Healthy building refers to an emerging area of interest that supports the physical, psychological, and social health and well-being of people in buildings and the built environment. Buildings can be key promoters of health and well-being since most people spend a majority of their time indoors. According to the National Human Activity Pattern Survey, Americans spend “an average of 87% of their time in enclosed buildings and about 6% of their time in enclosed vehicles.”
Healthy building can be seen as the next generation of green building that not only includes environmentally responsible and resource-efficient building concepts, but also integrates human well-being and performance. These benefits can include “reducing absenteeism and presenteeism, lowering health care costs, and improving individual and organizational performance.” In 2017, Joseph G. Allen and Ari Bernstein of the Harvard T.H. Chan School of Public Health published The 9 Foundations of a Healthy Building: ventilation, air quality, thermal health, moisture, dusts and pests, safety and security, water quality, noise, and lighting and views.
Healthy building involves many different concepts, fields of interest, and disciplines. 9 Foundations describes healthy building as an approach built on building science, health science, and building science. An integrated design team can consist of stakeholders and specialists such as facility managers, architects, building engineers, health and wellness experts, and public health partners. Conducting charrettes with an integrated design team can foster collaboration and help the team develop goals, plans, and solutions.
Buildings and health components
There are many different components that can support health and well-being in buildings.
Indoor air quality
Spengler considers indoor air quality as an important determinant of healthy design. Buildings with poor indoor air quality can contribute to chronic lung diseases such as asthma, asbestosis and lung cancer. Chemical emissions can be outgassed by building materials, furnishings, and supplies. Air fresheners, cleaning products, paints, printing, flooring, and wax and polish products can also be a source of volatile organic compounds (VOCs) and semi-volatile compound (SVOCs). The LEED v4 Handbook posits that indoor air quality is "one of the most pivotal factors in maintaining building occupants’ safety, productivity, and well-being."
Higher rates of ventilation affect indoor pollutants, odors, and the perceived freshness of air by diluting contaminants in the air. ASHRAE's Standard 55-2017 has minimum standards of 8.3 L/s/person. In one study, raising the rate to 15 l/s/person increased performance by 1.1% and decreased sick building symptoms by 18.8%. Whole Building Design Guide recommends separating ventilation from thermal conditioning so as to increase comfort.
Natural ventilation is discouraged in buildings that have strict filtration requirements, contaminant dilution concerns, special pressure relationships, speech privacy concerns, and internal heat load demands. The San Joaquin ASHRAE chapter recommends assessing the outside air quality and configuration of the facade and building before demonstrating compliance and control of natural ventilation. ASHRAE Standard 55-2017 section 6.4 requires the natural ventilation be “manually controlled or controlled through the use of electrical or mechanical actuators under direct occupant control.” Chris Schaffner, CEO of the Green Engineer, describes operable windows as the "HVAC engineer's ultimate safety factor." Spengler and Chen recommend natural ventilation being used wherever possible.
Dust and pests
Dust and dirt can be a source of exposure to VOC and lead as well as pesticides and allergens. High efficiency filter vacuums can remove particles such as dander and allergens that otherwise result in breathing issues. A study of asthmatic children in inner city urban communities suggests they became sensitive to the presence of cockroaches, mice, or rats due to their presence in their homes.
Thermal comfort is influenced by factors like air temperature, mean radiant temperature, relative humidity, air speed, metabolic rate, and clothing. Thermal conditions can affect learning, cognitive performance, task completion, disease transmission, and sleep. ASHRAE defines an acceptable thermal environment as one that 80% of occupants find acceptable, though individual occupant thermal control results in higher satisfaction of occupants. Indoor spaces that are not air conditioned can create indoor heat waves if the outside air cools but the thermal mass of the building traps the hotter air inside. Cedeño-Laurent et al. believe these may become worse as climate change increases the "frequency, duration, and intensity of heat waves" and will be harder to adjust to in areas that are designed for colder climates.
