The Netherlands

Abstract. or Design for All refers to the design philosophy of including as many users groups as possible in the target population of a to-be- designed product and to be aware of the ones that are excluded. This paper explains about the history, current status and possibilities of Inclusive Design as strategy. Within the FRR-project this strategy was leading when design decisions had to be taken. The outcome is a truly Friendly Rest Room, fulfilling the needs of disabled and elderly in a non-stigmatizing manner, and thus favoured by us all.

Keywords: Inclusive Design, Design for All,

1. Introduction

1.1. The Need to Design for All

In Europe and the Western world in general, the quality of life for its inhabitants has dramatically improved over the last couple of decades. The numbers of people that reach the age of 65 have been fast growing. For instance in the Netherlands 6% of the population in 1900 was aged 65+ to more than 12% in 2000 and perhaps 25% in 2050. Other countries in Europe show the same trend; it has to cope with a declining fertility rate and increased life expectancy [1]. As a consequence the population of Europe will slightly shrink, and importantly, will be much older. We even can speak of a double greying society; there will be more elderly and these elderly get older. Typical is the group fastest growing within the European population: the so-called ‘centenarians’, the people over 100 years of age. While in 1900 there were only a few centenarians per country, for instance in France there were around 2000 people aged 100 or older in 1990. In the European countries and Japan on average, the number of new centenarians increased at an annual rate of about 7% between the 1950s and the 1980s. In Finland and Japan this number is even growing 10% each year [2]! Because mortality risks for very old persons do not change significantly, the number of centenarians is determined mainly by the growth of potential centenarians, i.e. people who are currently in their eighties and nineties. A forecast calculation shows that the increase in the amount of centenarians is likely to continue over the next decades and will grow considerably from 2046. The first baby boomers will reach the age of 100 in

1 Corresponding Author: Johan Molenbroek, Faculty of Industrial Design , Delft University of Technology, Landbergstraat 15, 2628 CE Delft; Email: [email protected] 8 J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design that year. For example The Netherlands are anticipated to have nearly 14 thousand centenarians by then [3]. Although more and more of the older people are longer fit -quite a few even climb to the top of the Mount Everest at the age of 70+ [4, 5, 6] – people surviving to the ages of 80 and 90 often are in a health situation that is very delicate. In the Netherlands at least 30% of the people aged 65+ has one or more disabilities and 50% of the people aged 90+ is demented [7]. Because of our modern healthcare people are surviving serious illnesses more often. While staying alive they often inherit one or more disabilities. It causes a growing need for services and products that can help them to maintain their quality of life and stay independently at home for as long as possible. In addition to the growing group of elderly and disabled people, currently another population is calling for attention and rises in number and severity; obese people. In many western countries almost 50% of the people are overweight. They too need products and services that are better equipped to their needs (think about for example toilet seats and supports for heavy people). In short one can conclude that the European population now more than ever is in great need for products and services ‘Designed for All’.

1.2. History of Design for All

The term Design for All (DfA) was first embraced and perhaps even initiated by the European Institute for Design for Disabled (EIDD). Soon after its establishment in 1993, the EIDD developed the mission statement: “Enhancing the quality of life through Design for All”. Design for All refers to “design for human diversity, social inclusion and equality” [8]. The practice of Design for All makes conscious use of the analysis of human needs and aspirations and requires the involvement of end users at every stage in the design process [9]. Or as put on the EDeAN Design for All Education and Training website [10]:

“Design for All is a process whereby , manufacturers and service providers ensure that their products and environments address users irrespective of their age or ability. It aims to include the needs of people who are currently excluded or marginalised by mainstream design practices and links directly to the concept of an inclusive society. A key feature of design for all is the emphasis placed on working with user groups representing the true diversity of users as a route to innovation and .”

The Design for All philosophy developed in Scandinavia, as a logical continuation of that region’s ‘Society for All’ concept, and gradually spread through Europe [11]. Two European networks have greatly helped to promote and develop the Design for All philosophy [12]:

 EIDD - Design for All Europe. In 2006 the EIDD renamed itself into ‘EIDD Design for All Europe’ and is currently a federation of 22 national en corporate design organisations [8]. Its aim is to encourage active interaction and communication between professionals interested in the theory and practise of Design for All and to build the bridges to J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design 9

other communities where Design for All can make a difference to the quality of life for everyone.

 EDeAN - The European Design for All eAccessibility Network. EDeAN was launched under the lead of the European Commission and the European Member States in 2002 to promote e-Inclusion; creating an information society for all. It now is a network of 160 organisations in member states and its goal is to support all citizens’access to the Information Society [13].

