USGBC-Health Anthology Report

Research Anthology of
Health-Promoting Building Strategies

Principal Author: Charu Srivastava, Doctoral Student, Harvard University
Contributors: Alexandra Hopkins, MPH, U.S. Green Building Council
Kelly Worden, MPH, U.S. Green Building Council
April 2021
ACKNOWLEDGEMENTS:
Substantial work on this document was funded by the
Schneider Fellows program, Stanford University.
Advisor: Elizabeth Beardsley, U.S. Green Building Council

Graphics: Sophia McGee, U.S. Green Building Council
Publisher: U.S. Green Building Council
TABLE OF CONTENTS
1. INTRODUCTION 4
2. BACKGROUND 4
3. HOW TO USE THIS RESOURCE 8
4. BUILDING STRATEGIES 9
A. INDOOR AIR QUALITY 9
B. WATER QUALITY 12
C. LIGHTING 14
D. THERMAL COMFORT 16
E. ACOUSTIC COMFORT 18
F. VIEWS/BIOPHILIA 20
G. ACTIVE DESIGN 22
H. SITE/LANDSCAPE 24
5. APPENDICES 26
INTRODUCTION
1
Human health is a longstanding value of green building. Green buildings can promote health and well-being
in the near term while preserving resources and protecting the environment. By intentionally deploying green
building strategies, like those available for use within the LEED rating systems, owners and practitioners can
simultaneously promote health and well-being at a variety of population scales.
The real estate industry is well-positioned to improve population health through its direct influence over the
design, construction, and operations of our buildings and communities. By making the decision to promote
health, green building practitioners are intentionally utilizing public health research to advocate for and
contribute to a culture of health within real estate, while maintaining a critical focus on climate change mitigation.
Harnessing LEED’s health promotion capacity

While LEED contains a number of health-related strategies, practitioners must be intentional in their use of
LEED to maximize its potential health benefit. The majority of credits within the LEED rating systems address
the health of the site user and health-related credits are found within every LEED credit category. These credits
include guidance on improving indoor air quality, promoting physical activity and healthy nutrition, and designing
for mental health and comfort, among many others. Some strategies, however, do not fully state their potential
health benefit(s) and/or require practitioners to choose a specific health-related compliance pathway.
With an intentional, needs-based approach to the application of credit requirements, projects can target health
goals most relevant to their project’s population. Practitioners can also leverage the power of the LEED to
achieve sustainability and energy efficiency goals while maintaining a focus on health promotion efforts.
BACKGROUND
2
Last year, the USGBC announced its new vision, Healthy people in healthy places equals a healthy economy,
sharing a series of actions and priorities to shape a healthy future for all. While many interpretations of health
exist, USGBC, and this anthology, utilize the World Health Organization’s definition of health which states that
health is “a state of complete physical, mental, and social well-being, and not merely the absence of disease or
infirmity.” This comprehensive definition of health helps provide a more holistic understanding of the effects of
our buildings and communities on the human body and mind.
Determinants of Health
Our buildings and communities have a direct impact on both individual and population health. Health and health
behaviors are highly influenced by social and environmental determinants—the physical, social, policy, and
economic characteristics of the places that we live, work, and play. The real estate industry is well-positioned to
improve population health through its direct influence over the design, construction and operation of the built
environment. Green buildings strategies, when used intentionally, can improve health for all, especially vulnerable
Research Anthology of Health-Promoting Building Strategies 4

populations such as children, seniors and low-income groups. While there are many determinants of health, this
anthology focuses on determinants that can be positively influenced by health-promoting building strategies.
To capture health most comprehensively, determinants are studied from a physical, social and individual lens.
Table 1. Health determinants affected by building strategies are highlighted in gray.
Health Determinants (KFF, Northridge & Schultz)

Physical Social Individual
(Environmental) (Social/Economic) (Behaviors)
Natural Environment Economic Stability Healthy Behaviors

Topography Employment Dietary practices
Climate Income Physical health
Water supply Expenses Health screening
Built Environment Debt Tobacco use
Land use Medical Bills
Transportation systems Support
Services Education
Public resources Literacy
Zoning regulations Language
Buildings Early childhood education
Housing Vocational training
Safety Higher education
Parks Food
Playgrounds Hunger
Walkability Access to healthy options
Zip code Community/Social Context
Social integration
Support Systems
Community engagement
Discrimination
Stress
Health Care System
Health Coverage
Provider availability
Provider linguistic/cultural competency
Quality of care

Evolution of Health Within LEED
Health is a longstanding value of the LEED rating system and the U.S. Green Building Council. Green buildings
can promote health and well-being in the near term while preserving resources and protecting the environment
for human benefit in the long term. Developed by an organization with a people-centric mission, LEED was
committed to rewarding spaces that created a healthy environment for occupants. Among these first health-
promoting design strategies for green building was the elimination of tobacco smoke in buildings and decreasing
occupant exposures to harmful chemicals. As the organization and rating system evolved, the connections
between buildings, materials and health became increasingly more clear and LEED adapted and expanded to
cover more considerations for health in design. These adaptations, coupled with the massive sustainability and
energy efficiency benefits LEED certification provides, contribute to its overall standing as the most widely used
green building rating system in the world.
In its current state, over 60% of each LEED rating system is associated with occupant health and health-related
credits are found within every LEED credit category. These credits include guidance on improving indoor air
quality, promoting physical activity and healthy nutrition, and designing for mental health and comfort, among
many others. As LEED was designed to be an adaptable framework, practitioners have a great level of choice
regarding which specific LEED strategies to deploy in their projects. While LEED contains a number of health-
related strategies, practitioners must be intentional in their use of LEED to maximize its potential health benefit.
Pilot credits such as the LEED Integrative Process for Health Promotion can help project teams select and
tailor LEED credits based on a project’s specific health context. By intentionally applying LEED strategies and
credit requirements, project teams can promote health and well-being by creating superior environments for
building occupants, while also reducing toxic exposures throughout the supply chain, advancing health of the
surrounding communities and mitigating climate change to benefit global populations.
Founded in 2013, the Green Health Partnership (GHP) is an academic research and development group
between the University of Virginia School of Medicine and the U.S. Green Building Council with funding
from the Robert Wood Johnson Foundation. GHP utilizes the green building movement as a platform and
blueprint for creating a self-sustaining, scalable market for health promotion within the real estate industry.
Population Scales of the Built Environment

Green building strategies can be applied at various levels of the built environment: at the building-level, affecting
occupants, tenants and visitors; the city-level, shaping interactions in neighborhoods and communities; and
at the global-level, through climate change mitigation strategies. While research often associates building level
strategies with occupant outcomes and neighborhood or city level strategies with community level outcomes,
it becomes interesting to propose building-level strategies that can influence health impacts at the community
or even global level. For instance, a green roof on a building can have a positive impact on the surrounding
community, while natural ventilation in several buildings of a region may reduce the release of greenhouse
gases (GHGs) and air pollutants on a global scale. Figure 1 shows the various population scales in our created
environments. Table 2 shows some examples of building strategies applied to larger population scales.

Population
Scales of the
Built Environment
3
2 Global
City
1
Building
1 2 3
Occupant Community Global
Figure 1. The scales of impact of green building strategies on population health.
Table 2. Green building goals applied to multiple population scales using various strategies.
Green Building Goal Occupant Community Global

Reduce construction Reduce motor
Air Quality Adequate ventilation
pollution vehicle usage
Groundwater level/
Water Quality Water filtration Clean ocean water
water supply
Lighting Daylighting Streetlights Electrical grid
Thermal Comfort Thermal zoning Urban vegetation Reduce global warming
Acoustic Comfort Sound masking Noise blocking trees Reduce industrial noise
Views/Biophilia Indoor plants Access to nature Reforestation
Active Design Sit/stand desks Active spaces Walkability/zoning
Roof garden, permeable Reduce urban heat island Reduce climate change
Site/Landscape
surfaces effect, flood risk effects
METHODS

3 HOW TO USE THIS RESOURCE
Design professionals and others can use this resource to identify health impacts of design choices and to justify
design decisions based on desired health outcomes. It allows users to search for health outcomes based on
building strategies, or alternatively, use the cross-referenced index in Appendix A to search for building strategies
based on desired health outcomes. For more information on the research article selection process, please see
Appendix C.
Building Health Pathways

The building health pathways relate building strategies to building conditions to downstream health impacts
for building occupants (see Figure 2 below). For each building strategy (design, construction, operations), the
pathway identifies the anticipated building condition (environmental metric, health determinant, occupant
behavior) and the associated health benefit (physical, social, mental) of that improved building condition.
Long term health benefits are indicated with an *. This anthology focuses on building strategies at the building
level and the associated health impacts at the occupant level. Although the majority of the articles cited in this
anthology are based in office settings, the design strategies can be applied to various other building types as
well, including residential, school and healthcare buildings.
Building Strategy Building Condition Health Benefit
Design Environmental Physical

metric
Construction Social
Health determinant
Operations Mental
Occupant behavior
Figure 2. Concept diagram of health impacts of building-level strategies at the occupant level.

