`CHAPTER ELEVEN`

`What’s Now and What’s Next?`

The future is already here–it’s just not evenly distributed yet.

—WILLIAM GIBSON

THE GLOBAL REAL ESTATE and building industry is large and fragmented, and its levels of sophistication are not consistent. The quality of indoor—and outdoor—air also varies quite a bit around the world. The rise of cheap, ubiquitous, connected sensors; the ability of those sensors to talk to each other and share historical and predictive data; and growing individual attention to the details of health augur significant adjustments in who has knowledge about indoor air quality, and what they will choose to do with that knowledge.

Ultimately, we are interested in how to accelerate an industry transformation that is already under way. In this chapter we will present a vision for how to hasten the spread of these ideas and suggest how they might manifest next. We will, in other words, consider “what’s now” and “what’s next.”

`What’s Now? Adoption Curves, Industry Composition, and Clockspeed`

The current Healthy Building movement may feel like a race that’s only open to elite companies and well-heeled landlords. In some ways, that’s the present state of play. Much of the leading action takes place in cities like Paris, New York, Hong Kong, London, San Francisco, Shanghai, and Singapore. There, best-in-class participants in the real estate industry are thinking hard about how to further differentiate their businesses and their spaces, and how to address the apparent future concerns of occupants who will have plenty of access to information.

We are professionally engaged with some of the leading companies in the Healthy Buildings movement, but when we tell people that we are collaborating with leading real estate developers in Manhattan, or that we worked with Google on a healthier materials strategy for buildings and consulted with Pfizer on its new planned headquarters in Hudson Yards, we can feel the proverbial eye roll. These companies are unusual; they have the vision and ambition to pursue endeavors like these—and they have the resources to pull it off. So when we talk about their success, others don’t necessarily see themselves or their companies in those stories.

We hope we’ve shown you that the benefits of Healthy Buildings aren’t limited to the elite. This is why we intentionally made our hypothetical Health & Wealth Inc. a small, 40-person company in a 10,000 sq. ft. building. It was intended to reflect the vast majority of companies and buildings, which don’t have the purchasing power and research capabilities of a Pfizer or a Google.

Interestingly, this first group to enter the Healthy Buildings movement is doing so in cities that are not experiencing fast demographic growth. The total number of buildings in New York, Paris, and San Francisco increases so slowly that each new crane on the horizon is a big deal. The Healthy Building movement in places like these will have some limited focus on new construction, but the biggest opportunity is in the existing building space. Here we need to look beyond the initial category of first-mover participants in the building industry who already pursue investments and actions leading to certifications from LEED and WELL.

In other places in the world, demographic growth is rapid and the focus is on new development. In much of the developing world, housing, offices, government buildings, schools, and hospitals are going up quickly and in large quantities. The installed base is small, so there are not a lot of older buildings worth renovating. Buildings in many fast-growth locations may also be in poorer countries, with less wealthy landlords, where one can see that the outside air is palpably bad before even using instruments to measure anything. This might be Mumbai or Mexico City or Lagos or Chongqing.

Both settings—cities with established building stock and cities where new construction will dominate—feature connected people, largely young, who are well informed and who care a lot about their health and that of their children. There is opportunity everywhere to deliver cleaner air and healthier buildings, regardless of the starting conditions. Moving the needle may require a shift in how we think about these issues. Much as it is now accepted that “outdoor air” is a public good, a status that has helped raise attention to this issue globally, the World Health Organization has declared “healthy indoor air” a fundamental human right. This signaling is important.

What will it take for the means and methods in this book to propagate throughout the industry? Our research indicates that there are three factors to consider: diffusion of innovation, characteristics of real estate and construction, and life span of the assets. We express these as the Healthy Building adoption curve, industry composition, and clockspeed.

`Healthy Building Adoption Curve: Knowledge Generators, Early Adopters, and Leading Markets`

The Rogers Adoption Curve is a theory that was developed at Iowa State University in the 1950s to map out how farmers took up new ideas and techniques in agriculture.¹ The concept has been used again and again, notably by Geoffrey Moore of the Chasm Group at the birth of the internet era in his seminal marketing guide Crossing the Chasm and by Clayton Christensen as one of the foundations of his enormously influential strategy book The Innovator’s Dilemma.² The basic idea is that the uptake of innovations flows from innovators, to early adopters, to an early majority of users, to a late majority, and finally to laggards. Together these customers represent 100 percent of the market.

To use this concept to predict (and influence) the adoption of innovations in the broader building industry, we have developed a Healthy Building adoption curve. To see how progress can be made from a race for the elites (the early adopters) to “all buildings everywhere” (the broad majority), it’s worth considering where we are on this curve. The good news is that we’re making progress, with Healthy Building strategies being adopted in leading markets. The bad news is that we are in the steepest part of the climb. Before we go into what will be needed to get us to the top, let’s take a look at the first part of this adoption curve.

`FIGURE 11.1 Healthy Building Adoption Curve.`

`Knowledge Generators`

Movements usually start with knowledge generators, mostly from business or academia, who invent new tools or come up with new techniques. Moving from the lab to practice, a handful of inquisitive early adopters seek out, test, and deploy new knowledge or equipment.