In 2004, after ten years as the European platform on Design for All, the EIDD issued their Design for All Declaration (Stockholm Declaration 2004 [9]). In this document an appeal is made to the European institutions, national, regional and local governments and professionals, businesses and social actors to take all appropriate measures to implement Design for All in their policies and actions.

1.3. Diversity of Terminology

Comparable concepts have developed in parallel in other parts of the world. In the USA and Japan Design for All is called Universal Design. In the UK the term Inclusive Design has gained ground. Another term used, primarily in Japan and non-English speaking countries, is Barrier-free Design. It is mainly used in the field of , and refers to modifying buildings or facilities so that they can be used by the physically disadvantaged or disabled. In the case of new buildings, however, the idea of barrier free modification has largely been superseded by the concept of Universal Design, which seeks to design things from the outset to support easy access [12]. In the USA Universal Design is effectively promoted by the University of South Carolina with its Centre of Universal Design [14], as well as enforced by the Americans with Disabilities Act (ADA), a civil rights law that prohibits discrimination against people with disabilities in employment, transportation, public accommodation, communications, and governmental activities [15]. An example of the success of this approach can be seen in public transport. While in Europe the numbers of people using public transport are much higher, it is rarely accessible for wheelchair users. In the USA though, all public transport is made accessible for wheelchair users. Industry in Japan is also enforced to implement Universal Design, through standards (Japanese Industrial Standard X8341 (Caring) Series) and the Law for Facilitating Mobility of Elderly Persons and Persons with Disabilities. This law integrates and enhances the Barrier-Free Transport Law (established in 2000) which promotes the creation of barrier-free environments focusing on facilities used by travellers such as public transportation organizations, and the Heartful Building Law (established in 1994) which promotes the creation of barrier-free buildings [16]. In Japan a mixture of legislative push and market pull has made industry heightened aware of the principles of Universal Design [17]. Japanese companies have embraced the inclusive agenda and its challenges, resulting in the availability of many ‘universally designed’ products on the market. In the UK the term Inclusive Design has been favoured and it is successfully propagated by the Helen Hamlyn Centre at the Royal College of Art with ‘Include’, a biennial international conference that focuses on issues central to inclusive and people- centred design [18]. 10 J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design

2. Design for All in Practice

2.1. How Inclusive is Your Design Process?

Because the majority of things in our living environment are at some point in time designed by someone, you could say that if an individual has problems coping within that environment, that there is a mismatch between themselves and their environment. As Roger Coleman puts it [19]: “People are disabled by design, rather than their particular capabilities. However just as design can disable, it also can enable”. Would the characteristics and needs of this individual have been taken into account in the first place, the problems would not have occurred and hence the person would not be ‘disabled’ in his living environment. So the before mentioned ‘mismatches’ can often be eliminated or in the least reduced through appropriate user-aware design. This abstract way of expressing what Inclusive Design or Design for All is about invites to a next categorization. According to Pete Kercher products where Design for All is manifested fall under two headings: the involuntary and the intentional application of Design for All [11]. The first category is rather broader and has a very long history. It refers to products that were designed for a specific user population and accidently proved to be very useful and successful for the mainstream as well. Examples of familiar products in this category are the ballpoint pen (originally designed to cope with problems with fountain pens on high altitude [11]) and the flexible drinking straw (originally designed for children and marketed for hospitals [20]). The intentional application of Design for All refers to the design of products with a conscious mind for its future users - involving all the people that may come into contact with it one way or another – and importantly: with a conscious mind for the people that are excluded. Every stage of the design process involves users. A good example is the driverless Copenhagen metro system. The designers’ brief included installing a full-size mock-up of the carriage in Copenhagen’s main square, so that the general public could comment and suggest improvements [11]. Another way of perceiving Design for All solutions is described by Klaus Miesenberger [21]. He subdivides applications of Design for All as;

a) special features for specific target groups, which are usually seen more as assistive (e.g., ‘special’ cars for the aging population) than as mainstream features, or b) an improvement of the general , which most of the time is not recognised as ‘Design for All’, but as good design in general (e.g., good, accessible design of controls in cars)

When the application of Design for All is invisible, not specifically demonstrating that it aims at special user groups, it seems to be more successful:

“Explicit visibility of Design for All as a focus on non mainstream user groups is in danger of being recognised as stigmatising (e.g., mobile phones for special features for aging people never met with acceptance). It sounds paradox but, the more successful Design for All is, the less recognised it seems to be.” [21]

