Principle 1: Protect and Improve Health

 

State of health

‘9 out of 10 people worldwide breathe polluted air’ (World Health Organization1)

Air pollution is considered today as the greatest environmental threat to human health, causing approximately seven million deaths each year2. Exposure to polluted air increases mortality risk to
people from stroke, heart disease, pulmonary disease, lung cancer and respiratory infections3. Our buildings and cities across the world both expose people to indoor air pollution and contribute to the ambient (outdoor) pollution crisis. Both pollution sources have distinct causes across the building lifecycle and must be tackled accordingly to protect human health and wellbeing.

Indoor Air Quality

Studies suggest people spend 90% of their time indoors4. Therefore, exposure to pollutants within the home and other indoor environments can be highly damaging to human health, and worsened in sealed or contained indoor environments with reduced air flow. The primary causes of indoor air pollution that pose risk to human health are as follows:

  • Household air pollution from solid fuel combustion: 3.8 million premature deaths are attributed to household air pollution annually5, primarily due to the use of solid fuels and kerosene which creates toxic particulate matter through combustion. Primarily an issue in developing nations, where alternative sources of fuel can be scarce, the World Health Organization estimates that around 3 billion people worldwide lack access to clean or modern energy services for cooking6. Exposure to particulate matter can cause cardiovascular and respiratory disease and strokes7.
     
  • Household air pollution from gas appliances: gas stoves are used worldwide for heating and cooking, and often considered the ‘clean and safe’ upgrade from solid fuel combustion. However, research shows that pollutants released from gas appliances can lead to heightened nitrogen dioxide levels, which can worsen respiratory conditions such as asthma8. Gas is a fossil fuel; combustion of which releases greenhouse gas emissions, worsening climate change.
     
  • Release of harmful gases and chemicals from materials: pollutants released within the indoor environment include volatile organic compounds (VOCs) from building or fit-out materials including paints and varnishes, adhesives and furnishings, and household items such as electronics and cleaning materials. Exposure to these pollutants can be concentrated in an indoor environment, and consequently trigger health issues such as nausea, headaches, respiratory irritation, and allergies9. Organically derived gases, such as radon, can also generate a form of indoor pollution that presents major health risks. Exposure to hazardous chemicals within buildings is further detailed in Principle 6.4 below.
     
  • Biological contaminants: often linked to building quality, infiltration of air through cracks in the building façade (exterior) can cause damp, leading to mould and fungi growth within walls, releasing airborne microbial pollution within indoor air10. This occurs in both hot, humid climates and cold, temperate climates. Research has shown that asthma risk increases by up to 40% when occupants live in homes with mould11.
     
  • Infiltration from outdoors has also been identified as a significant health risk for people within buildings, with studies showing that 65% of our exposure to outdoor air pollution occurs indoors12.

Ambient air pollution

  • Ambient, or outdoor, air pollution is caused by a range of factors, including transport, agriculture, and waste. The contribution of the built environment across the building and construction lifecycle is substantial and must be mitigated to protect human and environmental health. Causes of ambient air pollution related to the built environment include:
     
  • Manufacturing of building materials: notably the use of highly polluting brick kilns, which contribute to up to 20% of global black carbon emissions, alongside steel and iron production13. 90% of global brick production is concentrated in central Asia, causing direct localised health impacts to local people. Emissions from production are further increased by transportation to global markets11.
     
  • Building construction: 11% of global energy-related carbon emissions are attributed to emissions embodied in the construction process, which further impacts human health through dust creation14. The release of toxic dusts from construction sites (such as silica or hardwood, which are recognised as having carcinogenic properties) creates localised extreme health hazards to construction workers and people living nearby15.
     
  • Operational buildings:
    o 28% of global energy-related carbon emissions are attributed to operational buildings,predominantly from energy used for heating, cooling and lighting12. The release of carbon emissions is a core contributor to climate change, explained as a health risk in Principle 6.1.
    o Fine particles (PM2.5) are emitted from the combustion of fuels to power our buildings, and for heating or cooking within, as well as from transport emissions16.
    o The use of traditional cookstoves, open fires or kerosene lamps for heating, cooking, and lighting within homes in the developing world is responsible for up to 58% of black carbon emissions worldwide17.

Outcome:

Building provides only clean air through the mitigation of air quality risks and incorporation of health-based strategies, whilst maintaining energy efficiency. Air quality should be enhanced at all stages of lifecycle, including construction workers, and protecting health of people within and outside, considering both building occupants and neighbouring people.

Strategies across the lifecycle

Tackling ambient air pollution:

Design:

  • Support the switch to more efficient building material production, particularly around traditional brick firing
  • Energy efficient building design (and renovation) to improve the quality of building envelope and consequential energy load for heating and cooling
  • Passive design strategies, including energy efficient building fabric, vegetation, and ventilation, can reduce heating or cooling requirement within buildings and maintain comfortable living conditions (see Principle 2.1 for more detail)
  • Sustainable urban planning also has a role in the reduction of air pollution, through mitigation of emissions from transport through a low or zero carbon infrastructure networ

Construction:

  • Dust production should be appropriately managed with national and organisational regulation, best practice and policy adherence on site, and other dust-reduction strategies. Off-site, modular construction practices can be preferable due to lower volume and more controlled dust production
  • Support the switch to more efficient building material production, particularly around traditional brick firing

Operation:

  • Reduce operational and embodied carbon emissions (see Principle 6.1 for more information)
  • Commit to monitoring indoor and outdoor air quality in real-time, to increase awareness and promote data-driven action to mitigate pollution sources and improve public health. Air quality monitoring can be undertaken as part of World Green Building Council’s Plant a Sensor campaign.

Improving indoor air quality:

Design:

  • Lessen exposure to hazardous chemicals in the indoor environment through conscious product selection and the use of low emission materials, such as low volatile organic compounds (VOCs) emission paints, sealants, adhesives, fixtures, fit-outs, and flooring as well as low- formaldehyde products
  • Energy efficient building design and/or renovation to reduce risk of damp or mould build up
  • Minimisation of potentially harmful chemicals in building materials (see Principle 6.4 for information)
  • Proper filtration of air for forced air systems, particularly in locations susceptible to poor air quality, such as areas susceptible to wildfires

Construction:

  • Removal of harmful materials from existing buildings
  • Installing porous materials after ‘wet products’ (adhesives/sealants and paints/coatings) have been given a chance to off-gas, when possible

Operation:

  • Use appropriate ventilation to remove indoor air and toxins to exchange with fresh and clean air into buildings, including designs that maximise cross-flow ventilation. Ventilation can be mechanical, mixed-mode or natural, with energy efficient solutions prioritised.
  • Minimise the use of traditional cookstoves through access to clean fuels and technology within buildings, prioritising electric alternatives rather than gas-based
  • Phase out fossil fuels, including gas, as an energy source worldwide, prioritising residential
  • buildings
  • Ensure localised extraction around gas appliances when used
  • Inspect installation, maintenance, and cleaning of filtration and ventilation systems to ensure cleanliness, filter functionality and reduce the potential for mould and bacteria growth
  • Commit to monitoring indoor and outdoor air quality in real-time, to increase awareness and promote data-driven action to mitigate pollution sources and improve public health. Air quality monitoring can be undertaken as part of the WorldGBC Plant a Sensor campaign

Benchmarks:

The World Health Organization (WHO) provides guidance on outdoor air quality, including information of particulate and gaseous pollutants. These outdoor values are also relevant for indoor environments due to close infiltration of pollutants between outdoors and indoors (research suggests an average of 65% of our exposure to outdoor pollution happens indoors4). The WHO Air Quality Guidelines (AQGs) for 24-hour mean concentration limits are18:

• PM2.5 less than 10 μg/m3
• PM10 less than 20 μg/m3

These figures are published as ‘the lowest levels at which total, cardiopulmonary and lung cancer mortality have been shown to increase with more than 95% confidence in response to long-term exposure to PM2.5’19. Interim targets, which reduce mortality risk to a lesser extent than the AQGs, are also available within the WHO Air Quality Guidelines.

There is no simple measure for indoor air quality due to the broad spectrum of parameters that are influenced by external and adjoining environments as well the activities and construction of the internal space. Common factors that contribute to the assessment of indoor air quality are volatile organic chemicals (VOCs) such as formaldehyde, and other gases including carbon dioxide and carbonmonoxide, ozone, nitrogen dioxide water vapour and radon; particulate matter; and biological components including bacteria, fungi (such as mould) and pollen; and ‘odours’. Benchmarks for air quality and ventilation are embedded within country specific standards.

Examples of specific benchmarks or limit values used in international rating tools20,21,22 are as follows:

• Carbon dioxide (CO2): 800ppm
• Carbon monoxide (CO): 9ppm
• Formaldehyde (CH2O): 27 ppb
• TVOC: 500 μg/m3
• Radon (Rn): 0.148 Bq/L [4 pCi/L]

An additional consideration for indoor air quality is humidity, which can heighten susceptibility to microbial airborne pollutants from damp or mould within a building. The American Society of Heating Refrigerating and Air-conditioning Engineers (ASHRAE) sets benchmarks for acceptable ventilation rates to control this risk. See also World Health Organization ‘Guidelines for Indoor Air Quality: Dampness and Mould’;

• ASHRAE Standard 62.1-2016 recommends that relative humidity in occupied spaces be controlled to less than 65% to reduce the likelihood of conditions that can lead to microbial growth
• Humidity levels significantly below 30% are considered less optimum for the respiratory system23. If the relative humidity is below 30%, the air is too dry this can cause irritation of the mucous membranes of the nose and throat, and breathing difficulties in at-risk individuals (e.g., people with asthma). Dry air is also harmful to people with skin or eye conditions24 .

In certain locations, filtration of air is required in addition to ventilation to ensure adequate air quality. MERV ratings of 11 or higher (or HEPA filters) provide air cleaning for pollutants that enter buildings or are recirculated in buildings. Residential homes can be designed to accommodate HEPA filtration.

 

State of health

Access to clean and safe drinking water and sanitation facilities is a fundamental right within our buildings, for all people worldwide. Within this sub-principle we identify the specific health risks relating to water quality through the lens of built environment – water quality and sanitation and infrastructure.

Sanitation:
One-third of the world’s population, 2.4 billion people, do not have access to adequate sanitation; 40% of the world does not have access to basic handwashing facilities25. Lack of access to poor sanitation is a leading risk factor for infectious diseases, including cholera, diarrhoea, dysentery, hepatitis A, typhoid, and polio. It ranks as a very important risk factor for death globally, with approximately 5% of deaths in low-income countries resulting from unsafe sanitation26. According to the Global Burden of Disease study, 775,000 people died prematurely in 2017 as a result of poor sanitation27.

Water quality:
Health risks may arise from consumption of water contaminated with infectious agents, toxic chemicals, and radiological hazards. Improving access to safe drinking-water can result in tangible improvements to health28. Contaminated water can transmit diseases such diarrhoea, cholera, dysentery, typhoid, and polio as well as cause the ingestion of toxic materials, causing conditions such as lead poisoning29. Contaminated drinking water is estimated to cause 485 000 diarrhoeal deaths each year30. Micro plastics have emerged as an additional source of contamination31.

