The Asthma + Lung UK Breathing Space Garden at RHS Chelsea Flower Show 2026

This post by Kate Binnie reports on a groundbreaking approach to creating space for reflection and conversation about respiratory ill health at the Chelsea Flower Show.

In communities disproportionately affected by deprivation and respiratory ill health, the legacy of mining and heavy industry, smoking-related disease, air pollution and occupational exposures (dust, chemicals) is compounded by healthcare inequalities and the inverse care law, whereby resources are often least available in areas of greatest need. For millions of people living with chronic lung conditions, the resulting breathlessness limits everyday life, undermining physical, psychological, social, financial and spiritual wellbeing.

Yet breathlessness remains remarkably difficult to talk about. People living with lung conditions often struggle to communicate their experience, while health professionals may lack the time, confidence or psychosocial resources to treat it as more than a lungs-and-brain "problem." Miranda Fricker describes this as hermeneutical injustice: "a significant area of experience obscured from understanding owing to prejudicial flaws in shared resources for social interpretation." In other words, when something cannot be communicated, it may be rendered invisible.

This is a phenomenon that my PhD research explored. Among the 50 patients and professionals I interviewed, experiences of shared understanding — what Hutchinson has called ‘Breathing Space’ were rare and challenging for all concerned within systems of care that do not provide the space and time to explore the breathless person's social, cultural and personal history. From a critical realist perspective, my analysis indicated not only gaps in interpersonal communication and at service level (epistemic injustices in themselves), but that these gaps are generated and sustained by deeper and persistent social, cultural and material conditions – what Alderson calls ’hostile absences’.

The Asthma + Lung UK Breathing Space garden, which has just won a silver medal at RHS Chelsea Flower Show 2026, emerged as a creative response to these experiences of restriction and absence. Drawing on findings from my research into how mind-body interventions help people living with lung conditions, the garden sought to embody their antonyms: space and presence.

Designed by my partner Angus Thompson in collaboration with patients and staff at the Breathing Space lung rehabilitation centre in Rotherham — where the garden is currently being rehomed —  the garden is grounded in a simple idea:  when we create even momentary conditions of safety and calm, the body can naturally find its own way back to easier breathing.

Inspired by the Japanese concepts of ma and yohaku no bi (the beauty of empty space and time), Angus translated empirically grounded ideas from my research into a design that reframes emptiness as possibility:  a calm, green space in which space, choiceful movement, reflection and connection become possible.

For us, the design team, the most striking aspect of the Chelsea garden was the conversations it made possible with hundreds (if not thousands, as 160,000 people visited the show this year) of visitors. One of our volunteers handing out leaflets for Asthma + Lung UK reflected:

There were people living with asthma, relatives of miners, and so many from Rotherham, Sheffield and the surrounding communities. The garden seemed to create an atmosphere of trust that encouraged people, especially men, to open up and share deeply personal experiences. I honestly couldn't believe how willing people were to connect and talk.

Design features such as the oxygen cylinders supporting the Breathing Space platform, the 6:4 breathing rhythm reflected in the fencing, the carbon-capture concrete, and the calming effect of the planting acted as unexpected conversation starters. Visitors frequently responded by sharing personal and family experiences of lung disease, loss, caring, hope, meaning and recovery. Respiratory professionals were equally enthusiastic, welcoming the rare visibility afforded to their often underfunded speciality and asking when they, too, might have a Breathing Space garden at their own hospital.

This matters because hermeneutical injustice is not only a problem of individual communication and epistemic asymmetry between patients and professionals in the clinical setting, but a problem of collective understanding which limits the potential of everyone concerned with lung disease. When experiences remain difficult to articulate, societies, institutions and healthcare cultures struggle to recognise, respond or make space for them.  We were delighted that for one week at Chelsea, a carefully designed garden could become a site of shared interpretation in which conversations about breathing, breathlessness, recovery and hope could be expressed and understood in new ways.

The garden is now relocated at the Breathing Space lung rehabilitation centre in Rotherham, where many of the ideas that shaped its design emerged through conversations with patients, families and staff. The garden is now under the ownership of the local community and is beginning a new life beyond Chelsea.