J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design 11

Summarizing the above there are several options when judging the process and its outcome in practice; a) There was no or little attention for the (mainstream) user population and actual product usage, only attention for sales numbers (technical or marketing viewpoint) b) There was attention for the (mainstream) user population and actual product usage, though little or no attention for special user groups c) There was involuntary application of Design for All, taking into account the characteristics of one or more special user groups, and with an outcome that is ‘stigmatizing’ and therefore not acceptable for the mainstream user population d) There was involuntary application of Design for All, taking into account the characteristics of one or more special user groups, and with an outcome useful and acceptable for the mainstream population as well e) There was intentional application of Design for All, taking into account the characteristics of the mainstream user population and special user groups incorporated, testing the outcome with representatives of these user groups and awareness about excluded user groups.

Next two questions arise when bringing groups of people who normally are excluded (based on age or disability) now into the mainstream design process: 1) Does the investment for enlarging the aimed user population beyond the mainstream population pay back and 2) how to decide on the new aimed user population boundaries for which to design?

2.2. Is the Investment Worth It?

There exists a general idea among entrepreneurs that DfA is very costly and it does not pay back the investments. Disregarding the fact that legislation in many countries simply obliges companies not to exclude people based on disabilities and the fact that that some of the ‘special’ user groups (e.g. elderly) can form huge market segments, and thus represent a huge business potential, there is of course no guarantee that the investments will pay back. One could turn the challenge into an opportunity though. There are more than enough examples of important product innovations and business successes that are due to the application of DfA, either involuntary or intentional. An example is the electrical or e-Bike (see Figure 1). This bicycle supports the normal pedalling with electromotor amplification to help the cyclist who can’t exert enough power to turn the paddle against the slope, against the wind or over long distances. The new generation e-bikes have a fashionable appearance, without any ‘elderly’ stigma and are therefore also attractive for younger people. It made them grow very popular; one out of every eight bicycles sold in the Netherlands is now an e-Bike, which is on average three times more expensive than a regular bicycle. In 2009 electric bike sales accounted for one-third of the turnover of the whole bike sector in the Netherlands [22]! This being just one example, but many ideas for product innovations and business opportunities can be found when simply looking at the world through the glasses of ‘extraordinary’ user groups, like small and big persons, the disabled and elderly, expectant mothers and children. Like Peter Laslett illustrates in his personal experiment, trying to see the world through the glasses of the elderly [23]:

12 J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design

“During the month of September 1996 I recorded in my diary every instance I encountered of a designed object which needed to be redesigned if it was to serve at all adequately the purposes of someone in the Third Age2. There were plenty of those to be sure, and when I talked of my findings to others of all ages, I found that their experience was identical with my own. People at every point in the Second Age expressed their frustration and exasperation with such thing as the design of TV set controls, video tape recorders and even . Directions for the use of highly important things were never, never adequate, so these younger people asserted, just as I found them to be. What is worse, these directions seem to have been written in a peculiar way so as to make the reader feel ashamed to confess to himself or anyone else that he or she could not follow them. It would amount to an admission which no one dares to make: a confession of not being with it, not being in .”

Other excellent examples and case studies of intentional Design for All can be found on several sources [10, 12, 24].

Figure 1. Invisible application of Design for All; the popular e-Bike

2.3. How to Start Designing for All?

Still the next question stands: When you are convinced about Design for All and your product has to be designed, how to proceed? The term ‘Design for All’ in itself is often misunderstood: it does not mean you actually have to design for all 7 billion people on earth. Because it conveys the message clearer, some people therefore prefer to use the term ‘Inclusive Design’ instead. The general idea is to include as many as people possible and to be aware of the people that are excluded from proper use. Figure 2 shows 8 drawings representing the normal distribution of a specific body measurement of a given population. The consecutive hatchings show how designers, consciously or unconsciously, can exclude potential users. This can be done by just designing for themselves (ego design), designing for the mean (excluding everybody else), for the small, the tall ones, designing for adjustability (and forgetting that the

2 Refers to stages of the life course, stages which are named as the First Age of socialization, education and youth; the Second Age of maturity, earning, parenthood and professional engagement; the Third that of retirement and personal fulfillment and the Fourth that of disablement, decline, dependency and death. J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design 13 limits of variations are just as important), or for more types. See also [25] for an of the consequences of applying these design styles in the toilet environment. These graphs are not limited to body measurements. Apart from the anthropometry aspects there could be many other aspects relevant for your design problem. It depends on the problem and context and designers should be educated to explore the aspects relevant, for example biomechanical, cognitive psychological, social or cultural aspects. It would be ideal if tools and data existed to tangle all of these aspects, however at this moment in time unfortunately those data are yet unavailable.

