The letter, organised by the International WELL Building Institute (IWBI), has been sent to members of Congress, mayors, governors and school superintendents, among other, requesting them to help change how buildings and indoor environments are perceived – from mere structures to critical levers for public health.

It lays out compelling evidence showing the outsized role that buildings can play to enhance health outcomes, prevent disease and boost economic productivity.

“Buildings have a profound impact on our safety and wellbeing,” said Rachel Hodgdon, president and chief executive of the IWBI. “Yet we’re largely missing out on the benefits of healthy building practices because our policymakers aren’t thinking about them as part of a prescription for public health.

“This letter shows unequivocally why we need our leaders in government to guide this policy shift and help ensure the places and spaces where we live our lives keep all of us safe, healthy and well.”

The letter helps serve as a wake-up call for decision-makers across the nation. “We hope all policymakers will embrace this new policy paradigm wherein buildings are not seen merely as structures, but as pillars supporting our nation’s health,” says the letter’s signatories, each a nationally recognised public health figure, including:

Surgeons-general who have signed the letter include Dr Richard Carmona, Dr David Satcher, Dr Joycelyn Elders, Dr Antonia Novello, Dr Boris D. Lushniak, and Dr Kenneth Moritsugu. They are joined by executives of several leading public health organisations, including the American Lung Association, the American Public Health Association, the Asthma and Allergy Foundation of America, the International Council on Active Aging, and the Society for Public Health Education.

“Buildings are not just walls and roofs; they’re health-critical environments where we spend 90 per cent of our lives,” said Dr Carmona, the 17th surgeon-general of the United States. “The pandemic showed us that our current building policies are severely lacking in health-focused strategies. We can’t afford to ignore this any longer.”

Productivity gains and lower medical costs

The sign-on letter underscores the urgency of revising building policies to be in alignment with public health goals. It also highlights the potential for significant economic benefits. Evidence highlighted in the letter include a potential $200bn annual productivity gain corresponding to a 20- to 50-per-cent reduction in Sick Building Syndrome symptoms for office workers in the US.

Increasing minimum ventilation rates in US offices could yield an estimated $38 billion in annual economic benefits, says the letter, while a return of $3.48 is cited for every dollar companies spend on workplace wellness programmes owing to reduced medical costs, and an additional return of $5.82 owing to reduced absenteeism. In addition, states the letter, there is the opportunity for an up to 101-per-cent improvement in cognitive function, supporting employee productivity benefits up to $7500 per person per year.

“Over the next ten years, our federal, state and local governments will invest billions in buildings, including funding for public schools, affordable housing, and large federal incentives for commercial buildings,” said Jason Hartke, executive vice-president of external affairs and advocacy at the IWBI. “The key question is: will these public investments prioritise human health? If, starting right now, our decision-makers begin to embrace sound policy solutions that prioritise healthy building practices, then we can help ensure our public dollars are going to support huge positive public health outcomes.”

“A new era”

Dr Kenneth Moritsugu, who served twice as acting surgeon-general of the United States, proposed that buildings hold a key to a new era in public health – “an era where our built environment is seen not just as a collection of structures but as critical infrastructure for wellbeing”.

Asthma, for example, is the leading chronic disease in children and a leading reason for absence from school. Kenneth Mendez, president and chief executive of the Asthma and Allergy Foundation of America, said: “Poor indoor air quality in school buildings is harmful to children – increasing sickness and resulting in missed learning time. It’s imperative that policymakers make indoor air quality in schools and other buildings a priority.”

Echoing Mendez, Harold Wimmer, president and chief executive of the American Lung Association, said: “The quality of air in the home can influence the health of its occupants and the healthfulness of air at school affects how children learn and develop. Poor indoor air quality can impact anyone, but children, older adults and people living with lung disease are at a higher risk of harm and require extra protection.”

William Potts-Datema, DrPH, interim chief executive of the Society for Public Health Education, observed that buildings are “vital determinants” of health and “an important strand in the intricate web of social factors influencing wellbeing”.

He concluded: “Recognising this, it becomes clear that our building policies should better prioritise health in building design and operations, particularly in places serving our most vulnerable, such as schools and hospitals. Let’s build for health, for now and the future.”