Acknowledgements

The garden was funded by Project Giving Back https://www.givingback.org.uk for Asthma + Lung UK https://www.asthmaandlung.org.uk

Designed by Angus Thompson https://www.angusthompsondesign.com and built by Dan Flynn.

Sculpture by Oliver Barratt https://www.oliverbarratt.co.uk

Rotherham Breathing Space https://www.therotherhamft.nhs.uk/patients-and-visitors/our-sites/breathing-space

Author bio

Kate is an HCPC registered music therapist with 20 years’ clinical experience in palliative care, based in Oxford. In 2016, she completed an MSc in palliative care from King’s College London funded by the Samuel Sebba Scholarship.  Kate is also a qualified yoga and mindfulness teacher and works with people with chronic and life-limiting conditions and their families into bereavement. She delivers training workshops for clinicians at www.sobelleducation.org.uk, and she is a guest lecturer on the MSc in Palliative Care at KCL and on the UK’s first PG training in Psycho-spiritual care at Oxford Brookes University. After 5 years as senior research associate on the Wellcome-funded Life of Breath project, Kate is now in the final year of her part-time PhD at the Wolfson Centre for Palliative Care Research at the Hull York Medical School funded by UKRI (i3) exploring the relationship between emotion regulation and breathlessness in advanced disease. 

Ageing, Life, and Philosophy

This post by Anna Videbaek Smith reports on the proceedings of a workshop on ageing and philosophy at the University of Nottingham.

  

On the 8th of June, the University of Nottingham hosted the EPIC Project workshop, “Ageing, Life, and Philosophy.” The event featured presentations by Saloni de Souza (Bath Spa University), Nga Chun Josh Law (University of Bristol), and Victoria Cluley (University of Nottingham).

The workshop opened with Saloni de Souza’s exploration of immortality in a talk entitled “I Want to Be Forever Old?” Souza introduced Bernard Williams’ conditions for a choiceworthy life, noting that Williams does not consider immortality a choiceworthy life for anyone. Souza then distinguished between two forms of immortality: the Babylon 5 model, where death is eliminated and physical ageing stalls at one’s physiological prime, and the Struldburg model, which similarly removes death but involves continuous physiological ageing. 

With this groundwork in place, Souza challenged two assumptions: (i) that Struldburg immortality cannot offer a choiceworthy life, and (ii) that Babylon 5 immortality is clearly preferable to the Struldburg model. To address (i), Souza disputed the claim that progressive physiological ageing necessarily entails a loss of pleasures and memory, suggesting that other benefits may offset any such losses. Regarding (ii), Souza questioned whether immortality necessarily involves a loss of categorical desires. While it may be possible to develop new categorical desires or find different ways to fulfil existing ones under a Babylon 5 model, ongoing physiological ageing may complicate this process. 

To mitigate this concern, Souza noted that physiological decline need not correlate with cognitive or moral decline, and that adapting to physiological ageing may prompt shifts in our categorical desires or the way we pursue them. Finally, the talk provoked discussion about how life cycles and the concept of ‘biographical disruption’ apply to ageing more broadly.

After lunch and a walk around Nottingham’s scenic campus, Josh Law presented a chapter from his PhD thesis, “Habit in Later Life: Repetition Without Stagnation in Beauvoir’s Old Age.” Law aimed to identify the optimism in Beauvoir’s otherwise pessimistic Old Age by exploring the role of habits in later life.  As Beauvoir takes old age to involve a reduction of future possibilities, we may wonder whether authentic transcendence is even possible at this stage of life. To examine this, Law drew on Beauvoir’s notion of old age as a ‘normal abnormality’: a paradoxical mode of existence where the ‘abnormal’ becomes the governing norm of daily life. 

Using the example of the paralysed painter, August-Pierre Renoir, Law argued that habits can enable older individuals to find a new, if fragile, sense of normalcy. Importantly, this does not hold for all habits, prompting Law to distinguish between two types. Invertebrate habits can be understood as “the habit of having a habit,” reflecting withdrawal, rigidity, and stagnation. This is contrasted with what Beauvoir calls ‘the poetry of habit,’ denoting habits that are integrated into our lives, providing us with a sense of “ontological security.” Law maintained that this latter type of habit can anchor older individuals in our shared social world and enable them to engage in repetition without stagnation.

