Your building might be making you sick: 9 foundations of a healthy building

By Coleen Walsh

Harvard Gazette

On his first day as an assistant professor of exposure-assessment sciences at the Harvard Chan School, in 2014, Joe Allen was immediately put on the spot.

“One of the deans asked me, ‘How will your research impact the world?’” Allen recalled on a recent afternoon in his office near Fenway Park. “I put that line up in our lab and it’s still there. Our approach is to pursue research that we know will transform the market — and transform health.”

As the head of the Healthy Buildings program at the Harvard T.H. Chan School of Public Health, Allen is working to transform design and construction of indoor spaces by revealing how ventilation, temperature, lighting, and noise affect health. His team drove a key part of that research forward in 2015 with a series of papers that proved what countless office workers long suspected: Indoor air quality influences job performance.

The CogFX studies, conducted in collaboration with Syracuse University and SUNY Upstate Medical University, and supported by a gift to Harvard from United Technologies, showed a direct link between cognitive function and indoor environment.

In the study’s first phase, 24 participants worked for six days in a simulated office while researchers regulated the room’s concentrations of volatile organic compounds (VOCs), the chemicals released from things such as carpets and surface cleaners. They also set ventilation rates and carbon dioxide levels, re-creating the conditions of green and green+ certified buildings and conventional office space. Then they put subjects to the test.

“We watched how they made plans and decisions and accessed information relative to what was happening to see if they could be strategic in their thinking and we found really dramatic effects even from minor changes to the indoor environment,” Allen said.

Participants’ cognitive function was significantly affected in all nine areas tested, including focused-activity levels, information usage, and strategy. Crisis-response scores were 97 percent higher at the green office setting compared with that of conventional office space, and 131 percent higher at the green+ office setting.

The results supported Allen’s idea that your physician may have less of a role in day-to-day well-being than the facilities manager where you work.

“All of that has such a big impact on our health, but we just don’t recognize or appreciate it every day.”

Most of us aren’t alarmed by the smell of fresh paint or a new carpet. But those odors, released in the form of VOCs, can be toxic. In his lab, Allen is probing the health effects of VOCs and other chemicals, including hormone-disrupting agents lurking in flame retardants commonly found in furniture, toys, and other household items. Last year he co-authored a paper with Linda Birnbaum, director of the National Institute of Environmental Health Sciences, exploring possible links between flame retardants and thyroid disease. The research, said Allen, showed “a higher risk of thyroid disease in women who have higher concentrations of this chemical in their blood, and an even greater risk for women who are postmenopausal.”

Allen and his team are also researching possible links between a class of chemicals found in stain repellents and immune suppression, testicular and kidney cancer, and high cholesterol. Such compounds have been dubbed “Forever Chemicals” because they “never go away,” Allen wrote in a Washington Post opinion piece last month.

Indoor air quality is an important focus of Allen’s work with the Healthier Buildings Materials Academy, an initiative developed by the Harvard Office for Sustainability (OFS) in collaboration with the Chan School that helps educate Harvard project managers and purchasers about a range of issues, including the problem of swapping out one banned chemical for an equally harmful substitute.

The academy is translating “research into practice, creating a new model for how to define health in the built environment,” said Heather Henriksen, director of the Office for Sustainability.

To date the academy has collaborated with more than 50 manufacturers to get them to remove harmful chemicals from their products, and integrated healthier building materials requirements into Harvard’s Green Building Standards. Much of the academy’s work has been informed by exchanges of information with Google, Kaiser Permanente, and Facebook, companies increasingly focused on the environment in their own buildings. The University is one of the early adopters of Portico, a Web app developed by the nonprofit Healthy Building Network and Google that includes a database listing the environmental hazards of more than 2,500 products.

Making the case

For the typical full-time U.S. worker, the office doubles as a second home, and unhealthy air comes with consequences.

In a 2011 study, scientists at Lawrence Berkeley National Laboratory and the Environmental Protection Agency examined costs and benefits of improving indoor air quality in U.S. office buildings. The findings suggested that better air quality led to “increased work performance, reduced Sick Building Syndrome symptoms, reduced absence, and improved thermal comfort for millions of office workers.” The researchers also estimated a potential economic benefit of $20 billion.

Allen has no doubt about the economic benefits of a healthier, happier, and more productive workforce. What he does worry about is the perception that healthy buildings are too expensive. When companies survey their finances, “many costs show up as a line item in the budget and are therefore easy to track, but the health benefits show up across the entire business enterprise, making it a bit harder to quantify,” he said.

In response, Allen and his team crunched the numbers in their CogFX findings. Their report concluded that “doubling the ventilation rate costs less than $40 per person per year in all climate zones. However, the same change in ventilation rate can increase the productivity of an employee by $6,500 a year.” Allen summarized the economic benefits in a piece published last year in the Harvard Business Review.

“The challenge for those of us in public health is twofold: produce the science that quantifies these impacts and then make sure health is part of the cost/benefit calculus,” he said. “Businesses track key performance indicators every minute of every day throughout the year to understand how their company is performing. Why not health? Tracking Health Performance Indicators, or HPIs, must be part of corporate strategy moving forward. Their buildings are the perfect place to start.”