4 BUILDING STRATEGIES
There are a number of strategies that can be implemented at the building level to promote occupant health and
wellbeing including: indoor air quality, water, lighting, thermal conditions, acoustic conditions, views/biophilia,
active design and site/landscape.
A. INDOOR AIR QUALITY

Indoor air quality (IAQ) is a building design feature closely linked to physical health. In the context of created
environment design, IAQ is most commonly associated with heating, cooling, ventilation, low-emitting materials,
pollution, and cleaning strategies. IAQ is a subset of Indoor Environmental Quality (IEQ), the LEED category
which addresses occupant comfort most directly. Several studies show the impacts of IEQ on occupant health,
summarized in Impact of indoor environmental quality on occupant well-being and comfort: A review of the
literature (2016). This systematic review of recent literature considers the relationship of indoor air quality with
thermal, acoustic and visual comfort. Various studies show that improved indoor air quality (measured by levels
of CO2, pollutants (SOx, NOx, PM2.5) and VOCs) are associated with reduced respiratory illnesses, asthma,
allergies, headaches, and infectious disease transmission (see Table 3 on the next page).
INDOOR AIR QUALITY
Cognitive functioning
Pulmonary functions
Ventilation rate
CO2
Asthma
Natural ventilation
Dust
Allergies
MERV filters
SOx, NOx,
PM 2.5, VOCs Headaches
Carbon filters
Infectious disease
transmission
Figure 3. Indoor air quality building health pathway
1. Harvard COGfx Study: Part 1 and 2
1A. Environmental Health Perspectives

Title: Associations of Cognitive Function Scores with Carbon Dioxide, Ventilation, and Volatile Organic
Compound Exposures in Office Workers: A Controlled Exposure Study of Green and Conventional Office
Environment (Joseph G. Allen et al., 2016)

The three-phase COGfx studies by a research group at the Harvard T.H. Chan School of Public Health uses
an experimental study design to investigate the impact of IEQ on human health. The first study measured the
increase in higher-order cognitive functioning due to improved IEQ. By simulating “Conventional,” “Green” and
“Green+” buildings in the lab, they found that increased ventilation and reduced CO2 and VOC levels correlated
with significantly higher scores on the SMS test in eight of the nine domains of cognitive functioning. Most
significant domains were Crisis Response, Information Usage, and Strategy. “Green” building occupants scored
61% higher, “Green+” scored 101% higher.
1B. Building and Environment

Title: The impact of working in a green certified building on cognitive function and health (Piers McNaughton
et al., 2017)
In their follow up study, the authors studied the impact of green building (high IEQ, thermal conditions and
lighting) on cognitive functioning through test scores in actual buildings. They measured sleep quality and sick
building symptoms. Overall, they found a positive association between green building strategies (high IEQ,
thermal conditions and lighting) and increased cognitive functioning and human health.
2. International Journal of Environmental Research and Public Health

Title: Building-Related Symptoms among Office Employees Associated with Indoor Carbon Dioxide and
Total Volatile Organic Compounds (Chung-Yen Lu et al., 2015)
This study measured the association between indoor air quality and the incidence of sick building syndrome
(SBS) among office workers. Levels of carbon dioxide, temperature, humidity and total volatile organic
compounds (VOCs) in 87 office rooms were measured for eight hours of the day, using the difference between
indoor and outdoor carbon dioxide concentrations to infer ventilation rates. Using self-report questionnaires,
417 participants rated prevalence of symptoms such as eye syndrome, upper respiratory and non-specific
symptoms. Researchers found moderate association between exposure to carbon dioxide and tiredness,
difficulty in concentrating, eye dryness, dry throat and dizziness. An increased exposure to VOCs was associated
with reported symptoms such as upper respiratory symptoms, dry throat and irritability.

Title: Respiratory Diseases in University Students Associated with Exposure to Residential Dampness or
Mold (Mathieu Lanthier-Veilleux et al., 2016)
In this large-scale observational study, researchers studied the prevalence of respiratory diseases among
students living in residential dorms at a university in Canada. Using an online survey, they examined the
incidence of self-reported respiratory diseases, residential dampness or mold and covariates (such as student
characteristics). They found high rates of allergic rhinitis, asthma-like symptoms and respiratory infections.
Using logistic regression analysis, they showed that exposure to residential dampness or mold was associated
with allergic rhinitis and asthma-like symptoms. Symptomatic students also faced significant levels of
uncontrolled and burdensome symptoms.

Table 3. Studies showing the health impacts of indoor air quality (IAQ) on occupants.
Health Impacts Studies
• The impact of working in a green certified building on cognitive function and health (2017)
• Associations of cognitive function scores with carbon dioxide, ventilation, and volatile organic
compound exposures in office workers: A controlled exposure study of green and conventional
office environments (2016)
Cognitive Function • Effects of ventilation rate per person and per floor area on perceived air quality, sick building
syndrome symptoms, and decision‐making (2014)
• Association between substandard classroom ventilation rates and students’ academic
achievement (2010)
• Household Air Pollution Exposure and Influence of Lifestyle on Respiratory Health and Lung
Function in Belizean Adults and Children: A Field Study (2016)
• Investigation of Acute Pulmonary Deficits Associated with Biomass Fuel Cookstove Emissions
in Rural Bangladesh (2017)
• Respiratory Diseases in University Students Associated with Exposure to Residential Dampness
or Mold (2016)
• Volatile Organic Compounds in Anatomical Pathology Wards: Comparative and Qualitative
Assessment of Indoor Airborne Pollution (2017)
Pulmonary Function • Building-Related Symptoms among Office Employees Associated with Indoor Carbon Dioxide
and Total Volatile Organic Compounds (2015)
• Association of Sick Building Syndrome with Indoor Air Parameters (2015)
• Outdoor air pollution, meteorological conditions and indoor factors in dwellings in relation to
sick building syndrome (SBS) among adults in China (2016)
• Endotoxin, ergosterol, muramic acid and fungal DNA in dust from schools in Johor Bahru,
Malaysia — Associations with rhinitis and sick building syndrome (SBS) in junior high school
students (2016)
• Air pollution and temperature are associated with increased COVID-19 incidence: A time series
study (2020)
• Airborne transmission of SARS-CoV-2: The world should face the reality (2020)
• Evidence for probable aerosol transmission of SARS-CoV-2 in a poorly ventilated restaurant
(2020)
Infection Control • Airborne spread of infectious agents in the indoor environment
• Role of mechanical ventilation in the airborne transmission of infectious agents in buildings
(2016)
• HVAC filtration for controlling infectious airborne disease transmission in indoor environments:
Predicting risk reductions and operational costs (2013)

B. WATER QUALITY
Water makes up 70% of the human body and is essential for several physiological functions such as maintaining
body temperature and transporting nutrients and waste. Contaminated drinking water is a major global health
issue, with the WHO reporting that almost one billion people do not have access to safe drinking water. Pathogens
in water can cause diseases such as cholera, dysentery, typhoid and polio. Inorganic contaminants such as
lead and mercury may induce developmental delays in learning for children as well as high blood pressure and
kidney problems in adults, while organic contaminants such as polychlorinated biphenyl have been linked to
cancer, immune deficiency and nervous system difficulties. Global Water Pollution and Human Health (2010)
provides a comprehensive review of the various hazards in water, their impact on human health and strategies
to mitigate pollution of freshwater resources.
WATER QUALITY
Learning
Heavy metals
Reverse-osmosis Memory
filters Organic contaminants
High blood pressure
Kinetic-degradation Herbicides and
fluxion filters pesticides Kidney problems
Granular activated Disinfectants Cancer

carbon filters
Fluoride Immune deficiency
Ultraviolet germicidal
irradiation Oil and gas Nervous system
difficulties
Figure 4. Water quality building health pathway
1. Science Total Environment

Title: A discussion about public health, lead and Legionella pneumophila in drinking water supplies in the
United States (Michael B Rosen et al., 2017)
The Flint water crisis that occurred in 2014 in Flint, Michigan provides a rich example to study the public health
effects of contaminated water. This article uses Flint as a case study to summarize the impacts of elevated
levels of lead and legionella on public health. It addresses the policy regulations and responses that contributed
to the crises, barriers associated with measuring and reducing lead levels in tap water and factors influencing
legionella growth. The paper analyzes the relationship between changes in water chemistry and public health
effects, while offering a discussion on future water quality research to inform and guide public health decision-
making.

2. Environmental Research
Title: A community-based evaluation of proximity to unconventional oil and gas wells, drinking water
contaminants, and health symptoms in Ohio (Elise G Elliott et al., 2018)
In this exploratory study, researchers examined the environmental health impacts from water contamination
in residents living close to an unconventional oil and gas (UO&G) well. They analyzed levels of contaminants
such as volatile organic compounds (VOCs), gasoline-range organics (GROs) and diesel-range organics.
Through interviews and self-report assessments, they found a relationship between distance to UG&O wells,
water contamination and health. They found that proximity to UG&O wells likely to result in elevated levels of
contaminants and health symptoms such as stress or fatigue.
3. Journal of Cellular Biochemistry

Title: Prevalence of exposure of heavy metals and their impact on health consequences (Kanwal Rehman et
al., 2018)
This article reviews the global contamination of drinking water with heavy metals and the associated health
impacts of consuming metal-contaminated water. The article describes health hazards ranging from
cardiovascular disorders, neuronal damage, renal injuries and risk of cancer and diabetes. It also delves into the
growing rise in morbidity and mortality rates worldwide due to heavy-metal contaminated water. Discussions
about exposure limits and physiological responses, major organs affected and acute vs chronic poisoning
symptoms are included as well.
Table 4. Studies showing the health impacts of water quality on occupants

• Prevalence of exposure of heavy metals and their impact on health consequences (2018)
Cognitive • Public Health Consequences of Lead in Drinking Water (2018)
Performance • Mercury, lead and arsenic: impact on environment and human health (2016)
• Lead (Pb) in Tap Water and in Blood: Implications for Lead Exposure in the United States (2011)
• Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea
and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda
(2019)
• A post-implementation evaluation of ceramic water filters distributed to tsunami-affected communities
in Sri Lanka (2012)
• Climate and Health Co-Benefits in Low-Income Countries: A Case Study of Carbon Financed Water
Healthy Eating and Filters in Kenya and a Call for Independent Monitoring (2017)
Water Quality • Antibiotic resistance in drinking water systems: Occurrence, removal, and human health risks (2019)
• WHO water quality standards Vs Synergic effect(s) of fluoride, heavy metals and hardness in drinking
water on kidney tissues (2017)
• A discussion about public health, lead and Legionella pneumophila in drinking water supplies in the
United States (2017)
• A community-based evaluation of proximity to unconventional oil and gas wells, drinking water
contaminants, and health symptoms in Ohio (2018)

C. LIGHTING
A growing body of evidence shows the numerous benefits of daylighting not only for building energy-efficiency,
but also for the health and wellbeing of the occupants. Lighting can be measured by quantity (lumens, lux),
quality, glare, daylight, and task type. Direct health impacts of daylighting include physical health effects such
as increased productivity, but also mental health effects such as increased positive feelings and reduction in
depression and seasonal affective disorder. The Benefits of Natural Light: Research supports day lighting’s
positive effect on building performance and human health (2014) provides a review of several research studies
that explore the positive effects of daylit spaces on efficiency, productivity and the circadian rhythm. The article
also includes several external resources to guide designers through the design-making process for daylighting
design.
LIGHTING
Circadian rhythm
Alertness
Daylighting Lumens Physical activity
User controls Lux Productivity
Shading Solar Heat Gain Sleep
Glare Mental well-being
Depression
Sick Building Syndrome
Figure 5. Lighting building health pathway
1. International Journal of Environmental Research and Public Health (View Inc.)