Moisture and humidity
The Whole Building Design Guide recommends the indoor relative humidity to be between 30-50% to prevent unwanted moisture and to design for proper drainage and ventilation. Moisture is introduced into the building either by rainwater intrusion, outside humid air infiltration, internally generated moisture, and vapor diffusion through the building envelope. High temperatures, precipitation, and building age enable mold. It contributes to mold and poor indoor air quality. Vapor retarders have traditionally been used to prevent moisture in walls and roofs.
While noise is not always controllable, it has a high correlation and causation relationship with mental health, stress, and blood pressure. One study suggests that there is a higher correlation of noise irritation and bodily pain or discomfort in women. Effects of excessive noise pollution include hearing impairment, speech intelligibility, sleep disturbance, physiological functions, mental illness, and performance. The World Health Organization recommends creating a "National Plan for a Sustainable Noise Indoor Environment" specific to each country.
Water quality can be contaminated by inorganic chemicals, organic chemicals, and microorganisms. The World Health Organization considers waterborne diseases to be one of the world's major health concerns, especially for developing countries and children. WHO recommends following water safety plans that include management, maintenance, good design, cleaning, temperature management, and preventing stagnation. Stagnant water is found to deteriorate the microbiological quality of water, and increase corrosion, odors, and taste issues. The bacterial pathogen Legionella may have a higher potential for growth in large buildings due to long water distribution systems and not enough maintenance.
Awareness of these issues is recommended by the WHO in order to maintain water quality:
- External quality management
- Independent water supply
- Water pressure
- Water temperature
- Storage tank integrity
- Seasonal use areas
- Cross connections
- Minimization of dead ends and stagnation
- Material use
Safety and security
Concerns of safety affect the mental and possibly physical health of residents by reducing the amount of physical activity. Fear of crime can result in less physical activity as well as increased social isolation. Atkinson posits that crime is based on motivated offenders, targets, and absence of guardians. Adjusting these in buildings may increase presumed safety.
Lighting and view
The type and timing of light throughout the day affects circadian rhythms and human physiology. In a study done by Shamsul et al., cool white light and artificial daylight (approximately 450-480 nanometers) was associated with higher levels of alertness. Blue light positively affects mood, performance, fatigue, concentration, and eye comfort and enabled better sleep at night. Bright light during winter has also been shown to improve self-reported health and reduce distress.
Daylighting refers to providing access to natural daylight, which can be aesthetically pleasing and improve sleep duration and quality. The LEED handbook writes that daylighting can save energy while "increasing the quality of the visual environment" and occupant satisfaction.
Views to green landscapes can significantly increase attention and stress recovery. They can also have positive influence on emotional states. Ko et al consider views to be "important for the comfort, emotion, and working memory and concentration of occupants." Providing a view to nature through a glass window may benefit occupants’ well-being and increase employee’s effectiveness.
Creating a walkable environment that connects people to workplaces, green spaces, public transportation, fitness centers, and other basic needs and services can influence daily physical activity as well as diet and type of commute. In particular, proximity to green spaces (e.g., parks, walking trails, gardens) or therapeutic landscapes can reduce absenteeism and improve well-being.
There are many aspects of a building that can be designed to support positive health and well-being. For example, creating well-placed collaboration and social areas (e.g., break rooms, open collaboration areas, cafe spaces, courtyard gardens) can encourage social interaction and well-being. Quiet and wellness rooms can provide quiet zones or rooms that help improve well-being and mindfulness. Specifically, a designated lactation room can support nursing mothers by providing privacy and helping them return to work more easily.
Biophilic design has been linked to health outcomes such as stress reduction, improved mood, cognitive performance, social engagement, and sleep. Ergonomics can also minimize stress and strain on the body by providing ergonomically designed workstations.