Readers new to the topic might suppose that the key knowledge generators are the relatively new building certification systems that we mentioned in Chapter 8; the Healthy Buildings movement is relatively young, so for many people their first introduction to this topic might have come from thoughtful promoters like WELL and Fitwel. But the history is much deeper, and we think it’s important to recognize the true early pioneers—the initial knowledge generators—in the Healthy Building space. These were the early “healthy worker” researchers of the early 1900s, who were then succeeded by researchers who started the field of “indoor air” beginning in the 1960s and 1970s.

Today’s Healthy Building researchers stand on the shoulders of giants who came before. These are not the high-profile science giants who are household names like Isaac Newton or Marie Curie, but their names should be immortalized just the same. The giant of giants was “Harvard’s first lady,” Alice Hamilton. Hamilton was the first woman from any field appointed to the faculty of Harvard University, and she advanced the field of worker health (then called “industrial medicine”), memorialized in her book Exploring the Dangerous Trades, first published in 1943.³ Hamilton studied the work environment of the Industrial Revolution, but her focus, methods, and findings still hold sway today, 100 years after her appointment.

The field of worker health was largely constrained to clinical medicine and industrial sites for much of the twentieth century, until the birth of the environmental movement in the 1970s. This spurred the creation of the Environmental Protection Agency and the Occupational Safety and Health Administration, the latter of which was the first major effort in the United States to codify and enforce worker protections. And while many Occupational Safety and Health Administration exposure limits were focused on industrial and manufacturing environments, this attention paved the way for other worker-health-focused research and entities.

Also at about this time, some scientific researchers began peeling away from the study of outdoor pollutants to focus on the indoor environment. Ole Fanger was a venerated researcher who gave us our first thermal health targets for offices and other environments. (They are still in use today.) Others, like Joe’s mentor Jack Spengler and a handful of additional researchers across the globe, including Jan Sundell at the Karolinska Institute in Sweden and the Danish Technical University, Lance Wallace at the Environmental Protection Agency, and Bill Fisk at Lawrence Berkeley National Laboratory, started turning their queries toward indoor environments, too. They were some of the first to tell us about the potential harms of secondhand smoke, volatile organic compounds (VOCs) off-gassing from products in homes, low-level lead exposure and its impacts on kids’ IQ, and the hidden hazards of mold, radon, and unvented combustion sources in homes. This era also produced early research not just on the hazards of bad air and sick buildings but also on the benefits of better building strategies, notably how bringing in more fresh air can reduce sick building symptoms and how air purifiers can be an effective tool for controlling indoor particle levels.

These “indoor air” giants then opened the door for another cohort of scientists studying indoor air. Contemporary researchers like Heather Stapleton at Duke University are moving us past “Indoor Air Quality 101” and telling us about the less obvious chemicals in our indoor environment—those that seep quietly out of building materials and out of our rugs, curtains, chairs, and mattresses and stealthily begin wreaking havoc on our hormones and other bodily systems in ways we can’t immediately see. Others, such as Frederica Perera at Columbia University and Tracey Woodruff at the University of California, San Francisco, focus on children’s and women’s health indoors. Others in academia and industry are using new tools to expand our understanding of the reactions that take place on surfaces in our buildings (and on the skin of people in those buildings)—the field of study called indoor chemistry.⁴ Recently, more researchers are using new metagenomics tools to explore the role of biological organisms in and around us—a new field of study called the microbiome of the built environment.

On the nanoscale side of things, our Harvard colleague Philip Demokritou studies engineered nanomaterials currently in and on products throughout our buildings. They are hard to track because disclosures are not required. We don’t currently know very much about these nanoparticles when it comes to potential human health impacts, but research in Demokritou’s lab led by Dilpreet Singh showed that when certain nano-enabled products are disposed of and incinerated, they catalyze the formation of toxic polycyclic aromatic hydrocarbons.⁵ A collaboration between researchers in France and China found that photocatalytic paints in buildings that use titanium dioxide nanoparticles may also generate and release formaldehyde indoors.⁶ Nanotechnology also holds the potential for benefit, and Demokritou is working on a “nature-inspired antimicrobial” using engineered water nanostructures.⁷ These fields are moving quickly, and these are just some of the knowledge generators whose contributions will be incorporated into Healthy Building strategies in the next 5 to 10 years.

During this period of increasing attention to public health, the business world was similarly advancing thinking on the power of people to drive business profits. Harvard Business School’s James Heskett, Earl Sasser, and Leonard Schlesinger shared the concept of the “service profit chain.” This management work established substantial links between employee satisfaction and customer satisfaction, between employee loyalty and customer loyalty, and of course between customer loyalty and profit in service businesses.⁸ This has taken us a long way from the manufacturing and process experiments of Frederick Winslow Taylor, who saw humans more as manipulable cogs in a machine, and it paved the way for the works by Felix Barber, Rainer Strack, and John Doerr that explored the economics of “people businesses” and “measuring what matters.”

