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How healthy buildings affect our wellbeing

“The connection between health and the dwelling of the population is one of the most important that exists.”

– Florence Nightingale

What is a healthy building?

A healthy building is one that supports the physical health and emotional wellbeing of its users. This is chiefly addressed by using non-hazardous materials and by designing-in features that improve people’s productivity and mood. 

While being built, project teams also consider a healthy building’s impact on its supply chain – for example the working conditions of its construction workers. Once built and in operation, connecting the building with the local community can promote social wellbeing through outreach programmes and events.

The history of healthy buildings

The blueprint for a healthy building comes from research by leading air quality expert, Professor Joseph G Allen, Director of the Healthy Building Programme at Harvard University’s T.H. Chan School of Health.

Allen’s Healthy Buildings Team identified key factors that contribute towards a building’s health, known as the 9 Foundations of a Healthy Building:

  • Air quality
  • Ventilation
  • Thermal health
  • Moisture
  • Dust and pests
  • Safety and security
  • Water quality
  • Noise
  • Lighting and views

The 9 Foundations project came about after years of conversations between Professor Allen and building owners, facility managers and real estate professionals. The study was followed by constructive, but frustrating, feedback: 

 “Your research is very interesting, but I can’t take a scientific paper into my meeting on Monday and convince a building owner or manager to do things differently. I need a short summary.”

Armed with this insight, it wasn’t long before Professor Allen embarked on one of the healthy building movement’s most important studies to date, the effects of air on occupant productivity and wellbeing, which we’ll explore in depth in the Workforce productivity: the COGfx Global Buildings study section. Firstly, we’ll look at how buildings generally affect people’s health.

Causes of unhealthy buildings

What makes a building unhealthy? Materials commonly used in construction have, over time, proved to be hazardous. Varnishes, sealants, adhesives and manufactured wood all emit toxic total volatile organic compounds (TVOCs). Often found in older buildings, lead and asbestos are two infamously dangerous products that can cause life-threatening conditions. But lots of other factors, such as mould, electromagnetic fields and particulate matter, can create an unhealthy building.


The danger of lead is not a recent discovery; Hippocrates described lead poisoning in 400 BC, yet lead wasn’t banned in paint until 1909, by Austria, France and Belgium. 

As a commonly used pollutant in vehicles, lead helped petrol burn smoothly, preventing engine knock. In paint, lead quickens drying and enhances durability and waterproofing. It was commonly added to paint for domestic and commercial use and was also used to decorate children’s toys.

Lead-based paint was banned in the late 1970s in the US, but the UK sold leaded paint to consumers up until 1992.

Effects of lead-based paint poisoning are serious, and include:

  • High blood pressure
  • Joint and muscle pain
  • Difficulties with memory or concentration
  • Headache
  • Abdominal pain
  • Mood disorders
  • Reduced sperm count and abnormal sperm
  • Miscarriage, stillbirth or premature birth in pregnant women
  • Death

Lead poisoning can be fatal, and long-term exposure throughout their lifetimes can seriously harm adults. Small children are particularly vulnerable to the effects, suffering from hearing loss, developmental delays, learning difficulties, weight loss, and seizures. Babies can be born prematurely, with low-birth weight, or die in utero. 

Domestic refurbishment involving the removal and inhalation of old paint, and children eating chips of old paint, are the most common causes of lead poisoning today.


Asbestos is a group of six naturally occurring silicate minerals: chrysotile, amosite, crocidolite, anthophyllite, tremolite and actinolite.

Offering excellent fireproofing capabilities and chemical resistance, asbestos was, and still is, a popular building material which is routinely added to tiles, cement sealants and insulation. 

A UK government inquiry in 1906 was the first time asbestos was linked to lung disease. By 1930 asbestos had been attributed as a cause of lung conditions, namely asbestosis, and by 1955, asbestos was linked to lung cancer. However, the full range of illnesses as a result from asbestos exposure wasn’t fully understood until the 1960s.