Title: The Impact of Optimized Daylight and Views on the Sleep Duration and Cognitive Performance of
Office Workers (Mohamed Boubekri et al., 2020)
In this experimental study, researchers studied the impact of daylight and views on sleep duration and
cognitive performance. Thirty knowledge workers were put in two identical office environments, however one
had electrochromic glass (optimized condition), the other had traditional blinds (control). Participants in the
optimized condition slept for 37 minutes longer on average and scored 42% higher on a cognitive simulation
used to test higher-order decision making. Results could be seen after just one day; however, results were more
significant after a week of being exposed to the condition.
2. Journal of Clinical Sleep Medicine

Title: Impact of windows and daylight exposure on overall health and sleep quality of office workers: A case-
control pilot study (Mohamed Boubekri et al., 2014)

Researchers conducted an observational study to assess the effects of daylighting on the physical and
mental health of office workers. They administered tests to two groups: workers in offices with windows and in
windowless environments. The results revealed that workers in windowless environments suffered from less
or poorer sleep, while workers in offices with windows were exposed to more light and trended towards more
physical activity and better quality and quantity of sleep. While these results are significant, the limitations of
this study includes the small sample size of participants, a potential convenience sample bias, unaccounted
confounding factors such as caffeine, errors in their measurement tools and obscuring of natural light versus
views versus daylighting.
3. U.S. Green Building Council (USGBC)

Title: Daylighting-Bias and Biophilia: Quantifying the Impact of Daylighting on Occupants Health (Ihab M.K.
Elzeyadi, 2011)
This study conducted an observational study to investigate the relationship between lighting quality, views
from windows and occupant health in office spaces. Split over three phases, the study involved both qualitative
and quantitative methods of data collection, through observation, interviews, online surveys and health data
records. The researchers recorded the quantity and quality of daylight and biophilic views in 120 office spaces
and compared it to the number of days of sick leave and Sick Building Syndrome (SBS) symptoms of 175 office
workers. They also investigated mental health effects, such as stress levels and hypersensitivity to biophilic
features in the environment and their impact on sick leave and health of office workers. Using statistical analysis
tests, they showed that access to daylighting and biophilic environments improves physical and mental health
of office workers.
Table 5. Studies showing the health impacts of lighting on occupants
Cognitive • The Impact of Optimized Daylight and Views on the Sleep Duration and Cognitive Performance of
Performance Office Workers (2020)
• Blinded by the light: Occupant perceptions and visual comfort assessments of three dynamic daylight
Productivity control systems and shading strategies (2019)
Balanced Circadian • Impact of windows and daylight exposure on overall health and sleep quality of office workers: A case-
Rhythm control pilot study (2014)
• The Impact of Optimized Daylight and Views on the Sleep Duration and Cognitive Performance of
Sleep Office Workers (2020)
• Natural Light and Productivity: Analyzing the Impacts of Daylighting on Students’ and Workers’ Health
Alertness and Alertness (2016)
Reduced Sick
• Daylighting-Bias and Biophilia: Quantifying the Impact of Daylighting on Occupants Health (2011)
Building Syndrome
• Increased daylight availability reduces length of hospitalisation in depressive patients (2016)

Reduced Depression • Pilot study to examine the effects of indoor daylight exposure on depression and other
neuropsychiatric symptoms in people living with dementia in long-term care communities (2018)

D. THERMAL HEALTH
Thermal comfort is the term used to describe occupant satisfaction with building conditions such as indoor
air temperature, air speed and humidity levels. However, thermal conditions can affect more than just comfort,
thus the ForHealth team at Harvard has proposed the more holistic term Thermal Health to include health
impacts such as productivity, stress and even mortality. The metric for measuring thermal conditions include
operative temperature (ºF), operative relative humidity % (RH%), indoor air flow speed (CFM) and mean
radiant temperature (MRT). Other measurements used to describe thermal health are personal factors such as
clothing insulation (clo) and metabolic rate (BMR).
THERMAL HEALTH
Cognitive function
Operative Perceived productivity

temperature
Comfort
Natural conditioning Relative humidity
Mental well-being
User controls Air speed
Chronic medical
Façade design Clothing conditions*
Metabolic rate Respiratory disorders
Arthritis/rheumatism
*long-term health benefit

Figure 6. Thermal health building health pathway
1. International Journal of Indoor Environment and Air

Title: Wellbuilt for wellbeing: Controlling relative humidity in the workplace matters for our health (Javad
Razjouyan et al., 2019)
This research study measured the impact of relative humidity and objectively measured stress response,
physical activity and sleep quality on 134 participants in 4 federal office buildings. Chest-mounted heart-
variability monitors were used to measure stress levels and relative humidity and temperature was measured
in the workspaces. The research team found that participants in a room with 30-60% relative humidity
experiences 25% less stress than those in drier conditions. There was also an indirect effect of poorer sleep
quality as mediated by stress responses for those participants outside this range.
2. Harvard Kennedy School Research Faculty Working Paper Series

Title: Heat and Learning (Joshua Goodman et al., 2018)
New studies also show the impact of poor thermal health on cognitive functioning. An observational study
in school settings showed that cumulative heat exposure affects student cognitive performance. Increased
temperatures before an exam negatively impacted students’ scores due to reduced learning in the days leading

up to the exam. Socio-economic levels of students add compounding effects, further driving down learning
levels. A financial assessment calculated that the health benefits of installing air conditioning in school buildings
likely outweighs the costs. The strengths of this study include using a large sample size, quantifying the benefit
of air conditioning and documenting the effect of socioeconomic level. However, it was limited in its solution,
considering if air-conditioning really is the best method for cooling if it does not help in climate change mitigation.
Perhaps classrooms can also look into passive techniques for cooling and ventilation as well. The study also
excluded some of the poorer areas of the country, where their results on change in academic performance
could potentially be more significant.
3. Journal of Green Building

Title: The relationship between comfort perceptions and academic performance in university classroom
buildings (Simi Hoque et al., 2016)
Another recent finding on the effect of thermal health on cognitive performance studied 409 university students
in 9 classrooms over 3 seasons. Students were given thermal comfort questions as an extension to their class
exams; scores on these exams were used as a measure of academic performance. The researchers found that
the perception of thermal discomfort negatively affected academic performance. Higher thermal discomfort
was associated with a more significant difference in academic performance. Although the study quantifies the
relationship between thermal comfort parameters, psychological comfort and academic performance, it is still
weak because the researchers did not control the room thermal conditions or educational material for students.
Since this is only an association study, the researchers cannot deduce causation.
Table 6. Studies showing the health impacts of thermal conditions on occupants.

Cognitive Function • Heat and Learning (2018)
• The relationship between comfort perceptions and academic performance in university classroom
Perceived
buildings (2016)
Productivity • The impact of thermal environment on occupant IEQ perception and productivity (2017)
• The underlying linkage between personal control and thermal comfort: Psychological or physical
Comfort effects? (2016)
• Potential indicators for the effect of temperature steps on human health and thermal comfort (2016)
• Living in a cold and damp home: frameworks for understanding impacts on mental well-being (2015)
Stress
• Wellbuilt for wellbeing: Controlling relative humidity in the workplace matters for our health (2019)

E. ACOUSTIC COMFORT
Another feature often considered within IEQ is acoustic comfort. It can be measured in decibels (dB) indoors,
as well as through levels of outdoor noise, traffic noise or occupational noise. Some of the main physical and
mental health impacts of acoustic comfort include increased attention span and productivity. The feature
article, Acoustics is instrumental in creating spaces that support employee wellbeing, engagement and
productivity (2020) details some of the challenges in achieving acoustic comfort in open offices, along with
building conditions that can help mitigate the adverse health impacts of noise.
ACOUSTIC COMFORT
Loud/quiet zones
Cognitive functioning
Sound isolation Reverberation time
Attention span
Sound barriers Noise-reducing
coefficient Perceived productivity
Sound absorbing
materials Sound-transmitting Stress recovery
class
Sound masking Sleep
Decibels
Cardiovascular disease*
Noise criteria
Figure 7. Acoustic comfort building health pathway

1. Psychological Bulletin
Title: Noise effect on human performance: a meta-analytic synthesis (James L. Szalma et al., 2011)
Several meta-analytical studies show the negative effect of noise on human health, further making the case for
increased acoustic comfort in buildings. This paper studied the effect of different durations and types of noise
in office settings on perceptual, cognitive and psychomotor performance and tasks requiring communication.
The magnitude, intensity and duration of noise causes varying amounts of stress on occupants, which can in
turn affect their performance on different types of tasks. This paper highlights the lack of observed data linking
negative effects of stress from noise on performance, however, it does show that intermittent speech noise is
more deleterious than continuous noise on cognitive performance. In addition, nonspeech continuous noise is
slightly helpful to performance, while continuous speech has small negative impacts and continuous music has
largely negative impacts.
2. World Health Organization

Title: Burden of disease from environmental noise: Quantification of healthy life years lost in Europe (WHO
Regional Office for Europe, 2011)
Another comprehensive meta-analytical study by the WHO outlined the diverse health impacts of environmental
noise, including cardiovascular disease, cognitive impairment in children, sleep disturbance, tinnitus and
annoyance. The report notes that children and elderly are more vulnerable populations, while low-income
communities are also more susceptible to adverse effects of environmental noise.

Title: Stress recovery during exposure to nature sound and environmental noise (Jesper J Alvarsson et al.,
2010)
Researchers investigated if auditory stimulation affects the sympathetic and parasympathetic recovery of the
body. After completing a stressful mental arithmetic test, participants were exposed to nature or environmental
sounds. Measuring skin conductance levels (sympathetic activity) and high frequency heart rate levels
(parasympathetic activity) after the exposure revealed that nature sounds facilitate recovery from sympathetic
activation after a psychological stressor.
Table 7. Studies showing the health impacts of acoustic conditions on occupants.