`Early Adopters`

These early pioneers of health and business science raised awareness of the problem and created the beginning of a new scientific base of information. As this scientific evidence accumulated, some early adopters started to implement Healthy Building strategies, well ahead of the advent of formal Healthy Building rating systems. Buildings like the Adam Joseph Lewis Center for Environmental Studies at Oberlin College, by David W. Orr, adopted green building strategies in the mid-1990s, at a time when most builders had not even heard of the idea of a green building. These early adopters in the green building spaced opened up pathways for the first “green + healthy” buildings that followed about a decade later. The Bank of America Tower at 1 Bryant Park in New York, owned by the Durst Organization and designed by COOKFOX Architects, is a great example of early leadership in the Healthy Buildings space. The design focused on increasing fresh air, increasing access to daylight, and, perhaps most notably, formally incorporating biophilic design into the building. Crucially, the team also went beyond just designing a building that claimed to focus on health at the ribbon cutting: they actually sought to measure and verify that they were achieving their targets over time. The tower at 1 Bryant Park does things like tracking and monitoring real-time Health Performance Indicators such as CO₂ levels on each floor. (They don’t call them HPIs yet … but we think they will!)

This early adoption of Healthy Buildings is happening in Europe, too. Norman Foster continued to advance his early work on breathing buildings with the SwissRe building in London (affectionately known as The Gherkin). Completed in 2004, it has an atria that serves as the building’s lungs, bringing in fresh air through panels in the façade and distributing it around the building. He continues to invoke his buildings as living, breathing creatures; with his most recent work on the Bloomberg Headquarters in London, he talks about using “fins as gills” that not only enable the building to breathe (through a vortex starting at the ground floor), but also act as filters that attenuate sound. Here he also incorporates a living ceiling; 2.5 million petals with chilled and warm water pulsing through to modulate acoustics and temperature.

Another recent innovative building that highlights how technology is being incorporated into this movement is the Edge building in Amsterdam, which opened in 2015 and which Bloomberg dubbed “the Smartest Building in the World.”⁹ The developer, OVG Real Estate, created a “digital ceiling” embedded with thousands of sensors that let the building track and respond to light, temperature, and other factors at a hyperlocal level. The Edge, designed by PLP Architects, represents an early marriage of smart buildings and Healthy Buildings.

For early adopters of healthier materials, we need look no farther than our own campus. The revitalized Harvard Smith Campus Center by Hopkins Architects and Bruner / Cott and the brand new Klarman Hall at Harvard Business School by Willam Rawn Associates, both unveiled in 2018, feature products and building materials that carefully avoided several classes of toxic chemicals mentioned in Chapter 7, such as flame retardants, Forever Chemicals, and antimicrobials. Led by Heather Henriksen, the managing director at Harvard’s Office for Sustainability, Harvard worked with (that is, forced) suppliers to revisit their supply chain and deliver products without toxic chemicals. Some of these suppliers initially said they couldn’t, or wouldn’t, do this—but then ultimately found a way. The most important takeaway from both projects was that the sourcing of these healthier materials had no impact on the budget, project schedule, or product performance. We repeat: a healthier indoor environment with no impact on budget, project schedule, or product performance. So why aren’t we doing this more often?

As is typical for this phase of the curve, all of these players acted on the science well before their peers acknowledged that this was a winning strategy. Foster + Associates (Norman Foster’s firm), Oberlin, COOKFOX Architects, OVG Real Estate, and Harvard were acting as early adopters, pushing themselves, and the market, toward healthier buildings. These are elite organizations, but their pushing of boundaries, investment in resources, and establishment of best practices make it easier for others to follow.

`Seeking Competitive Advantage: The Industry Anticipates User Preferences`

Where are we today? The early adopters have set the stage for Fortune 500 companies, with their global portfolios, to get in the game. This phase of the adoption curve is happening in leading markets from Singapore to San Francisco, but we’ll start with the New York City commercial real estate market and expand our discussion from there.

New York City seems to be in a contest for who can have the healthiest building. We’ve discussed our case study on the health aspects of 425 Park Avenue, where we explored the decisions made by David Levinson and L&L Holding about health.¹⁰ Just a few blocks away, JPMorgan Chase is building a new headquarters and they have a bold vision, as one would expect. In the words of Alec Saltikoff, an executive director at the bank and a point person for the project, “Employees are our most important asset. We have the best talent and best technology, now we want the best building.”¹¹

Saltikoff told us that he and his team examined the science and then applied their own analysis and came away with the conclusion that current building standards are not designed to optimize human performance. Ultimately, he sees pursuing excellence in JPMorgan Chase’s new headquarters as good business, and as consistent with their company philosophy. “By virtue of enabling our people to perform their best, we are also serving our clients and simultaneously serving our shareholders,” he said. “Creating an environment that maximizes these three factors becomes a competitive advantage. We don’t see the building and people as one-time investments—they are part of a systemic and philosophical approach consistent with the vision of our founder, J. P. Morgan Chase, who set the goal of ‘first-class business in a first-class way.’ We are now creating a first-class building.”

