Healthy Buildings

1. Buildings Impact Health and Productivity

We shape our buildings and afterwards our buildings shape us.

Buildings as determinants of health. Buildings are no longer just shelters; they are integral to our lives, influencing our health, well-being, and productivity. We spend approximately 90% of our time indoors, making the indoor environment a critical factor in our overall health. Ignoring the impact of buildings on our health is akin to ignoring the air whales breathe underwater.

The shift from green to healthy. The green building movement, focused on energy efficiency, is transitioning to the Healthy Building movement, which prioritizes the health and well-being of occupants. This shift recognizes that the true cost of operating buildings is not energy, waste, and water, but the people inside.

A win-win proposition. Healthy Building strategies are not only beneficial for occupants but also for businesses. By optimizing buildings for health, companies can attract and retain talent, improve employee productivity, and enhance their bottom line. This convergence of health science, building science, and business science presents a significant opportunity for savvy business leaders.

2. Time and Money: The 90 Percent We Ignore

In a modern society, total time outdoors is the most insignificant part of the day, often so small that it barely shows up in the total.

Time spent indoors. People in developed countries spend about 90% of their time indoors, highlighting the importance of indoor environmental quality. This translates to roughly 72 years of an 80-year lifespan spent inside buildings.

The 3-30-300 rule. This rule of thumb illustrates the relative costs associated with buildings: for every $3 spent on utilities, $30 is spent on rent, and $300 is spent on payroll. This underscores the importance of focusing on the 90% of costs associated with people, rather than the 1% associated with energy, waste, and water.

The business case for healthy buildings. The green building movement largely focused on energy savings, representing only 1% of building costs. By shifting the focus to the 90% of costs associated with people, businesses can unlock significant value by improving employee health and productivity. This requires a shift from measuring energy to "metering" the health of people in a building.

3. The Three-Pronged Assault: Indoor Environmental Risks

The finding that emerges is that we are basically an indoor species.

Outdoor air pollution indoors. A significant portion of our exposure to outdoor air pollution occurs indoors, as pollutants infiltrate buildings. Even with lower concentrations indoors, the extended time spent inside leads to a higher overall exposure.

Indoor sources of pollution. Indoor sources, such as volatile organic compounds (VOCs) from building materials, cleaning products, and personal care items, can create higher concentrations of pollutants indoors than outdoors. This is exacerbated by tightly sealed buildings designed to conserve energy.

The neighbor effect. Air quality in multi-unit buildings can be affected by neighboring units, as air can transfer between apartments. This means that even if you maintain a healthy indoor environment, your neighbor's activities can impact your air quality.

4. Ventilation: The Foundation of Healthy Buildings

I am persuaded that no common air from without is so unwholesome as the air within a close room that has been often breathed and not changed.

Ventilation is key. Adequate ventilation, or the amount of fresh outdoor air brought into a building, is a critical determinant of indoor air quality and health. It helps to dilute and remove indoor pollutants, improving overall air quality.

The COGfx Study. This study demonstrated that improved ventilation rates can significantly enhance cognitive function in office workers. Participants in optimized indoor environments showed dramatic improvements across nine cognitive function domains.

Acceptable vs. optimal. Current ventilation standards, such as those set by ASHRAE, are often minimum acceptable levels, not optimal for health and productivity. Many buildings fail to even meet these minimum standards, leading to poor indoor air quality.

5. Beyond Ventilation: The 9 Foundations

We partnered up and have been talking with business leaders together for several years now.

A holistic approach. A Healthy Building strategy requires a holistic approach that considers multiple factors beyond ventilation. These factors include air quality, thermal health, water quality, moisture, dust and pests, lighting and views, acoustics, and safety and security.

The 9 Foundations. These foundations provide a framework for creating healthier indoor environments. Each foundation addresses a specific aspect of building design and operation that impacts occupant health and well-being.

Building engineers as heroes. Building engineers and facilities managers play a crucial role in maintaining healthy indoor environments. Their expertise and attention to detail are essential for ensuring that building systems are functioning properly and protecting occupant health.

