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Buildings, health, and well-being: new research and practice
intersections
B u i l d i n g s , h e a l t h , a n d w e l l - b e i n g : n e w
r e s e a r c h a n d p r a c t i c e i n t e r s e c t i o n s
I R C - O R A L - 8 4 8
V e i t c h , J . A .
A version of this document is published in / Une version de ce document se trouve dans: Presented at the University of Ottawa Institute of Mental Health Research, Ottawa, ON., Feb. 1, 2008, pp. 1-26
The material in this document is covered by the provisions of the Copyright Act, by Canadian laws, policies, regulations and international agreements. Such provisions serve to identify the information source and, in specific instances, to prohibit reproduction of materials without written permission. For more information visit http://laws.justice.gc.ca/en/showtdm/cs/C-42
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1
Buildings, Health, and Well-being:
New Research and Practice Intersections
Jennifer A. Veitch, Ph.D.
Abstract:
Canadians, like others in the industrialized world, spend approximately 90% of their time indoors, making these environmental conditions important determinants of our health and well-being. For instance, noise exposure in the home and classroom adversely affects children’s’ acquisition of reading skills; noise exposure at work can contribute to the development of cardiovascular disease. A growing literature on exposure to daylight and nature views shows benefits for these conditions in reducing strain and improving healing following surgery. These findings have had limited influence on building design, construction, and operation, in part because of limited interaction between the relevant disciplines. Success in understanding how our built environment affects our health demands such interdisciplinary work; success in improving our living conditions demands further co-operation with designers, builders, and policy-makers. This presentation will briefly summarize current research, and make the case for an urgent need for broadly-based interdisciplinary research to provide a basis for practical interventions.
Presented at the University of Ottawa Institute of Mental Health Research, Ottawa, ON, Friday Feb. 1, 2008. (Part of the "First Fridays" lecture series there.
Learning Objectives:
•An awareness of research findings indicating that physical environments affect health and well-being. •An awareness of challenges facing investigations into these interdisciplinary problems.
•An awareness of avenues available for researchers to transfer research into application and practice
2
Overview
• Introduction to NRC
• Health effects of indoor conditions
• Interdisciplinary research
• Avenues for application
I find that many people are not familiar with NRC so I will start with a few slides about us and my institute within NRC.
3
3
National Research
Council Canada
• Developing and transferring knowledge to support innovation
and commercialization
– 24 research institutes & programs – 1 institute for construction sector – ~4000 employees across Canada
• Network of technology advisors to
support small business
– 260 industrial technology advisors in 90 communities – over $125 M in support each year
http://www.nrc-cnrc.gc.ca/main_e.html http://www.nrc-cnrc.gc.ca/main_f.html
4
NRC Institute for
Research in
Construction
(NRC-IRC)
• Established 1947
• Guided by industry advisory board & 2 independent
commissions
• Facilities in Ottawa, Arnprior,
London, Regina
• ~$30 million annual budget
• ~250 employees
+ ~15-20 visiting workers
http://irc.nrc-cnrc.gc.ca/index_e.html http://irc.nrc-cnrc.gc.ca/index_f.html
5
5
NRC-IRC Activities
• Research to address industry and government
priorities:
– Durability – Sustainability – Safety
– Health and well-being
• Support for building
regulatory system
• Evaluation of innovative
construction
products
Producing:
Technical knowledge - journal and conference papers Decision tools - software and design guidance Technology - patents and licenses
6
NRC-IRC Research –
Well-being
Research into health is centered in the Indoor Environment Research Program, which has three sub-programs. The subprogram staff also work together on multidisciplinary
consortium projects.