• Different Effects of Adding White Noise on Cognitive Performance of Sub-, Normal and Super-
Attentive School Children (2014)
Cognitive Function • The effect of background music and noise on the cognitive test performance of introverts and
extraverts (2011)
• Burden of disease from environmental noise: Quantification of healthy life years lost in Europe
Productivity (2011)
• Noise effect on human performance: a meta-analytic synthesis (2011)
Stress Recovery • Stress recovery during exposure to nature sound and environmental noise (2010)
Cardiovascular Disease • Cardiovascular effects of environmental noise exposure (2014)
• Impact of overnight traffic noise on sleep quality, sleepiness, and vigilant attention in long-haul
truck drivers: Results of a pilot study (2015)
Sleep • Effect of nocturnal road traffic noise exposure and annoyance on objective and subjective sleep
quality (2014)

F. VIEWS/BIOPHILIA
One of the most widely building design features studied is the effect of views and biophilia on human health
and wellbeing, which can be measured by visibility or access to open and green space. Health impacts include
increased cognitive functioning and positive feelings and reduced feelings of stress and cases of depression.
Exploring pathways linking greenspace to health: Theoretical and methodological guidance (2017) highlights
pathways for understanding three main functions of greenspace on human health: reducing harm (air pollution,
noise, heat), restoring capacities (attention restoration, physiological stress recovery) and building capacities
(physical activity, social cohesion).
VIEWS/BIOPHILIA
Cognitive function
Line of sight to
Window-wall ratio Attention restoration
glazing
View of flora, fauna, Short term memory
Unobstructed
movement, sky
views
Positive feelings
Plant wall/floor area
Indoor vegetation
Blood Pressure*
Paintings/mural area
Biophilic motifs,
art Perceived stress
Mental fatigue

Figure 8. Views and biophilia building health pathway
1. Building and Environment

Title: Physiological and cognitive performance of exposure to biophilic indoor environment (Jie Yin et al.,
2018)
This controlled experimental study measured the physiological and cognitive performance of 28 people after
being in biophilic rooms and control rooms for five minutes each. The authors found that biophilic environments
reduce blood pressure and skin conductance levels. These environments also improve short term memory,
decrease negative emotions and increase positive emotions.
2. Environment International
Title: Effects of biophilic indoor environment on stress and anxiety recovery: A between-subjects experiment
in virtual reality (Jie Yin et al., 2020)
In a follow up study, the Harvard research group found that biophilic environments perceived through virtual
reality (VR) trigger similar physiological responses in participants. After being exposed to a stress task, 100
participants experienced one of four virtual office environments (three biophilic and one control). Bio-monitoring
sensors measured their heart-rate variability, heart rate, skin conductance and blood pressure. Participants in
biophilic indoor environments had better recovery responses in terms of stress and anxiety levels.

3. Building Research and Information
Title: Human stress responses in office-like environments with wood furniture (Michael David Burnard et al.,
2019)
Another example of incorporating biophilia indoors is through material choice. The use of natural materials, such
as wood, can provide similar health impacts as direct access to nature. An experimental study was undertaken
in controlled lab rooms with four test-settings: two experimental conditions (furniture made of oak wood and
walnut wood) and two control conditions (white furniture with no wood). After giving participants an induced
stressor, the research team measured levels of salivary cortisol concentration. They found that overall stress
levels in rooms with oak wood furniture were lower than the control room.
Table 8. Studies showing the health impacts of views/biophilia on occupants.

• Physiological and cognitive performance of exposure to biophilic indoor environment (2018)

• Quantitative Improvement in Workplace Performance Through Biophilic Design: A Pilot Experiment Case
Cognitive Function
Study (2018)
• Are biophilic-design site office buildings linked to health benefits and high performing occupants? (2014)
• Impact of views to school landscapes on recovery from stress and mental fatigue (2016)
Productivity/Focus • Benefits of indoor plants on attention capacity in an office setting (2011)
• Impact of views to school landscapes on recovery from stress and mental fatigue (2016)
Stress Recovery • Human stress responses in office-like environments with wood furniture (2019)
• Impact of window views on recovery-an example of post-cesarean section women (2019)
• Workplace settings and wellbeing: Greenspace use and views contribute to employee wellbeing at peri-
Wellbeing urban business sites (2015)

G. ACTIVE DESIGN
Active design in buildings is a more recent building design feature that has gained attention as an important way
of promoting health in buildings. The news article, Don’t Get Too Comfortable at That Desk (2017) cites several
companies that are beginning to pay more attention to attractive and accessible stairs, bike racks and showers
to encourage more movement during work hours and walking, running or biking to work. The health impacts of
increased movement include lower risk of cardiovascular disease and diabetes and lower levels of obesity.
ACTIVE DESIGN
Well-lit, accessible stairs

Mood
Bike racks
Step count
Showers Gym Utilization
Standing time
Treadmills/exercise Stairway Utilization
equipment Cardiovascular disease*
Standing/operating desk Diabetes*
Layout promoting walking Obesity*
Figure 9. Active design building health pathway
1. BMJ Occupational & Environmental Medicine

Title: Effects of office workstation type on physical activity and stress (Casey M Lindberg et al., 2018)
Workstation design can directly impact occupant physical activity and stress levels. In an observational study,
researchers measured the effect of workstation design on physiological stress response, physical activity
and perceived stress for 231 office workers in four office buildings. The workstations belonged in one of three
categories: 1) private office, 2) cubicle, 3) open bench seating. Wearable, sensor-based technology measured
cardiac activity (heart rate variability) and physical activity (intensity of activity as opposed to step count).
Workers in open bench seating were more physically active than those in private offices and cubicles and also
experienced lower levels of perceived stress than those in cubicles. Higher physical activity was also associated
with lower physiological stress levels outside the office.
2. BMJ
Title: Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial
(Charlotte L Edwardson et al., 2018)
In this randomized and controlled experimental study, the research team evaluated the impact of a
multicomponent intervention to reduce sitting time and measure changes in physical activity, physical,
psychological and work-related health over multiple time intervals. The intervention group received a height
adjustable workstation, education materials for planning and goal setting, self-monitoring tools and coaching
sessions. The results showed that sitting times reduced over short, medium and long periods of time. Positive

changes in work related and psychological health were also found, such as greater job performance, work
engagement and quality of life and reduced occupational fatigue, sickness presenteeism and daily anxiety.
3. Work
Title: Is Active Design changing the workplace? - A natural pre-post experiment looking at health behavior
and workplace perceptions (Lina Engelen et al., 2017)
Researchers investigated the effect of Active Design on physical activity, sedentary behavior, musculoskeletal
complaints and perceptions of the workplace and productivity. 118 participants who moved into a new open
plan office building were asked to fill out a pre and post survey questionnaire. Participants in the new workplace
tended to sit less during the day and stand more. They also reported fewer cases of lower back pain. Perceptions
of the new workplace included greater satisfaction with environmental characteristics such as better light, air
quality and lighting. Participants also found the new space more motivating, however, perceptions of productivity
varied.
Table 9. Studies showing the health impacts of active design on occupants.
• Is Active Design changing the workplace? - A natural pre-post experiment looking at health behavior and
workplace perceptions (2017)
• Active design in affordable housing: A public health nudge (2018)
• Effects of office workstation type on physical activity and stress (2018)
Physical Activity • Moving to an “Active” Biophilic Designed Office Workplace: A Pilot Study about the Effects on Sitting
Time and Sitting Habits of Office-Based Workers (2019)
• Prompts to increase physical activity at points-of-choice between stairs and escalators: what about
escalator climbers? (2019)
• Is Active Design changing the workplace? - A natural pre-post experiment looking at health behavior and
workplace perceptions (2017)
• Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial
Mood/Mental Health (2018)
• Implementation of Active Workstations in University Libraries-A Comparison ofPortable Pedal Exercise
Machines and Standing Desks (2018)
Cardiovascular
• Do stair climbing exercise “snacks” improve cardiorespiratory fitness? (2019)
Disease
• Repeated 3-minute stair climbing-descending exercise after a meal over 2 weeks increases serum
Diabetes 1,5-anhydroglucitol levels in people with type 2 diabetes (2019)
• The effects of abdominal drawing-in maneuver during stair climbing on muscle activities of the trunk
Musculoskeletal and legs (2019)
System • Lower limb muscle activities and gain in balancing ability following two types of stair gait intervention in
adult post-chronic stroke patients: A preliminary, randomized-controlled study (2020)

H. SITE/LANDSCAPE
A lot of the research about healthy indoor environments is based in office spaces, however, the social
determinants of holistic health expand much beyond the boundaries of commercial building walls. More
importantly however, green buildings can leverage their health benefits to improve public health and wellbeing
and population scales larger than the individual. Healthier Eating Starts on the Roof (2012) is an article in the
New York Times that delves into the concept of urban agriculture and the associated health impacts on diet.
Green spaces, permeable surfaces and roof gardens are all site and landscape strategies that can improve
mental health, increase resiliency and encourage better nutrition.
SITE/LANDSCAPE
Building Strategy Site Condition Health Benefit
Mental Health
Green space Vegetated area Resilience
Permeable surfaces Permeable Growth

surface area

Roof garden Nutrition
Produce
Trees BMI*
Tree diversity
Cancer*
Figure 10. Site and landscape building health pathway
1. Landscape and Urban Planning

Title: More green space is linked to stress in deprived communities: Evidence from salivary cortisol patterns
(Catherine Ward Thompson et al., 2012)
Existence and access to green space is one of many social determinants of health. This observational study
examined population-level health effects of green space in a domestic, low socio-economic created environment.
The researchers found that an increased percent of green space correlated negatively with self-reported stress
levels. There was a significant negative correlation between cortisol slope (measurement of stress) and percent
green space, meaning that more green space caused a lower stress response in participants.
2. U.S. Green Building Council (USGBC), E-Capital

Title: Delivering Urban Resilience (Greg Kats et al., 2018)
The authors carried out a cost benefit analysis to better understand the financial effect of deploying smart
surfaces at a city-wide scale in DC, Philadelphia and El Paso. They also analyzed the health benefits of this
intervention for low- and high-income communities. The study considered five smart surfaces: cool roofs, green
roofs, solar PV, reflective pavements and urban trees. The benefits studied include energy cost savings, better
air quality and public health, reduced stormwater runoff, climate change mitigation and increased employment.

Due to limited data, the authors state that the calculated benefits for comfort and health are likely lower than
what might occur in reality.
3. Maternal Child Nutrition

Title: An agriculture-nutrition intervention improved children’s diet and growth in a randomized trial in
Ghana (Grace S Marquis et al., 2018)
Stunting is a physiological problem in poor, rural and low-educated communities in Ghana. This randomized
controlled trial examined the effect of a yearlong intervention in agricultural training and nutritional education
on diet and nutrition in children. Interventions included training in poultry farming and home gardening and
educational programs in nutrition and health. Outcomes measured were diet diversity, consumption of eggs and
growth metrics (length-for-age/height-for-age (LAZ/HAZ), weight-for-age, weight-for-length/weight-for-height
(WLZ/HLZ). Compared to the control group, children in the intervention group met minimum diet diversity and
had higher LAZ/HAZ and WAZ. They concluded that integrated interventions that increase access to healthy
foods and nutritional education improve nutrition in children.
Table 10. Studies showing the health impacts of site/landscape on occupants.