Pfizer is moving its New York headquarters to Hudson Yards in New York and adopting Healthy Building certifications. Tishman Speyer announced that its entire portfolio would be certified under the Fitwel system. And several more major companies that we can’t name are making similar moves. The race is on. It’s a race because these savvy real estate players are asking the same questions that David Levinson shared about 425 Park Avenue: What would happen to tenancy and rents if he didn’t design his building for health, but all of his competitors did?

This is not just a contest going on in New York City. Look at what Apple is doing with its new headquarters in Cupertino, California. The new headquarters, designed, like 425 Park Avenue, by Norman Foster, will feature real-time air-quality monitoring using technology from a company that runs tubing into each room to draw air into centralized monitoring locations, “sniffing” the air every few seconds. They will be measuring CO₂ in real time throughout the building.

If you look at what the major service providers in the facilities management and user experience space are doing, you will find more evidence of the seismic shifts under way. JLL has its “Healthy and Productive Workplace” offering and its 3-30-300 analysis discussed in Chapter 3. CBRE has a healthy office research arm and has certified its headquarters in Los Angeles as a WELL building. The list of leading companies continues, from Boston Properties to Kilroy Realty and many others.

It’s not just the owner-operators and facilities management companies that are in the arena, either. Once a critical mass of leading companies with massive global portfolios started to design with Healthy Buildings in mind, building suppliers and technology companies began moving in this direction with them. Take Carrier, a major supplier of building technology to real estate developers best known for its air-conditioning business unit. We mentioned in Chapter 10 that Carrier recently designed, built, and moved into a new building of its own called the Center for Intelligent Buildings. This was designed specifically as a space where prospective buyers could walk through the building to discover the often hidden aspects of how building systems work. Importantly, this living showroom is not just about how chillers and mechanical systems operate—it showcases how these building technologies promote health and human performance.

View is another building product company focused on health. View makes dynamic glass—windows that that can automatically change their tint to adjust the glare coming in based on the time, day, and season. This comes with significant energy savings (20 percent reduction in operating expenses). But take a look at how its leaders are positioning the company: the first thing its website talks about is how the company’s glass affects health and productivity. They even created a new position, director of health strategy, and quickly filled it with a public health expert, Piers MacNaughton. Why the health focus? MacNaughton says, “At View we’ve come to realize that in the built environment, health is the primary motivator.”¹² Taken in isolation, these examples from JLL, Carrier, and View may not seem like much, but this turn toward health in the built environment represents nothing short of a seismic shift in the market.

New technologies are transforming possibilities for monitoring and conforming with every one of the 9 Foundations of a Healthy Building. New healthy lighting offerings from Philips or Lighting Science Group no longer talk about light levels and lux—they address how their products affect circadian rhythm and health. There are sensor startups like Aclima, Awair, and Yanzi that sell monitoring systems to track real-time air quality in offices and homes. And there are some big building product manufacturers, like Velux and View, that are leading the charge toward “smart” building technology by incorporating sensors right into their skylights and dynamic glass windows. In the building safety and security startup space are companies like Evolv, which is deploying rapid screening technologies combined with employee-recognition systems to improve the security checkpoint process—increasing speed and effectiveness (“secure flow”), while decreasing the burden and associated stress of this function.

Add to this landscape the many companies innovating in energy. This list includes established global players like Schneider Electric, with its strong focus on energy efficiency, microgrid solutions, digital buildings, monitoring, and optimization. (Schneider Electric, long known for its energy services, is now also moving into the Healthy Building space with digital services for smart buildings, like its Workplace Advisor, which monitors and reports real-time space utilization and indoor environmental quality.) The energy innovation movement also includes startups like Phase Change Energy Solutions, which uses the natural heat-absorbing and heat-releasing properties of so-called phase change materials as a super energy-efficient insulator. Products like this come with an energy benefit, but they come with a health benefit, too. The demand for these types of energy-saving and health-promoting products is set to grow rapidly.

Then there are companies working on better ways to clean the air. This includes the big incumbents and recognized brands in the portable air purification space, like the health-care company Dyson (we’re going to convince you yet …), and startups like EnVerid, which can install a system within your existing ductwork to capture and purge VOCs, CO₂, and other chemicals.

Investors are getting in the game, too. In 2018, JLL introduced a $100 million fund to invest in Healthy Building technologies. SoftBank created its $100 billion Vision Fund, which has a heavy focus on “PropTech”—technology and companies that focus on real estate buying, selling, and management. And recently, colleagues of ours at Harvard have been engaged with PGGM, a multibillion-dollar pension fund, which is exploring how to invest in “healthy companies.” Healthy Buildings are part of that conversation.

We’ve introduced a few specific companies at this point not to promote them but because they provide good examples for how the market is advancing, and how much innovation and rapid adoption are now taking place. We chose to single out these particular companies because we’ve gotten to know them well. We’ve met with dozens of executives from different organizations, and there is a reason these companies show up in our book: we think they are doing it right, or are on the path to doing it right. (We’ve also seen a lot of “how not to do it”—but that deserves its own book.)

