Review of Healthy Buildings by Joseph G. Allen and John D. Macomber

I don’t often write book reviews these days but every so often a book comes along that is so important or moving that I feel the need. ‘Healthy Buildings’ is one of those and it should become the go to reference for anyone maintaining, refurbishing, designing, owning or just working in buildings – so that is just about everybody. Clearly in the light of COVID-19 it is a very timely book.

It starts with very personal introductions explaining how the authors got to where they are and the work that led to this book.  I liked this approach as it helps to frame the ‘why’, why is the subject important and why do they care enough about it to write a book, which as I know is a huge commitment on top of your day job. Throughout the book is highly informative, extensively referenced and yet easy to read. I really like the style of the book when explaining scientific concepts, captured in the phrase; “environmental media, which is the annoying public health way of saying air, water, or dust”.

A lot of the issues discussed have been known about for a long while, but either hidden away, dealt with peripherally or separately in silos, which is part of the problem we face. This book brings them all together in an integrated way and presents enough hard evidence on the value of addressing health in building design, refurbishment and operation to convince even the most hard-nosed real estate investor.  It is interesting how much evidence there is that is either not known about or has been systematically ignored, something that the authors bring out using the story of a C-suite executive from company selling air filters asking if there was any evidence of the health effects of PM2.5. There is a huge evidence base but surprisingly enough, a senior executive from a company that has an interest in being on top of that particular subject didn’t know about it. That is a sad commentary on the ‘captains of industry’ that we have in the built environment sector.

The book brings home the clear message that our collective health is not something that comes solely from random events, or is managed or influenced solely by medical professionals, but instead is highly affected by the buildings we inhabit for 90% of the time and hence by building designers, owners and operators. It also makes the overwhelming case on the effects on productivity of higher levels of ventilation. The 3/30/300 rule quoted in the book is a good ready reckoner, at least for office buildings: 3 units of cost on utilities, 30 on rent and 300 on staff, so a small gain in productivity is worth far more than the usual energy savings. All of this fits with the thinking about multiple, strategic non-energy benefits of energy efficiency which I have often talked about. The strategic (and financial) value of improved productivity far outweighs energy savings and we need to be selling productivity improvements that as a side benefit can bring energy savings. There is a twist to this, making a building healthier, for instance by increasing ventilation rates, will increase energy use but this could be very worthwhile from productivity gains. It also of course improves the returns from any energy efficiency measure e.g. heat recovery and it can improve the case for onsite-generation and/or storage, so we need to factor all these things into better business cases for holistic projects that incorporate health related benefits, productivity benefits and energy efficiency benefits.  We need to think about the energy baseline we are comparing to – the current situation or the new situation with increased ventilation.

The book once again reminds us of the importance of language. Indoor Air Quality (IAQ) is a known concept but actually IEQ, Indoor Environmental Quality, may be a better metric as it covers all aspects of the indoor environment not just air quality.  It also reminds us that design codes or building regulations are minimum performance standards and may be far from the ideal. Who really wants to perform at the minimum level? But we design and operate buildings at those levels, or even below, all the time. 

As well as a treasure trove of evidence and tools that can be used to sell healthy buildings to decision makers, as well as operationalise healthy buildings in real life situations, the book offers suggestions and tools for doing just that. As I have said before, capturing and valuing all the benefits of building upgrades is critical for making the business case stack up, and the health and productivity benefits are ones that are the largest and yet the most often ignored. Like energy efficiency there is massive potential for cost-effective improvement in the health impact of buildings and exploiting that potential is critical for addressing massive health problems in all societies, just like exploiting energy efficiency is for addressing the climate problem. This issue seems to be being neglected in a lot of the ‘build back better’ conversations which seem too focused on the real and important energy efficiency benefits. Health benefits may get better traction with governments, especially in the COVID world we now inhabit.

I am sure this is a book that I will come back to time and time again. We are now taking inspiration from it as we develop new ideas and service offerings about integrated health and energy retrofits.