While some components of healthy buildings are inherently designed into the built environment, other components rely on the behavioral change of occupants, users, or organizations residing within the building. Well-lit and accessible stairwells can provide building occupants the opportunity to increase regular physical activity. Fitness centers or an exercise room can encourage exercise during the work day, which can improve mood and performance, leading to improved focus and better work-based relationships. Exercise can also be promoted by encouraging alternative means of transportation (e.g., cycling, walking, running) to and from the building. Providing facilities such as bicycle storage and locker/changing rooms can increase the appeal of cycling, walking, or running. Active workstations, such as of sit/stand desks, treadmill desks, or cycle desks, can encourage increased movement and exercise as well.“Behavioral measures” can be taken to “encourage better public health outcomes: e.g., reducing sedentary behaviors by increasing access to stairways, using more active transportation options, and working at sit-to-stand desks.” Other examples that can promote health and well-being include establishing workplace wellness programs, health promotion campaigns, and encouraging activity and collaboration.
ASHRAE states that "Transmission of SARS-CoV-2 through the air is sufficiently likely that airborne exposure to the virus should be controlled. Changes to building operations, including the operation of heating, ventilating, and air-conditioning systems, can reduce airborne exposures." Current recommendations include increasing air supply and exhaust ventilation, using operable windows, limiting air recirculation, increasing hours of ventilation system operation and upgraded filtration. Joseph Allen of the Healthy Buildings Program at Harvard suggests 4-6 air changes per hour in classrooms, especially when masks are off.
Proper ventilation of areas has been found to have the same effect as vaccinating 50-60% of the population for influenza. Enhanced filtration using a MERV 13 filter would be adequate to protect against transmission of viruses. Allen mentions three ways humidity can affect transmission: respiratory health, decaying, and virus evaporation. Drier air also dries out the respiratory cilia that catch particles. Viruses decay faster between 40-60% humidity. Respiratory droplets that become aerosols are less likely to do so at higher humidity. After 60%, mold growth begins to be encouraged.
Health and well-being in standards and rating systems
There are several international and governmental standards, guidelines, and building rating systems that incorporate health and well-being concepts:
- WELL Building Standard
- Green Building Initiative Green Globes
- Leadership in Energy and Environmental Design
- ANSI/ASHRAE/USGBC/IES Standard 189.1-2014, Standard for the Design of High-Performance Green Buildings
- United States Department of Defense Unified Facilities Criteria Program
- General Services Administration Facilities Standards for the Public Buildings Service (P-100)
- "Buildings and Health". GSA Sustainable Facilities Tool. Retrieved 2020-12-17.
- Berkowitz, Bonnie; Stanton, Laura (2014-08-06). "Are you in an unhealthy office relationship?". Washington Post. Retrieved 2018-08-07.
- Klepeis, Neil E.; Nelson, William C.; Ott, Wayne R.; Robinson, John P.; Tsang, Andy M.; Switzer, Paul; Behar, Joseph V.; Hern, Stephen C.; Engelmann, William H. (2001-07-26). "The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants". Journal of Exposure Science & Environmental Epidemiology. 11 (3): 231–252. doi:10.1038/sj.jea.7500165. ISSN 1559-064X. PMID 11477521.
- Ramanujam, Mahesh (2014-03-28). "Healthy buildings and healthy people: The next generation of green building". US Green Building Council. Retrieved 2020-12-17.
- Allen, Joseph G; Bernstein, Ari (2020). "The 9 Foundations of a Healthy Building" (PDF). 9Foundations. Retrieved 2020-12-17.
- "Integrative Design Process - GSA Sustainable Facilities Tool". sftool.gov. Retrieved 2018-08-08.
- "Welcome to the Healthy Buildings Movement". 9Foundations.
- Todd, Joel Ann (2016-11-19). "Planning and Conducting Integrated Design (ID) Charrettes". www.wbdg.org.