Cognitive
• School Gardens Enhance Academic Performance and Dietary Outcomes in Children (2015)
Performance
• More green space is linked to stress in deprived communities: Evidence from salivary cortisol patterns
(2012)
Mental Health • Green space as a buffer between stressful life events and health (2010)
• What is the Best Dose of Nature and Green Exercise for Improving Mental Health? A Multi-Study
Analysis (2010)
• Rooftop Gardening for Improved Food and Nutrition Security in the Urban Environment (2017)
• School gardens and adolescent nutrition and BMI: Results from a national, multilevel study (2016)
• An agriculture-nutrition intervention improved children’s diet and growth in a randomized trial in
Ghana (2018)
• Feasibility of an experiential community garden and nutrition programme for youth living in public
Healthy Eating and
housing (2015)
Water Quality • LA Sprouts: A Garden-Based Nutrition Intervention Pilot Program Influences Motivation and
Preferences for Fruits and Vegetables in Latino Youth (2012)
• American Cancer Society guidelines on nutrition and physical activity for cancer prevention (2012)
• Healthy food access for urban food desert residents: examination of the food environment, food
purchasing practices, diet, and body mass index (2014)

5 APPENDIX A: CITATIONS
Health Focused Rating Project

Concern Study Name and Year Published Design Strategy
Health Concern System Type
Associations of Cognitive Function Scores

with Carbon Dioxide, Ventilation, and Volatile
Organic Compound Exposures in Office Workers: Indoor Air Quality BD+C Office
A Controlled Exposure Study of Green and
Conventional Office Environment (2016)
The impact of working in a green certified

building on cognitive function and health (2017)
Indoor Air Quality BD+C Office
General Cognitive
Association between substandard classroom
Function
ventilation rates and students’ academic Indoor Air Quality O+M Schools
achievement (2010)
Heat and Learning (2018) Thermal Comfort O+M Schools
Different Effects of Adding White Noise on

Cognitive Performance of Sub-, Normal and Acoustic Comfort O+M Schools
Super-Attentive School Children (2014)
The effect of background music and noise on

the cognitive test performance of introverts and Acoustic Comfort O+M Schools
extraverts (2011)
Physiological and cognitive performance of

exposure to biophilic indoor environment (2018)
Views/Biophilia ID+C Office
Cognitive
Function Quantitative Improvement in Workplace
Performance Through Biophilic Design: A Pilot Views/Biophilia ID+C Office
Experiment Case Study (2018)
Are biophilic-design site office buildings linked to

health benefits and high performing occupants? Views/Biophilia ID+C Office
(2014)
School Gardens Enhance Academic Performance

Productivity Site/Landscape BD+C Schools
and Dietary Outcomes in Children (2015)
/Focus
Effects of ventilation rate per person and per
floor area on perceived air quality, sick building
syndrome symptoms, and decision‐making
Indoor Air Quality O+M Schools
(2014)
Blinded by the light: Occupant perceptions and

visual comfort assessments of three dynamic
daylight control systems and shading strategies
Light BD+C All
(2019)
The relationship between comfort perceptions

and academic performance in university Thermal Comfort O+M Schools
classroom buildings (2016)
The impact of thermal environment on occupant Office,

Thermal Comfort O+M
IEQ perception and productivity (2017) Schools

Concern Study Name and Year Published Design Strategy
Health Concern System Type
Burden of disease from environmental noise:

Quantification of healthy life years lost in Europe Acoustic Comfort - All
(2011)
Productivity
Noise effect on human performance: a meta- Office,
/Focus Acoustic Comfort O+M
analytic synthesis (2011) Schools
Benefits of indoor plants on attention capacity in
an office setting (2011)
Views/Biophilia ID+C Office
Prevalence of exposure of heavy metals and their

impact on health consequences (2018)
Water Quality - All
Cognitive
Function Public Health Consequences of Lead in Drinking
Water (2018)
Water Quality - All
Learning/Memory
Mercury, lead and arsenic: impact on
environment and human health (2016)
Water Quality - All
Lead (Pb) in Tap Water and in Blood: Implications

for Lead Exposure in the United States (2011)
Water Quality - All
Natural Light and Productivity: Analyzing the

Alertness Impacts of Daylighting on Students’ and Workers’ Light BD+C Schools
Health and Alertness (2016)

Concern Health Concern Study Name and Year Published Design Strategy
System Type
Household Air Pollution Exposure and Influence

of Lifestyle on Respiratory Health and Lung
Function in Belizean Adults and Children: A Field
Indoor Air Quality BD+C Residential
General Pulmonary Study (2016)
Function
Investigation of Acute Pulmonary Deficits
Associated with Biomass Fuel Cookstove Indoor Air Quality BD+C Residential
Emissions in Rural Bangladesh (2017)
Respiratory Diseases in University Students

Associated with Exposure to Residential Indoor Air Quality BD+C Residential
Dampness or Mold (2016)
Asthma
Volatile Organic Compounds in Anatomical
Pathology Wards: Comparative and Qualitative Indoor Air Quality BD+C Healthcare
Assessment of Indoor Airborne Pollution (2017)
Pulmonary
Building-Related Symptoms among Office
Function
Employees Associated with Indoor Carbon
Dioxide and Total Volatile Organic Compounds
Indoor Air Quality BD+C Office
(2015)
Association of Sick Building Syndrome with Office,

Indoor Air Quality BD+C
Indoor Air Parameters (2015) Residential
Sick Building Outdoor air pollution, meteorological conditions
Syndrome and indoor factors in dwellings in relation to sick
building syndrome (SBS) among adults in China
Indoor Air Quality BD+C Residential
(2016)
Endotoxin, ergosterol, muramic acid and fungal

DNA in dust from schools in Johor Bahru,
Malaysia — Associations with rhinitis and sick Indoor Air Quality BD+C Schools
building syndrome (SBS) in junior high school
students (2016)

System Type
Cardiovascular effects of environmental noise

Acoustic Comfort ID+C All
General exposure (2014)
Pulmonary
Cardiovascular
Function Do stair climbing exercise “snacks” improve
Function Active Design - All
cardiorespiratory fitness? (2019)

System Type
Daylighting-Bias and Biophilia: Quantifying the
Impact of Daylighting on Occupants Health Light BD+C All
(2011)
Workplace settings and wellbeing: Greenspace

use and views contribute to employee wellbeing Views/Biophilia BD+C Office
at peri-urban business sites (2015)
Effectiveness of the Stand More AT (SMArT)

Work intervention: cluster randomised controlled Active Design ID+C Office
trial (2018)
General Mental Implementation of Active Workstations in

Health and University Libraries-A Comparison of Portable
Pedal Exercise Machines and Standing Desks
Active Design ID+C Schools
Well-being
(2018)
More green space is linked to stress in deprived

communities: Evidence from salivary cortisol Site/Landscape BD+C All
patterns (2012)
Green space as a buffer between stressful life

events and health (2010)
Site/Landscape BD+C All
Mental What is the Best Dose of Nature and Green

Health and Exercise for Improving Mental Health? A Multi- Site/Landscape O+M All
Well-being Study Analysis (2010)
Impact of windows and daylight exposure on

overall health and sleep quality of office workers: Light BD+C Office
A case-control pilot study (2014)
The Impact of Optimized Daylight and Views on

the Sleep Duration and Cognitive Performance of Light BD+C Office
Office Workers (2020)
Sleep / Circadian
Rhythm Impact of overnight traffic noise on sleep quality,
sleepiness, and vigilant attention in long-haul Acoustic Comfort - All
truck drivers: Results of a pilot study (2015)
Effect of nocturnal road traffic noise exposure

and annoyance on objective and subjective sleep Acoustic Comfort BD+C Residential
quality (2014)
Increased daylight availability reduces length of

hospitalisation in depressive patients (2016)
Light BD+C Healthcare
Depression Pilot study to examine the effects of indoor

daylight exposure on depression and other
neuropsychiatric symptoms in people living with
Light BD+C Healthcare
dementia in long-term care communities (2020)

System Type
Living in a cold and damp home: frameworks
for understanding impacts on mental well-being Thermal Comfort BD+C Residential
(2015)
Wellbuilt for wellbeing: Controlling relative

General Mental humidity in the workplace matters for our health Thermal Comfort BD+C Office
Health and (2019)
Well-being Stress recovery during exposure to nature sound
and environmental noise (2010)
Acoustic Comfort ID+C All
Impact of views to school landscapes on recovery

from stress and mental fatigue (2016)
Views/Biophilia BD+C Schools
Mental
Health and
Human stress responses in office-like
Well-being Views/Biophilia ID+C Office
environments with wood furniture (2019)
Impact of window views on recovery-an example

of post-cesarean section women (2019)
Views/Biophilia BD+C Healthcare
Sleep / Circadian
The underlying linkage between personal control
Rhythm
and thermal comfort: Psychological or physical Thermal Comfort O+M All
effects? (2016)
Potential indicators for the effect of temperature

steps on human health and thermal comfort Thermal Comfort O+M All
(2016)

System Type
Is Active Design changing the workplace? - A

natural pre-post experiment looking at health Active Design BD+C Office
behavior and workplace perceptions (2017)
Active design in affordable housing: A public

health nudge (2018)
Active Design BD+C Housing
Effects of office workstation type on physical

Active Design ID+C Office
General Physical activity and stress (2018)
Activity
Moving to an “Active” Biophilic Designed Office
Workplace: A Pilot Study about the Effects on
Sitting Time and Sitting Habits of Office-Based
Active Design ID+C Office
Physical Workers (2019)
Activity
Prompts to increase physical activity at points-of-
choice between stairs and escalators: what about Active Design BD+C Office
escalator climbers? (2019)
The effects of abdominal drawing-in maneuver

during stair climbing on muscle activities of the Active Design - All
trunk and legs (2019)
Musculoskeletal
Lower limb muscle activities and gain in
System balancing ability following two types of stair gait
intervention in adult post-chronic stroke patients: Active Design - Healthcare
A preliminary, randomized-controlled study
(2020)

System Type
Repeated 3-minute stair climbing-descending

Physical Diabetes exercise after a meal over 2 weeks increases
Active Design - All
Activity Prevention serum 1,5-anhydroglucitol levels in people with
type 2 diabetes (2019)