According to Harvard architect Holly Samuelson, some of that work is well underway.

“Yes, absolutely we are already seeing companies getting serious about these topics and investing a good deal of money and time into improving their work spaces to optimize employee health,” said Samuelson, an assistant professor of architecture at Harvard’s Graduate School of Design who studies the energy and environmental performance of buildings.

Samuelson, who practiced architecture for eight years and was a green-building consultant before coming to Harvard, is optimistic that health-conscious design will someday be an industry norm, but like Allen she thinks decision-makers need help understanding the math.

“In an office building, it might cost $3 per square foot for utilities, while the rent or mortgage might cost another $30 per square foot,” she said. “But the salary and benefits of the employees could cost well over $300 per square foot. So a big challenge is overcoming the first cost in order to invest in better buildings. If we can design buildings that affect performance … that could make a big change in the company’s bottom line.”

Another challenge, Samuelson noted, is the need to balance air-quality concerns with conservation efforts. The oil crisis of the 1970s helped usher in a new era of building standards. But the increased efficiency of more insulation, reduced ventilation rates, and locked windows came at a cost — airtight buildings that made occupants sick.

Twenty years later, with the introduction of the LEED green-building rating system, designers tried making their buildings more occupant-friendly by increasing ventilation rates and including features such as all-glass facades to enhance natural lighting and views. But many of those buildings used more energy than their “non-green” counterparts, and that problem persists.

“I think we need more research to convince building owners, architects, engineers, and other decision-makers of the benefits of working on both,” Samuelson said.

Allen is on the case. In a paper published Jan. 30, he and his colleagues studied how buildings’ lower emissions have translated into a reduction of greenhouse gases, which benefits the climate, and a reduction in air pollution.

Informing tomorrow’s buildings

Scientific sleuthing is a good fit for Allen, who honed his investigative skills working for his father’s detective agency after college. A biology major, he was headed to a graduate program in environmental science at the University of Pennsylvania when a summer as a Harvard researcher studying household chemical exposures changed everything.

“I got hooked by the connection between the environment and health and I knew immediately that this field was where I needed to be,” said Allen. He dropped out of the Penn program and enrolled at Boston University, where he earned his master’s degree in public health and a doctorate of science. Later he became a forensic building investigator in Boston studying cancer clusters, outbreaks of Legionnaire’s disease, and chemical-tainted indoor environments.

“I think I’ve seen most everything that goes wrong in buildings,” said Allen. “Every chemical, biological, radiological, physical hazard you could think of. In the Healthy Buildings program we are exploring how we design and optimize buildings for health from the start.”

The current phase of the CogFX study, funded with primary support from United Technologies, a Fortune 50 company with interests in building-control technologies, and additional support by JLL, a U.S. professional services and investment management company specializing in real estate, involves 10 buildings in China, with plans to include 100 building in countries around the world in the near future.

The project involves an environmental monitor small enough to fit on a desk that tracks air quality and ventilation; a wrist monitor that tracks sleep and physical activity; and an iPhone app that feeds researchers real-time data.

Taking his research global, said Allen, is key.

“So much of what we know about basic health — from air pollution or how much exercise is good for us or what foods to eat — comes from great epidemiological cohort studies, many of which were done here at Harvard, such as the comprehensive Nurses’ Health Study and the famous Harvard Six Cities study. We don’t have a similar longitudinal cohort of buildings and people in buildings, so we are launching a global study looking at environmental factors, building factors, mechanical systems, lighting, green certifications, everything.”

Another forward-looking aspect of Allen’s work owes a debt to the past.

The research, backed by a Campus Sustainability Innovation Fund grant, builds on Harvard biologist E.O. Wilson’s work on “biophilia” — humankind’s inherent love and need of nature and the theme of Wilson’s 1984 book of the same name. A much-heralded study by environmental psychologist Roger Ulrich, also released in 1984, supported the premise, demonstrating that hospital patients recovering from gallbladder surgery did so more quickly, had fewer complications, and required less pain medication if their rooms had windows looking out at a tree instead of a brick wall.

On a recent afternoon in a windowless section of Allen’s lab two colleagues were creating rooms with impressive views. With the help of a virtual reality headset, subjects would be transported to a room complete with a lush living wall and an aquarium filled with tropical fish, or a sunlit corner office that looked on to rolling fields and distant ocean. Over time the work will track the stress responses and brain activity of participants as they are exposed to the different virtual environments, and use computer tests to track a subject’s productivity.

Looking to the horizon, Allen sees more designers and builders creating healthy office spaces. He also envisions a day when workers can adjust ventilation and temperature without leaving their desks, and without affecting their officemates. Ideal building temperature is determined by the American Society of Heating, Refrigerating, and Air-Conditioning Engineers, which relies on a temperature and relative humidity that 80 percent of people would find acceptable. But that calculation, said Allen, means we are “designing our buildings to a standard that guarantees that one in five will be uncomfortable.”

“I think we can do better, especially now that we know how important it is,” he said. “When someone is too hot or too cold, studies show their performance slips. It means disentangling ventilation — how much air you are bringing into the space — from the temperature setting in a building.

“It’s the parallel to personalized medicine — personalized indoor environment. This is where we have to go. We have to get there.”