Ventilation and Indoor Air Quality:
e.g., Managing emissions of VOC’s - Material Emissions Chamber - used in the creation of Material Emissions Database and Software (IAQuest)
- database provides list of materials with their properties
- software developed to model the IAQ in a specific area (using parameters from the database)
Acoustics:
Anechoic Chamber- used in speech intelligibility tests, part of work on speech security and classroom acoustics
Lighting:
- Lighting quality and individual control over lighting - lab and field experiments
- Design tools: Daysim, Daylight 1-2-3, Skyvision
Consortium projects:
e.g., Cost-effective open plan environments (COPE)
IRC studied the impact of various design factors-lighting, acoustics (speech privacy), and ventilation and thermal conditions-on occupant satisfaction in open-plan offices. We used our Indoor Environment Research Facility for behavioural and engineering experiments, as well as a large field study of 779 workstations in 9 buildings in 5 cities (and other IRC lab facilities).
7
7
Health Defined
• World Health Organization definition of health:
– “…a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”
We firmly define health according to the WHO definition, in our own research and in the review that follows.
This definition of health dates from 1948, and provides the basis of the WHO mandate. Although some have argued that it's too broad, it has the merit of being both negative (not a disease state) and positive (a state of complete fitness and content).
Well-being: "A good or satisfactory condition of existence." (Random House)
OED: a. The state of being or doing well in life; happy, healthy, or prosperous condition; moral or physical welfare (of a person or community).
8
Buildings and Health
— Media
• Study Links Air Pollutants with Autism: Bay Area children with
the disorder are 50% likelier to be from areas high in several
toxic substances
– LA Times, Jun 23, 2006
• A 'Silent Pandemic' Of Brain Disorders: Researchers Say
Chemical Exposures May Explain Rise in Autism And ADHD
– CBS News, Nov. 7, 2006
• Home reno may reduce asthma
(
http://www.theglobeandmail.com/servlet/story/RTGAM.200801
15.wlasthma15/BNStory/specialScienceandHealth/
)
– The Globe and Mail, January 15, 2008
You may be familiar with articles like these. There have been several over recent years; they occur in newspapers and magazines every few months. An interesting feature of them is that they often report the results of individual investigations, some while they are in the preprint stage and others after publication. Of course, there's rarely an opportunity in a short news article to place the results in the context of the wider literature.
These articles tell us three things: there is research going on; there are some possible connections between exposures to indoor conditions and health; and, there is public interest in knowing about it.
I will touch on selected areas of research interest. This is not exhaustive by any means, but will give you an idea of what areas are active. The notes will give an extensive reference list for those who wish to follow up.
9
9
Sources of
Building-Related Exposures
• Site: external conditions (e.g., pollution, noise, drainage)
• Construction details:
– Building envelope - tightness, moisture control – Ventilation
– Interactions with site conditions
• Emissions from building materials and contents, including
cleaning products
• Interior design (e.g., colour & texture of finishes; layout)
• Maintenance & operation (e.g., blinds use vs. daylight
availability)
Everything from where the building is located through how it is constructed to how it is maintained and operated influences the conditions to which we are exposed. These series of choices and actions interact, too, for example:
- The construction details (how the structure is put together) and the external noise together influence the acoustic conditions inside.
- The colour of interior walls influences how much light exposure occupants receive, whether from daylight or electric light. A dark wall absorbs light.
- People tend to close the blinds when the direct sun is bothersome; but they tend not to open them again later in the day even after the sun has moved on. Thus, they can get less benefit from daylight or a view of outdoors than the building design might provide.
10
Noise
• Classic environmental psychology and recent updates
• Transportation noise in buildings (aircraft, trains, traffic)…
– reduces memory in children (Hygge et al., 2002)
– interferes with reading acquisition by children (Bronzaft & McCarthy, 1975)
– induces physiological stress responses in children (Evans et al., 1995)
• Effects are reversible …
– noise attenuation resolved reading problems (Bronzaft, 1981) – end of chronic exposure reversed effects (Hygge et al., 2002)
Noise exposure has been the focus of research attention for nearly forty years, since the classic work by Glass and Singer (1972). Several studies have documented adverse effects of chronic noise exposure on children, including disrupted reading
acquisition (Bronzaft & McCarthy, 1975; Evans & Maxwell, 1997; Maxwell & Evans, 2000), memory impairment (Hygge, Evans, & Bullinger, 2002), and physiological stress responses (Evans, Hygge, & Bullinger, 1995).