System Type
Air pollution and temperature are associated

with increased COVID-19 incidence: A time series Indoor Air Quality BD+C All
study (2020)
Airborne transmission of SARS-CoV-2: The world Office,

Indoor Air Quality BD+C
should face the reality (2020) Residential
Evidence for probable aerosol transmission of
SARS-CoV-2 in a poorly ventilated restaurant Indoor Air Quality O+M Retail
Infection (2020)
General
Control and
Infection Control Airborne spread of infectious agents in the indoor Office,
Prevention Indoor Air Quality O+M
environment (2016) Residential
Role of mechanical ventilation in the airborne
Office,
transmission of infectious agents in buildings Indoor Air Quality O+M
(2016)
Residential
HVAC filtration for controlling infectious airborne

disease transmission in indoor environments:
Predicting risk reductions and operational costs
Indoor Air Quality O+M Office
(2013)

System Type
Rooftop Gardening for Improved Food and
Nutrition Security in the Urban Environment Site/Landscape O+M Residential
(2017)
An agriculture-nutrition intervention improved

Residential,
children’s diet and growth in a randomized trial in Site/Landscape O+M
Ghana (2018)
Community
School gardens and adolescent nutrition and

BMI: Results from a national, multilevel study Site/Landscape BD+C Schools
(2016)
Feasibility of an experiential community garden

Healthy General Healthy and nutrition programme for youth living in public Site/Landscape ND Residential
Eating and Eating and Water housing (2015)
Water Quality Quality
LA Sprouts: A Garden-Based Nutrition
Intervention Pilot Program Influences Motivation Schools,
Site/Landscape O+M
and Preferences for Fruits and Vegetables in Residential
Latino Youth (2012)
American Cancer Society guidelines on nutrition

and physical activity for cancer prevention (2012)
Site/Landscape All All
Healthy food access for urban food desert

Cities and
residents: examination of the food environment,
food purchasing practices, diet, and body mass
Site/Landscape ND Communi-
index (2014) ties?

System Type
Effects of a large-scale distribution of water
filters and natural draft rocket-style cookstoves
on diarrhea and acute respiratory infection: A Water Quality O+M All
cluster-randomized controlled trial in Western
Province, Rwanda (2019)
A post-implementation evaluation of ceramic

water filters distributed to tsunami-affected Water Quality O+M All
communities in Sri Lanka (2012)
Climate and Health Co-Benefits in Low-Income

Countries: A Case Study of Carbon Financed
Water Filters in Kenya and a Call for Independent
Water Quality - All
Monitoring (2017)
Healthy
E.coli / Waterborne
Eating and Antibiotic resistance in drinking water systems:
Pathogens Occurrence, removal, and human health risks Water Quality - All
Water Quality
(2019)
WHO water quality standards Vs Synergic

effect(s) of fluoride, heavy metals and hardness Water Quality - All
in drinking water on kidney tissues (2017)
A discussion about public health, lead and

Legionella pneumophila in drinking water Water Quality O+M All
supplies in the United States (2017)
A community-based evaluation of proximity to

unconventional oil and gas wells, drinking water
contaminants, and health symptoms in Ohio
Water Quality - All
(2018)

5
APPENDIX B: CITATIONS
BACKGROUND/INTRODUCTION
1. Worden, K., Hazer, M., Pyke, C., & Trowbridge, M. (2020). Using LEED green rating systems to promote
population health. Building and Environment, 172, 106550.
2. Ramanujan, M. (2020). Healthy people in healthy places equals a healthy economy. USGBC.
3. USGBC. SDG: Good Health and Wellbeing. USGBC (2018).
4. United Nations. Goal 3: Ensure healthy lives and promote well-being for all at all ages. UN Sustainable
Development Goals.
5. USGBC. Integrative Process for Health Promotion. USGBC. Pilot credits.
6. Bell, L. (2018). Designing for human health is the next frontier in sustainable building. USGBC+.
7. World Green Building Council. (2016). Building the business case: Health, wellbeing and productivity in green
offices. World Green Building Council.
8. Cedeño-Laurent, J. G., Williams, A., MacNaughton, P., Cao, X., Eitland, E., Spengler, J., & Allen, J. (2018).
Building evidence for health: green buildings, current science, and future challenges. Annual Review of
Public Health, 39, 291-308.
9. Health and Places Initiative. Harvard Graduate School of Design.
10. Health and Places Initiative. Research Briefs. Harvard Graduate School of Design.
11. Schulz, A., & Northridge, M. E. (2004). Social determinants of health: implications for environmental health
promotion. Health education & behavior, 31(4), 455-471.
12. Ulrich, R. S. (1984). View through a window may influence recovery from surgery. science, 224(4647), 420-
421.
AIR QUALITY
13. Arif, M., Katafygiotou, M., Mazroei, A., Kaushik, A., & Elsarrag, E. (2016). Impact of indoor environmental
quality on occupant well-being and comfort: A review of the literature. International Journal of Sustainable
Built Environment, 5(1), 1-11.
14. Allen, J. G., MacNaughton, P., Satish, U., Santanam, S., Vallarino, J., & Spengler, J. D. (2016). Associations of
cognitive function scores with carbon dioxide, ventilation, and volatile organic compound exposures in
office workers: a controlled exposure study of green and conventional office environments. Environmental
health perspectives, 124(6), 805-812.
15. MacNaughton, P., Satish, U., Laurent, J. G. C., Flanigan, S., Vallarino, J., Coull, B., ... & Allen, J. G. (2017). The
impact of working in a green certified building on cognitive function and health. Building and Environment,
114, 178-186.
16. Lu, C. Y., Lin, J. M., Chen, Y. Y., & Chen, Y. C. (2015). Building-related symptoms among office employees
associated with indoor carbon dioxide and total volatile organic compounds. International journal of
environmental research and public health, 12(6), 5833-5845.
17. Lanthier-Veilleux, M., Baron, G., & Généreux, M. (2016). Respiratory diseases in university students
associated with exposure to residential dampness or mold. International journal of environmental research
and public health, 13(11), 1154.
18. Maddalena, R., Mendell, M. J., Eliseeva, K., Chan, W. R., Sullivan, D. P., Russell, M., ... & Fisk, W. J. (2015).

Effects of ventilation rate per person and per floor area on perceived air quality, sick building syndrome
symptoms, and decision‐making. Indoor air, 25(4), 362-370.
19. Haverinen‐Shaughnessy, U., Moschandreas, D. J., & Shaughnessy, R. J. (2011). Association between
substandard classroom ventilation rates and students’ academic achievement. Indoor air, 21(2), 121-131.
20. Kurti, S. P., Kurti, A. N., Emerson, S. R., Rosenkranz, R. R., Smith, J. R., Harms, C. A., & Rosenkranz, S. K.
(2016). Household air pollution exposure and influence of lifestyle on respiratory health and lung function
in Belizean adults and children: a field study. International journal of environmental research and public
health, 13(7), 643.
21. Medgyesi, D. N., Holmes, H. A., & Angermann, J. E. (2017). Investigation of acute pulmonary deficits
associated with biomass fuel cookstove emissions in Rural Bangladesh. International Journal of
Environmental Research and Public Health, 14(6), 641.
22. Lanthier-Veilleux, M., Baron, G., & Généreux, M. (2016). Respiratory diseases in university students
associated with exposure to residential dampness or mold. International journal of environmental research
and public health, 13(11), 1154.
23. Cipolla, M., Izzotti, A., Ansaldi, F., Durando, P., & Piccardo, M. T. (2017). Volatile organic compounds
in anatomical pathology wards: comparative and qualitative assessment of indoor airborne pollution.
International journal of environmental research and public health, 14(6), 609.
24. Jafari, M. J., Khajevandi, A. A., Najarkola, S. A. M., Yekaninejad, M. S., Pourhoseingholi, M. A., Omidi, L., &
Kalantary, S. (2015). Association of sick building syndrome with indoor air parameters. Tanaffos, 14(1), 55.
25. Lu, C., Deng, Q., Li, Y., Sundell, J., & Norbäck, D. (2016). Outdoor air pollution, meteorological conditions
and indoor factors in dwellings in relation to sick building syndrome (SBS) among adults in China. Science
of the Total Environment, 560, 186-196.
26. Norbäck, D., Hashim, J. H., Markowicz, P., Cai, G. H., Hashim, Z., Ali, F., & Larsson, L. (2016). Endotoxin,
ergosterol, muramic acid and fungal DNA in dust from schools in Johor Bahru, Malaysia—Associations
with rhinitis and sick building syndrome (SBS) in junior high school students. Science of The Total
Environment, 545, 95-103.
27. Li, H., Xu, X. L., Dai, D. W., Huang, Z. Y., Ma, Z., & Guan, Y. J. (2020). Air Pollution and temperature are
associated with increased COVID-19 incidence: a time series study. International Journal of Infectious
Diseases.
28. Morawska, L., & Cao, J. (2020). Airborne transmission of SARS-CoV-2: The world should face the reality.
Environment International, 105730.
29. Li, Y., Qian, H., Hang, J., Chen, X., Hong, L., Liang, P., ... & Kang, M. (2020). Evidence for probable aerosol
transmission of SARS-CoV-2 in a poorly ventilated restaurant. medRxiv.
30. Wei, J., & Li, Y. (2016). Airborne spread of infectious agents in the indoor environment. American journal of
infection control, 44(9), S102-S108.
31. Luongo, J. C., Fennelly, K. P., Keen, J. A., Zhai, Z. J., Jones, B. W., & Miller, S. L. (2016). Role of mechanical
ventilation in the airborne transmission of infectious agents in buildings. Indoor air, 26(5), 666-678.
32. Azimi, P., & Stephens, B. (2013). HVAC filtration for controlling infectious airborne disease transmission in
indoor environments: Predicting risk reductions and operational costs. Building and environment, 70, 150-
160.
WATER QUALITY