All of these people and companies—the knowledge generators, the early adopters, and the leading market players—have paved the way for the rise of Healthy Building certification systems. The early adopters and players in leading markets now want a way to independently validate what they’re doing for investors, tenants, and employees. This has given us the WELL Building Standard, Fitwel, RESET, and probably a few more coming soon. Some developers are working with us to use the 9 Foundations of a Healthy Building as a guide toward creating a Healthy Building.

All signs point to a growing Healthy Building market. There is unequivocally momentum in the system. Now the trillion-dollar question is, Are these just one-off flagship projects, or will this become the new business as usual?

`Industry Composition: A Big Sector with a Long Tail`

It’s difficult to get a handle on the magnitude of the value of “built environment” assets in the world. On a planet with over 7 billion people, many families’ primary assets are their homes. Commercial real estate alone as an investable, tradable asset class is worth trillions of dollars. Add to that schools, courthouses, hospitals, and factories and the industry is very large indeed: in excess of $260 trillion in US dollars, according to the global real estate advisory Savills.¹³ Real estate of one form or another leads all other global stores of wealth.

`How Is the Wealth Distributed?`

In the commercial real estate space, the largest publicly traded property owner in the United States is Simon Property Group, with a market capitalization of about $50 billion. The 10th largest is Equity Residential with a market value of about $24 billion, and the 100th is Acadia Real Estate Trust with a market capitalization of just over $2.4 billion. The top 200 in aggregate have market capitalization well over a trillion dollars … but the biggest one represents just 5 percent of that total.¹⁴ This means that there are a few large players and a very long tail down to mom-and-pop investors who might own a few apartments and a neighborhood shopping center with five stores in it.

At the same time, capital providers like banks and mortgage companies see a similar industry spread. From the largest to the top 100 to the next 1,000, the curve looks much the same. Caliber Home Loans, number 1, originated $43.9 billion in transactions in 2017. PrimeLending, number 10, did $14.5 billion. Move down to number 75, Homeowners Financial Group, and the volume drops to just over $1.4 billion. Again, a very large market with a few big players and very long tail of smaller ones.¹⁵

`Why Is Understanding the Spread of Wealth Important?`

The largest landlords, in the biggest cities, with the most high-profile tenants, with the largest balance sheets, looking at the longest leases—and courting the most sought-after knowledge workers—have the capability and the competitive interest to be at the absolute cutting edge and to let people know it. Those resources, those contracts, and those interests fall off quickly in markets that are not as robust, in labor markets that are not as competitive, and where rents don’t justify large capital expenditures. Innovations do eventually propagate—office buildings in even the smallest out-of-the-way towns are now expected to have elevators and air-conditioning—but it will not be automatic. The “Class A” buildings in big cities with multinational corporations as tenants are the first to take up most new ideas in the real estate industry, and it can often take longer for the benefits to become apparent to smaller tenants in “B” or “C” space in smaller cities. Naturally, we hope that this book jump-starts and accelerates that idea dissemination since it’s so important to people’s health and well-being.

This means opportunity for many kinds of service firms, ranging from architects to contractors to Healthy Building specialists. Since only the largest firms have extensive in-house capability, almost all of the facilities thinking is outsourced. Sometimes this is to global behemoths like JLL, CBRE, and WeWork, and other times it is to local, smaller firms that have specialist knowledge, like Terrapin Bright Green, Environmental Health & Engineering, and KGS Buildings. These firms are differentiating themselves by focusing on energy, sustainability, … and health.

`Clockspeed: Cycle Time for Adoption`

Think of biology. Some small species of insects have a life span of days; small mammals like mice or moles have a life span of just months or years; people and elephants can live to 90 or 100; and some whales and tortoises may live well past the century mark. In a quickly propagating species like fruit flies, generations come and go in days or weeks and evolution can happen quickly. For people (or for whales), evolution is a lot slower.

The same phenomenon exists in industry. A new social networking app might have a life span of a few weeks or months before fading away or being subsumed. A new chip like the Intel Core i9 might have a selling life span of five years. In cars, brake calipers and brake shoes haven’t changed in decades. When catalytic converters came on the scene, even though they were quickly mandated in the US fleet, it took almost 20 years for them to become 90 percent established. Why? Because cars have useful lives of 10 to 20 years. So it takes more than 20 years to change out the whole fleet.

In his seminal book Clockspeed, Charles Fine of MIT identifies this phenomenon and describes how businesses can work with their internal systems and, even more importantly, with their customers and their supply chains (in the world of our book, architects, contractors, and building product manufacturers), to accelerate a time cycle, adopt new technology faster, and compete better.¹⁶

Why do we care? Because buildings have an even longer life span than turtles. There is a good chance that as you read this you are in a home or at an office that’s more than 50 years old. You probably wouldn’t even think the age of the structure was worth mentioning unless it was around 100 years old. Consider Boston, where 85 percent of the building square footage expected to be in place by 2050 already exists.¹⁷ The cycle time for the dissemination of advances in building technology can be very long indeed. In slow demographic growth economies like the United States, it will thus take a long time for the ideas in this book to fully propagate.