Fortunately, these effects appear to be reversible: The introduction of noise attenuation strategies resolved reading problems in elementary school children (Bronzaft, 1981), and the end of chronic noise exposure (because of the closing of a nearby airport) reversed the adverse effects on memory (Hygge et al., 2002). There is mounting evidence that chronic noise exposure has adverse effects on cardiovascular health (e.g., Ising & Kruppa, 2004), leading the WHO to formulate guidelines for urban noise levels (WHO Regional Office for Europe, 2007). Reviews by Evans (2006) and Ising and Braun (2000) can provide additional information.
11
11
Nature
• Views of nature are restorative:
– Nature view (vs. brick wall) in hospital reduced post-surgical stay and decreased pain medication use (Ulrich, 1984) – Viewing images of nature led to faster recovery from stress
(Ulrich et al., 1991)
– View of nature increased housing satisfaction and well-being (Kaplan, 2001)
In parallel to understanding environmental stressors and their health consequences, researchers have sought to understand conditions that assist in restoration (e.g., Kaplan & Kaplan, 1989). Natural settings are particularly associated with restoration: Ulrich (1984) found that hospital patients in rooms with windows that looked onto a nature view recovered more quickly from surgery than those with windows overlooking a brick wall. Further investigation has found that images of nature are more restorative than images of urban settings (Ulrich, Simons, Losito, Fiorito et al., 1991), that time spent in nature is more restorative than time spent in built settings (Hartig, Mang, & Evans, 1991), and that natural settings are more likely than built settings to be named by students as favourite places (Korpela, Hartig, Kaiser, & Fuhrer, 2001). Homes with views of nature from their windows, as opposed to views of other buildings or urban scenes, have been associated with greater resident well-being (Kaplan, 2001), and children’s’ cognitive function and ability to cope with stressful life experiences are improved by having access to green space near their homes (Wells, 2000; Wells & Evans, 2003). Stephen Kaplan’s Attention Restoration Theory (1995, 2001) is a framework for understanding the beneficial effects of restorative environments that takes into account both cognitive and physiological outcomes.
12
Nature
• Children's access to / playing in natural settings…
– Reduced ADHD symptoms (Kuo & Taylor, 2004) – Improved cognitive functioning in children (Wells, 2000) – Reduced life stress in children (Wells & Evans, 2003)
13
13
Light Exposure
• Daily light exposures are low:
– San Diego study, Aug/Sept- median person 40-64 yrs
• 4% of each day > 1000 lx
• 50%+ between 0.1 lx and 100 lx (Espiritu et al., 1994)
– Latitude comparison, daily time > 1000 lx:
Summer Winter
Montreal, QC (45°N) 2 h 36 m 24 m Rochester, MN (44°N) 2 h 23 m 23 m San Diego, CA (33°N) 2 h 10 m 1 h 20 m
Sources: Cole et al., 1995; Hebert et al., 1998.
The role of light as an influence on health is the hot new topic in lighting research, marked by three international symposia (CIE, 2004b; CIE, 2006; McGowan, 2004). Some writers are enthusiastic about the possibilities for immediate changes to lighting design and practice (Bommel & Beld, 2004; Bommel, 2005). Others are more circumspect, recommending more thorough investigation (Boyce, 2006; DiLaura, 2005; Veitch, 2005; Veitch, 2006).
In addition to the visual pathway, there exists a separate sensory system in the retina that transduces information about light and dark, with afferents leading, among other brain structures, to the suprachiasmatic nucleus of the hypothalamus and from there to the pineal gland (Commission Internationale de l'Eclairage (CIE), 2004a). The connection to the pineal gland is important for the regulation of the hormone melatonin, which regulates many circadian rhythms (CIE, 2004a). Research into melatonin and circadian rhythms has led to the development of light treatments to assist in shift work adjustment and to treat sleep disorders (CIE, 2004a).