Blue and brown asbestos – the most toxic types – were banned in the UK in 1985, and all types of asbestos were banned shortly after, in 1999. A short-lived ban from 1989-1991 in the US was retracted in a landmark case (Corrosion Proof Fittings vs. Environmental Protection Agency) that argued for economic reliance on the industry and, ironically, ‘death by regulation.’ Still used widely across the world, the US now imports most of its asbestos from Russian mines.

Electromagnetic fields (EMFs)

In 1979, a paper in the American Journal of Epidemiology associated magnetic fields and faults in electrical wiring to an increase in childhood cancer. 

During the early 1990s, following an unnerving amount of cancers in staff and young children at a Californian school, a report concluded that the building’s dirty electricity emissions increased the likelihood a teacher would develop cancer by 64%.

Electricity is the movement of electrons, or a current, through a wire. Electric and magnetic fields are invisible waves of energy – also called radiation – produced by electricity. Today, we are exposed to electromagnetic pollution through wireless devices and power transmission via radios, smartphones and laptops.Around 90% of the global population has access to some form of electricity, and scientists generally don’t think the resulting EMFs are a health concern. Peter Sullivan, founder of Clear Light Ventures, disagrees. The one-time Silicon Valley tech engineer, found that an electromagnetic detox changed his family’s mood and health for the better.


A well-known indoor air pollutant, mould is a fungal growth caused by humid, unventilated conditions. Common in both indoor and outdoor environments, airborne fungal spores are invisible and able to travel deep into people’s lungs and cause respiratory problems. 

There are many different types of mould fungi, with some being particularly destructive to buildings. Of these, dry rot is often the most damaging. In humans, mould poisoning can cause:

  • Headaches
  • Sore throat
  • Runny nose
  • Coughing
  • Sneezing
  • Watery eyes
  • Fatigue

Mould can also exacerbate asthma attacks, allergies and seriously infect people with an impaired immune system. Controlling humidity and therefore minimising mould is considered one of the most important ways to create good air quality and avoid health hazards inside buildings.

The US Federal Center for Disease Control and Prevention linked 10 cases of bleeding lung syndrome in young children and babies to Stachybotrys, a toxic mould that had overgrown in domestic homes following flooding and severe leaks. The event in Cleveland, US in 1993 left nine infants dead and highlighted several other infant deaths previously attributed to Sudden Infant Death Syndrome.Recently in the UK, poor housing in damp, crowded conditions where mould is prevalent, is being questioned as a major cause of otherwise unexplained infant mortality.

Particulate matter (PM2.5)

These fine particles are 100 times thinner than a human hair, and named due to having a diameter of less than 2.5 micrometres. Causes are plentiful and commonly include mould, bacteria, pet dander, and droplets from aerosols and cleaning products. 

Wood-burning stoves have been shown to triple the level of PM2.5 inside homes and have been pinpointed as the UKs biggest domestic small particulate pollutant, causing three times more PM2.5 than vehicle emissions.

The dangers of PM2.5 lie in their ability to travel deep into the lungs and bloodstream, causing respiratory problems, cardiovascular disease and cancer

Building materials are not the only source of airborne pollutants. Dangerous particles can also be emitted from man-made and naturally occuring sources.

Anthropogenic activities that contaminate air inside a building include cooking and heating, which can mean burning fossil fuels. Cleaning can involve the use of toxic chemicals, while office printers and copiers both emit toxins into the air. Even occupancy rates create a heady build-up of CO2, making people drowsy and inefficient.

In fact, there’s even an internationally recognised term for illness and malaise caused by a building – sick building syndrome.

Sick Building Syndrome (SBS)

From the 1960s, many occupants of newly built homes, nurseries and offices, started to report nonspecific symptoms associated with the time they spent inside a building. Complaints became so prolific,a decade later the mainstream media coined the term ‘office illness.’ By 1986, WHO research estimated that 10-30% of newly built offices in the west had indoor air problems, and ‘sick building syndrome’ was formally identified. Respected organisations such as the Health and Safety Executive (HSE) have carried out extensive research on SBS, finding that poor indoor air quality is a major contributor. 

