Finally, professionals in medicine, engineering and public health are coming together to better understand how to design and manage indoor environments to support occupant health. While this has seemed obvious to many engineers, infection preventionists, microbiologists and epidemiologists for decades, a myriad of reasons have interfered with acting on this understanding. 

The extent to which environmental exposures drive acute and chronic diseases became crystal-clear decades ago. The Human Genome Project, an international scientific research project to identify and sequence all of the genes comprising human chromosomes, was started in the early 1980’s. The goal was to identify genes linked to diseases, manipulate the DNA to correct the defects, and curtail human illness once and for all. After early hints of success, in 1997 the United States Department of Health and Human Services became involved, elevating the status of the effort to a research institute within the NIH. With the infusion of government funds, faster sequencing techniques were developed and by 2003 approximately 80% of human genes were fully decoded. This herculean effort gave scientists around the world access to a database that accelerated the pace of biomedical research. The remaining 20% of genes were finally decoded in 2022.

By 2003, results from the project, albeit incomplete, were already wreaking havoc on long held beliefs. For one thing, it became clear that, “highly evolved,” Homo-Sapiens had a similar number of genes as a mouse or a flowering plant! How could we explain the intricacies of our neurochemistry, immunity, endocrine and other systems? In short, the interconnected pathways and underlying cell functions that comprise a human would not exist if it were not for the multitude of microbes, viruses, bacteria and fungi that live in and on us, synthesizing signals from our gut to our brain and vice versa, training and supporting our immunity and participating in almost every function of our body. Remember this when you try to eradicate all “germs” from your surroundings – many microbes are your friends. 

For this column, however, I want to focus on another surprise that was revealed by sequencing the human genome. Scientists and health professionals learned that only around 10% of disease risks could be attributed to inherited DNA – and the remaining 90% are due to environmental exposures. While some exposures are due to lifestyle choices such as lack of exercise or substance abuse, expanding data sets are showing that contact with insensible airborne components are powerful determinants of short- and long-term health. 

Humans inhale and exhale approximately 2000 gallons of air per 24 hours. As air is drawn into our lungs, it is humidified to 100% saturation and processed to hopefully remove both biologic and nonbiologic particles before the air reaches our alveoli, our deepest lung tissue where oxygen and carbon dioxide are exchanged. For air to sustain us without short or long-term harmful consequences, it must be free from infectious bioaerosols and contaminants that disrupt our respiratory immune system and overall physiology. Knowing this, it follows that managing the environment in which we breathe, primarily indoors, to support human health is a powerful yet underutilized strategy to decrease diseases. 

Twenty years after learning about the power of environmental exposures from genetic research the US government is stepping in to provide funds to advance building management to support occupant health. In April of 2024, a branch of the Department of Health and Human Services released a request for proposals for strategies to support health through indoor air management. The Advanced Research Projects Agency for Health (ARPA-H), a program similar to the National Institute of Health, “supports the development of high-impact research to drive biomedical and health breakthroughs to deliver transformative, sustainable, and equitable health solutions for everyone.” 

The latest ARPA-H initiative, Building Resilient Environments for Air and Total HEalth (BREATHE) has allocated approximately $150 million dollars to be divided up and awarded to teams who propose a sound approach to supporting occupant health through building management. 

Can you imagine a future where our most powerful social media – indoor air – is devoted to safety, productivity and good health?  Now, back to the grindstone for this column author, our team’s grant proposal is due soon!