Separate lines of research suggest that people in industrialized countries may not
experience sufficient daily light exposure for optimal health (Espiritu et al., 1994; Jean-Louis, Kripke, Cohen, Zizi, & Wolintz, 2005).
14
Light Exposure
• Low daily light exposure correlates with more depressed mood
(Espiritu et al., 1994)
• Bright light exposure tended to reduce quarrelsome behaviours,
increase the incidence of agreeable behaviours, and improve
mood, in a sample of Montreal adults (aan het Rot et al., 2007)
• Exercising under brighter gym lighting improved feelings of
vitality and good mood (e.g., Partonen et al., 1998)
• Sunny hospital rooms reduced mortality (cardiac ICU) and
shortened stay for depression (psychiatric ward) (Beauchemin
& Hays, 1996, 1998)
Small increases in light exposure have been found to improve feelings of vitality in healthy people (Leppämäki, Partonen, & Lönnqvist, 2002; Partonen, Leppämäki, Hurme, & Lönnqvist, 1998; Partonen & Lönnqvist, 2000). Being in a sunny hospital room has been associated with lower mortality rates among cardiac patients (Beauchemin & Hays, 1998) and with faster symptom remission for depressive patients (Beauchemin & Hays, 1996). Leather, Pyrgas, Beale, and Lawrence (1998) found that greater sunlight penetration into an office was associated with better general well-being, and to better job satisfaction and lower intention to quit.
Beauchemin and Hays, researchers in Edmonton, conducted two investigations of the effects of sun exposure in hospital rooms on patient outcomes. Overall mortality was higher for cardiovascular intensive care unit patients in a dull space than in a sunny space; for women, the time to discharge was shorter if they had been in a sunny space (Beauchemin & Hays, 1996). For patients hospitalized for depression, the hospital stay was 15% shorter if their rooms were sunny that if they lacked sunlight (Beauchemin & Hays, 1998).
15
15
Chemical Exposures
• Well established risks: lead and mercury exposure cause
developmental disabilities and cognitive malfunctions
• More contentious questions:
– ADHD – Autism – chromium
– endocrine disruptors (e.g., phalates)
– polybrominated diphenyl ether (PBDE), a flame retardant
The adverse effects of childhood exposure to lead and mercury — developmental disabilities and cognitive malfunctions —are well-known (Graff, Murphy, Ekvall, & Gagnon, 2006; Grandjean & Landrigan, 2006; Mendola, Selevan, Gutter, & Rice, 2002), and this knowledge has led to policy changes aimed at limiting exposure, such as the banning of lead additives in gasoline and interior paints and recommendations for expectant mothers to limit fish consumption as a means to avoid excessive prenatal methylmercury exposure. Many other chemicals remain unregulated because, despite suspicion that they may cause neurotoxic effects, the evidence is not strong enough to convince policy-makers (Grandjean & Landrigan, 2006). Moreover, environmental exposures occur simultaneously to many chemicals at once, rather than to the single compounds that are the focus of most investigations, and the consequences of the combinations are unknown (Bellinger, 2007).
Some authors believe that exposure to certain compounds contributes to the development of attention deficit hyperactivity disorder and autism (Colborn, 2004; Windham, Zhang, Gunier, Croen, & Grether, 2006), although others disagree (Fitzpatrick, 2007). Compounds currently under scrutiny are used in household items and in building materials, and include various chemicals used in plastics (e.g., phalates, bisphenol A), flame retardants (e.g., polybrominated diphenyl ether (PBDE)), pigments used in paints (e.g., cadmium, chromium), and pesticides.
Children from poor families are disproportionally likely to be exposed to neurotoxins (Evans, 2004; Evans & Kantrowitz, 2002). Ongoing research into these issues recognizes these broad contextual environmental issues, as well as genetic, chemical, and biological variables that are potential moderators (Dietrich et al., 2005; Hertz-Picciotto et al., 2006).
