by Jeffrey C Kadlowec, Architect
Nine Foundations
The 9 Foundations of a Healthy Building (see Fig 1) was developed by public health experts at Harvard to define the key factors of healthy indoor environments (Allen 2017). Ventilation brings in fresh outdoor air by mechanical system to dilute indoor pollutants. Air quality is effected by the presence of biological and chemical pollutants. Thermal health involves the impact of temperature, humidity and air speed on human activity. Moisture can lead to mold, mildew and water damage. Dust is inhaled, absorbed or ingested, while pests introduce allergens. Safety and security affect our ability to survive and thrive against the biological response of fight or flight. Water quality is essential for life and must remain free of microbial contamination. Noise interferes with work, sleep and conversation as unwanted or disturbing sound. These factors are universal to all building types including homes, though are most concerning in commercial office environments.
Figure 1. The 9 Foundations of a Healthy Building (Allen 2017)
Sustainable Design
In his inaugural address as president of American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), McQuade (2025) said their vision is a “healthy and sustainable built environment for all.” Though extensive research has been conduct on indoor air quality (IAQ), household air pollutants (HAPs), and volatile organic compounds (VOCs), the global pandemic highlighted the risk of airborne pathogens and infectious disease transmission (Mishra 2025). Engineered solutions and technological advances optimize energy use and indoor environment quality (IEQ) to improve building design. Green Building Rating Systems provide non-mandatory frameworks for multi-criteria assessment of social, environmental and economic principles for design, construction, maintenance, and operations. Leadership in Energy and Environmental Design (LEED), Building Research Establishment Environmental Assessment Method (BREEAM), Comprehensive Assessment System for Built Environment Efficiency (CASBEE), and Green Rating for Integrated Habitat Assessment (GRIHA) use different categories and weightage for comfort, energy, materials, resources, waste, water, and climate.
Health Impact
Decisions made throughout the design process ultimately affects mental, physical, and social health and well-being, either directly or indirectly. Sustainable development must therefore endeavor to improve health and lifestyle while considering the impact of the built environment on local, regional and global economics (Serano 2022). Asbestos, radon, VOCs, cooking pollutants, and tobacco smoke are harmful substances linked to asthma, lung cancer and mesothelioma. Mold and dampness in cold climates are responsible for allergies along with skin and respiratory issues. Extreme temperatures can increase infectious diseases and cause cardiovascular and arthritic problems. Excessive noise is associated with depression and impacts the respiratory, cardiovascular and musculoskeletal systems. Daylight exposure is necessary for psychological well-being while lack of daylight is associated with depression. Inadequate indoor and outdoor space can lead to poor mental health. Lack of physical activity may result in stroke, cancer, cardiovascular and musculoskeletal disease. Exposure to poor air quality reduces life expectancy. Fewer social connections is associated with obesity, cardiovascular and psychological problems, and increased mortality. Urban sprawl increases obesity, stress, isolation, air pollution, and traffic injuries. Traffic impacts safety and usability for walking, cycling and play. Litter, graffiti, vandalism, and dilapidated areas increase anxiety and social disorders. Increasing public awareness of the value of sustainable design and promoting community participation in the transformational processes will benefit the health and well-being of current and future generations.
References
Allen, Joseph; Bernstein, Ari; Cao, Xiadong; Eitland, Erika; Flanigan, Skye; Gokhale, Maia; Goodman, Julie; Klager, Skylar; Klingensmith, Lacey; Laurent, Jose; Lockley, Steven; MacNaughton, Piers; Pakpour, Sepideh; Spengler, Jack; Vallarino, Jose; Williams, Augusta; Young, Anna & Yin, Jie. (2017) The 9 Foundations of a Healthy Building. Harvard T H Chan School of Public Health. healthybuildings.hsph.harvard.edu/about/9-foundations-of-a-healthy-building/.
McQuade, Bill. (2025). Healthy Buildings: Designing for Life. ASHRAE Transactions, 131(2): xix-xxii.
Mishra, Nishchaya & Patel, Sameer. (2025). Need for a Holistic Approach to Assessing Sustainable, Green, and Healthy Buildings. Environment & Health. 3: 218-226. doi.org/10.1021/envhealth.4c00161.
Serano, Bibang & Li, Zhu. (2022). The Impact of Sustainable Development in the Context of Healthy Buildings. Journal of Green Building, 17(2): 163-179. DOI: 10.3992/jgb.17.2.163.