33. Schwarzenbach, R. P., Egli, T., Hofstetter, T. B., Von Gunten, U., & Wehrli, B. (2010). Global water pollution
and human health. Annual review of environment and resources, 35, 109-136.
34. Rosen, M. B., Pokhrel, L. R., & Weir, M. H. (2017). A discussion about public health, lead and Legionella
pneumophila in drinking water supplies in the United States. Science of The Total Environment, 590, 843-
852.
35. Elliott, E. G., Ma, X., Leaderer, B. P., McKay, L. A., Pedersen, C. J., Wang, C., ... & Silva, G. S. (2018). A
community-based evaluation of proximity to unconventional oil and gas wells, drinking water
contaminants, and health symptoms in Ohio. Environmental research, 167, 550-557.
36. Rehman, K., Fatima, F., Waheed, I., & Akash, M. S. H. (2018). Prevalence of exposure of heavy metals and
their impact on health consequences. Journal of cellular biochemistry, 119(1), 157-184.
37. Levallois, P., Barn, P., Valcke, M., Gauvin, D., & Kosatsky, T. (2018). Public health consequences of lead in
drinking water. Current Environmental Health Reports, 5(2), 255-262.
38. Matta, G., & Gjyli, L. (2016). Mercury, lead and arsenic: impact on environment and human health. J. Chem.
Pharm. Sci, 9, 718-725.
39. Triantafyllidou, S., & Edwards, M. (2012). Lead (Pb) in tap water and in blood: implications for lead
exposure in the United States. Critical Reviews in Environmental Science and Technology, 42(13), 1297-
1352.
40. Kirby, M. A., Nagel, C. L., Rosa, G., Zambrano, L. D., Musafiri, S., Ngirabega, J. D. D., ... & Clasen, T. (2019).
Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea
and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda. PLoS
medicine, 16(6), e1002812.
41. Casanova, L. M., Walters, A., Naghawatte, A., & Sobsey, M. D. (2012). A post-implementation evaluation of
ceramic water filters distributed to tsunami-affected communities in Sri Lanka. Journal of water and
health, 10(2), 209-220.
42. Pickering, A. J., Arnold, B. F., Dentz, H. N., Colford Jr, J. M., & Null, C. (2017). Climate and health co-benefits
in low-income countries: a case study of carbon financed water filters in Kenya and a call for independent
monitoring. Environmental health perspectives, 125(3), 278-283.
43. Sanganyado, E., & Gwenzi, W. (2019). Antibiotic resistance in drinking water systems: Occurrence,
removal, and human health risks. Science of the Total Environment, 669, 785-797.
44. Wasana, H. M., Perera, G. D., Gunawardena, P. D. S., Fernando, P. S., & Bandara, J. (2017). WHO water
quality standards Vs Synergic effect (s) of fluoride, heavy metals and hardness in drinking water on kidney
tissues. Scientific Reports, 7(1), 1-6.
LIGHTING
45. Van Den Wymelenberg, K. (2014). The benefits of natural light. Architectural Lighting, 19.
46. Boubekri, M., Lee, J., MacNaughton, P., Woo, M., Schuyler, L., Tinianov, B., & Satish, U. (2020). The
Impact of Optimized Daylight and Views on the Sleep Duration and Cognitive Performance of Office
Workers. International journal of environmental research and public health, 17(9), 3219.
47. Boubekri, M., Cheung, I. N., Reid, K. J., Wang, C. H., & Zee, P. C. (2014). Impact of windows and daylight
exposure on overall health and sleep quality of office workers: a case-control pilot study. Journal of clinical
sleep medicine, 10(6), 603-611.
48. Elzeyadi, I. (2011). Daylighting-bias and biophilia: quantifying the impact of daylighting on occupants
health. US Green Building Council. http://www. usgbc. org/sites/default/files/OR10_Daylighting%
20Bias% 20and% 20Biophilia. pdf.
49. Day, J. K., Futrell, B., Cox, R., Ruiz, S. N., Amirazar, A., Zarrabi, A. H., & Azarbayjani, M. (2019). Blinded by the

light: Occupant perceptions and visual comfort assessments of three dynamic daylight control systems
and shading strategies. Building and Environment, 154, 107-121.
50. Shishegar, N., & Boubekri, M. (2016, April). Natural light and productivity: Analyzing the impacts of
daylighting on students’ and workers’ health and alertness. In Proceedings of the International Conference
on “Health, Biological and Life Science”(HBLS-16), Istanbul, Turkey (pp. 18-19).
51. Canellas, F., Mestre, L., Belber, M., Frontera, G., Rey, M. A., & Rial, R. (2016). Increased daylight availability
reduces length of hospitalisation in depressive patients. European archives of psychiatry and clinical
neuroscience, 266(3), 277-280.
52. Konis, K., Mack, W. J., & Schneider, E. L. (2018). Pilot study to examine the effects of indoor daylight
exposure on depression and other neuropsychiatric symptoms in people living with dementia in long-term
care communities. Clinical Interventions in Aging, 13, 1071.
THERMAL HEALTH
53. Allen, J. G., Bernstein, A., Xiadong, C., Eitland, E. S., Flanigan, S., & Gokhale, M. (2016). The 9 foundations of
a healthy building. Thermal Health. USA: Harvard T Chan School of Public Health, 14-16.
54. Razjouyan, J., Lee, H., Gilligan, B., Lindberg, C., Nguyen, H., Canada, K., ... & Ram, S. (2020). Wellbuilt for
wellbeing: Controlling relative humidity in the workplace matters for our health. Indoor air, 30(1), 167-179.
55. Goodman, J., Hurwitz, M., Park, J., & Smith, J. (2018). Heat and learning (No. w24639). National Bureau of
Economic Research.
56. Hoque, S., & Weil, B. (2016). The relationship between comfort perceptions and academic performance in
university classroom buildings. Journal of Green Building, 11(1), 108-117.
57. Geng, Y., Ji, W., Lin, B., & Zhu, Y. (2017). The impact of thermal environment on occupant IEQ perception
and productivity. Building and Environment, 121, 158-167.
58. Luo, M., Cao, B., Ji, W., Ouyang, Q., Lin, B., & Zhu, Y. (2016). The underlying linkage between personal
control and thermal comfort: psychological or physical effects?. Energy and Buildings, 111, 56-63.
59. Xiong, J., Lian, Z., Zhou, X., You, J., & Lin, Y. (2016). Potential indicators for the effect of temperature steps
on human health and thermal comfort. Energy and Buildings, 113, 87-98.
60.Liddell, C., & Guiney, C. (2015). Living in a cold and damp home: frameworks for understanding impacts on
mental well-being. Public Health, 129(3), 191-199.
ACOUSTIC COMFORT
61. interiors+sources. (2020) Acoustics is instrumental in creating spaces that support employee wellbeing,
engagement and productivity. interiors+sources, Continuing Education Series.
62. Szalma, J. L., & Hancock, P. A. (2011). Noise effects on human performance: a meta-analytic synthesis.
Psychological bulletin, 137(4), 682.
63. World Health Organization. (2011). Burden of disease from environmental noise: Quantification of healthy
life years lost in Europe. World Health Organization. Regional Office for Europe.
64. Alvarsson, J. J., Wiens, S., & Nilsson, M. E. (2010). Stress recovery during exposure to nature sound and
environmental noise. International journal of environmental research and public health, 7(3), 1036-1046.
65. Helps, S. K., Bamford, S., Sonuga-Barke, E. J., & Söderlund, G. B. (2014). Different effects of adding white
noise on cognitive performance of sub-, normal and super-attentive school children. PLoS One, 9(11),
e112768.
66. Dobbs, S., Furnham, A., & McClelland, A. (2011). The effect of background music and noise on the cognitive
test performance of introverts and extraverts. Applied cognitive psychology, 25(2), 307-313.
67. Münzel, T., Gori, T., Babisch, W., & Basner, M. (2014). Cardiovascular effects of environmental noise

exposure. European heart journal, 35(13), 829-836.
68. Popp, R. F., Maier, S., Rothe, S., Zulley, J., Crönlein, T., Wetter, T. C., ... & Hajak, G. (2015). Impact of overnight
traffic noise on sleep quality, sleepiness, and vigilant attention in long-haul truck drivers: Results of a pilot
study. Noise & Health, 17(79), 387.
69. Frei, P., Mohler, E., & Röösli, M. (2014). Effect of nocturnal road traffic noise exposure and annoyance on
objective and subjective sleep quality. International journal of hygiene and environmental health, 217(2-3),
188-195.
VIEWS/BIOPHILIA
70. Markevych, I., Schoierer, J., Hartig, T., Chudnovsky, A., Hystad, P., Dzhambov, A. M., ... & Lupp, G. (2017).
Exploring pathways linking greenspace to health: theoretical and methodological guidance. Environmental
research, 158, 301-317.
71. Yin, J., Zhu, S., MacNaughton, P., Allen, J. G., & Spengler, J. D. (2018). Physiological and cognitive
performance of exposure to biophilic indoor environment. Building and Environment, 132, 255-262.
72. Yin, J., Yuan, J., Arfaei, N., Catalano, P. J., Allen, J. G., & Spengler, J. D. (2020). Effects of biophilic indoor
environment on stress and anxiety recovery: A between-subjects experiment in virtual reality. Environment
International, 136, 105427.
73. Burnard, M. D., & Kutnar, A. (2020). Human stress responses in office-like environments with wood f
furniture. Building Research & Information, 48(3), 316-330.
74. Sanchez, J. A., Ikaga, T., & Sanchez, S. V. (2018). Quantitative improvement in workplace performance
through biophilic design: A pilot experiment case study. Energy and Buildings, 177, 316-328.
75. Gray, T., & Birrell, C. (2014). Are biophilic-designed site office buildings linked to health benefits and high
performing occupants?. International journal of environmental research and public health, 11(12), 12204-
12222.
76. Li, D., & Sullivan, W. C. (2016). Impact of views to school landscapes on recovery from stress and mental
fatigue. Landscape and urban planning, 148, 149-158.
77. Raanaas, R. K., Evensen, K. H., Rich, D., Sjøstrøm, G., & Patil, G. (2011). Benefits of indoor plants on
attention capacity in an office setting. Journal of Environmental Psychology, 31(1), 99-105.
78. Li, D., & Sullivan, W. C. (2016). Impact of views to school landscapes on recovery from stress and mental
fatigue. Landscape and urban planning, 148, 149-158.
79. Wang, C. H., Kuo, N. W., & Anthony, K. (2019). Impact of window views on recovery—an example of post-
cesarean section women. International Journal for Quality in Health Care, 31(10), 798-803.
80. Gilchrist, K., Brown, C., & Montarzino, A. (2015). Workplace settings and wellbeing: Greenspace use and
views contribute to employee wellbeing at peri-urban business sites. Landscape and Urban Planning, 138,
32-40.
ACTIVE DESIGN
81. Lohr, S. (2017). Don’t get too comfortable at that desk. The New York Times.
82. Lindberg, C. M., Srinivasan, K., Gilligan, B., Razjouyan, J., Lee, H., Najafi, B., ... & Heerwagen, J. H. (2018).
Effects of office workstation type on physical activity and stress. Occupational and environmental
medicine, 75(10), 689-695.
83. Edwardson, C. L., Yates, T., Biddle, S. J., Davies, M. J., Dunstan, D. W., Esliger, D. W., ... & Munir, F. (2018).
Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial. bmj,