The reason is that post-war buildings were built as airtight, centrally-heated structures, with no consideration for airflow or ventilation. Indoor air quality was simply not acknowledged as a threat to human health. 

Symptoms of SBS:

  • Lung inflammation (pneumonitis
  • Tightness of the chest
  • Difficulty breathing
  • Allergy-type symptoms
  • Itchy eyes
  • Irritated airways
  • Coughs and runny noses
  • Fatigue
  • Headaches
  • Difficulty concentrating
  • Body aches
  • Fever
  • Chill

People with preexisting respiratory or allergy problems will usually have more severe symptoms, for example asthma sufferers may have more asthma attacks, or more serious asthma attacks.

By the time you reach 80, you will have spent 72 years of your life indoors. Like it or not, humans have become an indoor species. This means that the people who design, build, and maintain our buildings can have a major impact on our health.

Healthy Buildings: How Indoor Spaces Drive Performance and Productivity, 2020, Joseph Allen and John D. Macomber.

SBS and workforce effects: absenteeism and presenteeism

While SBS describes acute health and comfort symptoms linked to time spent inside a building, its effects trigger two types of behavioural changes within a workforce. 

Absenteeism is the term used to describe an employee being away from work for more than is reasonable or usual; presenteeism describes being present at work, but performing at low levels due to feeling unwell.

We spend around a third of our lives in the office, or roughly 90,000 hours over an average lifetime. Academic studies have found presenteeism costs the UK economy around £4k per employee a year, as unwell people were seen to perform at only 84% of full capacity. A 2020 UK survey found that absenteeism and presenteeism combined cost the economy almost £92 billion in 2019, with productivity on the decline.And then there’s been a pandemic, which has driven a massive trend for hybrid working patterns. This, alongside a rise in time off due to mental health issues – now the biggest reason for long-term absence – means that offices need to be places that people want to return to. Employment itself has been shown to be vital for mental health while well-designed environments are regularly acknowledged for improving and protecting mental wellbeing.

If the effects of poor building design are so dramatic, wouldn’t it be worth exploring people’s performance when a major component, such as air quality, is improved? That’s exactly what one expert decided to do.

Workforce productivity: the COGfx Global Buildings study

At the beginning of his career, Professor Joseph Allen studied the effect of toxic chemicals found in furniture and building materials, namely TVOCs from finishes, processes and glues. But pivotal work came later, when Allen determined, absolutely, that good indoor air quality increases occupant productivity and wellbeing.

“Just like we’ve made great gains in public health around sanitation, water quality, and food safety, indoor air quality is going to be part of that conversation moving forward.”

– Professor Joseph Allen, CNBC, Nov 2021.

Conducted by Harvard T.H. Chan School of Public Health, the three-year COGfx Global Buildings study culminated in 2017, by comparing human performance and wellbeing across 100 offices around the world.

During Study 1: Indoor Environmental Quality – a year-long global experiment – Allen’s team placed sensors at workers’ desks, and handed them a custom-made phone app that delivered brief cognitive function tests throughout the day. Volunteers also took a short survey asking if they suffered headaches, dizziness or had trouble sleeping each day.

“When volunteers worked in well-ventilated conditions (which lowered the levels of CO2 and VOCs), they scored 61% higher than when they worked in typical office building conditions. When they worked in the cleanest conditions, with even lower CO2 levels and higher ventilation rates, their scores climbed 101%.”

– Professor Joseph Allen,

Study 2: Buildingonomics: The Impact of Working in a Green Certified Building on Cognitive Function and Health, found that green-certified buildings increased occupant cognition by 26% and health and wellbeing overall, compared to non green-certified buildings. 

For Study 3: Global Buildings, the effects of PM2.5 and CO2 , the team assessed 302 employees in urban office buildings in six countries (China, India, Mexico, Thailand, the United States of America, and the United Kingdom). The study took a year and concluded that for every decrease in the levels of exposure through ventilation and filtration, there is an equal increase in cognitive function.