16
Housing Quality
• Physical qualities of housing (objective rater) influence mental
health
– Improving housing quality improved mothers' mental health (Evans et al., 2000)
– Housing quality predicted children's socioemotional health, independent of SES (Gifford & Lacombe 2006)
• Poverty increases likelihood of multiple stressor exposure
• Cumulative risk factors predict physiological stress responses
and emotional regulation in children (Evans & English, 2002).
Both cross-sectional and longitudinal studies have found that objectively assessed housing quality influences mental health. Evans, Wells, Chan, and Saltzman (2000) developed and validated an objective housing quality rating scale. In a prospective longitudinal study, they found that improvements to housing quality reduced mothers’ psychological distress; in a cross-sectional sample, housing quality predicted mothers’ mental health after controlling for income. Gifford and Lacombe (2006) studied two
Canadian samples (one in Quebec and one in British Columbia) using an adaptation of the Evans et al. housing quality scale, and found that the quality of the home's interior, exterior, and neighbourhood predicted children’s’ socioemotional health as rated by their parents, after controlling for parental income, parental education, parental mental health status, the child's sex, and the family's tenure in the house. Evans, Wells, and Moch (2003) reviewed the literature on housing and mental health and provided an excellent methodological critique of issues in this area.
Although the demonstration that housing quality influences health
independently of socioeconomic status (SES) is compelling, the use of statistical controls for SES can obscure an important relationship (Evans, 2004). Children of low socioeconomic status are more likely to experience various physical and social environmental stressors (Evans & Kantrowitz, 2002). Moreover, children’s' cumulative exposures to potential stressors predict physiological stress responses, emotional regulation, heightened
cardiovascular and neuroendocrine parameters, increased deposition of body fat, and result in a higher summary index of total allostatic load (Evans, 2003; Evans & English, 2002). Thus, SES and income ought not to be considered mysterious confounds, but as explanatory variables in their own right (Evans, 2004).
17
17
Research Quality
• Extensive physical measurements are comparatively rare
• Fewer still in combination with good physiological or
behavioural measures
• Fewer still test mediated or moderated models
In most of the areas I've discussed there are some problems of research design. Chief among them is the absence of extensive physical measurements combined with extensive health or behavioural measurements in a strong research design. Our ability to understand the underlying mechanisms is weakened by this.
18
Multi-disciplinary
Problems
• Building Physics (physics, architecture, engineering: structural,
mechanical, civil, electrical, ….)
• Chemistry (analytical, organic, physical)
• Biology (physiology, mycology)
• Medicine (inc. toxicology, epidemiology, industrial hygiene)
• Acoustics
• Psychology (environmental, cognitive, developmental, health,
clinical, ….)
• Mathematics (modelling)
A large part of the problem is the inherently multidisciplinary nature of the problems. The work I've cited today encompasses all of these fields. As any of you who have tried it can attest, it is difficult to assemble teams of people from different scientific disciplines. We all have different approaches to science, different languages to talk about it, and barriers to working with others (including our own egos).
19 19
Integrated Models
noise exposure social support strain symptoms communication SES external environment building designAnd yet, to get to the point of being able to DO anything about any building-related exposures, we need just such multi-disciplinary teams. We need to be able to test models like the one shown here. The black areas are fairly well-supported relationships drawn from social and health psychology. The blue areas are where building scientists come in: and the links from noise exposure to communication and strain are the interface between the two. If we could engage the building scientists and the psychologists and medical community to work together, we could understand the relationships with sufficient specificity to describe specific changes to building design and construction, or to make recommendations about controlling or abating community noise, that would reduce the noise exposure sufficiently to avoid any adverse effects.
20
Integrated Models
• Levels of analysis
– Ecological approach, include sociological, demographic, neighbourhood, city as well as individual data
– Nested designs
– Genetic vs. environmental causes – Behavioural interactions
• Specific — relationships need to lead to specific applications,
whether program/policy development or design/building
The models we need to develop need to have several levels of analysis and to incorporate these levels correctly into the research designs. In some of these areas, engineers are trying to do this kind of research but they don't have the research design skills to grapple with nested designs (e.g., children in classrooms in schools in cities). Equally, medical and psychological researchers don't know how to characterize the physical environment nor how they might influence it.