The final talk, “The Relationship between Older Age, Health Inequality, and Race: Philosophical Interpretations”, was delivered by Victoria Cluley. Building on her work with the ‘Understanding Frailty’ Project, Cluley and her co-authors explored the interaction between ethnicity and the experience of frailty in old age using an anti-racist, photovoice approach. They provided 69 participants from six ethnic groups with digital cameras, instructing them to photograph their day-to-day activities to capture their experience of growing older. This culminated in 1,126 pictures depicting everything from pets to religious practices and bouncy houses at family functions. 

Several key themes emerged, including experiences of racism, the role of purpose, and the inherent diversity of older individuals as a social group. Particularly relevant to the EPIC Project were several photos depicting healthcare settings. This prompted participants to recall experiences of testimonial injustice in healthcare contexts, which they largely attributed to their race and old age. Cluley observed that some of the more privileged Black British participants referenced structural racism to make sense of these experiences. Interestingly, the participants of Indian or Caribbean descent, who tended to come from more disadvantaged backgrounds, did not invoke this concept. Perhaps the lack of access to a concept like structural racism can itself be considered an epistemic injustice. 

More information on this project can be found here.

Author bio

Anna Videbaek Smith is a DPhil candidate in philosophy at the University of Oxford. Her research explores ageism as an intersectional form of oppression, focusing on its moral, epistemic, and aesthetic dimensions. Prior to joining Oxford, she completed an MA (Hons) and an MLitt, both in Philosophy, at the University of St Andrews.

Whose knowledge counts? Learning from epistemic injustice in global health

This post, by Michael Bresalier, reports and reflects on a recent, interdisciplinary workshop about epistemic injustice in global health.

Global health aspires to reduce inequality—but its structures can also reproduce the very inequities it seeks to solve. This paradox sat at the heart of a recent EPIC roundtable on Learning from epistemic injustice in global health. Organised and convened by Michael Bresalier, the roundtable brought together a health systems researcher, a legal scholar, a consultant physician in HIV/Sexual Health, a doctoral researcher in mental health, and a philosopher to tackle this paradox. Seye Abimbola, Himani Bhakuni, Rageshri Dhairyawan, Ian James Kidd and Linda Maqutu shared their insights on how knowledge and power shape global health, how these forces determine whose voices are heard and ignored, and ways to address epistemic injustice in healthcare systems.

Defining key terms:  ‘epistemic injustice’ and ‘global health’

To start, panellists were asked to define the two key terms under discussion. They broadly agreed that epistemic injustice involves harms done to people in their capacity as knowers. Kidd explained that people have fundamental “epistemic needs” – to understand, interpret and share knowledge – and injustice occurs when these needs are blocked by prejudice, bias, or structural exclusion. Bhakuni extended this to global health, describing systematic forms of epistemic harm that affect entire populations, particularly through credibility deficits (where local expertise is dismissed) and interpretive marginalisation (where communities lack the resources to define their own experiences). Dhairyawan characterised epistemic injustice as one of the ways in which healthcare can dehumanise individuals and groups. There was broad agreement that these injustices are not incidental but deeply embedded in healthcare systems.

Defining global health proved more difficult. Rather than settling on a single definition, panellists agreed that global health is a set of relationships structured by inequality. Abimbola offered a resonant framing of global health as a “meeting of unequals,” a relationship structured by disparities in power, resources, and authority—especially epistemic power—that shape how health problems are defined and addressed across the globe. This imbalance determines everything from which problems are prioritised to how research is conducted—and whose knowledge is seen as legitimate.

Others reinforced this relational view. Bhakuni stressed that the “global doesn’t exist without the local,” pointing out that similar power asymmetries recur at multiple scales – from international partnerships to doctor-patient interactions. Maqutu similarly pointed to “unequal epistemic authority” not only between the Global North and South but also within healthcare systems. Taken together, global health emerged as both an aspirational project of reducing health inequities and a field structured by persistent asymmetries in what knowledge is produced, valued and applied.