- Spengler, John D.; Chen, Qingyan (2000-11-01). "Indoor air quality factors in designing a healthy building". Annual Review of Energy and the Environment. 25 (1): 567–600. doi:10.1146/annurev.energy.25.1.567. ISSN 1056-3466.
- Jones, A. P. (1999-12-01). "Indoor air quality and health". Atmospheric Environment. 33 (28): 4535–4564. Bibcode:1999AtmEn..33.4535J. doi:10.1016/S1352-2310(99)00272-1. ISSN 1352-2310.
- Kubba, Sam (2016-01-01), Kubba, Sam (ed.), "Chapter 7 - Indoor Environmental Quality (IEQ)", LEED v4 Practices, Certification, and Accreditation Handbook (Second Edition), Butterworth-Heinemann, pp. 303–378, doi:10.1016/b978-0-12-803830-7.00007-4, ISBN 978-0-12-803830-7, PMC 7150165
- Allen, Joseph G. (2020-03-04). "Your Building Can Make You Sick or Keep You Well". The New York Times. ISSN 0362-4331. Retrieved 2020-12-18.
- Fisk, W. J.; Black, D.; Brunner, G. (2011). "Benefits and costs of improved IEQ in U.S. offices". Indoor Air. 21 (5): 357–367. doi:10.1111/j.1600-0668.2011.00719.x. ISSN 1600-0668. PMID 21470313.
- "Promote Health and Well-Being". WBDG - Whole Building Design Guide. 2018-04-09. Retrieved 2020-12-18.
- McConahey, E. (2019). The Feasibility of Natural Ventilation [PowerPoint]. Retrieved from http://sjvashrae.starchapter.com/images/downloads/Natural_Ventilation.pdf
- Schaffner, C., (2020) Pandemic Resilience in Buildings: Proposed LEED Pilot Credit [PowerPoint presentation]. USGBC Healthy Economy Forum, Online
- Thorn, Ariana (2020-12-08). "Healthy Buildings: How to Improve Indoor Air Quality". Illumtek Corporation.
- Crain Ellen F; Walter Michelle; O'Connor George T; Mitchell Herman; Gruchalla Rebecca S; Kattan Meyer; Malindzak George S; Enright Paul; Evans Richard; Morgan Wayne; Stout James W (2002-09-01). "Home and allergic characteristics of children with asthma in seven U.S. urban communities and design of an environmental intervention: the Inner-City Asthma Study". Environmental Health Perspectives. 110 (9): 939–945. doi:10.1289/ehp.02110939. PMC 1240995. PMID 12204830.
- Kubba, Sam. (2016). LEED v4 Practices, Certification, and Accreditation Handbook (2nd Edition) - 7.1 General Overview. Elsevier. Retrieved from http://app.knovel.com/hotlink/pdf/id:kt010SFR91/leed-v4-practices-certification/leed-v4-pr-general-overview
- Shahzad, Sally; Brennan, John; Theodossopoulos, Dimitris; Hughes, Ben; Calautit, John Kaiser (2017-01-02). "A study of the impact of individual thermal control on user comfort in the workplace: Norwegian cellular vs. British open plan offices". Architectural Science Review. 60 (1): 49–61. doi:10.1080/00038628.2016.1235544. ISSN 0003-8628. S2CID 114414700.
- Cedeño-Laurent, J.G.; Williams, A.; MacNaughton, P.; Cao, X.; Eitland, E.; Spengler, J.; Allen, J. (2018-04-01). "Building Evidence for Health: Green Buildings, Current Science, and Future Challenges". Annual Review of Public Health. 39 (1): 291–308. doi:10.1146/annurev-publhealth-031816-044420. ISSN 0163-7525. PMID 29328864.
- Prowler, Don (2016-12-19). "Mold and Moisture Dynamics". WBDG - Whole Building Design Guide. Retrieved 2020-12-18.