At the same time, most homes, offices, hospitals, and schools regularly undergo major renovations, sometimes taking things right down to the shell of the building. During major renovations, when the space is vacant and there is already disruption, is a good time to act on sustainability, on energy efficiency … and on making your building truly and measurably healthy. This window does not come around that often—and if this book is successful, we will ensure that decision makers don’t miss that window.

On a global scale, the opportunities in new construction are enormous. In the United States alone, about $1.2 trillion of new construction is put in place each year (about 6 percent of the country’s gross domestic product of $19 trillion).¹⁸ Globally the amount of new construction is thought to be about $12.7 trillion annually, according to the Construction Intelligence Center.¹⁹ Even though the existing stock is large, this massive level of new activity justifies building things right, starting now.

Like the real estate and finance industries, the construction industry is highly skewed. The largest firm in the Western world, Vinci from France, earned about $46 billion in revenue in 2017—less than 1 percent of the total.²⁰ There are few other industries in the world where the market leader has less than 1 percent share. This means that the opportunity to be an intellectual and operational leader in health is everywhere … and firms can take the leadership mantle.

`What’s Next: Sensors, Awareness, Communication, and Analytics`

So far we have mostly considered technologies that are widely available today. We have argued for awareness and substantially increased investment in indoor air quality and other aspects of health you can measure in office settings. But the world is changing. What might be next for building owners, homeowners, workers, and investors?

Imagine this future scenario:

Nina and David were super excited about the arrival of their new baby, Sam. They were selecting a new apartment in the big city. The air in the big city was pretty bad, with almost daily warnings about outdoor air pollution, but they had read The 9 Foundations of a Healthy Building and were up on the science of how outdoor air pollution becomes indoor air pollution. Nina and David wanted to find a nice place for Sam, so they checked the online real-time indoor air quality trend data—now reported at a microscale level as a result of ubiquitous outdoor air monitoring in cities—and projection statistics compiled by the Fitbit, Alibaba, Dyson, Zillow, and Chase Consortium. They wanted to see which apartments in which complexes were rated the highest against key pathogens, as well as the pollutants that had led to so many of David’s childhood allergies.

Armed with this info—much like shopping for a vehicle with Carfax in hand—the couple went to negotiate with apartment landlords. They cared about location and access to transit, although since neither worked in a traditional office those factors were not so important to them. They looked at two nice complexes in the city: the Starnight Building, a relatively modest design in a new building where the developers had made a big deal about so-called indoor air quality, touting its LEED, WELL, and Fitwel ratings; and the Warwick Building, which was older but very fancy, with lots of tall ceilings and plenty of woodwork from renewable sources.

In the end they paid a rent premium for an apartment in the Starnight Building, where, their analysis concluded, they would pay less for energy consumption in the long run because of the landlord’s extensive capital investments in the building. More importantly, they calculated that they would sleep better and that Sam would breathe better. The air quality was objectively superior at the Starnight, based on data available from Morningstar’s analysis of data from the consortium. Social media reports confirmed that others had had good experiences. A few years from now, they reasoned, Sam would score higher on his standardized college entrance examinations thanks to the advantage of clean air and water and its proven cumulative impact on brain development and human cognition. Nina and David were fortunate to have a choice; many other young parents couldn’t afford a premium-air building like the Starnight.

`The Future Is Already Here`

Some may find this story farfetched and alarmist. But consider what Google is already doing with its Sidewalk Labs project in Toronto. It is creating, digitizing, and democratizing data on city performance at an unprecedented local scale. Air pollution data is part of what they are monitoring, measuring, and reporting. Then look at what Google did in San Francisco with a company, Aclima, where they placed air pollution sensors on the top of Google Street View cars.²¹ As the Street View cars did their normal routine, driving through every city street to update images and data for Google Maps, they were simultaneously collecting air pollution data. For the first time ever, residents could get a block-by-block look at air pollution in the city. Guess what? It varies significantly, even within a city. Now this hyperlocal monitoring approach is being exported to other cities. It’s not hard to imagine a future in which air pollution monitors are on every streetlight (LED lights can already act as sensors for VOCs and other pollutants) or on every Google Street View car, or every Lyft car or UPS delivery truck. Nina and David will have this type of air pollution data at their fingertips.

As for indoor environmental quality data, consider what some companies like Yanzi and Awair are already offering today: the ability to install air-quality monitors on every desk in a large building or each room in a home within one day to stream real-time data about the indoor environment. Joe’s team has deployed monitoring networks like these in buildings across six countries as part of a research project on buildings and cognitive function. Many consumer products have air quality sensors built right into them and are already collecting environmental data indoors. Millions of homes already have environmental data being collected through these products, all of which can be freely shared and analyzed in open data cloud applications. This is just the beginning—seeing air pollution sensors in an office or apartment building will be as common as seeing a thermostat on the wall. (That’s really just an air-quality sensor, too, when you stop to think about it.)

We are convinced that there will be ubiquitous sensing and air-quality data at consumers’ fingertips in short order. But maybe you think what is farfetched about our Nina and David example is that, despite all of this data being readily available, consumers won’t use it to make decisions. So let us move from a hypothetical to a real-world scenario, and move from homes to commercial real estate.

