As the third-largest asset class in the U.S. behind stocks and bonds, real estate is a cornerstone of a vibrant economy. By some estimates, the domestic commercial real estate (CRE) industry has a market value well over $1 trillion. Yet our streets feel empty, storefronts look vacant, and offices feel abandoned. The COVID-19 pandemic functioned as an accelerant for hybrid and remote workplace trends and now employers are searching for ways to entice people to come back to the office and investors are looking for a competitive edge.

A recent survey of a range of enterprises with approximately $5.75 trillion in total global assets under management revealed an “extensive” post-pandemic spike in demand for healthy buildings. A staggering 89 percent of respondents described the current demand for healthy buildings as either “moderate” or “strong.” Data also indicated that healthy building yielded a 4.4 to 7 percent increase in rental premiums.

This demand is not new. Data was emerging before the pandemic. What we are witnessing today is a post-pandemic spike in personnel demand for healthy buildings in commercial real estate. If one considers the 30-year lifecycle costs of a stand-alone commercial office building, personnel costs significantly outweigh other building and operational costs at approximately 92 percent of the total. By comparison, the initial building design and construction costs accounted for about 2 percent of the total investment; while operations and maintenance costs amounted for approximately 6 percent.

But where does one start? How do we define “healthy buildings”?

Let us examine health and wellness in the built environments from three aspects: Healthy Buildings, Active Design, and Biophilic Patterns.

What makes a building “healthy”? This has become a complicated topic as “health” is a relative concept that can take on many definitions.

In the interest of simplicity, nine concepts are offered below. This list was derived from the work of Joseph G. Allen and a research team at the Harvard T.H. Chan School of Public Health, who distilled decades of research on key determinants of health in our buildings down to a shortlist referred to as The 9 Foundations of a Healthy Building.

Increased ventilation is cheap and it matters. Run the fans, get fresh air, and filter it. Current ventilation standards are specified by ASHRAE at about 20 cubic feet per minute of air per person (cfm/person) as a bare minimum. However, research has clearly shown benefits to occupants at 40 cfm/person. The Harvard COGfx Study revealed increased ventilation brought significant benefits in cognitive ability.First and foremost, “turn off the spigot” by finding and controlling indoor pollution sources.

Specify low-emitting products and materials. This is where air filtration, green cleaning agents, low-VOC paint selections, and formaldehyde-free products come into play. This is not an all-or-nothing proposition. Every little bit helps.

Test the air. Measure what is actually present. Real-time monitoring should be supplemented with targeted sampling on at least an annual basis.

Thermal comfort is a matter of health as it is directly tied to physiology. Consider the impact of changing air temperature. A recent study showed that every 2 degree Fahrenheit variation from the optimal temperature, there was a 1 percent reduction in throughput cognitive performance. Another study found a 10 percent relative reduction in performance when the air temperature fell out of the optimal thermal range. Research has also demonstrated that a 2 percent productivity boost from better thermal health could lead to 9 percent in bottom-line gains – after accounting for the energy premium for increased ventilation and paying a premium on rent.Staying hydrated is one of the keys to good health. The National Primary Drinking Water Regulations set maximum levels for various contaminants. However, once water passes the building meter, all bets are off and other localized threats may come into play, such as Legionella and lead contamination. Managing the pH level of water in the building is critical. That reverse osmosis filter at each drinking water source is not a bad idea. Moisture management essentially boils down to four recommendations:

• Prevent moisture intrusion through proper building enclosure design and detailing – watch those transitions
• Detect moisture intrusion early through regular inspection
• Fix the damage quickly once it is identified
• Clean it – letting it dry out is often not enough

Relative humidity also matters. Too much can foster mold and fungus growth, too little can increase ozone production and harbor certain viruses.

Indoor dust is a chemical and biological reservoir. Moreover, dust can get into our bodies in three ways: through the air, through our skin, or through incidental ingestion.

Want a healthy building? Reduce dust. Prompt users to wash hands frequently, clean floors regularly with a HEPA vacuum, clean surfaces regularly, and do what you can to mitigate or control sources of animal allergens.

Prolonged exposure related to noise has been linked with hearing damage. However, the quality of an acoustic environmental has also been linked with cognitive performance and health.

Solutions for healthier acoustic environments begin with a thoughtful definition of noise criteria per type of space. Next, address sound transmission from one zone to another. Then, fine-tune the building materials used in a space in recognition of which surfaces should absorb sound or reflect it. Finally, there are technological solutions in terms of sound cancellation or masking.

Light is one of the main drivers of circadian rhythms – that is, our internal biological clock that keeps the body's hormones and processes on a diurnal cycle, even in continuous darkness. When the human body receives any kind of light, the brain is stimulated and regulates physiological rhythms throughout the body's tissues and organs, impacting hormone levels and the sleep-wake cycle.

Recommendations for healthy illumination begin with defining and designing for illuminance requirements. Maximize access to full-spectrum daylight. Focus lighting design on intensity, spectrum, and the timing of lighting exposure.

Human beings have a biological “fight or flight” response that can alter our physical and psychological functioning. Healthy Buildings identifies our natural “wall-hugging” tendencies in navigating space. They also identify the unique challenge of promoting “secure flow” in our structures in which people, goods, and networks can move freely and securely.

Since the end of WWII, the prevalence of chronic disease has steadily rose to become the dominant cause of illness in the U.S.

One of the greatest drivers of chronic disease is our sedentary lifestyle. According to John Hopkins Medicine, our inactivity is leading to a variety of chronic health concerns, including high blood pressure, increased risk of type 2 diabetes, feelings of anxiety and depression, and obesity. The World Health Organization (WHO) reports that less than a quarter of adults get a sufficient amount of exercise on a regular basis.

What if our buildings could help change this?

“Active design” refers to a set of building and planning principles that promote physical activity. There are strategies for a variety of scales; however, building strategies may include appealing stair environments; supportive walking routes; and facilities that support exercise.

While mental and physical health are often addressed as separate domains, we know our minds and bodies are inextricably connected. How we feel about our spaces matter.

Healthy buildings must be beautiful buildings.

It has been nearly 40 years since Harvard biologist Edward O. Wilson, Ph.D., first published his seminal book, Biophilia. According to Wilson, humans have a genetically-based relationship to the dynamic sensory effects of nature.

Over the past century, our highly-engineered structures have cultivated a standard for tightly-controlled, mechanically-based systems for lighting ventilation, heating, and cooling. We cut off our access to nature; yet studies have shown that access to nature can alleviate feelings of stress and induce positive cardiac deceleration as well as beneficial physiological arousal.

Biophilic patterns offer potential economic advantages as well.

Again, it is not all-of-nothing. Even a few contributory biophilic patterns will compliment healthy buildings with active design features to collectively enhance the wellbeing of building occupants by offering opportunities for delight.