The role of a sustainable built environment must be to enhance the quality of our infrastructure, serving occupants and surrounding community with clean, safe, accessible water. An important element to address is the disparity between developed and developing countries regarding buildings regulations and codes related to water quality.

However, research studies in developed nations highlight that health risks persist worldwide: in 2015, at least 18 million Americans were served by water systems with lead violations32.

Outcome:

All buildings should provide occupants with adequate, safe, and sustainable access to clean water and sanitation, whilst maintaining efficient use of water and striving for circularity on-site.

Strategies across the lifecycle

Regulatory:

• Implementation of universal health-based targets for water quality: locally developed standards and regulations, preventative risk management across the water supply chain (catchment to consumer) including filtration, with independent testing for microbiological and chemical compliance.

Operation:

• Test for toxins and contaminants, and roll-out of water treatment plans within the water distribution system. Smart water distribution systems can provide notification of testing results from the treatment plant within the distribution network to inform buildings of their risk management options
• Legionella management plan, controlling risk of legionella bacteria commonly found in water (mitigate risk of bacteria multiplication, particularly in temperature range of 20-45°C with
available nutrients)
• Ensure regular, thorough cleaning takes place in communal areas like a shared kitchen and toilet facilities

Benchmarks: 

The continuous delivery of safe water requires effective management and operation throughout the water-supply chain, from catchments to consumer taps and points of use. The WHO Guidelines for Drinking-Water Quality indicate that this is most effectively achieved through the Framework for safe drinking-water, which encompasses the following elements33:

• establishing health-based targets as benchmarks for defining safety of drinking water
• assuring safety by systematically assessing and managing risks
• establishing a system of independent surveillance to verify the meeting of health-based targets

 

State of health

Good mental health is related to mental and psychological wellbeing34. The global burden of mental health illnesses is significant. In 2010, mental illnesses and substance use disorders accounted for 183.9 million disability-adjusted life years (DALYs)35 worldwide. It is estimated that the life expectancy among those with mental illness is over 10 years shorter compared to those without mental illnesses36.

Considered building design can reduce stress, improve mental health, and positively impact comfort, well-being, and happiness, through the adoption of strategies such as biophilic design.

Outcome:

The built environment is designed and operated to enhance occupant and neighbouring community mental health and wellbeing. Ensure design strategies are accessible and inclusive to support social health for people of all levels of physical, cognitive and mental ability.

Strategies across the lifecycle

Design:

  • Designing buildings to reduce occupants’ stress, using strategies such as: incorporating biophilic design, aesthetically pleasing interiors, acoustic comfort, access to external views and integrated design, including the creation of break out and shared communal spaces
  • Community and neighbourhood design to improve mental and social health, including access to nature, active space for exercise and design to facilitate social connection
  • Design for social justice to reduce systemic stresses on under-represented communities, including racial justice and the suggested concept of direct mental and physical health impacts, which can be tied to under-lying conditions37 (see Principle 5)

Regulatory:

  • National services and programs access at a regional or national level, such as depression and mental health, suicide prevention, domestic violence and nutrition services
  • Regional and national policies that advocate for increased availability and accessibility to housing, alongside tenure security, working towards increased general affordability of housing

Operation:

  • Use post occupancy evaluation surveys to collect self-reported measures for occupant health and comfort
  • Establish a feedback collection system for current occupants to share on the ongoing impact their built environment has on their mental and social health, such as via suggestion boxes

Benchmarks:

The World Health Organization has developed an Assessment Instrument for Mental Health Systems (WHO-AIMS) which is used for collecting information on the mental health system of a country or region, with the goal of collecting this information to improve and monitor mental health systems. The indicators include the presence of a mental health policy or plan as well as mental health expenditure.

There is limited research available on benchmarks for building design for benefitting mental health. Incorporating bespoke strategies for specific projects, as well as awareness of other elements of the built environment that can impact an individual’s mental and psychological wellbeing, is recommended.

State of health

In the 18-month period from 2019-2020 within which this Framework was developed and under consultation the COVID-19 pandemic changed the face of the planet, the atmospheric balance of pollutants and most substantially, human lifestyle, beyond any comparable alternative in peacetime history. As of October 2020, over one million have died from the coronavirus COVID-19 outbreak worldwide38.

Research has suggested the primary route of transmission of COVID-19 is directly from person to person, which is applicable to many other infectious diseases. However, viruses also settle on surfaces,
which can become heavily contaminated quickly, and virus survival on surface time remains uncertain. Guidance suggests that the COVID-19 virus can survive on inanimate objects and can remain viable for up to five days at temperatures of 22-25°C and relative humidity of 40-50% (which is typical of air-conditioned indoor environments)39.  Estimates range from a number of hours to days, depending on the material and conditions40. Therefore, regularly cleaning surfaces, appliances and working locations and thorough handwashing are important41.

Ventilation and filtration strategies can also play a role in reducing disease transmission. Increasing the amount of air flowing in from outside and the rate of air exchange can dilute virus particles indoors, however, high air flow could also stir up settled particles and put them back in the air42. Research has also demonstrated the importance of lessening exposure to air pollution, particularly around particulate matter (PM). The Harvard School of Public Health have identified that a small increase in long-term exposure to PM2.5 leads to a substantial increase in the COVID-19 death rate, approximately 8% higher43.

Outcome:

The indoor and outdoor built environment actively mitigates risk of infectious disease transmission, including both strategic design measures and implementation of building policies to enhance health, whilst maintaining energy efficiency.

Strategies across the lifecycle

Design:

  • Use of technology to minimise physical contact within the building, such as sensor type activation for lifts, fixtures, and security control

Operation:

  • Pandemic planning, (including planning for the reopening of buildings)
  • Employ operational concepts to reduce/counter infectious disease transmission (including regular checks of the HVAC system and filters, replacing as indicated or needed)
  • Clean/disinfect areas such as high touch surfaces sanitising, handwashing, social distancing provision
  • Control of microbial count and bacteria (e.g. use of UV lamps, testing of surfaces)
  • Maintain and clean pipes/faucets to prevent legionella in buildings that have been unoccupied as a consequence of the COVID-19 pandemic
  • Monitor and implement health guidance from national government and other authorities
  • Consider and mitigate wider sources of internal disease transmission, including fungal spores and pest control

Benchmarks:

Benchmarks around infectious disease mitigation measures related to the general built environment design and operation, particularly around COVID-19, do not exist at time of writing. We therefore share
some useful guidance documents that offer tools for the built environment sector:


Resource List for 1.1:

• American Society of Heating Refrigerating and Air-conditioning Engineers (ASHRAE):
ASHRAE Standard 62.1-2019, ‘Ventilation for Acceptable Indoor Air Quality, Atlanta’: https://ashrae.iwrapper.com/ViewOnline/Standard_62.1-2019
• Beam Plus New Buildings V2.0, ‘Health and Wellbeing, Materials and Waste, Integrated Design and Construction Management’: https://www.hkgbc.org.hk/eng/beam-plus/file/BEAMPlus_New_Buildings_v2_0.pdf
• Beam Plus Neighbourhood V1.0, ‘Outdoor Environmental Quality’: https://www.beamsociety.org.hk/files/Manual/BEAMPlusNDManualWithCorrigendumNo1.pdf
• BREEAM International New Construction Standard, ‘Hea 02 Indoor air quality’ and ‘Pol 02 NOx emissions’: https://www.breeam.com/discover/technical-standards/
• BREEAM International In-Use Standard, ‘Hea 16 Indoor air quality management’ and ‘Pol 03 Local air quality’: https://www.breeam.com/discover/technical-standards/
• BSRIA. 2018. ‘Soft Landings Guidance’: https://www.bsria.com/uk/consultancy/project-improvement/soft-landings/guides/
• C40 Cities. ‘Towards a Healthier World: Climate Change, Air Quality and Health’: https://www.c40.org/research
• CABR & CSUS: Green Building Research Centre, ‘Healthy Building Evaluation Standard ‘Air’ Chapter’ & Wei Jingya, Zhang Yinping. Interpretation of the air chapter of ‘Healthy Building Evaluation Standard’. Architecture Technology, 2018, 49(05): 482-485
• Chartered Institute of Building Service Engineers (CIBSE). ‘Indoor Air Quality, An outline of guidance’: https://www.cibse.org/getmedia/8c7fe54c-b712-49e3-9bb1-44bf9f3fdaa0/An-outline-of-CIBSE-guidance-on-IAQ.pdf.aspx
• DGNB. 2019. ‘Liveable and Fit for the Future’: https://www.dgnb.de/en/council/publications/index.php
• DGNB. 2018. ‘No More Excuses’: https://www.dgnb.de/en/council/publications/index.php
• DGNB. 2018. ‘The Cost Trap of Refrigerants’: https://www.dgnb.de/en/council/publications/index.php
• Emirates Green Building Council. ‘Emirates Coalition for Green Schools’: https://emiratesgbc.org/technical-programs/green-schools/
• Green Building Council of Australia: Green Star, ‘Design & As Built ‘Indoor Environment Quality’: https://new.gbca.org.au/rate/rating-system/design-and-built/
• Green Building Council of Australia: Green Star, ‘Communities ‘Environment’’: https://new.gbca.org.au/rate/rating-system/communities/
• G7 Executive Briefing Series. 2018. ‘Smart Facades for a Sustainable Future’: https://digital.thecatcompanyinc.com/g7magazine/june-2018/smart-facades-sustainable-future/
• Indian Green Building Council: Green Interiors Rating Tool, ‘Fresh Air Ventilation’, ‘CO2 Monitoring’ and ‘Indoor Air Quality Management’: https://igbc.in/igbc/redirectHtml.htm?redVal=showgreeninteriorsnosign#GreenHomes
• Indian Green Building Council: ‘Health and Wellbeing Rating Tool: ‘Indoor Air Quality’: https://igbc.in/igbc/redirectHtml.htm?redVal=showHealthWellBiengnosign#Resources
• International Living Future Institute. Living Building Challenge, ‘Health and Happiness Petal’ https://living-future.org/lbc/basics4-0/
• Dr. Allen, J. et al. 2017. ‘The 9 Foundations of a Healthy Building’: https://forhealth.org/9_Foundations_of_a_Healthy_Building.February_2017.pdf
• J. Allen and J. Macomber. 2020. ‘Healthy Buildings. How Indoor Spaces Drive Performance and Productivity’ Harvard University Press. https://www.hup.harvard.edu/catalog.php?isbn=9780674237971
• Jordan GBC. ‘Your Guide to Green Building in Jordan’: https://drive.google.com/file/d/13IvMnkqoi09FhuNenh_j58sq_HRB4TjT/view
• Michael Driedger. 2020. ‘The Impact of Air Quality on a Building’s Safety and Comfort’: https://www.propmodo.com/the-impact-of-air-quality-on-a-buildings-safety-and-comfort/
• Mujan, I. 2019. ‘Influence of indoor environmental quality on human health and productivity’ A review, Journal of Cleaner Production: https://www.sciencedirect.com/science/article/abs/pii/S0959652619303348?via%3Dihub
• Wargocki, P, Wyon, D et al. 1999. ‘Perceived Air Quality, Sick Building Syndrome (SBS) Symptoms and Productivity in an Office with Two Different Pollution Loads’: https://pubmed.ncbi.nlm.nih.gov/10439554/
• RESET. Standard for ‘Continuous Air Quality Monitoring’: https://www.reset.build/
• Saint-Gobain. ‘Multi-Comfort’ principles: Indoor Air Comfort’: https://multicomfort.saint-gobain.com/comforts-and-solutions/indoor-air-comfort
• Seals, B. and Krasner, A. 2020. ‘Gas Stoves: Health and Air Quality Impacts and Solutions’ Rocky Mountain Institute’: https://rmi.org/insight/gas-stoves-pollution-health
• Dodson, R et al. 2017. ‘Chemical Exposures in Recently Renovated Low-Income Housing: Influence of Building Materials and Occupant Activities’. Environment International Journal: https://www.sciencedirect.com/science/article/pii/S0160412017308413
• UL. ‘UL GREENGUARD Certification Program’: https://www.ul.com/resources/ul-greenguard-certification-program
• Urban Land Institute. 2015. ‘Building Healthy Places Toolkit’: https://bhptoolkit.uli.org/
• UNICEF. ‘Silent Suffocation in Africa: Air Pollution is a Growing Menace, Affecting the Poorest Children the Most’: (https://www.unicef.org/media/55081/file/Silent_suffocation_in_africa_air_pollution_2019.pdf)
• U.S. Environmental Protection Agency. 2012. ‘A Citizen’s Guide to Radon: The Guide to Protecting Yourself and Your Family from Radon’: http://www.epa.gov/radon/pdfs/citizensguide.pdf.
• USGBC: LEED v4 Building Design & Construction (BD+C), ‘Indoor Air Quality Assessment’: https://www.usgbc.org/credits/new-construction-commercial-interiors-core-and-shell-schools-new-construction-retail-new-c-8• USGBC: LEED v4 BD+C, ‘Minimum indoor air quality performance’: https://www.usgbc.org/credits/new-construction/v4-draft/eqp1?return=/credits/New%20Construction/v4
• USGBC: LEED v4 Homes, ‘Air Filtering’: https://www.usgbc.org/credits/homes-high-rise/v4-draft/eqp5?return=/credits/Homes/v4
• USGBC: LEED v4.1 BD+C, ‘Low-emitting materials’: https://www.usgbc.org/credits/new-construction-core-and-shell-schools-new-construction-retail-new-construction-healthc-178?return=/credits/New%20Construction/v4.1
• Washington State Department of Health. 2003. ‘School Indoor Air Quality: Best Management Practices Manual’ Washington: https://www.doh.wa.gov/portals/1/Documents/Pubs/333-044.pdf
• Wei, W. et al. 2020. ‘Review of parameters used to assess the quality of the indoor environment in Green Building certification schemes for offices and hotels’ Energy and Buildings.
• World Green Building Council. ‘Air Quality in the Built Environment’: https://worldgbc.org/clean-air-buildings/
• World Green Building Council. ‘Plant a Sensor’: https://worldgbc.org/plant-a-sensor
• World Health Organization. ‘Air Pollution’: https://www.who.int/news-room/air-pollution
• World Health Organization. ‘Air Quality Guidelines’: https://www.who.int/phe/health_topics/outdoorair/outdoorair_aqg/en/
• World Health Organization. ‘WHO Guidelines for Indoor Air Quality Household Fuel Combustion’: https://www.who.int/airpollution/guidelines/household-fuel-combustion/IAQ_HHFC_guidelines.pdf
• World Health Organization. 2005. ‘WHO Air Quality Guidelines for Particulate Matter, Ozone, Nitrogen Dioxide and Sulphur Dioxide. Geneva: World Health Organization’: 9, 14. https://apps.who.int/iris/handle/10665/69477WHO indoor air quality guidelines: household fuel combustion.
• World Health Organization. ‘Guidelines for household fuel combustion’: https://www.who.int/airpollution/guidelines/household-fuel-combustion/recommendation1/en/
• World Health Organization. ‘Guidelines for indoor air quality: selected pollutants’: https://www.euro.who.int/en/health-topics/environment-and-health/air- quality/publications/2010/who-guidelines-for-indoor-air-qualityselected-pollutants
• World Health Organization. ‘Housing and health guidelines’: https://www.who.int/publications/i/item/who-housing-and-health-guidelines
• World Health Organization. ‘Guidelines for indoor air quality: dampness and mould’ https://www.who.int/airpollution/guidelines/dampness-mould/en/