“The results showed the biggest improvements in areas that tested how workers used information to make strategic decisions and how they plan, stay prepared, and strategise during crises.”

– Joseph G. Allen, The Harvard Business Review.

Ultimately, results showed occupants’ cognitive function test scores doubled in good indoor air environments. The cost of running better ventilation systems to heighten employee performance came in at $14–40 per person per year, while the estimated ROI (in improved productivity in faster response times and increased accuracy), was measured at between $6,500 and $7,500 per person per year. Not only that, senior managers made better decisions when in healthier air environments.

More recently, in Allen’s 2020 book Healthy Buildings: How Indoor Spaces Drive Performance and Productivity (co-written with Harvard Business School lecturer John D. Macomber), Allen outlines the bottom-line gains of healthy air, citing research that estimates improved air quality could add $20 billion annually to the US economy.

“We shape our buildings, and afterwards our buildings shape us.”

– Winston Churchill.

Building for health

Never has the importance of designing for health and wellbeing been more important. Innovations in building design have led to new professions and industries committed to improving a building’s health. 

Building biologists are trained environmental health experts who identify air, water, electromagnetic fields and biological contaminants inside a building. The Association of Building Biologists list 25 Guiding Principles of Building Biology, and explain that while a building may not meet each principle, the goal is most often geared towards optimising as many as possible.

First coined in 1964 by prominent psychologist Erich Fromm, biophilia was later popularised by biologist Edward O. Wilson during the 1980s. The word biophilia comes from the Greek ‘philia’ which means ‘love of’ – translating literally as ‘love of nature.’ Biophilia was originally a general attempt to offset urbanisation’s disconnect with nature, by drawing on humankind’s intrinsic bond with all living things.Today, biophilic design is an approach to architecture that connects occupants with natural elements in order to increase wellbeing. The idea is that by incorporating natural light, plants, water features, and organic materials (such as cork, stone and wood), occupants’ physical, physiological, and emotional wellbeing are improved. Biophilic additions to new buildings may include living walls, large skylights or wood-clad walls.

The healthy building movement and its supporters

As a next-generation green building movement, the healthy building movement has come about as emphasis grew from a building’s impact on its physical environment, to its impact on the physical and emotional health of its users.

There are several ways to assess the health of a building using newer pathways that focus on both the hard and soft aspects of a healthy building. 

Hard aspects include the quality of air, water and comfort, with soft aspects meaning things like physical activity support (for example, bicycle storage and showers), available nutrition (perhaps the choice of organic vegetables and fruit on site) and design that encourages good mental health (biophilia is a perfect example). 

The most well-known assessments have been developed by BREEAM, the International WELL Building Institute, Fitwel and LEED. They all provide certification programmes that take a holistic view of a building’s health with intentions ranging from the provision of a healthy indoor environment, to impact on the wider community and working towards net zero.

The trend for wellbeing

The effect of the beauty of our surroundings on our mental wellbeing and potential to lead happier, more fulfilling lives, was explored in The Architecture of Happiness by Alain de Botton in 2006. 

The book links architecture and design to psychological feelings of wellbeing, and argues that people will more likely reach their full potential if surrounded by beauty. Since the early 2000s, we’ve seen trends for fitness, nutrition and mental health grow heartily alongside a conscious need to protect the natural world and our planet.

Between 2014 and 2019, the number of vegans in the UK quadrupled, and over the past ten years, the number of gyms and fitness centres has more than doubled.  Mindfulness and meditation have become hugely popular with the digital app Headspace having been downloaded over 65 million times and having over two million paid subscribers. 

The wellness industry, valued at $4.4 trillion worldwide, is avidly consumed by its main audiences, millennials and Generation Z. Having just reached their forties, the eldest millennials are the largest workforce and biggest consumer group ever experienced, but where do they want to live? Both millennials and Generation Z are likely to spend more on wellness and, having grown up alongside the climate crisis, care deeply about sustainability. 

Now, more than ever, is the time to design wellbeing into the heart of new buildings and retrofits, so that buildings of the future deliver health for their users and for the planet.