Rachel Kapisak Jones

The thesis of Healthy Buildings: How Indoor Spaces Can Make You Sick—or Keep You Well, a newly updated version of a 2020 book by Harvard professors Joseph Allen and John Macomber, is simple: Buildings should keep us healthy. But, the duo argues, this seemingly obvious conceit needs to become universally accepted, or we’ll continue to suffer social, financial, and health and wellness-related consequences.

The health of the people who use buildings, Allen and Macomber claim, hasn’t traditionally been the paramount concern in designing them. The authors provide a succinct case for ensuring that developers, building owners, designers, and other stakeholders start to take imminent health risks seriously when constructing new buildings and renovating old ones.

Both writers approach this subject from a unique background. Macomber was born into the construction world; his great-grandfather founded George B. H. Macomber Co., a Boston-based business that built some of the first steel buildings in the city. The enterprise was passed down through generations, and Macomber eventually became chairman and principal stakeholder for 15 years before embarking on a career as a professor at Harvard Business School.

Allen trained to become an FBI Special Agent, but ended up working as a forensic investigator. In 2009, he was hired to help solve a problem at Grady Hospital in Atlanta, where within a month, four patients on two floors developed Legionnaires’ disease, a serious type of pneumonia caused by breathing in or ingesting Legionella bacteria. After sampling the water in the plumbing lines, Allen and his team found the bacteria in the water on those two floors. Through this experience, Allen became increasingly fascinated with “sick buildings” and the work architects and designers can do to make them healthy.

“I was beginning to see firsthand that solving the problems of sick buildings required a merging of the skills of building science and health science,” says Allen. Throughout the book, he and Macomber make sure the readers see their worldview firsthand. Humans spend 90% of our lives indoors, according to the Enivronmental Protection Agency, and every type of building we enter impacts the health of those who occupy it. Good health often means good performance in the context of work and academia, and Allen and Macomber use school buildings as a primary example of what healthy buildings can mean to the students who use them.

According to a study by the University of Tulsa Indoor Air Program cited in Healthy Buildings, more than 3,000 fifth graders scored higher on math, reading, and science in classrooms with higher ventilation rates. According to a Harvard study, among nearly one million New York City students, the likelihood of failing an exam on a 90 degree Fahrenheit day versus a 75 degree Fahrenheit day is 14% greater. And in a study of more than 4,000 sixth graders by the Finnish National Institute of Health and Welfare, lower ventilation rates, moisture, and dampness, as well as inadequate ventilation, were all associated with a higher incidence of respiratory symptoms, which meant more missed school days.

Nine Foundations

Allen and Macomber outline the “nine foundations of a healthy building” in the book, laying out the ways that buildings can be more environmentally friendly and less toxic to the people inside of them. From proper ventilation to thermal heath, water quality to acoustics and noise, the authors explain the essential takeaways and recommendations for each of the nine elements. This section and the tips provided within it are the fulcrum of Healthy Buildings. The chapter simplifies the key findings and quantifies the economic benefit of working to make buildings healthy.

Published in April 2020 at the height of the COVID-19 pandemic, Healthy Buildings: How Indoor Spaces Drive Performance and Productivity was the original title of this book until additional information regarding COVID-19 was added to the current version of Healthy Buildings.

In the newly released version, a new chapter, “Buildings as a First Line of Defense Against Covid and Other Airborne Infectious Diseases,” explains exactly why fresh air is important in stopping infectious disease.

While critiquing the “baseless,” according to the authors, 6-feet-apart rule as a mode of stopping the transmission of COVID-19, the chapter provides evidencebased strategies to limit airborne infectious diseases, including simply allowing in more outdoor air. The new additions to the book go as far as providing recommendations for bringing more air indoors even when pollution outside is bad.

Allen and Macomber theorize that the public is “unlikely to forget the lost years of 2020 and 2021” and hope that this experience leads to an increased focus on indoor air quality. “We expect that office workers, apartment renters, cruise ship passengers, students, teachers, factory workers, and many others will be prompted by the memory of COVID-19 to think about the air they breathe,” they write. “If that happens, then landlords, school administrators, managers of retirement homes, real estate developers, and condo salespeople alike will clamor to make their buildings healthier than their competitors.” Is this a pipe dream in a world driven by immediate cost savings, since healthier buildings can sometimes be perceived as being more expensive? Perhaps. But the duo makes a convincing, all-too-relevant case for why indoor air quality has never been more essential in the COVID-19 era.

It’s not controversial to want buildings to keep people healthy, and one of the keys to the success of Healthy Buildings is how pragmatically that sentiment is presented. Even the data-rich portions are simple to grasp, and the chapters are written with enough first-hand experience interspersed throughout that the book never becomes dry.

“The way we see it, one of the most accessible ways to influence the health of people around the world is to influence the design, operation, and maintenance of the billions of square feet of enclosed space where we live, work, learn, play, pray, and heal,” Allen and Macomber state plainly toward the end of the book.

“We think the key to making this theory of change operational is to show that it’s a ‘win for all’ scenario; that acting in your own self-interest can influence others to do the same, and that, building by building, we can begin to improve the health of all people, in all buildings, everywhere, every day.”

In Healthy Buildings, Allen and Macomber provide the key actions needed to make sure “sick buildings are a thing of the past.” It’s a fascinating read for anyone interested in keeping our society healthy and well, and a near-mandatory one for anyone who works in the field.