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 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)
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