While travelling in Europe to the Indoor Air 2016 conference in Belgium, I had the opportunity to discuss a largely unspoken shift in the management of IAQ with a like-minded colleague, Dr. Walter Hugentobler from the University of Zurich, Switzerland. Also a phy-sician, he is very concerned about the impact of IAQ on occupant health. Despite the fact that most of us spend the vast majority of our time indoors, I have found few physicians focusing on this crucial relationship.

Nowadays, building codes are written to preserve building materials and control energy consumption. Thus, “healthy buildings” are defined by metrics on the structure and equipment with alarmingly few clauses addressing everyday IAQ and occupant health. In fact, in this century, little new data on our physiological response to indoor air parameters has been collected. We need to ask why this is so, but more importantly, we need to change this knowledge deficit.

Historically, advances in housing technology such as the provision of clean drinking water, improved sanitation facilities, safe dis-posal of waste water, windows for daylight, heating and ventilation far exceeded medical progress in promoting the health of man-kind. Yet, today’s indoor building conditions are one of the most significant factors causing disease. In building code literature, occu-pant health has been demoted to much the less compelling subject of occupant comfort. This change in vocabulary is indicative of an unspoken and harmful shift of priorities in the building industry. Few people seem to realize this fact.

In the last several decades, doctors have largely abandoned the field of occupant health and indoor air management. This was not always the case. At some point, environmental hygiene and preventive medicine was downgraded in medical school curricula and replaced by pharmacology classes, clinical rotations in subspecialties, and other treatment interventions which stimulate the “business of medicine.” Like any neglected area, the lack of attention and research on environmental hygiene has had serious con-sequences on our health.

As doctors turned away, architects and engineers were forced to design buildings and manage HVAC systems without the benefit of data from medical research.

Understandably, they focused on their areas of expertise — the maintenance of building materials and controlled energy use. (Being a physician, I would not want to be in charge of designing a variable refrigerant flow, dual-return heat capturing system).

Physicians have not always neglected their patients who use buildings. For example, in the 1980s, Professors Diebschlagand and Grandjean, both physicians and engineers at the Institute of Hygiene and Occupational Physiology, along with the Canadian ASHRAE engineers Scofield, Sterling and Arundel, shaped research on IAQ and clinical outcomes. Their work, based on clinical studies dealing with humidity effects on health, gave rise to the well-known Scofield Sterling diagram that defines the best humidity range for minimizing viral and bacterial respiratory infections, allergies, fungal growth, and mite exposure in building users.

Their focus was on health and not merely on comfort.

Without any new scientific evidence, these excellent studies on indoor climate and occupant health outcomes were buried when the correlations were relabelled as comfort issues. Subsequently, studies on indoor climate after 1985 focus on comfort and perfor-mance, with few new studies on adverse health effects.

The enormous health costs resulting from our current way of designing, constructing, and operating buildings pose a major socie-tal challenge. To protect people’s health by incorporating physiological data into building codes will require a serious paradigm shift. The current language of IAQ adequate for “comfort” must return to IAQ to maximize the health of building occupants.

To make this shift, we must encourage physicians to partner with architects and engineers to optimize indoor air management for the benefit of our most basic asset, our health.

Some steps to accomplish this:

•  Correlate IAQ data to privacy-protected occupant health information.
•  Protect occupant health through IAQ building codes.
•  Educate engineers about the basics of respiratory health.
•  Educate primary care physicians about patient symptoms associated with poor IAQ. ES