21 21
Influencing Building
Practice
• Codes (
http://www.nationalcodes.ca
)
• Standards (
http://www.scc.ca/
)
• Regulations (
http://www.regulation.gc.ca/
)
• Design guidance (e.g.,
http://www.researchdesignconnections.com
,
http://irc.nrc-cnrc.gc.ca/ie/cope/index_e.html
,
http://daylight1-2-3.com/
)
• Design education (e.g., CE seminars, university educators)
If we did have such models, how could we - as researchers - influence building practice? 1. Canada's National Building Codes, published by NRC for the Canadian Commission on Building and Fire Codes
NRC is an objective-based code, which aims to achieve safety, health, accessibility, fire & structural protection
Anyone may propose a code change.
Changes also undergo public review
Codes if adopted by appropriate legislative body (e.g., province) have force of law. 2. Standards, developed by independent bodies, define safety requirements, performance requirements, social or environmental concerns. These have force when referenced in legislation.
3. Regulations, developed by government agencies www.regulation.gc.ca, are made under authority of legislation. They define the application and enforcement of the issue identified in the legislation. Agencies have mechanisms for public comment & involvement.
4. Design guidelines - written by professional associations, industry groups, interested experts (including people like me).
5. Design education - get them while they're young - change how they think about buildings. Why do this? It's probably not part of your tenure or promotion criteria. The answer is, because it's your responsibility, once the knowledge base is strong enough, to take appropriate action to see the condition changed. If you don't, it won't happen - or it will happen in the wrong way, with the wrong emphasis, or without considering other interactions.
22
Involvement Invitation
• Canadian Building & Health Sciences Network
– A multi-disciplinary organization that will
• share information
• foster interdisciplinary collaboration
• improve the health of Canadians through innovations in the design, construction, operation, and maintenance of the built environment
http:/ /irc.nrc-cnrc.gc.ca/health/cbhsn_e.html
http:// irc.nrc-cnrc.gc.ca/health/cbhsn_f.html
If this presentation has piqued your interest and you would like to become connected to other researcher with interests in this area, please consider signing up to the Canadian Building and Health Sciences Network. It's free. My institute, together with assistance from the Canadian Institute of Health Research, Canada Mortgage & Housing Corp., and Health Canada, has initiated this effort to bring together Canadian researchers in the various disciplines, to try to improve co-ordination and knowledge-sharing, to stimulate research and to attempt to move forward to application.
23
23
Conclusions
• Environmental conditions in buildings influence health and
well-being
• Complete understanding requires true interdisciplinary research
• Research results don't end our responsibilities
24
Contact Information
Jennifer A. Veitch, Ph.D.
NRC Institute for Research in Construction (NRC-IRC)
National Research Council Canada
Building M-24, 1200 Montreal Road
Ottawa, ON K1A 0R6 Canada
tel. +1-613-993-9671 / fax +1-613-954-3733
e-mail: jennifer.veitch@nrc-cnrc.gc.ca
http://irc.nrc-cnrc.gc.ca/ie/index_e.html
http://irc.nrc-cnrc.gc.ca/ie/index_f./html
Biography: Dr. Veitch is a Senior Research Officer in the NRC Institute for Research in Construction’s Indoor Environment Program, where she leads research into lighting effects on health. She has been actively involved in environmental psychology and lighting research since 1985 and joined NRC in 1992, after completing her Ph.D. in psychology at the University of Victoria. She's best known for her research on lighting quality, which has influenced lighting design recommendations in North America, and more recently for research into
environmental and job satisfaction in open-plan offices. She is active in several professional associations and is a Fellow of the Canadian Psychological Association, the American Psychological Association, and the Illuminating Engineering Society of North America.
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