Figure 2. Overview of how to include or exclude people by design

2.4. DfA in the Toilet Environment: an Example

In the EU-funded FRR-project the application of DfA played a central role (see the majority of papers in this book). In the design process of its ‘user-friendly and technologically advanced toilet environment’ users were continuously involved and were asked to comment on respectively the proposed user requirements, design concepts, design models and prototypes. The idea for developing a toilet that is more ‘user-friendly’ also sprung from the Inclusive Design philosophy. Most people do not consider their toilet to be that user-unfriendly, and probably would not admit it if it was. The fact that everybody needs a toilet does not automatically imply however that all 14 J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design toilets are that comfortable for all of its users. Let’s consider the following groups and the standard public toilet environment;

 Wheel chair users (How to get on and off the toilet?)  Rollator / Walker users (Where to park the walking aid and how to transfer to the toilet?)  Blind people / people with bad eye sight (How to locate the white toilet in white-tiled background or how to locate it in the first place? Finding out how to flush the toilet is even for people who can see often a real challenge!)  People with a stoma (Where to place their hygienic aids?)  People who suffer from arthritis (How to lock and unlock the door?)  Obese people (Toilet seats are often unstable, even for people with moderate weight. Another problem is that big buttocks do not fit small toilet seats, and bad positioning can result in a soiled seat and brim)  Parents with a baby or a small child (Changing diapers can be a challenge in itself, but in a public toilet without a proper changing table it is nearly undoable. Small children on big toilets; afraid to fall in, they grasp the seat and brim, they sit not far enough and pee upwards wetting their pants, their mothers/fathers do not fit in the room, trying to clean the child they hit their heads against the paper towel dispenser, and bending over to wipe the buttocks small hands touch the floor again and never, never the hand washing utensils are on children’s height..)

And the list continues. The total number of people for whom the standard public toilet is far from comfortable might be up to more than 20% of the population. It seems a justified reason to stimulate designers, researchers and policymakers to create more DfA solutions for toilets environments.

3. Design for All: Still Some Roadblocks

3.1. ’s Interpretation

Unfortunately, still too many entrepreneurs, architects and designers, those who are responsible for creating our living environment, products or services, apply Design for All only as a mean to solve problems for specific user groups. They see Design for All as a special assignment to design solutions for disabled persons or elderly, for which they then rely on a limited amount of specific ergonomic data. Besides the fact that Design for All should include ergonomic data of all potential user groups, other data such as social, cultural and psychological variables are rarely involved. As Don Norman [26] puts it:

“Good design requires consideration of all aspects of human beings: the behavioural (hence Universal Design), the Visceral (hence, attractive style), and the Reflective (hence, cultural differentiation)”.

Despite the fact that some of these ‘special’ target groups can form huge market segments, and thus represent a huge business potential, industry at large is still a true J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design 15 follower of the traditional product development methodologies. Many people share the impression that Design for All is the opposite of developing for specific market segments. As said earlier, Design for All principles should not be explained as ‘one design for all’ or especially not as ‘one size for all’ meaning one product for 7 billion people on earth: which is impossible because of the great variety in lifestyle and of civilisation: for some groups a plough is really an outcome not to dig manually by hand to prepare their food. For others they need a scooter mobile to come to the spinach in the supermarket. The big and valuable differences in cultures, economies and social structures, and above all people, simply imply the need for market segmentation. Leading industries, mainly developing and producing consumer goods, use a more integrated approach. In this so-called ‘integrated product development process’ knowledge of many different human oriented disciplines, such as ergonomics, behavioural science, and user-involved research are involved. For those companies, Design for All is applied for developments of all their products and services. They now understand that new product development or improved (redesigns) not only benefit special groups, but all users.