Resource List for Further 1.2:

• Beam Plus New Buildings V2.0, ‘Health and Wellbeing, Water Use, Integrated Design and Construction Management’: https://www.hkgbc.org.hk/eng/beam-plus/file/BEAMPlus_New_Buildings_v2_0.pdf
• BREEAM International New Construction Standard, ‘Hea 09 Water quality’: https://www.breeam.com/discover/technical-standards/
• BREEAM International In-Use Standard, ‘Hea 18 Legionella risk management’: https://www.breeam.com/discover/technical-standards/
• CABR & CSUS: Green Building Research Centre, ‘Healthy Building Evaluation Standard ‘Water’ Chapter’ & Zeng Jie, Lü Shilei. 2018. ‘Interpretation of the water chapter of "Healthy Building Evaluation Standard’ [J]. Building Technology, 49(05): 486-489.
• Centers for Disease Control and Prevention (CDC). ‘Legionella (Legionnaires' Disease and Pontiac Fever). Guidelines, standards and laws’: https://www.cdc.gov/legionella/resources/guidelines.html
• Centre for Health Protection, Department of Health, the Government of Hong Kong. ‘Health Topics: Legionnaires Disease’: https://www.chp.gov.hk/en/healthtopics/content/24/2117.html
• Daniel Okun. 1991. ‘A Water and Sanitation Strategy for the Developing World, Environment: Science and Policy for Sustainable Development’: https://www.researchgate.net/scientific-
contributions/2002910407-Daniel-A-Okunhttps://www.researchgate.net/scientific-contributi
• ESGLI. ‘Guidance for managing Legionella in building water systems during the COVID-19 pandemic’: https://www.escmid.org/fileadmin/src/media/PDFs/3Research_Projects/ESGLI...
COVID-19_PANDEMIC_20200418_v02.00.pdf
• Emirates Green Building Council. ‘Emirates Coalition for Green Schools’: https://emiratesgbc.org/technical-programs/green-schools/
• Green Building Council of Australia: Green Star, ‘Design & As Built, ‘Indoor Environment Quality’’: https://new.gbca.org.au/rate/rating-system/design-and-built/
• Green Building Council of Australia: Green Star, ‘Communities ‘Environment’’: https://new.gbca.org.au/rate/rating-system/communities/
• Indian Green Building Council: Health and Wellbeing Rating, ‘Water Quality’:
https://igbc.in/igbc/redirectHtml.htm?redVal=showHealthWellBiengnosign#R...
• Jordan GBC. ‘Your Guide to Green Building in Jordan’: https://drive.google.com/file/d/13IvMnkqoi09FhuNenh_j58sq_HRB4TjT/view
• United States Environmental Protection Agency. 2018. ‘Drinking water standards and health advisories’ March 2018: 11-12.: EPA 2018 Edition of the Drinking water standards and heath advisory tables
• World Health Organization. 2011. ‘Water Safety Plan, Water Safety in Buildings’: https://www.who.int/water_sanitation_health/publications/2011/9789241548...
• World Health Organization. ‘WHO Guidelines for drinking-water quality (GDWQ)’: https://www.who.int/water_sanitation_health/water-quality/guidelines/en/
• Why is access to clean, safe drinking water so elusive?’ Article: https://gresb.com/why-access-clean-safe-water-elusive/

Resource List for 1.3:

• Beam Plus New Buildings V2.0, ‘Integrated Design and Construction Management’: https://www.hkgbc.org.hk/eng/beam-plus/file/BEAMPlus_New_Buildings_v2_0.pdf
• Beam Plus Neighbourhood V1.0, ‘Community Aspects’: https://www.beamsociety.org.hk/files/Manual/BEAMPlusNDManualWithCorrigen...
• BREEAM International New Construction Standard, ‘Man 05 Aftercare’, ‘Hea 01 Visual Comfort’ and ‘Hea 06 Accessibility’: https://www.breeam.com/discover/technical-standards/
• BREEAM International In-Use Standard, ‘Man 02 Management Engagement and Feedback’, ‘Hea 06 View out’, ‘Hea 11 Provision of Rest Areas’ and ‘Hea 12 Inclusive Design’: https://www.breeam.com/discover/technical-standards/
• Buro Happold. ‘Design for Student Mental Health and Wellbeing’: https://www.burohappold.com/wp-content/uploads/2019/06/BuroHappold_HEDQF...
• CABR & CSUS: Green Building Research Centre Healthy Building Evaluation Standard, ‘Humanities Chapter’ & Hong, J. et al. 2018. ‘The interpretation of "Healthy Building Evaluation Standard; Construction Technology’
• Centre for the Built Environment. ‘Occupant Indoor Environmental Quality (IEQ) Survey’: https://cbe.berkeley.edu/resources/occupant-survey/
• The Centre for Urban Design and Mental Health. ‘How Urban Design Can Affect Mental Health’: https://www.urbandesignmentalhealth.com/how-urban-design-can-impact-mental-
health.html
• Chrysikou, Evangelia. 2015. ‘Ill performing buildings for mental health’: https://www.researchgate.net/publication/280007782_IILL_PERFORMING_BUILD...
_MENTAL_HEALTH
• Colloqate. ‘Design Justice for Black Lives’: https://colloqate.org/design-justice-for-black-lives
• DGNB. 2019. ‘ Liveable and Fit for the Future’: https://www.dgnb.de/en/council/publications/index.php
• Green Building Council of Australia: Green Star, ‘Communities Liveability’: https://new.gbca.org.au/rate/rating-system/communities/
• Indian Green Building Council: Green Interiors Rating Tool, ‘Occupant Wellbeing Facilities’: https://igbc.in/igbc/redirectHtml.htm?redVal=showgreeninteriorsnosign#Gr...
• WELL Building Standard. ‘Mind’: https://standard.wellcertified.com/mind
• World Health Organization. ‘Mental Health Evidence Research’: https://www.who.int/mental_health/evidence/en/
• World Health Organization. ‘Building Back Better: Sustainable Mental Health Care After Emergencies’: https://www.who.int/mental_health/emergencies/building_back_better/en/

Resource List for 1.4:

• American Society for Microbiology. 2019. ‘Novel Coronavirus (COVID-19) Pandemic: Built Environment Considerations to Reduce Transmission’: https://msystems.asm.org/content/5/2/e00245-20
• The American Institute of Architects. 2020. ‘Re-occupancy assessment tool’: http://content.aia.org/sites/default/files/2020-06/STN20_%20344901_ReOcc...
• Archinect News. 2020. ‘“Hygiene ventilation” and the case for green stimulus’ https://archinect.com/news/article/150195914/hygiene-ventilation-and-the...
• American Society of Heating Refrigerating and Air-conditioning Engineers (ASHRAE): 170, ‘Ventilation of Health Care Facilities - including Hospital Spaces, Outpatient Spaces, and Nursing Home Spaces’
• BREEAM International In-Use Standard, ‘Man 03 Maintenance policies and procedures’, ‘Hea 16 Indoor air quality management’, ‘Hea 18 Legionella risk management’ ‘Rsl 06 Emergency plans and climate-related physical risks’
• Centers for Disease Control and Prevention (CDC). ‘Guidance for Reopening Buildings After Prolonged Shutdown or Reduced Operation’: https://www.cdc.gov/coronavirus/2019-ncov/php/building-water-system.html
• GOV.UK. ‘Transmission characteristics and principles of infection prevention and control’: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infec...
• Harvard University. 2020. ‘Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study’: https://projects.iq.harvard.edu/covid-pm
• Fast Company. 2020. ‘How we can redesign cities to fight future pandemics’: https://www.fastcompany.com/90479665/how-we-can-redesign-cities-to-fight...
• Interact Lighting. ‘Re-inventing the workplace after COVID-19’: https://www.interact-lighting.com/global/iot-insights/workplace-post-cov...
• Passive House Accelerator. ‘Hygiene Ventilation, Heard of it?’: https://passivehouseaccelerator.com/articles/hygiene-ventilation-heard-o...
• Perkins & Will. ‘Understanding antimicrobial ingredients in building materials – COVID-19 Statement’: https://healthybuilding.net/reports/22-covid-19-statement-understanding-...
• Recovery Readiness. ‘A ‘how to’ guide for reopening your workplace’: https://www.cushmanwakefield.com/en/insights/covid-19/recovery-readiness...
• Science Daily, University of California. ‘COVID-19 and the built environment - Examining how building design can influence disease transmission’: https://www.sciencedaily.com/releases/2020/04/200410162450.htm
• USGBC: LEED ‘Safety-First’ Pilot credits: https://www.usgbc.org/about/covid-19-resources - LEED-safety-first
• World Health Organization. 2017. ‘Keeping The Vector Out: Housing Improvements for Vector Control and Sustainable Development’: https://apps.who.int/iris/bitstream/handle/10665/259404/9789241513166-en...


References

1 World Health Organization. ‘Air Pollution’: https://www.who.int/news-room/air-pollution

2 United Nations Economic Commission for Europe. ‘Air Pollution and Health’: https://www.unece.org/environmental-policy/conventions/envlrtapwelcome/c...
pollution-and-health.html#:~:text=Air%20pollution%20is%20now%20considered,pulmonary%20illnesses%20and%20heart%20disease.

3 World Health Organization. ‘Health Topics: Air Pollution’: https://www.who.int/health-topics/air-
pollution#tab=tab_1

4 Klepeis, N. et al. 2001. ‘The National Human Activity Pattern Survey (NHAPS)’: https://indoor.lbl.gov/sites/all/files/lbnl-47713.pdf

5 World Health Organization. 2018. ‘Household Air Pollution and Health Facts’: https://www.who.int/en/news-room/fact-sheets/detail/household-air-pollut...

6 World Health Organization. 2018. ‘Household Air Pollution and Health’: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution...

7 World Health Organization. 2018. ‘Household Air Pollution and Health Facts Sheet’:
https://www.who.int/en/news-room/fact-sheets/detail/household-air-pollut...

8 Seals B. and Krasner A. 2020. ‘Gas Stoves: Health and Air Quality Impacts and Solutions’ Rocky
Mountain Institute. https://rmi.org/insight/gas-stoves-pollution-health

9 United States Environmental Protection Agency. ‘Volatile Organic Compounds’ Impact on Indoor Air Quality’ https://www.epa.gov/indoor-air-quality-iaq/volatile-organic-compounds-im...
quality

10 World Health Organization Europe. 2009. ‘Guidelines for Indoor Air Quality: Dampness and Mould’:
http://www.euro.who.int/__data/assets/pdf_file/0017/43325/E92645.pdf?ua=1

11 Velux. 2017. ‘Healthy Homes Barometer 2017’: https://www.velux.com/what-we-do/healthy-
buildings-focus/healthy-homes-barometer.

12 Fisk W.J., Chan W.R. 2017. ‘Effectiveness and Cost of Reducing Particle-Related Mortality with
Particle Filtration. Indoor Air.’
3 Science Direct. ‘Chemical Exposures in Recently Renovated Low-Income Housing: Influence of
Building Materials and Occupant Activities’:
https://www.sciencedirect.com/science/article/pii/S0160412017308413

13 Climate and Clean Air Coalition. ‘Bricks’: http://www.ccacoalition.org/en/initiatives/bricks

14 UN Environment. 2017. ‘Global Status Report 2017’: https://www.worldgbc.org/sites/default/files/UNEP%20188_GABC_en%20%28web...

15 Roadmap on carcinogens. ‘Hardwood Dust’: https://roadmaponcarcinogens.eu/hardwooddust/

16 Environmental Protection Agency. ‘Particulate Matter Emissions’: https://cfpub.epa.gov/roe/indicator_pdf.cfm?i=19

17 Climate and Clean Air Coalition. ‘Household Energy’: http://www.ccacoalition.org/en/initiatives/household-energy

18 World Health Organization. ‘Air Quality Guidelines’: https://www.who.int/phe/health_topics/outdoorair/outdoorair_aqg/en/

19 World Health Organization. ‘Air Quality Guidelines’: https://www.who.int/phe/health_topics/outdoorair/outdoorair_aqg/en/

20 Green Building Council of Australia: Green Star, ‘Design & As Built Submission Guidelines v1.3’: https://new.gbca.org.au/rate/rating-system/design-and-built/

21 USGBC: LEED v4, ‘Reference Guide for Building Design and Construction’:
USGBChttps://www.usgbc.org/sites/default/files/LEED%20v4%20BDC_07.25.19_curre...

22 USGBC: LEED v4, ‘Reference Guide for Building Design and Construction’:
USGBChttps://www.usgbc.org/sites/default/files/LEED%20v4%20BDC_07.25.19_curre...

23 Your Healthy Home Guide. ‘Temperature and Humidity Variations’: https://www.caaquebec.com/en/at-home/guides/your-healthy-home-guide/temp...
variations/

24 Your Healthy Home Guide. ‘Temperature and Humidity Variations’: https://www.caaquebec.com/en/at-home/guides/your-healthy-home-guide/temp...
variations/

25 Our World in Data. ‘Other Health Impacts of Poor Sanitation’: https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-ris...

26 Our World in Data. ‘Unsafe Sanitation is A Leading Risk Factor for Death’: https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-ris...

27 Our World in Data. ‘Unsafe Sanitation is A Leading Risk Factor for Death’: https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-ris...

28 World Health Organization. ‘Health Topics, Drinking Water’ https://www.who.int/topics/drinking_water/en/

29 Scientific American. 2016. ‘Thousands of U.S Areas affected with Lead Poisoning beyond Flint’s’ https://www.scientificamerican.com/article/thousands-of-u-s-areas-afflic...
beyond-flints/

30 World Health Organization. 2019. ‘Drinking Water Facts Sheet’: https://www.who.int/en/news-room/fact-sheets/detail/drinking-water

31 World Health Organization. 2019. ‘Microplastics in drinking-water’: https://www.who.int/water_sanitation_health/publications/microplastics-i...

32 Olson, E.D. Fedinick K.P. 2016. ‘What's in Your Water? Flint and Beyond’ Natural Resources Defense Council. Viewed October 23, 2017 & Young A., Nichols M. 2016. ‘Beyond Flint: excessive lead levels found in almost 2,000 water systems across all 50 states. USA Today’: https://www.healthandenvironment.org/environmental-health/environmental-....

33 World Health Organization. ‘Guidelines for Drinking-Water Quality (GDWQ)’: https://www.who.int/water_sanitation_health/water-quality/guidelines/en/

34 World Health Organization. 2020. ‘Mental health and substance use’: https://www.who.int/mental_health/en/

35 Whiteford H.A., Degenhardt L., et al. 2010. ‘Global Burden of Disease Attributable to Mental and Substance Use Disorders’ Global Burden of Disease Study 2010.

36 WELL Building Standard. 2020. ‘Mind’: https://standard.wellcertified.com/mind

37 National Center for Biotechnology Information (NCBI). 2006. ‘“Weathering” and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States’: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470581/

38 World Health Organization. 2020. ‘Coronavirus Disease (COVID-19) Dashboard’: https://covid19.who.int/

39 Public Health England. June 2020. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infec...

40 Science Daily, University of California. ‘COVID-19 and the Built Environment - Examining How Building Design Can Influence Disease Transmission’: https://www.sciencedaily.com/releases/2020/04/200410162450.htm

41 Science Daily, University of California. ‘COVID-19 and The Built Environment - Examining How Building Design Can Influence Disease Transmission’: https://www.sciencedaily.com/releases/2020/04/200410162450.htm

42 Science Daily, University of California. ‘ COVID-19 and The Built Environment - Examining How
Building Design Can Influence Disease Transmission’:
https://www.sciencedaily.com/releases/2020/04/200410162450.htm

43 Harvard University. 2020. ‘Exposure to Air Pollution and COVID-19 Mortality in the United States: A Nationwide Cross-Sectional Study’: https://projects.iq.harvard.edu/covid-pm


Disclaimer: The resource lists for each sub-principle are a non-exhaustive set of references provided from the WorldGBC network, peer review panel and industry through the Framework consultation period. A regular update of resource lists will be undertaken by WorldGBC to ensure updated information is available.

WorldGBC supports all certifications and is proud to unite a network that runs over 40 rating tools, plus support the uptake of all tools across the industry. Rating scheme inclusion within the Framework is based on submission from global GBC network and consultation responses, with aim of amalgamating a host of resources for a global audience to offer further detail for users beyond the high-level outline of each principle.

Regarding specific certifications, eg. BEAM or Green Star, there are often a number of versions or tools available for different building types (eg. Design, As-Built, Interiors, Communities). To maintain brevity of Framework document, one building level tool (eg. Design or New Construction) and one larger scale tool (eg. community level) is included within the Resource List of each sub-principle. Users with alternative building projects in mind are encouraged to acquire the appropriate version of the tool for most applicable guidance.

 

Health & Wellbeing Framework Back to the Health & Wellbeing Framework Homepage Read More

 

State of health

‘9 out of 10 people worldwide breathe polluted air’ (World Health Organization1)

Air pollution is considered today as the greatest environmental threat to human health, causing approximately seven million deaths each year2. Exposure to polluted air increases mortality risk to
people from stroke, heart disease, pulmonary disease, lung cancer and respiratory infections3. Our buildings and cities across the world both expose people to indoor air pollution and contribute to the ambient (outdoor) pollution crisis. Both pollution sources have distinct causes across the building lifecycle and must be tackled accordingly to protect human health and wellbeing.