363, k3870.
84. Engelen, L., Chau, J., Bohn-Goldbaum, E., Young, S., Hespe, D., & Bauman, A. (2017). Is Active Design
changing the workplace?–A natural pre-post experiment looking at health behaviour and workplace
perceptions. Work, 56(2), 229-237.
85. Engelen, L., Chau, J., Bohn-Goldbaum, E., Young, S., Hespe, D., & Bauman, A. (2017). Is Active Design
changing the workplace?–A natural pre-post experiment looking at health behaviour and workplace
perceptions. Work, 56(2), 229-237.
86. Garland, E., Garland, V., Peters, D., Doucette, J., Thanik, E., Rajupet, S., & Sanchez, S. H. (2018). Active
design in affordable housing: A public health nudge. Preventive medicine reports, 10, 9-14.
87. Wallmann-Sperlich, B., Hoffmann, S., Salditt, A., Bipp, T., & Froboese, I. (2019). Moving to an “active”
biophilic designed office workplace: a pilot study about the effects on sitting time and sitting habits of
office-based workers. International journal of environmental research and public health, 16(9), 1559.
88. Bellettiere, J., Nguyen, B., Liles, S., Berardi, V., Adams, M. A., Dempsey, P., ... & Hovell, M. (2019). Prompts to
increase physical activity at points-of-choice between stairs and escalators: what about escalator
climbers?. Translational behavioral medicine, 9(4), 656-662.
89. Bastien Tardif, C., Cantin, M., Sénécal, S., Léger, P. M., Labonté-Lemoyne, É., Begon, M., & Mathieu, M. E.
(2018). Implementation of active workstations in university libraries—a comparison of portable pedal
exercise machines and standing desks. International journal of environmental research and public health,
15(6), 1242.
90. Jenkins, E. M., Nairn, L. N., Skelly, L. E., Little, J. P., & Gibala, M. J. (2019). Do stair climbing exercise
“snacks” improve cardiorespiratory fitness?. Applied Physiology, Nutrition, and Metabolism, 44(6), 681-
684.
91. Honda, H., Igaki, M., Hatanaka, Y., Komatsu, M., Tanaka, S. I., Miki, T., ... & Hayashi, T. (2017). Repeated
3-minute stair climbing-descending exercise after a meal over 2 weeks increases serum 1,
5-anhydroglucitol levels in people with type 2 diabetes. Journal of Physical Therapy Science, 29(1), 75-78.
92. Lee, S. K. (2019). The effects of abdominal drawing-in maneuver during stair climbing on muscle activities
of the trunk and legs. Journal of Exercise Rehabilitation, 15(2), 224.
93. Yoon-Hee, C., Kyoung, K., Sang-Yong, L., & Yong-Jun, C. (2020). Lower limb muscle activities and gain
in balancing ability following two types of stair gait intervention in adult post-chronic stroke patients: A
preliminary, randomized-controlled study. Turkish Journal of Physical Medicine and Rehabilitation, 66(1),
17.
SITE/LANDSCAPE
94. Gregor, A. (2012). Healthier Eating Starts on the Roof. New York Times, 8.
95. Thompson, C. W., Roe, J., Aspinall, P., Mitchell, R., Clow, A., & Miller, D. (2012). More green space is linked to
less stress in deprived communities: Evidence from salivary cortisol patterns. Landscape and urban
planning, 105(3), 221-229.
96. Kats, G. R. E. G., & Glassbrook, K. E. I. T. H. (2018). Delivering Urban Resilience.
97. Marquis, G. S., Colecraft, E. K., Kanlisi, R., Aidam, B. A., Atuobi‐Yeboah, A., Pinto, C., & Aryeetey, R. (2018).
An agriculture–nutrition intervention improved children’s diet and growth in a randomized trial in Ghana.
Maternal & child nutrition, 14, e12677.
98. Berezowitz, C. K., Bontrager Yoder, A. B., & Schoeller, D. A. (2015). School gardens enhance academic
performance and dietary outcomes in children. Journal of School Health, 85(8), 508-518.

99. Van den Berg, A. E., Maas, J., Verheij, R. A., & Groenewegen, P. P. (2010). Green space as a buffer between
stressful life events and health. Social science & medicine, 70(8), 1203-1210.
100. Barton, J., & Pretty, J. (2010). What is the best dose of nature and green exercise for improving mental
health? A multi-study analysis. Environmental science & technology, 44(10), 3947-3955.
101. Baudoin, W., Desjardins, Y., Dorais, M., Charrondière, U. R., Herzigova, L., El-Behairy, U., ... & Ba, N. (2017).
Rooftop gardening for improved food and nutrition security in the urban environment. In Rooftop Urban
Agriculture (pp. 219-233). Springer, Cham.
102. Utter, J., Denny, S., & Dyson, B. (2016). School gardens and adolescent nutrition and BMI: Results from a
national, multilevel study. Preventive medicine, 83, 1-4.
103. Grier, K., Hill, J. L., Reese, F., Covington, C., Bennette, F., MacAuley, L., & Zoellner, J. (2015). Feasibility of
an experiential community garden and nutrition programme for youth living in public housing. Public
health nutrition, 18(15), 2759-2769.
104. Gatto, N. M., Ventura, E. E., Cook, L. T., Gyllenhammer, L. E., & Davis, J. N. (2012). LA Sprouts: a garden-
based nutrition intervention pilot program influences motivation and preferences for fruits and
vegetables in Latino youth. Journal of the Academy of Nutrition and Dietetics, 112(6), 913-920.
105. Kushi, L. H., Doyle, C., McCullough, M., Rock, C. L., Demark‐Wahnefried, W., Bandera, E. V., ... & American
Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee. (2012). American
Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of
cancer with healthy food choices and physical activity. CA: a cancer journal for clinicians, 62(1), 30-67.
106. Dubowitz, T., Zenk, S. N., Ghosh-Dastidar, B., Cohen, D. A., Beckman, R., Hunter, G., ... & Collins, R. L.
(2015). Healthy food access for urban food desert residents: examination of the food environment, food
purchasing practices, diet and BMI. Public health nutrition, 18(12), 2220-2230.

5 APPENDIX C: RESEARCH METHODS
Search Process
The landmark research study View through a window may influence recovery from surgery (1984) by Roger
Ulrich pioneered the concept of evidence-based design. It has inspired an entire field of research studying the
effect of the built environment on human health and well-being. Since this anthology focuses on the first level
of both the built environment and population scales, articles in this anthology study the impact of building level
strategies on occupant health.
We started with sources cited in a few key systematic reviews by the USGBC, World GBC and the Harvard T.
H. Chan School of Public Health, who are furthering new research in this area. We also built on work started
by Kelly Worden’s LEED v4 health scan. After gaining a better understanding of the health impacts of certain
building conditions, we searched for more recent articles based on specific health impacts for each building
strategy. These yielded 200+ sources in the form of:
- Experimental studies
- Observational studies
- Meta-analyses
- Systematic reviews
- Other reports - research briefs, etc.
Inclusion Criteria
Abstracts for all articles included were read, and in many cases, the entire article was carefully reviewed.
Eventually, 106 journal and news articles were included in this review. The main criteria for inclusion were
date of publication (2010 and beyond), article type (peer-reviewed journal article, reputable news source) and
relevance (relating a green building strategy and building condition to a health determinant and health impact
at the occupant level). For each building strategy, three key experimental or observational studies are featured
with article summaries, while related articles or those cited by key systematic reviews are included in tabular
format at the end of each section.

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Research Anthology of

Health-Promoting Building Strategies

Advisor: Elizabeth Beardsley, U.S. Green Building Council

3. HOW TO USE THIS RESOURCE 8

A. INDOOR AIR QUALITY 9

Harnessing LEED’s health promotion capacity

Research Anthology of Health-Promoting Building Strategies 4

Table 1. Health determinants affected by building strategies are highlighted in gray.

Health Determinants (KFF, Northridge & Schultz)

Natural Environment Economic Stability Healthy Behaviors

Research Anthology of Health-Promoting Building Strategies 5

Population Scales of the Built Environment

Research Anthology of Health-Promoting Building Strategies 6

Figure 1. The scales of impact of green building strategies on population health.

Green Building Goal Occupant Community Global

Thermal Comfort Thermal zoning Urban vegetation Reduce global warming

Views/Biophilia Indoor plants Access to nature Reforestation

Active Design Sit/stand desks Active spaces Walkability/zoning

Research Anthology of Health-Promoting Building Strategies 7

Building Health Pathways

Building Strategy Building Condition Health Benefit

Design Environmental Physical

Research Anthology of Health-Promoting Building Strategies 8

A. INDOOR AIR QUALITY

Building Strategy Building Condition Health Benefit

Figure 3. Indoor air quality building health pathway

1. Harvard COGfx Study: Part 1 and 2

1A. Environmental Health Perspectives

Research Anthology of Health-Promoting Building Strategies 9

1B. Building and Environment

2. International Journal of Environmental Research and Public Health

3. International Journal of Environmental Research and Public Health

Research Anthology of Health-Promoting Building Strategies 10

Research Anthology of Health-Promoting Building Strategies 11

Building Strategy Building Condition Health Benefit

Granular activated Disinfectants Cancer

Figure 4. Water quality building health pathway

1. Science Total Environment

Research Anthology of Health-Promoting Building Strategies 12

3. Journal of Cellular Biochemistry

Table 4. Studies showing the health impacts of water quality on occupants

Research Anthology of Health-Promoting Building Strategies 13

Building Strategy Building Condition Health Benefit

Daylighting Lumens Physical activity

User controls Lux Productivity

Shading Solar Heat Gain Sleep

Glare Mental well-being

Sick Building Syndrome

Figure 5. Lighting building health pathway

1. International Journal of Environmental Research and Public Health (View Inc.)

2. Journal of Clinical Sleep Medicine

Research Anthology of Health-Promoting Building Strategies 14

3. U.S. Green Building Council (USGBC)

• Increased daylight availability reduces length of hospitalisation in depressive patients (2016)

Research Anthology of Health-Promoting Building Strategies 15

Building Strategy Building Condition Health Benefit

Operative Perceived productivity

Metabolic rate Respiratory disorders

*long-term health benefit