3.2. Tools for Designers

A second roadblock for Design for All is formed by the lack of tools and data necessary for designers and researchers to put Design for All into practice. They need sources which depict and specify the large variety of human characteristics. Currently most sources are representing the ‘average’ user, ironically being the one individual that does not really exist. At the faculty of Industrial Design of the Delft University of Technology (the Netherlands) an interactive website named DINED [27] was developed to give designers and ergonomists insight into a large amount of body measurements of several populations, using established anthropometrical databases. Nevertheless, users of the website are not always aware of the limitations of 1D anthropometry. Only one body measurement is focused on at a time, which is usually not sufficient for everyday design issues. More difficult is it for designers and researchers to take care of relations between different variables in 2D or in 3D. An example is the elbow-height that does not correlate with thigh length, although many manufacturers of wheelchairs do seem to think so: wheelchairs with larger seat-depth usually also have higher armrests! In fact this is a wrong assumption. Because the correlation between the two variables is almost zero, the seat depth and armrest height actually should be adjustable, just as they are in office chairs. More tools, guidelines and inspirational cases for designers are available and accessible through the internet. Examples are the CEN/CENELEC Guide 6 [28] and websites of the Cambridge Group for Inclusive Design [29], Design for All Europe [30], the Centre for Universal Design [31] and the Helen Hamlyn Research Centre in London [32], also organiser of the series Include Conferences where the current state of the art in the field of Inclusive Design (Design for All) biannually is published. Even though some tools already are available for designers, still more tools are necessary, for instance to gain more insight in the variations between different user groups (e.g. a wheelchair user versus walker/rollator user), or to get more insight into 16 J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design other aspects like cognitive and social characteristics that play a role in the way products are used. And maybe even more important: Designers should be properly educated to read and use these sources in a correct way!

3.3. Education

In the curriculum of leading educations for engineering, architecture, software programmers or city planners, Design for All plays in general a marginal role. On the other hand, almost all curricula for education of designers of artefacts and services include courses, which form a knowledge base to apply Design for All principles. There are a few courses known at university level. Most are mentioned at the website of the Institute of Human Centered Design in Boston [33]. From here a popular free Newsletter about Universal Design is edited by Elaine Ostroff and distributed. In this newsletter the highlights from each country are listed. One of the known courses at university level is the elective course Inclusive Design of the Industrial Design Engineering Faculty of the Delft University of Technology (the Netherlands) that is educating product designers since 1987. Students at the faculty of Architecture from the same university on the other hand receive surprisingly few or no lectures in Design for All. It seems that –despite some exceptions e.g. the University of Buffalo where Prof Edward Steinfeld initiated IDEA Center for Inclusive Design and Environmental Access [34] – still much is to gain in educating future designers, architects and planners about Design for All.

4. Conclusions

Design for All or Inclusive Design can be considered a design philosophy with the aim to design products and services for the widest possible audience. In the "world of design", mainly the responsibility of (industrial) designers, architects and city planners, but also ergonomists and behavioural scientists, the practise of the principles of Design for All is rapidly growing. It must be stressed that applying Design for All principles should be evident for all ‘public’ products and services. People, users cannot avoid nor choose public services or components of the public building environment. Many governmental organisations, city councils or policy makers are not aware of the great responsibility they have concerning the access of public products, services and . It is surprising how many public buildings, even newly created, do not offer for all. An increasing number of design firms and in-house design departments offer services related to the principles of Design for All. Governments increasingly understand the importance of creating a ‘non-excluding’ society, offering equal opportunities and improvement of quality of live for all, organising conferences, workshops and setting up organisations with the task to select best practices and give awards to designs or environments that pay special attention to Design for All aspects. But in spite of all these initiatives and achievements, Design for All is still a ‘special kind of design’, a design for a ‘special’ target user group. Should we not all expect that the main principles of Design for All, the principle of trying not to exclude anybody, would be a normal designers’ objective? For some design schools, such as the Faculty of Industrial Design Engineering at the Delft University of Technology, ‘human centred design’ and ‘sustainable J.F.M. Molenbroek et al. / Design for All: Not Excluded by Design 17 wellbeing’ is the core of their curriculum. Hopefully, educations for business management, marketing, engineering and business administration will pay more attention to the role of and development processes and the principle of Design for All. This could be a sustainable strategy for improvement of the quality of live. For product designers, and the many professions involved in designing our living environment, it should not be required to follow a special Design for All education though. Designers, and certainly product designers, should always try to include as many users in the use of their products. This implies that they should also be aware of whom they exclude. It should not be what you have been told or some tools you can use, but a basic mentality of every designer. Design aims to fulfil future needs, which are nowadays aimed at the quality of life of the whole human race: Design for All. As Susan Szenas, editor-in-chief of the Metropolis magazine, expressed it in her keynote speech at the conference Designing for the 21st century (Rio de Janeiro, 2004):

“The time is coming for building that road to a design that no longer needs to call itself ‘sustainable’ or ‘universal’ - just good, need-oriented, environmentally sensitive design. Just design. Design with justice at its core.” [35]

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