Indoor Air Quality

Studies suggest people spend 90% of their time indoors4. Therefore, exposure to pollutants within the home and other indoor environments can be highly damaging to human health, and worsened in sealed or contained indoor environments with reduced air flow. The primary causes of indoor air pollution that pose risk to human health are as follows:

  • Household air pollution from solid fuel combustion: 3.8 million premature deaths are attributed to household air pollution annually5, primarily due to the use of solid fuels and kerosene which creates toxic particulate matter through combustion. Primarily an issue in developing nations, where alternative sources of fuel can be scarce, the World Health Organization estimates that around 3 billion people worldwide lack access to clean or modern energy services for cooking6. Exposure to particulate matter can cause cardiovascular and respiratory disease and strokes7.
     
  • Household air pollution from gas appliances: gas stoves are used worldwide for heating and cooking, and often considered the ‘clean and safe’ upgrade from solid fuel combustion. However, research shows that pollutants released from gas appliances can lead to heightened nitrogen dioxide levels, which can worsen respiratory conditions such as asthma8. Gas is a fossil fuel; combustion of which releases greenhouse gas emissions, worsening climate change.
     
  • Release of harmful gases and chemicals from materials: pollutants released within the indoor environment include volatile organic compounds (VOCs) from building or fit-out materials including paints and varnishes, adhesives and furnishings, and household items such as electronics and cleaning materials. Exposure to these pollutants can be concentrated in an indoor environment, and consequently trigger health issues such as nausea, headaches, respiratory irritation, and allergies9. Organically derived gases, such as radon, can also generate a form of indoor pollution that presents major health risks. Exposure to hazardous chemicals within buildings is further detailed in Principle 6.4 below.
     
  • Biological contaminants: often linked to building quality, infiltration of air through cracks in the building façade (exterior) can cause damp, leading to mould and fungi growth within walls, releasing airborne microbial pollution within indoor air10. This occurs in both hot, humid climates and cold, temperate climates. Research has shown that asthma risk increases by up to 40% when occupants live in homes with mould11.
     
  • Infiltration from outdoors has also been identified as a significant health risk for people within buildings, with studies showing that 65% of our exposure to outdoor air pollution occurs indoors12.

Ambient air pollution

  • Ambient, or outdoor, air pollution is caused by a range of factors, including transport, agriculture, and waste. The contribution of the built environment across the building and construction lifecycle is substantial and must be mitigated to protect human and environmental health. Causes of ambient air pollution related to the built environment include:
     
  • Manufacturing of building materials: notably the use of highly polluting brick kilns, which contribute to up to 20% of global black carbon emissions, alongside steel and iron production13. 90% of global brick production is concentrated in central Asia, causing direct localised health impacts to local people. Emissions from production are further increased by transportation to global markets11.
     
  • Building construction: 11% of global energy-related carbon emissions are attributed to emissions embodied in the construction process, which further impacts human health through dust creation14. The release of toxic dusts from construction sites (such as silica or hardwood, which are recognised as having carcinogenic properties) creates localised extreme health hazards to construction workers and people living nearby15.
     
  • Operational buildings:
    o 28% of global energy-related carbon emissions are attributed to operational buildings,predominantly from energy used for heating, cooling and lighting12. The release of carbon emissions is a core contributor to climate change, explained as a health risk in Principle 6.1.
    o Fine particles (PM2.5) are emitted from the combustion of fuels to power our buildings, and for heating or cooking within, as well as from transport emissions16.
    o The use of traditional cookstoves, open fires or kerosene lamps for heating, cooking, and lighting within homes in the developing world is responsible for up to 58% of black carbon emissions worldwide17.

Outcome:

Building provides only clean air through the mitigation of air quality risks and incorporation of health-based strategies, whilst maintaining energy efficiency. Air quality should be enhanced at all stages of lifecycle, including construction workers, and protecting health of people within and outside, considering both building occupants and neighbouring people.

Strategies across the lifecycle

Tackling ambient air pollution:

Design:

  • Support the switch to more efficient building material production, particularly around traditional brick firing
  • Energy efficient building design (and renovation) to improve the quality of building envelope and consequential energy load for heating and cooling
  • Passive design strategies, including energy efficient building fabric, vegetation, and ventilation, can reduce heating or cooling requirement within buildings and maintain comfortable living conditions (see Principle 2.1 for more detail)
  • Sustainable urban planning also has a role in the reduction of air pollution, through mitigation of emissions from transport through a low or zero carbon infrastructure networ

Construction:

  • Dust production should be appropriately managed with national and organisational regulation, best practice and policy adherence on site, and other dust-reduction strategies. Off-site, modular construction practices can be preferable due to lower volume and more controlled dust production
  • Support the switch to more efficient building material production, particularly around traditional brick firing

Operation:

  • Reduce operational and embodied carbon emissions (see Principle 6.1 for more information)
  • Commit to monitoring indoor and outdoor air quality in real-time, to increase awareness and promote data-driven action to mitigate pollution sources and improve public health. Air quality monitoring can be undertaken as part of World Green Building Council’s Plant a Sensor campaign.

Improving indoor air quality:

Design:

  • Lessen exposure to hazardous chemicals in the indoor environment through conscious product selection and the use of low emission materials, such as low volatile organic compounds (VOCs) emission paints, sealants, adhesives, fixtures, fit-outs, and flooring as well as low- formaldehyde products
  • Energy efficient building design and/or renovation to reduce risk of damp or mould build up
  • Minimisation of potentially harmful chemicals in building materials (see Principle 6.4 for information)
  • Proper filtration of air for forced air systems, particularly in locations susceptible to poor air quality, such as areas susceptible to wildfires

Construction:

  • Removal of harmful materials from existing buildings
  • Installing porous materials after ‘wet products’ (adhesives/sealants and paints/coatings) have been given a chance to off-gas, when possible

Operation:

  • Use appropriate ventilation to remove indoor air and toxins to exchange with fresh and clean air into buildings, including designs that maximise cross-flow ventilation. Ventilation can be mechanical, mixed-mode or natural, with energy efficient solutions prioritised.
  • Minimise the use of traditional cookstoves through access to clean fuels and technology within buildings, prioritising electric alternatives rather than gas-based
  • Phase out fossil fuels, including gas, as an energy source worldwide, prioritising residential
  • buildings
  • Ensure localised extraction around gas appliances when used
  • Inspect installation, maintenance, and cleaning of filtration and ventilation systems to ensure cleanliness, filter functionality and reduce the potential for mould and bacteria growth
  • Commit to monitoring indoor and outdoor air quality in real-time, to increase awareness and promote data-driven action to mitigate pollution sources and improve public health. Air quality monitoring can be undertaken as part of the WorldGBC Plant a Sensor campaign

Benchmarks:


The World Health Organization (WHO) provides guidance on outdoor air quality, including information of particulate and gaseous pollutants. These outdoor values are also relevant for indoor environments due to close infiltration of pollutants between outdoors and indoors (research suggests an average of 65% of our exposure to outdoor pollution happens indoors4). The WHO Air Quality Guidelines (AQGs) for 24-hour mean concentration limits are18:


• PM2.5 less than 10 μg/m3
• PM10 less than 20 μg/m3


These figures are published as ‘the lowest levels at which total, cardiopulmonary and lung cancer mortality have been shown to increase with more than 95% confidence in response to long-term exposure to PM2.5’19. Interim targets, which reduce mortality risk to a lesser extent than the AQGs, are also available within the WHO Air Quality Guidelines.

There is no simple measure for indoor air quality due to the broad spectrum of parameters that are influenced by external and adjoining environments as well the activities and construction of the internal space. Common factors that contribute to the assessment of indoor air quality are volatile organic chemicals (VOCs) such as formaldehyde, and other gases including carbon dioxide and carbonmonoxide, ozone, nitrogen dioxide water vapour and radon; particulate matter; and biological components including bacteria, fungi (such as mould) and pollen; and ‘odours’. Benchmarks for air quality and ventilation are embedded within country specific standards.

Examples of specific benchmarks or limit values used in international rating tools20,21,22 are as follows:


• Carbon dioxide (CO2): 800ppm
• Carbon monoxide (CO): 9ppm
• Formaldehyde (CH2O): 27 ppb
• TVOC: 500 μg/m3
• Radon (Rn): 0.148 Bq/L [4 pCi/L]


An additional consideration for indoor air quality is humidity, which can heighten susceptibility to microbial airborne pollutants from damp or mould within a building. The American Society of Heating Refrigerating and Air-conditioning Engineers (ASHRAE) sets benchmarks for acceptable ventilation rates to control this risk. See also World Health Organization ‘Guidelines for Indoor Air Quality: Dampness and Mould’;


• ASHRAE Standard 62.1-2016 recommends that relative humidity in occupied spaces be controlled to less than 65% to reduce the likelihood of conditions that can lead to microbial growth
• Humidity levels significantly below 30% are considered less optimum for the respiratory system23. If the relative humidity is below 30%, the air is too dry this can cause irritation of the mucous membranes of the nose and throat, and breathing difficulties in at-risk individuals (e.g., people with asthma). Dry air is also harmful to people with skin or eye conditions24 .

In certain locations, filtration of air is required in addition to ventilation to ensure adequate air quality. MERV ratings of 11 or higher (or HEPA filters) provide air cleaning for pollutants that enter buildings or are recirculated in buildings. Residential homes can be designed to accommodate HEPA filtration.

 


State of health

Access to clean and safe drinking water and sanitation facilities is a fundamental right within our buildings, for all people worldwide. Within this sub-principle we identify the specific health risks relating to water quality through the lens of built environment – water quality and sanitation and infrastructure.

Sanitation:
One-third of the world’s population, 2.4 billion people, do not have access to adequate sanitation; 40% of the world does not have access to basic handwashing facilities25. Lack of access to poor sanitation is a leading risk factor for infectious diseases, including cholera, diarrhoea, dysentery, hepatitis A, typhoid, and polio. It ranks as a very important risk factor for death globally, with approximately 5% of deaths in low-income countries resulting from unsafe sanitation26. According to the Global Burden of Disease study, 775,000 people died prematurely in 2017 as a result of poor sanitation27.

Water quality:
Health risks may arise from consumption of water contaminated with infectious agents, toxic chemicals, and radiological hazards. Improving access to safe drinking-water can result in tangible improvements to health28. Contaminated water can transmit diseases such diarrhoea, cholera, dysentery, typhoid, and polio as well as cause the ingestion of toxic materials, causing conditions such as lead poisoning29. Contaminated drinking water is estimated to cause 485 000 diarrhoeal deaths each year30. Micro plastics have emerged as an additional source of contamination31.

The role of a sustainable built environment must be to enhance the quality of our infrastructure, serving occupants and surrounding community with clean, safe, accessible water. An important element to address is the disparity between developed and developing countries regarding buildings regulations and codes related to water quality.

However, research studies in developed nations highlight that health risks persist worldwide: in 2015, at least 18 million Americans were served by water systems with lead violations32.

Outcome:

All buildings should provide occupants with adequate, safe, and sustainable access to clean water and sanitation, whilst maintaining efficient use of water and striving for circularity on-site.


Strategies across the lifecycle


Regulatory:


• Implementation of universal health-based targets for water quality: locally developed standards and regulations, preventative risk management across the water supply chain (catchment to consumer) including filtration, with independent testing for microbiological and chemical compliance.

