Healthy Buildings as a Public Health Tool

The ways people use and interact in commercial buildings—particularly office spaces—will likely be changed significantly due to the COVID-19 crisis, with building and workplace health being a top concern, according to two healthy-building experts featured on an April 21 webinar hosted by ULI’s Building Healthy Places Initiative.

“Confronting COVID 19: Everything You Need to Know about Healthy Buildings Q&A Session” provided insights from Joseph Allen, assistant professor at Harvard University’s T.H. Chan School of Public Health, and John Macomber, senior lecturer of business administration at Harvard Business School, on the role of the built environment in supporting health and wellness. Allen and Macomber recently co-authored a new book, Healthy Buildings: How Indoor Spaces Drive Performance and Productivity, which is available for sale. Other healthy-building research as well as commentaries specific to combatting the coronavirus can be found at forhealth.org. The event was the latest in a series of webinars offered by ULI to explore how the real estate industry is being affected by the virus and the industry’s response.

The webinar is free for all to access at ULI’s Knowledge Finder.

According to Allen, the health of indoor spaces—where most people spend up to 90 percent of their time—is a highly critical but often overlooked component of overall health and well-being. He pointed to a hierarchy of “controls” or layered actions that can be taken to slow the spread of diseases and foster good health in buildings. The most extreme control measure is to stay at home, which reduces exposure but does not repopulate nonresidential buildings or revive the economy. Engineering controls involve health promotion strategies such as increased air ventilation, enhanced air filtration and purification, and increased humidity. Administrative controls involve de-densifying the workspace through employee rotations and shifts, social distancing throughout the space, and the use of masks and other measures. Wearing personal protection equipment such as masks is a practice that Allen predicted will become widespread in common areas of buildings and elevators.

“None of these controls does the trick [in combatting infectious diseases] alone,” Allen said. “The goal is a layered defense. We need to use every control to attack all modes of transmission, with the ultimate goal of reducing risk in buildings and optimizing the performance of buildings and the people in the buildings.”

Macomber pointed to 10 global “mega changes” that are contributing to or informing the healthy buildings movement:

• Changing populations due to the large migration to cities;
• Changing cities due to increased densification;
• Changing resources, with urbanization making resources scarcer;
• Changing climate that requires adaptation to rising seas, frequent floods, and other environmental impacts;
• Changing definition of health, in terms of a heightened awareness of the need to protect and promote human health;
• Changing role of the private sector, with the private sector becoming more involved in funding strategies for healthy buildings and communities;
• Changing buildings, as reflected in the “mainstreaming” of buildings that are both green and healthy;
• Changing work, as underscored by the widescale shift to telecommuting during the coronavirus crisis;
• Changing technology, including advanced systems to improve the health of buildings; and
• Changing values, with the focus on sustainable and socially responsible investment possibly being sidetracked by the need to stay afloat during the current economic upheaval.

The key to determining the effectiveness of healthy-building strategies, Macomber said, is to monitor indicators that measure both the building’s performance and the user experience. Health performance indicators can be used for short-term purposes such determining when to repopulate the building or longer-term purposes such as enhancing investment appeal, he said. “It’s not just that healthy buildings are not that expensive, it’s that sick people are really expensive,” Macomber added.

The bulk of the webinar was devoted to attendee questions posed to Allen and Macomber regarding the post-COVID-19 environment, as people contemplate reentering offices, stores, and other commercial spaces. The following is an excerpt of the questions and answers, edited for succinctness:

What is the future of office space, in terms of design, layout, and operations? What can we expect in the short term and long term?

Allen: The one thing that is a definite is the changing expectations and heightened awareness [among owners, managers, and tenants] regarding building health and safety. We [building operators and users] will need to take pragmatic steps to minimize this threat, and that can be done with a layered defense approach that involves design and operational changes, as well as engineering changes. Companies will have to make decisions about personnel who must be in the office, and about spreading out workers. I anticipate an end to conference rooms for a while, the end of large meetings, and a portion of the workforce still working from home. Returning to offices will be a staged approach that may have to be tampered down depending on how the disease is spreading and the capacity of the health care system in that space. We will have to be quite flexible in how we approach this.

Macomber: With so many office workers now working from home and spending less time in traffic, we must consider why we have to congregate in one place to work. There is the question of proximity—it [the pandemic] makes it harder to justify having a lot of people sharing open office spaces—doing this does use less space, but if people are transmitting diseases, that is not good. And, when people return to offices, they likely will have to get used to wearing masks and washing more often, which raises the question of whether personal protection equipment will be optional, or mandated by thoughtful tenants or landlords who really want to have a safer building. You can imagine an environment where elevators, revolving doors, and escalators might be equipped with retinal scans, facial recognition, and sensors recording users’ temperature and pulse. I do not see that happening in two to four months, but it would not surprise me if landlords who want to have the safest buildings say, “This is what I want to do.”

What strategies can individuals use to keep themselves and their families safe?

Allen: Based on current models [tracking the spread of the virus], there is a good chance that we are going to have people sick in our buildings, and possibly someone sick in our homes. Some of the practical steps we can take is to open our windows, bring in fresh air, clean surfaces frequently, humidify and purify air, frequently wash our hands, cover our coughs, and definitely wear a mask when we go out. These are sensible public health interventions to reduce the risk of contracting the virus and break the chain across all three modes of transmissionperson-to-person, fomite [contaminated surfaces], and airborne.

How do you see strapped building owners or public agencies being able to make the types of health-related investments to improve health outcomes in their spaces and communities?