`Talent and Tenancy`

Recently we got a call from an executive at a Fortune 500 company (we can’t disclose who). This executive oversees the global real estate portfolio for the company, as well as the development of a new corporate campus. He called us because something happened that had never happened to him before—he got a call from his executive counterpart in the Human Resources Department asking all sorts of questions about green and Healthy Buildings. Specifically, this HR executive wanted to know if their new headquarters was going to be a “Healthy Building.” Why? She told him that the company was recruiting a top candidate for a job in the firm and this candidate was asking questions about the building she would be working in. The top prospect was interviewing the building! (A 2017 article titled “Are You Interviewing Your Building?” written by John Mandyck, then chief sustainability officer at United Technologies, seems prescient.²²)

This type of “bottom-up” demand for Healthy Buildings is likely to increase for three primary reasons. First is the expectation of transparency in all things, spurred on by social media. There is not much question that people share information, whether they are job seekers, home buyers, employers, credit rating agencies, or folks just looking for a good restaurant or a competent plumber. A recent example of this sharing related to work is the rise in popularity of the website Glassdoor, where people anonymously post about the company they work for, including their boss, workplace culture, salary, and, increasingly, the building. Here are a few examples of recent posts:

“Smells bad”: “Smells like garbage every day … better pay for the work and ventilation system for the summer.”²³
“Building smells like sewage”: “Yes, I would also hope this was a joke, but the building smells like sewage in between 7 and 9 A.M. in the morning. This just gives me even more the impression that they don’t mind their employees.”²⁴
“Perks, but noisy open office”: “There is no noise insulation in the ceiling so you’ll hear noise from the above floor. Sales and customer service teams are answering phones with no sound insulation in between desks. Years of complaining to management and facilities has barely gotten anywhere.”²⁵
“Unsafe and unprofessional workplace”: “The place is filthy and product is strewn everywhere. Fire exits and emergency equipment are blocked.”²⁶
“Great people but the office is way too cold”: “The office is too cold—so cold that it’s sometimes hard to focus on the job.”²⁷
“Great mentors, bad lighting”: “The building we were in had very few windows, grey wall-to-wall carpeting, and dim lighting. Luckily they were talking about moving when I left!”²⁸

You may not know it, but employees are already interviewing your building.

There are already huge catalogs of shared information about music, politics, travel, mutual funds, and more; why wouldn’t there be crowdsourced data and a rating platform for air quality in apartments, homes, offices, schools, hospitals, and government buildings? The ability to contain information and control ratings has escaped into the world—and it’s not coming back under corporate control.

Second, many companies are realizing that they are now in the health business, and they are marketing themselves as such. Consider the announcement that Amazon, Berkshire Hathaway, and JPMorgan Chase just created a new health-care venture led by our colleague Atul Gawande. Or consider that Apple’s CEO, Tim Cook, said in 2019 that health-care disruption may ultimately be Apple’s legacy, not the iPhone. Every company is a health-care company now—in some instances, literally.

Health and health care represent a third of the multitrillion-dollar US economy, so it’s not surprising that these companies are aggressively moving into this space. Many forms of media are also raising awareness of health issues. It’s possible to rely on mainstream media like the New York Times, social media like Facebook, YouTube, and Reddit, broadcast media like Oprah or CNN, and sifting and sorting algorithms like Google to look at websites like WebMD, Mayo Clinic, or the New England Journal of Medicine to learn more and more factual information about what goes into our bodies—whether ingested, inhaled, or injected. This barrage of information ensures that consumers are aware of what constitutes a healthy life, and it’s only a matter of time before buildings join the health zeitgeist. To understand the scale of what we’re talking about, think about it this way: health care represents a third of the US economy, and construction represents about another 10 percent, so between the two, we are looking at influencing almost half of the US economy in some manner in the Healthy Buildings movement.

Third, look at the rise of sensors, analytics, and big data, and think about what this means when it comes to providing objective and verifiable information on whether the building you are buying into is healthy. The Nina, David, and Sam scenario only makes sense if sensors are ubiquitous, and they are rapidly becoming so. Not long ago all a building could really tell you in real time was temperature and humidity—and you had to look at the gauge with your own eyes. A professional air-quality expert or Certified Industrial Hygienist taking samples to a lab had to wait days or weeks to measure things like lead paint, mold spores, asbestos particles, or formaldehyde. Today, your Nest or Ecobee or Carrier thermostat can tell you the history of the temperature and humidity in each room in your house, and your Yanzi or Awair is starting to do the same for CO₂, CO, particulates, and much more. What’s more, indoor air purifiers from Dyson or Honeywell don’t just purify the air; they sense the environment and respond to out-of-boundary conditions, as well as displaying the data and sending it to your phone—or anywhere else you’d like. Imagine an apartment or office landlord aggregating all the readings in the building, anonymizing them, and tuning airflow and filtration for optimum levels with real-time feedback from the Internet of Things operating in the building. Big data and analytics could crunch this info for thousands or millions of indoor spaces. The big players in the building management system space are moving in this direction. Quickly.