Operation:


• Test for toxins and contaminants, and roll-out of water treatment plans within the water distribution system. Smart water distribution systems can provide notification of testing results from the treatment plant within the distribution network to inform buildings of their risk management options
• Legionella management plan, controlling risk of legionella bacteria commonly found in water (mitigate risk of bacteria multiplication, particularly in temperature range of 20-45°C with
available nutrients)
• Ensure regular, thorough cleaning takes place in communal areas like a shared kitchen and toilet facilities


Benchmarks: 

The continuous delivery of safe water requires effective management and operation throughout the water-supply chain, from catchments to consumer taps and points of use. The WHO Guidelines for Drinking-Water Quality indicate that this is most effectively achieved through the Framework for safe drinking-water, which encompasses the following elements33:

• establishing health-based targets as benchmarks for defining safety of drinking water
• assuring safety by systematically assessing and managing risks
• establishing a system of independent surveillance to verify the meeting of health-based targets

 

State of health

Good mental health is related to mental and psychological wellbeing34. The global burden of mental health illnesses is significant. In 2010, mental illnesses and substance use disorders accounted for 183.9 million disability-adjusted life years (DALYs)35 worldwide. It is estimated that the life expectancy among those with mental illness is over 10 years shorter compared to those without mental illnesses36.

Considered building design can reduce stress, improve mental health, and positively impact comfort, well-being, and happiness, through the adoption of strategies such as biophilic design.

Outcome:

The built environment is designed and operated to enhance occupant and neighbouring community mental health and wellbeing. Ensure design strategies are accessible and inclusive to support social health for people of all levels of physical, cognitive and mental ability.

Strategies across the lifecycle

Design:

  • Designing buildings to reduce occupants’ stress, using strategies such as: incorporating biophilic design, aesthetically pleasing interiors, acoustic comfort, access to external views and integrated design, including the creation of break out and shared communal spaces
  • Community and neighbourhood design to improve mental and social health, including access to nature, active space for exercise and design to facilitate social connection
  • Design for social justice to reduce systemic stresses on under-represented communities, including racial justice and the suggested concept of direct mental and physical health impacts, which can be tied to under-lying conditions37 (see Principle 5)

Regulatory:

  • National services and programs access at a regional or national level, such as depression and mental health, suicide prevention, domestic violence and nutrition services
  • Regional and national policies that advocate for increased availability and accessibility to housing, alongside tenure security, working towards increased general affordability of housing

Operation:

  • Use post occupancy evaluation surveys to collect self-reported measures for occupant health and comfort
  • Establish a feedback collection system for current occupants to share on the ongoing impact their built environment has on their mental and social health, such as via suggestion boxes

Benchmarks:

The World Health Organization has developed an Assessment Instrument for Mental Health Systems (WHO-AIMS) which is used for collecting information on the mental health system of a country or region, with the goal of collecting this information to improve and monitor mental health systems. The indicators include the presence of a mental health policy or plan as well as mental health expenditure.

There is limited research available on benchmarks for building design for benefitting mental health. Incorporating bespoke strategies for specific projects, as well as awareness of other elements of the built environment that can impact an individual’s mental and psychological wellbeing, is recommended.

State of health

In the 18-month period from 2019-2020 within which this Framework was developed and under consultation the COVID-19 pandemic changed the face of the planet, the atmospheric balance of pollutants and most substantially, human lifestyle, beyond any comparable alternative in peacetime history. As of October 2020, over one million have died from the coronavirus COVID-19 outbreak worldwide38.

Research has suggested the primary route of transmission of COVID-19 is directly from person to person, which is applicable to many other infectious diseases. However, viruses also settle on surfaces,
which can become heavily contaminated quickly, and virus survival on surface time remains uncertain. Guidance suggests that the COVID-19 virus can survive on inanimate objects and can remain viable for up to five days at temperatures of 22-25°C and relative humidity of 40-50% (which is typical of air-conditioned indoor environments)39.  Estimates range from a number of hours to days, depending on the material and conditions40. Therefore, regularly cleaning surfaces, appliances and working locations and thorough handwashing are important41.

Ventilation and filtration strategies can also play a role in reducing disease transmission. Increasing the amount of air flowing in from outside and the rate of air exchange can dilute virus particles indoors, however, high air flow could also stir up settled particles and put them back in the air42. Research has also demonstrated the importance of lessening exposure to air pollution, particularly around particulate matter (PM). The Harvard School of Public Health have identified that a small increase in long-term exposure to PM2.5 leads to a substantial increase in the COVID-19 death rate, approximately 8% higher43.

Outcome:

The indoor and outdoor built environment actively mitigates risk of infectious disease transmission, including both strategic design measures and implementation of building policies to enhance health, whilst maintaining energy efficiency.

Strategies across the lifecycle

Design:

  • Use of technology to minimise physical contact within the building, such as sensor type activation for lifts, fixtures, and security control

Operation:

  • Pandemic planning, (including planning for the reopening of buildings)
  • Employ operational concepts to reduce/counter infectious disease transmission (including regular checks of the HVAC system and filters, replacing as indicated or needed)
  • Clean/disinfect areas such as high touch surfaces sanitising, handwashing, social distancing provision
  • Control of microbial count and bacteria (e.g. use of UV lamps, testing of surfaces)
  • Maintain and clean pipes/faucets to prevent legionella in buildings that have been unoccupied as a consequence of the COVID-19 pandemic
  • Monitor and implement health guidance from national government and other authorities
  • Consider and mitigate wider sources of internal disease transmission, including fungal spores and pest control

Benchmarks:

Benchmarks around infectious disease mitigation measures related to the general built environment design and operation, particularly around COVID-19, do not exist at time of writing. We therefore share
some useful guidance documents that offer tools for the built environment sector:

  • The American Institute of Architects (AIA). 2020. ‘Re-occupancy Assessment tool’: http://content.aia.org/sites/default/files/2020-06/STN20_%20344901_ReOccupancyAssessmentTool-V02_sm_v09.pdf
  • ArcSkoru. 2020. ‘Arc Re-entry’: https://arcskoru.com/sites/default/files/Arc%20Guide%20to%20Re-Entry.pdf
  • Guide to Pandemic Planning: http://bomacanada.ca/wp-content/uploads/2020/01/BOMA-Guide-to-Pandemics-2020.pdf
  • Centers for Disease Control and Prevention (CDC). ‘Guidance for Reopening Buildings After Prolonged Shutdown or Reduced Operation’: https://www.cdc.gov/coronavirus/2019-ncov/php/building-water-system.html

Resource List for 1.1:


• American Society of Heating Refrigerating and Air-conditioning Engineers (ASHRAE):
ASHRAE Standard 62.1-2019, ‘Ventilation for Acceptable Indoor Air Quality, Atlanta’: https://ashrae.iwrapper.com/ViewOnline/Standard_62.1-2019
• Beam Plus New Buildings V2.0, ‘Health and Wellbeing, Materials and Waste, Integrated Design and Construction Management’: https://www.hkgbc.org.hk/eng/beam-plus/file/BEAMPlus_New_Buildings_v2_0.pdf
• Beam Plus Neighbourhood V1.0, ‘Outdoor Environmental Quality’: https://www.beamsociety.org.hk/files/Manual/BEAMPlusNDManualWithCorrigendumNo1.pdf
• BREEAM International New Construction Standard, ‘Hea 02 Indoor air quality’ and ‘Pol 02 NOx emissions’: https://www.breeam.com/discover/technical-standards/
• BREEAM International In-Use Standard, ‘Hea 16 Indoor air quality management’ and ‘Pol 03 Local air quality’: https://www.breeam.com/discover/technical-standards/
• BSRIA. 2018. ‘Soft Landings Guidance’: https://www.bsria.com/uk/consultancy/project-improvement/soft-landings/guides/
• C40 Cities. ‘Towards a Healthier World: Climate Change, Air Quality and Health’: https://www.c40.org/research
• CABR & CSUS: Green Building Research Centre, ‘Healthy Building Evaluation Standard ‘Air’ Chapter’ & Wei Jingya, Zhang Yinping. Interpretation of the air chapter of ‘Healthy Building Evaluation Standard’. Architecture Technology, 2018, 49(05): 482-485
• Chartered Institute of Building Service Engineers (CIBSE). ‘Indoor Air Quality, An outline of guidance’: https://www.cibse.org/getmedia/8c7fe54c-b712-49e3-9bb1-44bf9f3fdaa0/An-outline-of-CIBSE-guidance-on-IAQ.pdf.aspx
• DGNB. 2019. ‘Liveable and Fit for the Future’: https://www.dgnb.de/en/council/publications/index.php
• DGNB. 2018. ‘No More Excuses’: https://www.dgnb.de/en/council/publications/index.php
• DGNB. 2018. ‘The Cost Trap of Refrigerants’: https://www.dgnb.de/en/council/publications/index.php
• Emirates Green Building Council. ‘Emirates Coalition for Green Schools’: https://emiratesgbc.org/technical-programs/green-schools/
• Green Building Council of Australia: Green Star, ‘Design & As Built ‘Indoor Environment Quality’: https://new.gbca.org.au/rate/rating-system/design-and-built/
• Green Building Council of Australia: Green Star, ‘Communities ‘Environment’’: https://new.gbca.org.au/rate/rating-system/communities/
• G7 Executive Briefing Series. 2018. ‘Smart Facades for a Sustainable Future’: https://digital.thecatcompanyinc.com/g7magazine/june-2018/smart-facades-sustainable-future/
• Indian Green Building Council: Green Interiors Rating Tool, ‘Fresh Air Ventilation’, ‘CO2 Monitoring’ and ‘Indoor Air Quality Management’: https://igbc.in/igbc/redirectHtml.htm?redVal=showgreeninteriorsnosign#GreenHomes
• Indian Green Building Council: ‘Health and Wellbeing Rating Tool: ‘Indoor Air Quality’: https://igbc.in/igbc/redirectHtml.htm?redVal=showHealthWellBiengnosign#Resources
• International Living Future Institute. Living Building Challenge, ‘Health and Happiness Petal’ https://living-future.org/lbc/basics4-0/
• Dr. Allen, J. et al. 2017. ‘The 9 Foundations of a Healthy Building’: https://forhealth.org/9_Foundations_of_a_Healthy_Building.February_2017.pdf
• J. Allen and J. Macomber. 2020. ‘Healthy Buildings. How Indoor Spaces Drive Performance and Productivity’ Harvard University Press. https://www.hup.harvard.edu/catalog.php?isbn=9780674237971
• Jordan GBC. ‘Your Guide to Green Building in Jordan’: https://drive.google.com/file/d/13IvMnkqoi09FhuNenh_j58sq_HRB4TjT/view
• Michael Driedger. 2020. ‘The Impact of Air Quality on a Building’s Safety and Comfort’: https://www.propmodo.com/the-impact-of-air-quality-on-a-buildings-safety-and-comfort/
• Mujan, I. 2019. ‘Influence of indoor environmental quality on human health and productivity’ A review, Journal of Cleaner Production: https://www.sciencedirect.com/science/article/abs/pii/S0959652619303348?via%3Dihub
• Wargocki, P, Wyon, D et al. 1999. ‘Perceived Air Quality, Sick Building Syndrome (SBS) Symptoms and Productivity in an Office with Two Different Pollution Loads’: https://pubmed.ncbi.nlm.nih.gov/10439554/
• RESET. Standard for ‘Continuous Air Quality Monitoring’: https://www.reset.build/
• Saint-Gobain. ‘Multi-Comfort’ principles: Indoor Air Comfort’: https://multicomfort.saint-gobain.com/comforts-and-solutions/indoor-air-comfort
• Seals, B. and Krasner, A. 2020. ‘Gas Stoves: Health and Air Quality Impacts and Solutions’ Rocky Mountain Institute’: https://rmi.org/insight/gas-stoves-pollution-health
• Dodson, R et al. 2017. ‘Chemical Exposures in Recently Renovated Low-Income Housing: Influence of Building Materials and Occupant Activities’. Environment International Journal: https://www.sciencedirect.com/science/article/pii/S0160412017308413
• UL. ‘UL GREENGUARD Certification Program’: https://www.ul.com/resources/ul-greenguard-certification-program
• Urban Land Institute. 2015. ‘Building Healthy Places Toolkit’: https://bhptoolkit.uli.org/
• UNICEF. ‘Silent Suffocation in Africa: Air Pollution is a Growing Menace, Affecting the Poorest Children the Most’: (https://www.unicef.org/media/55081/file/Silent_suffocation_in_africa_air_pollution_2019.pdf)
• U.S. Environmental Protection Agency. 2012. ‘A Citizen’s Guide to Radon: The Guide to Protecting Yourself and Your Family from Radon’: http://www.epa.gov/radon/pdfs/citizensguide.pdf.
• USGBC: LEED v4 Building Design & Construction (BD+C), ‘Indoor Air Quality Assessment’: https://www.usgbc.org/credits/new-construction-commercial-interiors-core-and-shell-schools-new-construction-retail-new-c-8• USGBC: LEED v4 BD+C, ‘Minimum indoor air quality performance’: https://www.usgbc.org/credits/new-construction/v4-draft/eqp1?return=/credits/New%20Construction/v4
• USGBC: LEED v4 Homes, ‘Air Filtering’: https://www.usgbc.org/credits/homes-high-rise/v4-draft/eqp5?return=/credits/Homes/v4
• USGBC: LEED v4.1 BD+C, ‘Low-emitting materials’: https://www.usgbc.org/credits/new-construction-core-and-shell-schools-new-construction-retail-new-construction-healthc-178?return=/credits/New%20Construction/v4.1
• Washington State Department of Health. 2003. ‘School Indoor Air Quality: Best Management Practices Manual’ Washington: https://www.doh.wa.gov/portals/1/Documents/Pubs/333-044.pdf
• Wei, W. et al. 2020. ‘Review of parameters used to assess the quality of the indoor environment in Green Building certification schemes for offices and hotels’ Energy and Buildings.
• World Green Building Council. ‘Air Quality in the Built Environment’: https://worldgbc.org/clean-air-buildings/
• World Green Building Council. ‘Plant a Sensor’: https://worldgbc.org/plant-a-sensor
• World Health Organization. ‘Air Pollution’: https://www.who.int/news-room/air-pollution
• World Health Organization. ‘Air Quality Guidelines’: https://www.who.int/phe/health_topics/outdoorair/outdoorair_aqg/en/
• World Health Organization. ‘WHO Guidelines for Indoor Air Quality Household Fuel Combustion’: https://www.who.int/airpollution/guidelines/household-fuel-combustion/IAQ_HHFC_guidelines.pdf
• World Health Organization. 2005. ‘WHO Air Quality Guidelines for Particulate Matter, Ozone, Nitrogen Dioxide and Sulphur Dioxide. Geneva: World Health Organization’: 9, 14. https://apps.who.int/iris/handle/10665/69477WHO indoor air quality guidelines: household fuel combustion.
• World Health Organization. ‘Guidelines for household fuel combustion’: https://www.who.int/airpollution/guidelines/household-fuel-combustion/recommendation1/en/
• World Health Organization. ‘Guidelines for indoor air quality: selected pollutants’: https://www.euro.who.int/en/health-topics/environment-and-health/air- quality/publications/2010/who-guidelines-for-indoor-air-qualityselected-pollutants
• World Health Organization. ‘Housing and health guidelines’: https://www.who.int/publications/i/item/who-housing-and-health-guidelines
• World Health Organization. ‘Guidelines for indoor air quality: dampness and mould’ https://www.who.int/airpollution/guidelines/dampness-mould/en/