- Norbäck, D.; Zock, J.-P.; Plana, E.; Heinrich, J.; Tischer, C.; Bertelsen, R. Jacobsen; Sunyer, J.; Künzli, N.; Villani, S.; Olivieri, M.; Verlato, G. (2017). "Building dampness and mold in European homes in relation to climate, building characteristics and socio-economic status: The European Community Respiratory Health Survey ECRHS II". Indoor Air. 27 (5): 921–932. doi:10.1111/ina.12375. ISSN 1600-0668. PMID 28190279. S2CID 45486328.
- Jensen, Heidi A. R.; Rasmussen, Birgit; Ekholm, Ola (2018-12-01). "Neighbour and traffic noise annoyance: a nationwide study of associated mental health and perceived stress". European Journal of Public Health. 28 (6): 1050–1055. doi:10.1093/eurpub/cky091. ISSN 1101-1262. PMID 29846583.
- Jensen, Heidi A. R.; Rasmussen, Birgit; Ekholm, Ola (2019-11-12). "Neighbour noise annoyance is associated with various mental and physical health symptoms: results from a nationwide study among individuals living in multi-storey housing". BMC Public Health. 19 (1): 1508. doi:10.1186/s12889-019-7893-8. ISSN 1471-2458. PMC 6849169. PMID 31718590.
- Berglund, Birgitta; Lindvall, Thomas; Schwela, Dietrich H. World Health Organization Occupational and Environmental Health (1999). "Guidelines for community noise".
- Guidelines for drinking-water quality. World Health Organization (Fourth edition incorporating the first addendum ed.). Geneva. 2017. ISBN 978-92-4-154995-0. OCLC 975491910.CS1 maint: others (link)
- Inkinen, Jenni; Kaunisto, Tuija; Pursiainen, Anna; Miettinen, Ilkka T.; Kusnetsov, Jaana; Riihinen, Kalle; Keinänen-Toivola, Minna M. (2014-02-01). "Drinking water quality and formation of biofilms in an office building during its first year of operation, a full scale study". Water Research. 49: 83–91. doi:10.1016/j.watres.2013.11.013. ISSN 0043-1354. PMID 24317021.
- Yu, Ge; Renton, Adrian; Schmidt, Elena; Tobi, Patrick; Bertotti, Marcello; Watts, Paul; Lais, Shahana (2011-09-01). "A multilevel analysis of the association between social networks and support on leisure time physical activity: Evidence from 40 disadvantaged areas in London". Health & Place. 17 (5): 1023–1029. doi:10.1016/j.healthplace.2011.07.002. ISSN 1353-8292. PMC 5066841. PMID 21784693.
- Atkinson, Rowland; Blandy, Sarah (2017). Domestic fortress : fear and the new home front. Manchester: Manchester University Press. pp. 86–106. ISBN 978-1-5261-0817-3. OCLC 966969696.
- Viola, Antoine U.; James, Lynette M.; Schlangen, Luc JM; Dijk, Derk-Jan (2008). "Blue-enriched white light in the workplace improves self-reported alertness, performance and sleep quality". Scandinavian Journal of Work, Environment & Health. 34 (4): 297–306. doi:10.5271/sjweh.1268. ISSN 0355-3140. PMID 18815716.
- Partonen, Timo; Lönnqvist, Jouko (2000-01-01). "Bright light improves vitality and alleviates distress in healthy people". Journal of Affective Disorders. 57 (1): 55–61. doi:10.1016/S0165-0327(99)00063-4. ISSN 0165-0327. PMID 10708816.
- Boubekri, Mohamned Boubekri; Cheung, Ivy N.; Reid, Kathryn J. (2014-06-15). "Impact of Windows and Daylight Exposure on Overall Health and Sleep Quality of Office Workers: A Case-Control Pilot Study". Journal of Clinical Sleep Medicine. 10 (6): 603–611. doi:10.5664/jcsm.3780. PMC 4031400. PMID 24932139.
