Buildings as a Prescription for Health

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September 26, 2023

To the Nation’s Elected Officials and Policymakers:

RE: Buildings as a Prescription for Health

On behalf of the public health signatories below, including six former Surgeons General and six CEOs and executive directors from many of the country’s leading public health organizations, we are writing to call attention to an important policy opportunity – indeed a policy imperative – focusing on the built environment as a catalyst for enhancing the public’s health. Policymakers at all levels have the opportunity and responsibility to position buildings as a prescription for health.

Our buildings, the places and spaces where we spend the vast majority of our time, hold the key to protecting our families, businesses and the wider public. A wealth of rigorous research highlights the profound role buildings play in promoting human health, preventing disease and supporting well-being. Several key factors within buildings – including indoor air quality, water quality, thermal comfort, acoustics, lighting, materials, and access to physical activity and healthy foods – have a direct influence on shaping positive health outcomes. According to a large and growing body of research, by adopting healthy building practices, we can drive numerous health, economic and societal benefits:

• A potential $200 billion annual productivity gain corresponding to a 20% to 50% reduction in Sick Building Syndrome symptoms for office workers in the U.S.
• An estimated $38 billion in annual economic benefits from increasing minimum ventilation rates in U.S. offices from 8 to 15 liters per second (or a $13 billion annual economic benefit if ventilation rates were only improved by a minimum of 8 to 10 liters per second). ,
• A return of $3.48 for every dollar companies spend on workplace wellness programs due to reduced medical costs, and an additional return of $5.82 due to reduced absenteeism.
• A 61% to 101% improvement in cognitive function, depending on the extent of enhanced indoor environmental quality improvements, which help yield employee productivity benefits to the tune of $6,500 to $7,500 per person per year.
• A net present value (NPV) of $21,172 per employee, or $115 per square foot (SF) over 10 years for a high-performance, healthy building, based on benefits only related to productivity, retention and improved well-being.
• Physical and mental health benefits similar to a longitudinal study finding nearly 30% improvement in occupant satisfaction, 26% increase in occupant perceived well-being scores, 10% improvement in reported mental health scores and 10 median points in productivity resulting from WELL Certification.

Furthermore, the importance of buildings also extends to our nation’s preparedness for and response to pressing global health challenges, from acute threats like COVID-19 to the escalating impacts of climate change.

Over the next decade, federal, state and local governments will invest hundreds of billions of dollars in our nation’s buildings, spanning considerable funding for affordable housing, federal buildings and schools and long-term, multi-billion-dollar incentives for the decarbonization of residential and commercial buildings. The pivotal question for policymakers is whether these investments will also prioritize the people inside, and in doing so, improve public health outcomes. Unless policymakers take action to elevate health in buildings, the answer, unfortunately, will likely be no.

Simply put, many government decision-makers are not looking closely enough at the outsized role buildings play to protect and enhance public health, safety and well-being. From a public policy perspective, what’s happening inside our buildings, and its significant impact on human health, is being largely ignored.

As a prime example, while we have decades of policy addressing outdoor air pollution, healthy indoor air is often overlooked. Of course, clean outdoor air is essential, but so is indoor air, especially considering we spend roughly 90% of our lives inside. This point becomes even more significant when we consider that indoor air is substantially more polluted than outdoor air, on average 2-5 times more, and often as high as 100 times more. This is especially important for the 4.2 million children with asthma who spend most of their days in school buildings and whose asthma can be exacerbated by poor indoor air quality. Asthma is both the leading chronic disease in children and the leading cause of missed school days.

Yet even in the aftermath of the COVID-19 pandemic, with its devastating health and economic impacts, decision-makers have yet to fully recognize the pivotal role buildings play in safeguarding and enhancing human health. The pandemic laid bare a glaring omission in the current building policy framework related to ventilation performance and indoor air quality – two essential factors that determine whether a building safeguards or jeopardizes people’s health. As a result, instead of acting as a first line of defense against the threat of COVID-19, many of our buildings may have contributed to its rapid spread.

Looking ahead, we find ourselves fast approaching another daunting challenge: an already changing climate that continues to heighten and intensify the severity of environmental impacts and weather disasters that threaten the health and well-being of people all around the world. The imperative for health-driven building policy has never been more pressing. Buildings must be fortified for health, accounting for the growing threats of extreme heat, wildfires, severe storms, flooding and rising sea levels. Delaying action increases risk to people’s health, and even their lives. Fortunately, there’s great potential for buildings to adapt and become more resilient, addressing the multifaceted health risks posed by climate change. Solutions like improved indoor air and water quality, emergency preparedness, integrative design, food security and sustainable materials can help comprise a more holistic approach to healthy buildings.

The considerations outlined above underscore the need to rapidly accelerate the adoption of healthy building practices in America. It also serves as a cautionary tale about the consequences of inaction. We need leaders who can guide this policy shift and help ensure our buildings better reflect a stronger commitment to public health.

Today, we urge policymakers at every level of government to rethink existing building policies, placing human health at the forefront. We hope all policymakers will embrace this new policy paradigm wherein buildings are not seen merely as structures, but as pillars supporting our nation’s health. Whether a national legislator or mayor, a federal agency leader or school superintendent, a governor or the president, your support is crucial in prioritizing health in buildings.

Together, we can reshape the future of building-focused policy by setting a higher bar, one that more purposefully integrates human health considerations into all aspects. In doing so, our policies can be a force for protecting and enhancing health and well-being, driving positive public health outcomes and fostering greater resilience against future health threats.

Sincerely,

Dr. Richard Carmona
17th Surgeon General of the United States

Dr. David Satcher,
16th Surgeon General of the United States

Dr. Joycelyn Elders
15th Surgeon General of the United States

Dr. Antonia Novello
14th Surgeon General of the United States

Dr. Kenneth Moritsugu
Former Acting Surgeon General of the United States

Dr. Boris D. Lushniak
Former Acting Surgeon General of the United States

Harold P. Wimmer
President and CEO
American Lung Association

Kenneth Mendez
President and CEO
Asthma and Allergy Foundation of America

Georges C. Benjamin, MD
Executive Director
American Public Health Association

Rachel Hodgdon
President and CEO
International WELL Building Institute

Colin Milner
CEO
International Council on Active Aging

William Potts-Datema, DrPH
Interim CEO
Society for Public Health Education