Resource List for Further 1.2:


• Beam Plus New Buildings V2.0, ‘Health and Wellbeing, Water Use, Integrated Design and Construction Management’: https://www.hkgbc.org.hk/eng/beam-plus/file/BEAMPlus_New_Buildings_v2_0.pdf
• BREEAM International New Construction Standard, ‘Hea 09 Water quality’: https://www.breeam.com/discover/technical-standards/
• BREEAM International In-Use Standard, ‘Hea 18 Legionella risk management’: https://www.breeam.com/discover/technical-standards/
• CABR & CSUS: Green Building Research Centre, ‘Healthy Building Evaluation Standard ‘Water’ Chapter’ & Zeng Jie, Lü Shilei. 2018. ‘Interpretation of the water chapter of "Healthy Building Evaluation Standard’ [J]. Building Technology, 49(05): 486-489.
• Centers for Disease Control and Prevention (CDC). ‘Legionella (Legionnaires' Disease and Pontiac Fever). Guidelines, standards and laws’: https://www.cdc.gov/legionella/resources/guidelines.html
• Centre for Health Protection, Department of Health, the Government of Hong Kong. ‘Health Topics: Legionnaires Disease’: https://www.chp.gov.hk/en/healthtopics/content/24/2117.html
• Daniel Okun. 1991. ‘A Water and Sanitation Strategy for the Developing World, Environment: Science and Policy for Sustainable Development’: https://www.researchgate.net/scientific-
contributions/2002910407-Daniel-A-Okunhttps://www.researchgate.net/scientific-contributi
• ESGLI. ‘Guidance for managing Legionella in building water systems during the COVID-19 pandemic’: https://www.escmid.org/fileadmin/src/media/PDFs/3Research_Projects/ESGLI/ESGLI_GUIDANCE_FOR_MANAGING_LEGIONELLA_IN_BUILDING_WATER_SYSTEMS_DURING_THE_
COVID-19_PANDEMIC_20200418_v02.00.pdf
• Emirates Green Building Council. ‘Emirates Coalition for Green Schools’: https://emiratesgbc.org/technical-programs/green-schools/
• Green Building Council of Australia: Green Star, ‘Design & As Built, ‘Indoor Environment Quality’’: https://new.gbca.org.au/rate/rating-system/design-and-built/
• Green Building Council of Australia: Green Star, ‘Communities ‘Environment’’: https://new.gbca.org.au/rate/rating-system/communities/
• Indian Green Building Council: Health and Wellbeing Rating, ‘Water Quality’:
https://igbc.in/igbc/redirectHtml.htm?redVal=showHealthWellBiengnosign#Resources
• Jordan GBC. ‘Your Guide to Green Building in Jordan’: https://drive.google.com/file/d/13IvMnkqoi09FhuNenh_j58sq_HRB4TjT/view
• United States Environmental Protection Agency. 2018. ‘Drinking water standards and health advisories’ March 2018: 11-12.: EPA 2018 Edition of the Drinking water standards and heath advisory tables
• World Health Organization. 2011. ‘Water Safety Plan, Water Safety in Buildings’: https://www.who.int/water_sanitation_health/publications/2011/9789241548106/en/
• World Health Organization. ‘WHO Guidelines for drinking-water quality (GDWQ)’: https://www.who.int/water_sanitation_health/water-quality/guidelines/en/
• Why is access to clean, safe drinking water so elusive?’ Article: https://gresb.com/why-access-clean-safe-water-elusive/

Resource List for 1.3:

• Beam Plus New Buildings V2.0, ‘Integrated Design and Construction Management’: https://www.hkgbc.org.hk/eng/beam-plus/file/BEAMPlus_New_Buildings_v2_0.pdf
• Beam Plus Neighbourhood V1.0, ‘Community Aspects’: https://www.beamsociety.org.hk/files/Manual/BEAMPlusNDManualWithCorrigendumNo1.pdf
• BREEAM International New Construction Standard, ‘Man 05 Aftercare’, ‘Hea 01 Visual Comfort’ and ‘Hea 06 Accessibility’: https://www.breeam.com/discover/technical-standards/
• BREEAM International In-Use Standard, ‘Man 02 Management Engagement and Feedback’, ‘Hea 06 View out’, ‘Hea 11 Provision of Rest Areas’ and ‘Hea 12 Inclusive Design’: https://www.breeam.com/discover/technical-standards/
• Buro Happold. ‘Design for Student Mental Health and Wellbeing’: https://www.burohappold.com/wp-content/uploads/2019/06/BuroHappold_HEDQF_-student_mental_health_thoughtpiece.pdf
• CABR & CSUS: Green Building Research Centre Healthy Building Evaluation Standard, ‘Humanities Chapter’ & Hong, J. et al. 2018. ‘The interpretation of "Healthy Building Evaluation Standard; Construction Technology’
• Centre for the Built Environment. ‘Occupant Indoor Environmental Quality (IEQ) Survey’: https://cbe.berkeley.edu/resources/occupant-survey/
• The Centre for Urban Design and Mental Health. ‘How Urban Design Can Affect Mental Health’: https://www.urbandesignmentalhealth.com/how-urban-design-can-impact-mental-
health.html
• Chrysikou, Evangelia. 2015. ‘Ill performing buildings for mental health’: https://www.researchgate.net/publication/280007782_IILL_PERFORMING_BUILDINGS_FOR
_MENTAL_HEALTH
• Colloqate. ‘Design Justice for Black Lives’: https://colloqate.org/design-justice-for-black-lives
• DGNB. 2019. ‘ Liveable and Fit for the Future’: https://www.dgnb.de/en/council/publications/index.php
• Green Building Council of Australia: Green Star, ‘Communities Liveability’: https://new.gbca.org.au/rate/rating-system/communities/
• Indian Green Building Council: Green Interiors Rating Tool, ‘Occupant Wellbeing Facilities’: https://igbc.in/igbc/redirectHtml.htm?redVal=showgreeninteriorsnosign#GreenHomes
• WELL Building Standard. ‘Mind’: https://standard.wellcertified.com/mind
• World Health Organization. ‘Mental Health Evidence Research’: https://www.who.int/mental_health/evidence/en/
• World Health Organization. ‘Building Back Better: Sustainable Mental Health Care After Emergencies’: https://www.who.int/mental_health/emergencies/building_back_better/en/

Resource List for 1.4:

• American Society for Microbiology. 2019. ‘Novel Coronavirus (COVID-19) Pandemic: Built Environment Considerations to Reduce Transmission’: https://msystems.asm.org/content/5/2/e00245-20
• The American Institute of Architects. 2020. ‘Re-occupancy assessment tool’: http://content.aia.org/sites/default/files/2020-06/STN20_%20344901_ReOccupancyAssessmentTool-V02_sm_v09.pdf
• Archinect News. 2020. ‘“Hygiene ventilation” and the case for green stimulus’ https://archinect.com/news/article/150195914/hygiene-ventilation-and-the-case-for-green-stimulus
• American Society of Heating Refrigerating and Air-conditioning Engineers (ASHRAE): 170, ‘Ventilation of Health Care Facilities - including Hospital Spaces, Outpatient Spaces, and Nursing Home Spaces’
• BREEAM International In-Use Standard, ‘Man 03 Maintenance policies and procedures’, ‘Hea 16 Indoor air quality management’, ‘Hea 18 Legionella risk management’ ‘Rsl 06 Emergency plans and climate-related physical risks’
• Centers for Disease Control and Prevention (CDC). ‘Guidance for Reopening Buildings After Prolonged Shutdown or Reduced Operation’: https://www.cdc.gov/coronavirus/2019-ncov/php/building-water-system.html
• GOV.UK. ‘Transmission characteristics and principles of infection prevention and control’: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/transmission-characteristics-and-principles-of-infection-prevention-and-control#section3
• Harvard University. 2020. ‘Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study’: https://projects.iq.harvard.edu/covid-pm
• Fast Company. 2020. ‘How we can redesign cities to fight future pandemics’: https://www.fastcompany.com/90479665/how-we-can-redesign-cities-to-fight-future-pandemics
• Interact Lighting. ‘Re-inventing the workplace after COVID-19’: https://www.interact-lighting.com/global/iot-insights/workplace-post-covid-19
• Passive House Accelerator. ‘Hygiene Ventilation, Heard of it?’: https://passivehouseaccelerator.com/articles/hygiene-ventilation-heard-of-it
• Perkins & Will. ‘Understanding antimicrobial ingredients in building materials – COVID-19 Statement’: https://healthybuilding.net/reports/22-covid-19-statement-understanding-antimicrobial-ingredients-in-building-materials
• Recovery Readiness. ‘A ‘how to’ guide for reopening your workplace’: https://www.cushmanwakefield.com/en/insights/covid-19/recovery-readiness-a-how-to-guide-for-reopening-your-workplace
• Science Daily, University of California. ‘COVID-19 and the built environment - Examining how building design can influence disease transmission’: https://www.sciencedaily.com/releases/2020/04/200410162450.htm
• USGBC: LEED ‘Safety-First’ Pilot credits: https://www.usgbc.org/about/covid-19-resources - LEED-safety-first
• World Health Organization. 2017. ‘Keeping The Vector Out: Housing Improvements for Vector Control and Sustainable Development’: https://apps.who.int/iris/bitstream/handle/10665/259404/9789241513166-eng.pdf?sequence=1


References

1 World Health Organization. ‘Air Pollution’: https://www.who.int/news-room/air-pollution

2 United Nations Economic Commission for Europe. ‘Air Pollution and Health’: https://www.unece.org/environmental-policy/conventions/envlrtapwelcome/cross-sectoral-linkages/air-
pollution-and-health.html#:~:text=Air%20pollution%20is%20now%20considered,pulmonary%20illnesses%20and%20heart%20disease.

3 World Health Organization. ‘Health Topics: Air Pollution’: https://www.who.int/health-topics/air-
pollution#tab=tab_1

4 Klepeis, N. et al. 2001. ‘The National Human Activity Pattern Survey (NHAPS)’: https://indoor.lbl.gov/sites/all/files/lbnl-47713.pdf

5 World Health Organization. 2018. ‘Household Air Pollution and Health Facts’: https://www.who.int/en/news-room/fact-sheets/detail/household-air-pollution-and-health

6 World Health Organization. 2018. ‘Household Air Pollution and Health’: https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

7 World Health Organization. 2018. ‘Household Air Pollution and Health Facts Sheet’:
https://www.who.int/en/news-room/fact-sheets/detail/household-air-pollution-and-health

8 Seals B. and Krasner A. 2020. ‘Gas Stoves: Health and Air Quality Impacts and Solutions’ Rocky
Mountain Institute. https://rmi.org/insight/gas-stoves-pollution-health

9 United States Environmental Protection Agency. ‘Volatile Organic Compounds’ Impact on Indoor Air Quality’ https://www.epa.gov/indoor-air-quality-iaq/volatile-organic-compounds-impact-indoor-air-
quality

10 World Health Organization Europe. 2009. ‘Guidelines for Indoor Air Quality: Dampness and Mould’:
http://www.euro.who.int/__data/assets/pdf_file/0017/43325/E92645.pdf?ua=1

11 Velux. 2017. ‘Healthy Homes Barometer 2017’: https://www.velux.com/what-we-do/healthy-
buildings-focus/healthy-homes-barometer.

12 Fisk W.J., Chan W.R. 2017. ‘Effectiveness and Cost of Reducing Particle-Related Mortality with
Particle Filtration. Indoor Air.’
3 Science Direct. ‘Chemical Exposures in Recently Renovated Low-Income Housing: Influence of
Building Materials and Occupant Activities’:
https://www.sciencedirect.com/science/article/pii/S0160412017308413

13 Climate and Clean Air Coalition. ‘Bricks’: http://www.ccacoalition.org/en/initiatives/bricks

14 UN Environment. 2017. ‘Global Status Report 2017’: https://www.worldgbc.org/sites/default/files/UNEP%20188_GABC_en%20%28web%29.pdf

15 Roadmap on carcinogens. ‘Hardwood Dust’: https://roadmaponcarcinogens.eu/hardwooddust/

16 Environmental Protection Agency. ‘Particulate Matter Emissions’: https://cfpub.epa.gov/roe/indicator_pdf.cfm?i=19

17 Climate and Clean Air Coalition. ‘Household Energy’: http://www.ccacoalition.org/en/initiatives/household-energy

18 World Health Organization. ‘Air Quality Guidelines’: https://www.who.int/phe/health_topics/outdoorair/outdoorair_aqg/en/

19 World Health Organization. ‘Air Quality Guidelines’: https://www.who.int/phe/health_topics/outdoorair/outdoorair_aqg/en/

20 Green Building Council of Australia: Green Star, ‘Design & As Built Submission Guidelines v1.3’: https://new.gbca.org.au/rate/rating-system/design-and-built/

21 USGBC: LEED v4, ‘Reference Guide for Building Design and Construction’:
USGBChttps://www.usgbc.org/sites/default/files/LEED%20v4%20BDC_07.25.19_current.pdf

22 USGBC: LEED v4, ‘Reference Guide for Building Design and Construction’:
USGBChttps://www.usgbc.org/sites/default/files/LEED%20v4%20BDC_07.25.19_current.pdf

23 Your Healthy Home Guide. ‘Temperature and Humidity Variations’: https://www.caaquebec.com/en/at-home/guides/your-healthy-home-guide/temperature-and-humidity-
variations/

24 Your Healthy Home Guide. ‘Temperature and Humidity Variations’: https://www.caaquebec.com/en/at-home/guides/your-healthy-home-guide/temperature-and-humidity-
variations/

25 Our World in Data. ‘Other Health Impacts of Poor Sanitation’: https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-risk-factor-for-death

26 Our World in Data. ‘Unsafe Sanitation is A Leading Risk Factor for Death’: https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-risk-factor-for-death

27 Our World in Data. ‘Unsafe Sanitation is A Leading Risk Factor for Death’: https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-risk-factor-for-death

28 World Health Organization. ‘Health Topics, Drinking Water’ https://www.who.int/topics/drinking_water/en/

29 Scientific American. 2016. ‘Thousands of U.S Areas affected with Lead Poisoning beyond Flint’s’ https://www.scientificamerican.com/article/thousands-of-u-s-areas-afflicted-with-lead-poisoning-
beyond-flints/

30 World Health Organization. 2019. ‘Drinking Water Facts Sheet’: https://www.who.int/en/news-room/fact-sheets/detail/drinking-water


31 World Health Organization. 2019. ‘Microplastics in drinking-water’: https://www.who.int/water_sanitation_health/publications/microplastics-in-drinking-water/en/

32 Olson, E.D. Fedinick K.P. 2016. ‘What's in Your Water? Flint and Beyond’ Natural Resources Defense Council. Viewed October 23, 2017 & Young A., Nichols M. 2016. ‘Beyond Flint: excessive lead levels found in almost 2,000 water systems across all 50 states. USA Today’: https://www.healthandenvironment.org/environmental-health/environmental-risks/global-environment/water-quality.

33 World Health Organization. ‘Guidelines for Drinking-Water Quality (GDWQ)’: https://www.who.int/water_sanitation_health/water-quality/guidelines/en/

34 World Health Organization. 2020. ‘Mental health and substance use’: https://www.who.int/mental_health/en/

35 Whiteford H.A., Degenhardt L., et al. 2010. ‘Global Burden of Disease Attributable to Mental and Substance Use Disorders’ Global Burden of Disease Study 2010.

36 WELL Building Standard. 2020. ‘Mind’: https://standard.wellcertified.com/mind

37 National Center for Biotechnology Information (NCBI). 2006. ‘“Weathering” and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States’: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470581/

38 World Health Organization. 2020. ‘Coronavirus Disease (COVID-19) Dashboard’: https://covid19.who.int/

39 Public Health England. June 2020. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/transmission-characteristics-and-principles-of-infection-prevention-and-control#section3

40 Science Daily, University of California. ‘COVID-19 and the Built Environment - Examining How Building Design Can Influence Disease Transmission’: https://www.sciencedaily.com/releases/2020/04/200410162450.htm

41 Science Daily, University of California. ‘COVID-19 and The Built Environment - Examining How Building Design Can Influence Disease Transmission’: https://www.sciencedaily.com/releases/2020/04/200410162450.htm

42 Science Daily, University of California. ‘ COVID-19 and The Built Environment - Examining How
Building Design Can Influence Disease Transmission’:
https://www.sciencedaily.com/releases/2020/04/200410162450.htm

43 Harvard University. 2020. ‘Exposure to Air Pollution and COVID-19 Mortality in the United States: A Nationwide Cross-Sectional Study’: https://projects.iq.harvard.edu/covid-pm


Disclaimer: The resource lists for each sub-principle are a non-exhaustive set of references provided from the WorldGBC network, peer review panel and industry through the Framework consultation period. A regular update of resource lists will be undertaken by WorldGBC to ensure updated information is available.

WorldGBC supports all certifications and is proud to unite a network that runs over 40 rating tools, plus support the uptake of all tools across the industry. Rating scheme inclusion within the Framework is based on submission from global GBC network and consultation responses, with aim of amalgamating a host of resources for a global audience to offer further detail for users beyond the high-level outline of each principle.

Regarding specific certifications, eg. BEAM or Green Star, there are often a number of versions or tools available for different building types (eg. Design, As-Built, Interiors, Communities). To maintain brevity of Framework document, one building level tool (eg. Design or New Construction) and one larger scale tool (eg. community level) is included within the Resource List of each sub-principle. Users with alternative building projects in mind are encouraged to acquire the appropriate version of the tool for most applicable guidance.

 

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Principle 3. Harmony with Nature Read More
Principle 4. Healthy Behaviour Read More
Principle 5. Social Value Read More
Principle 6. Take Climate Action Read More