Colonialism and epistemic injustice

A particularly nuanced discussion focused on the relationship between colonialism and epistemic injustice. Panellists agreed that colonial histories are deeply entangled with global health but resisted reducing all epistemic injustice to colonialism alone. Abimbola described the relationship as a “Venn diagram”: overlapping but not identical. Colonialism is one important driver of epistemic injustice, he suggested, but epistemic harms can also arise from other forms of exclusion and hierarchy. At the same time, colonial legacies continue to shape whose knowledge is recognised in global health. Maqutu illustrated this through the marginalisation of Indigenous knowledge systems, such as African traditional medicine, which are often excluded in mental health provision even when they are central to patients’ health beliefs and lives.

The roundtable stressed that while global health remains historically entangled with colonising forms of power, not all epistemic injustice in global health is colonial in origin. Overextending this connection risks collapsing complex problems into a single historical frame. Instead, analyses of unjust knowledge systems in global health require multifactorial perspectives.

These complex dynamics become especially visible in practice. In a discussion of the challenges in justifying funding for a small study of intimate partner violence among HIV-positive women, Dhairyawan described how both patients and healthcare workers can experience dismissal or silencing, sometimes leading to “testimonial smothering.” Abimbola highlighted how global metrics or standards—often set by organisations like the WHO—can distort local realities when imposed without context, forcing countries to “understand themselves” through external frameworks while ignoring local health realities. Across these cases, epistemic injustice appears as a structural feature of how knowledge is produced, validated, and applied.

From inclusion to transformation

When it came to solutions, panellists agreed that responses to epistemic injustice must be context-sensitive, dialogical, and attentive to power. But individual-level changes—such as encouraging clinicians or researchers to listen more—are not enough. While individual virtues such as empathy are important, they are insufficient on their own. Structural change is essential.

Bhakuni proposed reframing epistemic harms as violations of dignity and rights, requiring institutional accountability. Maqutu argued for epistemic decolonisation: not just including marginalised voices but transforming the standards by which knowledge is judged. Abimbola cautioned that even well-meaning efforts at inclusion can fail if underlying power structures remain unchanged.

Kidd added an important caveat for those using the epistemic injustice as a universal framework. Dominant understandings of epistemic injustice often reflect moral and political frameworks rooted in Global North traditions. Scholars in the Global South have challenged this apparent universality, emphasising the need for broader, more context-sensitive interpretations. In this view, epistemic injustice should be understood not as a single fixed concept, but as a wide class of epistemic wrongs—arising from prejudice, bias, and exclusion—shaped by long, complex historical and social processes, including but not limited to colonialism.

The roundtable closed with a powerful insight. Epistemic and material harms are deeply intertwined in healthcare. Ignoring people’s knowledge not only marginalises them—it can also undermine trust, worsen health outcomes, and deepen inequalities.

While global is committed to justice and equality, it often operates through unequal knowledge systems. If it is to live up to its promise of equity, global health must come to terms with this paradox. This means grappling not only with disparities in resources, but with inequalities in knowledge itself—asking, at every level, not just what works, but whose knowledge counts.

Watch the workshop in its entirety here: https://www.youtube.com/watch?v=ITsCjkTwijk

Further reading

Seye Abimbola (2024), The Foreign Gaze: Essays on Global Health (open access), Marseille: IRD Editions.

Himani Bhakuni and Seye Abimbola (2021), “Epistemic injustice in academic global health,” The Lancet: Global Health.

Himani Bhakuni (2023), “Epistemic repair in global health: a human rights approach towards epistemic justice,” BMJ Global Health.

Rageshri Dhairyawan (2024), Unheard: The Medical Practice of Silencing, Trapeze: London.

Linda Maqutu (2025), “Challenging Philosophical Instincts and Embracing Complexity: A Commentary on Elizabeth Barnes’s Health Problems,” Philosophical Psychology.

Author bio

Michael Bresalier is Senior Lecturer in the History of Medicine at Swansea University and Special Investigator on EPIC, for which he leads a case study on the history of ’selective’ tuberculosis vaccination in Britain, 1965-2005.