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Healthy Buildings Are Not What You Think, But Matter Now More Than Ever

Whether the public realizes it or not, the buildings they work in are probably unhealthy — an unsettling reality that is as true today as it was before the coronavirus pandemic.

That’s because defining what makes a building “healthy” or less than that ideal is complicated, especially now as building owners desperately search for ways to convince tenants and their employees that it is safe to come back to the office.

With millions of dollars in rent — and the health of millions of workers — at stake, clearing this uncertain air has become the priority of two entities, WELL and Fitwel, which have been issuing healthy building certifications and seals with the stated goal of enhancing the health and well-being of occupants.

However, those assurances come with a price tag and lingering misconceptions about what these healthy building labels mean. 

“Who isn't interested in healthy buildings today?” Skanska USA Commercial Development Sustainability Director Sarah King said. “As we come back and see the world reopen after the pandemic, it's really underscored how personal it is — you feel it very personally when you're entering into a building and wondering how it can impact your health.”


Americans spend about 90% of their time indoors, where certain types of pollution can be up to five times higher than outdoor concentrations, according to the U.S. Environmental Protection Agency. In the pandemic era, this indoor health risk is compounded by a greater threat of contagion.

“It definitely spreads more indoors than outdoors,” Harvard Medical School associate professor of immunology and infectious diseases Roger Shapiro said at a press conference last year. “The virus droplets disperse so rapidly and in the wind that they become a non-factor if you’re not really very close to someone outdoors, you know, let’s say within 6 feet.”

Overall, WELL targets ten concept categories of buildings: air, water, light, nourishment, thermal comfort, sound, movement, material, mind and community. Fitwel has seven health impact categories: community health, reducing morbidity and absenteeism, social equity, feelings of wellbeing, healthy food, occupant safety and physical activity.

Leveraging its WELL Building Standard developed in 2014 as a certification process for the built environment that includes over 100 features to address numerous aspects of human health and well-being, the International WELL Building Institute, a subsidiary of Delos, launched its Health-Safety Rating in response to the pandemic. 

The Health-Safety Rating is a scaled-down version of the WELL Building Standard that provides a framework for property owners, property managers and organizations to make buildings safer for occupants when it comes to respiratory diseases like the coronavirus.

“As organizations across the globe respond to the COVID-19 pandemic by making updates to their policies and protocols, the WELL Health-Safety Rating provides an efficient and effective opportunity to guide, validate, recognize and scale the efforts of owners and operators on critical health and safety issues,” IWBI Chief Commercial Officer Jessica Cooper said in an email.

Similarly, Fitwel, created by the Centers for Disease Control and Prevention and the General Services Administration and operated by the Center for Active Design, built on its more comprehensive Fitwel Certification and developed a Viral Response module as a respiratory disease mitigation strategy for the built environment. 

The healthy building movement seeks to address how to make buildings safer from a health perspective, and there is nothing like a celebrity ad campaign to gain attention. 

To promote the Health-Safety Rating, IWBI paid WELL celebrity ambassadors such as Lady Gaga, Jennifer Lopez, Robert De Niro and Venus Williams to participate in a “Look for the WELL Health-Safety seal” public awareness campaign. The move had the intended effect of catching attention, including some dubious responses.


For example, a recent Refinery29 article pointed out the ad campaign’s lack of thorough explanation of what the Health-Safety Rating is and put a spotlight on some negative reactions to it circulating on the internet. The article’s author cited one comment deemed most critical that pointed to the Health-Safety Rating’s disclaimer that it can’t guarantee that a space is free from pathogens.

To be clear: Attaining a pathogen-free building or selectively killing only SARS-CoV-2 viruses would be impractical, have unintended consequences and likely be impossible. Were it possible, vaccines probably wouldn’t be necessary.

Both IWBI and Fitwel attest that their respective Health-Safety Rating and Viral Response module cannot eliminate the threat of respiratory diseases but only mitigate them. In other words, there are steps that can be taken to make indoor environments safer, but some level of risk will persist.

While the continued vaccine rollout could assuage concerns, a March poll conducted by EMC Research on behalf of the Bay Area Council found that 78% of San Francisco Bay Area respondents viewed attending large indoor gatherings as unsafe. 

It is unclear what effect WELL’s Health-Safety Rating or Fitwel’s Viral Response module will have on the perception of or actual safety. However, IWBI and Fitwel have said that their respective Health-Safety Rating and Viral Response modules are based on the latest scientific research and informed by experts at academic and public health institutions.