Sensors aren’t just in the inanimate space. Your Fitbit or Apple Watch can monitor heart rate and breathing, and some wearables measure blood sugar and more. (The promise of measuring personal health is what underpins Apple CEO Tim Cook’s vision of Apple becoming known as a health-care disrupter.) Your device can share this information with your building to explore causal relationships between your space and your mood, but more importantly, it can then interact with the building systems to intervene autonomously. Do you think people won’t be willing to share this kind of personal information? They already do on apps like Strava, where athletes exchange information about details like VO₂ max (maximum oxygen uptake during exercise), and connected exercise devices like Peloton that can track your RPMs and BPMs, allowing you to share your fitness and performance metrics.

Many third-party aggregators of this kind of information exist in other domains: if you have a 401(k) or IRA or other investment vehicle, mostly likely you rely on services like Morningstar or Lipper. Those financial analysis entities look at millions of data points for direction and trends of investments—and to measure the performance of the human (and machine) managers making decisions. Green building indexes already exist. For example, GRESB aggregates self-reported data on sustainability aspects of real estate portfolios and delivers this to investors. It added a health module to it sustainability reporting, showing where it thinks the market is headed. Then there are companies like GeoPhy, which we mentioned in Chapter 10, that aggregate publicly available information on real estate risk such as natural disasters exacerbated by climate change. This type of data is also fed into the investor market. A Morningstar rating or Carfax for your office or school is not farfetched; it’s right around the corner.

The large pools of capital like pension funds, endowments, insurance companies, and sovereign funds look at two main criteria in their investments in debt and equities: What is the expected rate of return, and what is the risk or uncertainty around realizing that return? There is not much question that a building that repels renters or condo buyers is exposed to the uncertainty of lower rents and higher vacancies as better-informed tenants or buyers look at the data, realize the long-term impact of air and water on themselves and their loved ones, and gravitate to the objectively superior building. Investors will figure this out.

Will the ability to measure air quality—and to tie it incontrovertibly to health—become significant enough to people to actually move the needle over from other selection considerations like location, views, aesthetics, and cost? Today, no. Someday? Most definitely. A future of smart and connected curated indoor spaces is inevitable. The rise of the informed shopper—with choices enabled by sensors, open data, mobile platforms, apps, analytics, and social media—will be one of the key forces pushing us further up the Healthy Building adoption curve. Individuals, and the businesses that shelter or employ them, will drive best practice faster than government and regulation will be able to. This will amplify the positions of leaders—and laggards—among landlords, lenders, and vendors in the office, apartment, and institutional building industry.

`The Future of Healthy Buildings`

Our goal for this book was to present a vision for how to scale and accelerate a shift to healthier buildings for all. What happens next is … up to you. Faced with the collision of rapid population growth and rapid urbanization, nothing short of the health of people and the planet is at stake. Collectively we have the power—and responsibility—to influence the design and operations of billions of square feet of buildings around the world, thereby influencing the health of tens of billions of people globally.

The Healthy Building strategies in this book must not only benefit the 1 percent. Early adopters in major cities are essential for demonstrating that these strategies can be implemented and can yield business wins, without affecting budget or timeline. But are these first Healthy Buildings just vanity projects, or are the movement and awareness the new “business as usual”? The true measure of success will be determined based on how scalable these strategies are: how deeply and how quickly the core aspects of Healthy Buildings are picked up in suburbs, in smaller buildings, in museums and city halls, and in urban and peri-urban agglomerations all over the world. Getting Healthy Buildings right is an imperative. It can mean improving the lives of billions of people on the planet.

If you are reading this book, you are an influencer in the built environment and in the future of Healthy Buildings. You will guide the approach of using a human health lens to create better indoor spaces for people in schools, hospitals, theaters, restaurants, retail shops, places of worship, and commercial real estate of all sizes. If you are a landlord, building manager, architect, designer or contractor, business executive, sustainability professional, scientist, investor, or facility manager, or if you live and work indoors, you have a chance to maximize the potential for you and your colleagues or your family to live a healthy life.

You also are living at a time when advances in health science and building science are occurring rapidly—whether it’s new empirical observations about human cognition under differing indoor conditions or the invention of personal air-quality sensors that can be placed anywhere and immediately make the air quality visible. That means you can act.

Throughout this book we have shown you how to harness the extraordinary power of indoor spaces to drive performance and productivity. You are now armed with everything you need to make a cogent argument for Healthy Buildings in your organization. Hard science showing how buildings influence our health? Check. A financial argument for why Healthy Buildings are a sound business argument? Check. Tools for how to measure and track health performance? That, too. We have given you a sense of the global forces at play and the technological shifts that are creating the perfect conditions for an exciting future. This is an unprecedented moment in history—the convergence of health science, building science, and business science is giving us a chance to unlock the potential of our buildings to create economic value and advance health. It’s a simple formula, really: Healthy Building strategies are Healthy People strategies and therefore Healthy Business strategies. It seems like a cliché, but these can lead us together to a Healthy Planet. How will you be part of this future?