- Li, Dongying; Sullivan, William C. (2016-04-01). "Impact of views to school landscapes on recovery from stress and mental fatigue". Landscape and Urban Planning. 148: 149–158. doi:10.1016/j.landurbplan.2015.12.015. ISSN 0169-2046.
- Ulrich, Roger S. (2016-07-26). "Natural Versus Urban Scenes: Some Psychophysiological Effects". Environment and Behavior. doi:10.1177/0013916581135001. S2CID 145353028.
- Ulrich, Roger S. (1979-03-01). "Visual landscapes and psychological well‐being". Landscape Research. 4 (1): 17–23. doi:10.1080/01426397908705892. ISSN 0142-6397.
- Kaplan, Rachel (October 1993). "The role of nature in the context of the workplace". Landscape and Urban Planning. 26 (1–4): 193–201. doi:10.1016/0169-2046(93)90016-7. hdl:2027.42/30542.
- "Strategies for Enhancing the Built Environment to Support Healthy Eating and Active Living". www.preventioninstitute.org. Retrieved 2018-08-08.
- Rose, Emma (2012-11-01). "Encountering place: A psychoanalytic approach for understanding how therapeutic landscapes benefit health and wellbeing". Health & Place. 18 (6): 1381–1387. doi:10.1016/j.healthplace.2012.07.002. ISSN 1353-8292. PMID 22918064.
- "Biophilic Design - GSA Sustainable Facilities Tool". sftool.gov. Retrieved 2018-08-07.
- "Healthy Buildings: Take the Stairs". Pfaulong Architecture. Retrieved 2020-12-18.
- Coulson, J.C.; McKenna, Jim; Field, M (2008-09-26). "Exercising at work and self-reported work performance". International Journal of Workplace Health Management. 1 (3): 176–197. doi:10.1108/17538350810926534.
- "Green Building Advisory Committee - Advice Letter and Report: Recommendations for Adoption of Health and Wellness Policies for Federal Facilities". www.gsa.gov. Retrieved 2018-08-07.
- "COVID-19: Resources Available to Address Concerns". www.ashrae.org. Retrieved 2020-12-18.
- Harvard School of Public Health Faculty profile for Joseph G. Allen, DSc, MPH
- Healthy Buildings for Health subpage on Keeping Schools Open
- Twitter page for Joseph G. Allen, DSc, MPH
- Allen, Joseph G.; Bleich, Sara. "Opinion | Why three feet of social distancing should be enough in schools". Washington Post. ISSN 0190-8286.
- Smieszek, Timo; Lazzari, Gianrocco; Salathé, Marcel (2019-02-18). "Assessing the Dynamics and Control of Droplet- and Aerosol-Transmitted Influenza Using an Indoor Positioning System". Scientific Reports. 9 (1): 2185. Bibcode:2019NatSR...9.2185S. doi:10.1038/s41598-019-38825-y. ISSN 2045-2322. PMC 6379436. PMID 30778136.
- Washington State Department of Health. Ventilation and Air Quality for Reducing Transmission of COVID-19. Online. 2020.
- Allen, Joseph G.; Iwasaki, Akiko; Marr, Linsey C. "This winter, fight COVID-19 with humidity". Washington Post. ISSN 0190-8286. Retrieved 2020-12-18.
- "GBAC Crosswalk - GSA Sustainable Facilities Tool". sftool.gov. Retrieved 2018-08-07.
- "Fitwel". fitwel.org. Retrieved 2018-08-17.
- "International WELL Building Institute". wellcertified.com. Retrieved 2018-08-17.
- "Standard 189.1". ashrae.org. Retrieved 2018-08-17.
- "Department of Defense Unified Facilities Criteria Program". wbdg.org. Retrieved 2018-08-17.
- "Facilities Standards (P100) Overview". gsa.gov. Retrieved 2018-08-17.
- "Exploring Machine Learning in Healthcare and its Impact on the SARS-CoV-2 Outbreak". ResearchGate. Retrieved 2021-09-18.