6. Our Global Chemical Experiment: A Call for Transparency

If we are going to live so intimately with these chemicals—eating and drinking them, taking them into the very marrow of our bones—we had better know something about their nature and their power.

The scale of the problem. Over 80,000 chemicals are in commercial use in the United States, but only a small fraction have been thoroughly evaluated for health and safety. This lack of regulation and oversight has led to widespread exposure to potentially harmful chemicals.

Regrettable substitution. The regulatory system often leads to "regrettable substitution," where harmful chemicals are replaced with similar chemicals that have not been adequately tested. This creates a cycle of chemical whack-a-mole, where one harmful chemical is replaced by another.

The need for transparency. A lack of transparency in the building industry makes it difficult to assess and mitigate the risks associated with chemicals of concern. Greater transparency is needed to inform purchasing decisions and drive the development of safer alternatives.

7. Healthy Building Certifications: A Market in Progress

Organizing is a process; an organization is the result of that process.

The rise of certifications. The Healthy Building movement has spurred the development of certification systems, such as WELL and Fitwel, that aim to recognize and promote healthier buildings. These systems provide a framework for assessing and improving indoor environmental quality.

Lessons from LEED. The green building movement, led by LEED, offers valuable lessons for the Healthy Building movement. LEED's success in promoting energy efficiency and sustainability can be replicated in the pursuit of healthier indoor environments.

The future of certifications. The future of Healthy Building certifications will likely involve more dynamic assessments, real-time monitoring, and a greater emphasis on health outcomes. These systems will also need to address the issue of split incentives and ensure that all stakeholders benefit from healthier buildings.

8. From KPIs to HPIs: Measuring What Matters

Employees are a company’s greatest asset—they’re your competitive advantage.

The mismeasurement of "people businesses." Traditional business performance measures often fail to reflect the true value of employees and the impact of the work environment on their health and productivity. This leads to a mismeasurement of "people businesses."

Health Performance Indicators (HPIs). To address this, companies need to track Health Performance Indicators (HPIs) that measure the health and well-being of their employees. These indicators can be direct (measuring worker health) or indirect (measuring building characteristics).

The HPI framework. This framework categorizes HPIs into four quadrants: direct and lagging, indirect and lagging, indirect and leading, and direct and leading. By tracking indicators in each quadrant, businesses can gain a comprehensive understanding of the impact of their buildings on employee health and performance.

9. Beyond the Four Walls: Buildings and the Environment

Architecture must not do violence to space or its neighbors.

The building-energy-health-climate nexus. Buildings are interconnected with energy systems, climate change, and public health. Energy-efficient buildings can reduce emissions of air pollutants and greenhouse gases, leading to health co-benefits and mitigating climate change.

The importance of resilience. Buildings must be designed to withstand the impacts of climate change, such as extreme weather events and sea-level rise. This requires incorporating resilience measures into building design and construction.

The changing role of buildings. As energy grids become cleaner, buildings will play a greater role in reducing air pollution through material selection and other design choices. This requires a shift in focus from energy efficiency to a more holistic approach that considers the broader environmental and social impacts of buildings.

10. The Future is Now: Scaling Healthy Buildings

The future is already here–it’s just not evenly distributed yet.

The Healthy Building adoption curve. The Healthy Building movement is following a typical adoption curve, with knowledge generators, early adopters, and leading markets driving innovation. The challenge is to scale these strategies beyond the elite and make them accessible to all.

Industry composition and clockspeed. The fragmented nature of the real estate and construction industry, combined with the long lifespan of buildings, can slow the adoption of new technologies and practices. Overcoming these barriers requires a concerted effort to promote awareness, transparency, and collaboration.

The power of data and technology. New sensor technologies, data analytics, and mobile platforms are empowering consumers to make informed decisions about their indoor environments. This bottom-up pressure will drive demand for Healthy Buildings and accelerate the adoption of healthier building practices.

Last updated: February 22, 2025