Macomber: This [pandemic] presents a great opportunity for [private sector] investment in resilience. There are a lot of perils—pandemics, rising seas, wildfires, and droughts—and it is clear that governments are not going to have money for anything extra for a very long time; they will not be able to support the private sector with building upgrades or improving infrastructure. At same time, the world has a capital surplus, and that capital wants to go somewhere. So, if a very clear case is made for investing in an upgrade to a building, transit system, or utility service that is going to help reduce future health care costs, that should be investable. Capital will flow into the investable projects, so the people who have good access to information and capital and technology will do well.

Can you talk about high-tech maintenance strategies such as bipolar ionization air purification systems, electrostatic air misters, and other advanced air filtration systems that could be deployed at the building level?

Allen: There is a role for advanced technologies to play, but there is a danger in thinking there is a silver bullet that is going to solve this. That is why a layered-defense approach is so important—there is no “technology alone” solution. This is about taking a layered approach that includes public health fundamentals. There are strategies you can implement right now with what is already in your building. For instance, you can use engineering to control the airborne mode of transmission by bringing in more fresh air, increasing air filtration, and minimizing exposure with portable air purifiers. You have multiple means of control.

How do you deal with legal and ethical issues involving notifications about COVID-19 cases to building occupants?

Allen: I will not weigh in on legal issues, but there are ethical considerations regarding the stigma that goes with who has it, how they got it, and how to deal with people who are self-quarantining. The way to address these situations is to act like you have the virus and might infect others. This is going to involve a lot of social trust. Covering coughs, washing hands, and wearing masks involves social trust. To repopulate our buildings, we are all going to need to act as if we have the potential to get many other people sick. Approaching this by asking “what is my responsibility?” rather than “who is sick?” can go a long way toward changing behaviors.

Can you talk about how COVID-19 has exposed inequality in our society, how can we make sure some measures are available to everyone and not just the affluent?

Macomber: There are a couple of points regarding this. One is that in general, healthy buildings are not very expensive to operate. Just by running the fans, changing the air filters, and bringing in fresh air, you can save thousands of dollars in health costs. The other involves the likelihood of more government regulations related to health, and more publicly funded health-related actions to combat diseases, as well as private-sector investments that benefit the less affluent. For instance, you could imagine a large employer of moderately and low-paid people providing a supplement to people for home air purifiers—something that will help them stay healthy so they can work. This could help reduce health care costs associated with serious illnesses. Or, large employers might help fund sanitizing transit systems, because that could benefit their employees.

On a building level, what are some of the lower-cost options that smaller businesses can consider for protective measures?

Allen: It is a false premise that healthy buildings are expensive buildings. Once you factor in the costs for disease treatment, the costs for preventive measures [such as improving air quality and cleaning procedures] are overwhelmingly lower. We [society in general] are grossly underinvesting in public health—this crisis has made that clear, but the public health challenge has been around forever. And that is because when public health works, nothing out of the ordinary happens. It is hard to invest in things when we do not see the tangible benefit. In buildings, we tend to do the minimum to meet code requirements, and rarely are we thinking about precautionary steps to design, operate, and maintain our buildings better. That has to change. Healthy-building strategies lead to fewer sick buildings, reduced disease transmission, and improved employee cognitive functions—the benefits exist, but they have not been prioritized at the tenant, building, city, or national levels.

What is the role of the real estate industry in bolstering public health efforts?

Allen: The decisions we make today regarding our buildings will determine our collective health for generations. If you are in the real estate business, you are actually in the health care business. You have a responsibility for the health of everyone in your building, and if you take simple, preventive steps, you will recoup what you spend on health in multiples. If you think about your building as a health promotion tool, that goes a long way toward improving conditions for everybody.

Macomber: There are two ways to answer the question—one involves collective action, the other involves information dissemination. First, from the standpoint of collective action, the real estate industry is an influential voice regarding the national and global economy. If it is felt in a city or state that it is important to have a health-related issue accomplished at a regulatory or policy level, a number of real estate leaders could influence that. The second point involves information dissemination in a gigantic and hugely fragmented industry. There is a need to disseminate what is occurring with the biggest real estate players in the biggest cities to smaller businesses in smaller places. So, the industry has a collective action opportunity to speak with one voice [on health], and an opportunity to help disseminate best practices to provide better living and working environments with simple healthy solutions.

What changes do you see for the residential sector?

Macomber: In the long term, we will see the proliferation of individual air quality monitors so people can measure the presence of air particulates and gases in buildings and share this information in real time. Informed consumers sharing [health-related] conditions about apartments or condominiums that they are thinking of renting or buying adds a whole other level of information that has not been available to consumers before. I think there will be a tremendous change in people’s selectivity about the kind of buildings they think are healthy with regard to viruses and particulates and gases. So, developers will need to be aware of that.

What is the single most important thing attendees should take away from this webinar?

Macomber: First—run the fans in your buildings. Second—to stay competitive, you have to consider healthy buildings a “must have” rather than a “nice to have.”

Allen: This is an all-in moment like we have never had before. We need everyone to be all in [on mitigating the virus], and that means if you are in real estate, keep thinking about healthy-building strategies you can put in place now. The lives of tens of thousands of people and the global economy are at stake.

The webinar was moderated by Rachel MacCleery, senior vice president of ULI’s Building Healthy Places Initiative, which was created in 2013 to leverage the power of the Institute’s global networks to shape projects and places in ways that improve the health of people and communities. The goal of the series is to help members understand the role they can play in helping to slow the spread of the disease, help them navigate the long- and short-term impacts of the crisis, and help them understand how they can play a role in minimizing adverse impacts on vulnerable people.

The next webinar in the series, “Resiliency in a New Normal,” is scheduled for April 28 from 11 a.m. to 12 p.m. Eastern Daylight Time. The webinars are free of charge and open to ULI members and others.