Designing Buildings for Health: A Q&A with Joseph Allen

In my previous life, I was an engineer who helped build skyscrapers in New York City—think of the buildings you’ve seen that seem to be made only of windows. It was my job to design and test the five by 12-foot glass panels that would make up the 88 stories for each of the three buildings on our project. Each building consisted of over 10,000 panels, with the cost of each panel around the price of a new BMW. These panels, which were designed to withstand hurricane force winds, not only formed an air and water seal, referred to as the “curtain wall”, but also allowed for a beautiful view of the city.

While working on the project, I became curious about the fundamental goal of our buildings. I was helping design buildings that would hold thousands of people, but how much of their health and well-being was I considering (beyond the obviousness of a nice view)?

We did take into account things like noise and safety, but often at our engineering meetings we would prioritize our deliverables and timeline, our expenses and production rates. Maybe it was someone else’s job to keep the future occupants’ health top-of-mind? Even so, when making decisions like which materials to use, we optimized for quality, cost, and meeting our contract requirements. It felt like something was missing.

Eventually, I left my engineering career to pursue a doctoral degree at the intersection of behavioral science and engineering. And it wasn’t until I read a new book, which investigates how buildings affect public health, that it clicked. Healthy Buildings argues that the job of engineers, designers, and developers is to create buildings where health is the top priority.

I reached out to one of the book’s co-authors, Joseph Allen, a professor of public health at Harvard University, to learn more. In our conversation, we discussed what makes a building healthy, how our indoor environment impacts our mental and physical health, and what it might mean to reframe the building industry as a healthcare service. We also touched on the advice he would give to real-estate investors and professionals who want to create healthy buildings. Our conversation has been edited for length and clarity.

Katelyn Stenger: How did the idea for healthy buildings begin?

Joseph Allen: I got to this point first by fully understanding what makes buildings sick. I spent years doing forensic investigations of sick buildings and seeing everything that can go wrong—chemical hazards, radiological hazards, biological hazards—and understanding all the ways that we can fix these sick buildings. We can create indoor environments that lead to healthier living, improved well-being, and also promote productivity.

What would it look and feel like if we went to work and live in healthy buildings? What would the impact be on things like our well-being, productivity, and overall health?

We’ve all been in a bad conference room in some meeting, where it’s hot, it’s uncomfortable and stuffy, the air feels stale, you’re drowsy, you may not be paying attention, you’re looking at the clock. And when the door opens it literally and figuratively breathes life back into the room. I think that’s just a simple illustration of the power that something as simple as better air quality can have on us.

Of course, it goes beyond just these acute effects of benefits. A lot of times we think about factors that are immediate, but buildings also influence our health on a chronic level. The decisions we make regarding the materials we choose also influence our health. It’s typically the chemicals that are in our office chairs and carpets that we don’t see or smell. We don’t have a visceral, immediate reaction like we do for temperature, or stuffiness, or even VOCs (Volatile Organic Compounds), but they are impacting us just the same, just over longer durations in subclinical effects like hormone disruption, for example.

What are some of the costs of living and working in an unhealthy building?

Some of the work from Lawrence Berkeley National Lab estimates that there are billions of dollars in cost of the U.S. economy every year from sick buildings. Some of the costs at the individual level are worker absenteeism, loss of productivity, and increasing presenteeism. Buildings are also associated with infectious disease transmission. Buildings can act as a tool to fight infectious disease—or work against us in that regard.

Buildings can act as a tool to fight infectious disease—or work against us.

Typically building owners use key performance indicators (KPIs) like occupant satisfaction to measure an occupant’s experience in a building. You suggest we need to replace these with health performance indicators (HPIs) like quality of building materials and total sick days of occupants. Can you tell us more about health performance indicators and how they might be used in practice?

This is a really critical piece to advance the healthy buildings movement. If we are really going to drive these healthy building interventions into society, we have to be cognizant of the economic considerations that we are operating in.

The idea of HPI, Health Performance Indicators, was intentional in that we were leveraging and using the language that’s really familiar to business owners. Business owners track KPIs all the time, every year, every month, every week, and every day. We think health is the most important KPI. If we start with that, it changes the types of things we are tracking. Ultimately, we care about human health and performance.

The idea of using health performance indicators is that we only manage what we measure. That’s business 101. We haven’t been measuring those factors that we know directly influence human health.

The central thesis of our book is that building performance drives human performance drives business performance. The idea of using HPI is that we only manage what we measure. That’s business 101. We haven’t been measuring those factors that we know directly influence human health. HPI is a way we hope that people will start to think differently and track those things in a building that drive better human performance.

Another solution you’ve proposed is a building nutrition label. What information would a building nutrition label consist of?

Would you ever buy something in a grocery store with a label that just listed “proprietary ingredients”? Of course not. We do this all the time with our buildings and building materials. There’s a real lack of transparency about what goes into our building.

In terms of what should go on the label, we have the nine foundations of a healthy building. We dedicate an entire chapter in the book to these nine foundations—ventilation, air quality, health, moisture, dust and pests, safety and security, water quality, noise, lighting, and views. They are derived from 40 years of scientific evidence on the factors that drive better health and performance.

Given that many buildings currently omit health as a key feature, how might we align developers, architects, engineers, and facility operators to build and sustain healthy buildings?

First and foremost, I think everybody in this space has to see themselves as being in the healthcare space. I’ve said many times that the person who designs and operates your building has a greater impact on your health than your doctor. If all of these fields start thinking of themselves as being in the health business, the decisions we make regarding our buildings will be necessarily different. Because the responsibility is different. If we go beyond code minimums, we go beyond standards that are not set around people thinking about the real reason we design and create buildings, and that is the people in them.

I’ve said many times that the person who designs and operates your building has a greater impact on your health than your doctor.

Whose behaviors should we be targeting to improve the health of people in buildings?

The onus should not be on the end user, the onus should be on everyone in the entire chain on the building side—including investors, developers, owners, operators, the tenant companies. We see top down pressures from investors who had demanded previously that they wanted their investments in buildings to be green buildings. We see those same investors now demanding or asking about healthy buildings. We see many owners viewing this as a way to position their property or building in a positive light: 1) for their future tenants, 2) for the future employees, and 3) to position it back to investors and the wider conversations that are happening around corporate social responsibility, and ESG— environmental social governance.

Is there anything else you’d like to add?

We won’t be successful with healthy buildings unless it’s healthy buildings for all. The big picture goal here is to get to a place where healthy buildings are the norm, not the exception.