The coronavirus is hardly the only health risk encountered during all this time spent indoors. 

Indoor air pollution is responsible for thousands of cancer deaths and hundreds of thousands of respiratory ailments annually, according to the EPA. And every year, hundreds of thousands of children are exposed to lead from buildings that enter their bloodstream, potentially causing severe health problems.

The presence of toxic substances like asbestos, carbon monoxide and airborne microbes in one’s living space or workplace might be alarming, but the unhealthiness of buildings can seem innocuous. The lack of access to natural light in many places of work can lead to elevated cortisol levels, depressive symptoms and sleep disturbances, a study published in Chronobiology International found. Office buildings equipped with elevators that transport workers to desks where they sit for hours can be part of a sedentary lifestyle that leads to cardiovascular disease. 

As is the case with bacteria, of the estimated 380 trillion viruses living on or in the human body, many fall into “good” and “bad” categories, as reported by Scientific American. Studies have also linked increasingly clean environments with a rise in allergies, inflammation and immune disorders, as reported by The New York Times

Achieving healthy buildings is complicated, and an explanation of what is entailed doesn’t lend itself well to short sound bites. Conversely, buildings that contribute to illness appear to come easily, as evidenced by an April study published in Environmental Health Perspectives by the Harvard T.H. Chan School of Public Health, which found that as little as four micrograms of indoor dust can cause hormone-disrupting effects in the body, which in turn can lead to infertility, thyroid disease and diabetes, among other conditions. 

Ally Charlotte Center in Charlotte, N.C., was recently awarded Precertification status by the WELL Building Institute.

Measures to make buildings healthier can be fraught with pitfalls. HKS Sustainable Design Leader Allison Smith had to advise against clients’ wishes to add antimicrobial building materials over the past year, saying that such finishes are not a sound infection control strategy and are associated with negative health impacts.

“This is something that we've been talking about that has given us an opportunity to have a very direct and frank conversation with our clients,” Smith said. “But that expands beyond antimicrobials, and really we're concerned with the impact that these materials have on the life cycle — so other environmental impacts, impacts on the communities where products are extracted and then manufactured; impacts for the construction workers and then also understanding what's going to happen to the product at the end of its life.”

The development of WELL’s Health-Safety Rating was informed by IWBI’s Task Force on Covid-19, which included the 17th Surgeon General of the U.S. Richard Carmona, Harvard T.H. Chan School of Public Health Buildings Director Joseph Allen, and Tsinghua University Center for Healthy Cities Professor Wang Yu, among many others, and received guidance from the World Health Organization and the CDC. 

Fitwel’s Viral Response module was created from global research on viral mitigation, thousands of academic research studies and input from recognized experts from public health, infectious disease, mental health and behavioral psychology, according to a statement.

Neither the Health-Safety Rating nor the Viral Response module is required or used by government agencies to determine economic reopening schedules.

The Health-Safety Rating, involves third-party verification of project policies and proof of implementation by the Green Business Certification Inc. and is an example of a voluntary leadership standard that is market-driven and consensus-based in its development, according to U.S. Green Building Council Senior Vice President of Communications Taryn Holowka.

The Viral Response module entails an online portal where applicants benchmark and prioritize strategies being pursued for healthier buildings that are assessed and scored by the system and undergo a double-blind review process. Evidence of practices in the form of photographs and test results performed by building engineers are uploaded to the portal. 

Earning a Health-Safety Rating seal or a Viral Response module plaque for a building isn’t free. 

For a single location, the former costs $4,200. However, if more buildings are enrolled, the price drops, Cooper said. The Viral Response Module has a $500 registration fee, an annual certification fee of $4,500 and a per asset fee of $200 that comes with a 10% discount for applications with over 10 assets.

Despite these rates, plus the costs of implementing the measures, healthy building strategies have grown in popularity in the commercial real estate industry. Over 700M SF of real estate was engaged in the WELL Health-Safety Rating in 2020, according to Cooper, who said that the rating is geared to be applied at scale across a company’s real estate portfolio. By March 18, that number had surpassed 1B SF. The increase includes companies like JPMorgan Chase that have achieved the Health-Safety Rating for all of its global offices and retail branches — about 6,200 locations, Cooper said.

Viral Response module statistics have not yet been publicly disclosed but between 2019 and 2020 the growth of Fitwel registrations and certifications about doubled due in part to the pandemic, according to a Fitwel spokesperson. 

