Diagnosis and treatment of sick building syndrome

The main reason humans started creating buildings was to protect us from health risks including exposure to extremes of temperature, weather impacts such as rain and damp, and fortified shelter from dangerous organisms such as wild animals. But as civilisation has progressed, it appears the way we design and deliver domestic and commercial shelter is causing new and persistent health problems.

Back in the 1980s, researchers and air quality experts started identifying a link between people becoming unwell after prolonged periods inside a specific building, and the quality of the air inside the building. They called it ‘Sick Building Syndrome’, and in the 1990s new standards were developed around air quality and ventilation to attempt to reduce the impact of poor-quality buildings on human health.

In the 1990s, occupational health and safety started to consider factors such as natural light levels, fresh air as opposed to recirculated conditioned air, and the level of Volatile Organic Compounds (VOCs) being off-gassed by finishes, furnishings and fixtures. VOCs have been implicated in both short-term health effects such as allergies and asthma; negative impacts on the ability to concentrate; and, potentially linked to serious conditions including cancer and immune system dysfunction.

By the 2000s, the science on indoor environment quality (IEQ) was becoming accepted across the commercial office sector, healthcare, education and hospitality. Design standards and building codes began to integrate requirements around IEQ. Sustainability rating tools including Green Star, LEED, WELL, Fitwel, Green Mark, NABERS IE, AirRated and the Living Building Challenge incorporated IEQ requirements such as natural daylighting, fresh air levels, acoustic management, design for active movement and low- or no VOCs as core considerations.

Hazards that can hang around for decades

By the 2010s, another grouping of organic pollutants had risen in importance, specifically semi-volatile organic compounds (SVOCs).

International organisations such as the World Health Organisation have been acknowledging the serious health impacts of SVOCs for years, but they have only recently been on the radar of designers, specifiers and health and safety professionals in the built environment. Sustainability ratings systems such as WELL have also had to understand and act on mitigation approaches for SVOCs.

The major issue with SVOCs is their capacity to remain within indoor environments for an extended period, as well as their toxicity at lower concentrations. This makes them far more hazardous than other pollutants when considering the dose-response curve of toxicity.

In this respect they have much on common with another major health threat – the Persistent Organic Pollutants (POPs) such as dioxins, PCBs (polychlorinated biphenyls), brominated flame retardants, PFAS (per- and polyfluoroalkyl substances) and other chemicals listed under the United Nations' Stockholm Convention.

POPs have the ability to biomagnify (increase through the food chain), bioaccumulate (build up in the body due to lack of effective biological mechanisms for them to be fully excreted) and can persist in the environment for hundreds if not thousands of years.

It is because of the ability of POPs to migrate through the environment and the food chain that researchers have found traces of dioxins and other carcinogenic POPs in the breastmilk of Inuit women who live thousands of kilometres away from farmlands where dioxin-containing pesticides and herbicides have been deployed.

Under the criteria of the Living Building Challenge, POPs and other substances of concern are explicitly not permitted for use. LBC Projects must avoid all substances on the Living Future Institute Red List. This catalogue of the “worst in class” materials, chemicals and elements commonly used in buildings incorporates VOCs, VVOCs, SVOCs, POPs and specific product types many of us take for granted such as PVC.

And then along came Rona

Then, in 2020, along came COVID-19, and IEQ became fundamental in terms of mitigating the risks of continued infection.

Now we arrive at a collective ‘aha moment’: the evidence shows that auditing current IEQ in a building and taking steps to improve it also means a building becomes healthier for everyone, all the time. It can also ensure spaces and places are better adapted for coping with events including high levels of smoke (pollution or bushfires), extreme heat, asthma thunderstorm events … and other risks yet to emerge.

But you don't know what you don't measure.

Achieving optimal IEQ and its associated health and productivity benefits should start with a solid foundation that includes a comprehensive monitoring and management plan.

As a minimum this will include:

• Engagement of a suitably qualified consultant to create an install plan.
• The embedding of 'WELL accredited' IEQ monitors that analyse at a minimum, PM2.5, VOCs, CO2, sound, lux levels, temperature, and humidity throughout all hours of occupation.
• Installation of the monitors every 325 m2 within occupied spaces and at ‘breathing height’, i.e., not on the ceiling.
• An indoor air quality rating such as AirRated, NABERS IEQ or RESET. This will signify to tenants that the area achieves levels of air quality in alignment with acknowledged governmental / international benchmarks.
• An ongoing management strategy which includes, at a minimum, a notification system for air quality violations and strategies for abatement, sensor maintenance / replacement planning, and training and engagement of building management staff and occupiers.

To find out more about how our expertise supports healthy places for people, visit our Health, Wellbeing & Productivity Services page.