With a tightening of budgets during the pandemic, some commercial real estate companies have to weigh the cost of pursuing the certifications with the potential costs of not doing so. One of the considerations might be whether to absorb the costs of the healthy building measures and certifications while not knowing to what degree tenants will return to benefit from them. On the other hand, not implementing the measures or forgoing a certification could lower tenant demand.

A February JLL report cited data from MIT’s Real Estate Innovation Lab showing that buildings deemed healthy garner between 4.4% and 7.7% higher rent per SF than nearby buildings that lack WELL or Fitwel certification.

“People's health and well-being are on top of everyone's mind, and using a certification like WELL or Fitwel gives people a sense that it's a trusted label,” Steinberg Hart Senior Design Manager Raquel Bito said, adding that the label is akin to going to two different Starbucks and knowing you will get the same cup of coffee. “Building owners are taking the initiative to provide these for their workers or tenants.”

The increase in demand for healthier buildings and the certifications that attest to them isn’t a trend, Smith said. Instead, the uptick in momentum toward buildings that promote greater health and wellness will continue to be increasingly important even after heightened pandemic-induced anxiety fades. However, the WELL and Fitwel certifications don’t represent a panacea for the entire built environment.

While Smith receives significant interest from clients who want to explore WELL and Fitwel’s offerings, the interest doesn’t always translate into the pursuit of an actual certification. Some will complete an evaluation to see how the certifications align with their requirements and project goals, she said.

The connection between healthy buildings and recovery may run even deeper. If a lack of adequate indoor ventilation, air quality standards and sanitation practices result in higher rates of illness among workers, future economic shutdowns, or at least partial ones, could result.

“Having a high-scoring building isn't what will make people feel healthier. It is that given the evidence-based Fitwel strategies, the behavior of the people associated with those buildings will lead to the occupants being healthier,” Fitwel President and CEO Joanna Frank said.

The healthy building strategies cover a large number of health-related minutiae. The Health-Safety Rating covers 22 strategy categories within the core areas of cleaning and sanitization procedures, emergency preparedness, health service resources, air and water quality management, and stakeholder engagement and communication.

The Viral Response module contains a section that focuses on mechanical systems that impact viral transmission in indoor environments, including a humidity control policy and an indoor air quality testing and monitoring protocol. 

To address potential misunderstandings among building occupants who might conclude that a Viral Response module plaque means that they are 100% protected from contracting the coronavirus, Fitwel has a strategy on building occupant trust, which involves close engagement between Fitwel and participants to ensure understanding, as well as establishing a protocol with occupants, so they too understand what the plaque means, according to a Fitwel spokesperson.

Similarly, the Health-Safety Rating contains a Stakeholders Engagement and Communication feature requiring "project teams to establish a health-oriented project mission and to provide a guide to occupants that highlights the features pursued by the project, the relationship between health and buildings and available health resources and programs. 

This feature also requires a physical or digital feature guide, such as the WELL Health-Safety Rating report, to be prominently displayed and/or made widely available to all occupants upon rating achievement, meeting the following requirement describing the WELL Health-Safety Rating features achieved by the project.”

Government agencies currently do not require or regulate healthy building certifications. However, last year the U.S. Conference of Mayors, which represents mayors in over 1,400 cities, passed a resolution encouraging action on healthy building solutions such as the WELL Building Standard and the WELL Health-Safety Rating to support the recovery, according to a press release. WELL has been adopted in about 100 countries, according to Cooper. 

Greater adoption of WELL and Fitwel might not translate into the certifications becoming project requirements at the municipal planning level as has been the case in some cities with the LEED certification, said Bito, who is also a San Francisco Building Inspection Commissioner. In addition to not wanting to impose more restrictions and rules on projects, Bito said that unlike LEED, which involves more static design measures, WELL and Fitwel are more dynamic certifications that draw on research and industry knowledge from more diverse sources, making potential enforcement by planning and building departments cumbersome.

CORRECTION, APRIL  27, 10:18 A.M. PT: A previous version of this story included seven performance targets for the WELL Building Standard. However, those concepts were phased out in WELL v2 in place of 10 concept categories for buildings. Also, a previous version of this story stated that the Health-Safety Rating involves third-party on-site verification, but though the WELL Building Standard involves on-site verification, the Health-Safety Rating does not. The article has been updated.