Evidence
Evidence supporting the health benefits of Buildings
Authors: Professor Billie Giles-Corti, Dr Sarah Foster, Dr Nyssa Hadgraft, Dr Lucy Gunn, Julianna Rozek.
Health benefits can include the design of the building’s circulation system that encourages stair use, provision of end of trip facilities, convenient access to public transport options, and natural surveillance of the streetscape.
Scope of evidence
A growing body of research is exploring how the design of buildings influences health. The evidence in this section is primarily from the physical activity and sedentary behaviour research field. However, emerging evidence is also discussed on the connection of building design with broader physical, environmental and psychological health issues. Evidence is mostly drawn from studies from the UK, USA and Australia.
In this section, you will learn more about:
Location and external design of buildings
The interface between buildings and the street shapes the experience of pedestrians and affects the walkability of a neighbourhood. For example, varied facades at the street level create an interesting and human-scaled environment which can encourage walking. [4, 10]
Building frontages that maximise natural surveillance improve safety and feelings of safety. This can be achieved by designing buildings to overlook streets, providing well-lit entrances, and limiting long stretches of blank walls and inactive spaces. Transparent building facades, which allow people inside to see the street and vice-versa, are another feature which increases natural surveillance. [7]
Active ground floor uses, such as cafes and shops that encourage pedestrian activity, also foster feelings of safety. Building awnings, which extend over footpaths, provide shade and protection from the rain and can improve the experience of being on the street. [4, 7] Shading building frontages can also benefit energy performance by minimising incidental solar radiation, thereby cooling the building. [32]
Well-located and designed buildings can encourage the use of active transport by providing convenient access points between origins and destinations. Strategies include providing convenient access to footpaths, bicycle lanes and public transport stops. [7, 10, 11]
Building internal movement networks
Building internal movement networks consist of corridors, elevators, stairs and lobbies that connect spaces. [1] A good network encourages walking and provides opportunities for social interaction between co-workers, residents and other building users.
The location, prominence and accessibility of stairs within a building affects their use. A 2007 study found that stairs were more likely to be used when: [24]
- They were visible from the building entrance
- They were within 7.5m of the entrance and encountered before an elevator
- They did not require keys or an access card
- There were fewer turns required to travel from the entrance to the closest stairs
Encouraging people to use stairs is an easy way to incorporate more physical activity into daily routines. These small but frequent bursts of activity can accumulate into significant positive health benefits. [26, 27] For example, the Harvard Alumni Health study of 11,000 men found that those who climbed at least 20 floors per week had a 20% lower risk of stroke or death from all causes. [19]
This has led to extensive research on effective strategies for encouraging stair use, such as visual prompts and improvements to stairwells. [22] Signs typically highlight the health, time, fitness or weight-loss benefits from taking the stairs [27] and have been found to increase stair use to varying degrees in a number of settings including shopping malls, bus and train stations, airports, healthcare facilities and universities. [22, 27] A review of stair-prompt studies to date found that the most effective signs were:
- Focused on a single message
- Easy to see (A1 to A0 in size)
- Included text and images
- Targeted time and fitness, rather than vague ‘health’ benefits
Several studies have investigated the impact of stairwell improvements in combination with signage and point-of-decision prompts. Point-of-decision prompts and building modifications such as painting walls, laying carpet, adding artwork and playing music can make stairs more attractive and increase the effectiveness of signage. Other studies have shown that wider staircases are associated with increased stair use.
[24, 25]
Office building design
There is growing interest in understanding how the office building environment affects worker health and performance. [13] The internal design and layout of offices can provide opportunities for social interaction and connection, and promote or deter physical activity. [10]
Studies have looked at the effects of thermal comfort, indoor air quality, ventilation systems, levels of lighting, room and furniture layouts, access to nature, views and natural light, colour, noise control, and density on workers performance, employee engagement, productivity, satisfaction and health. [13, 18]
A large European study found the features most important for overall comfort were noise, followed by air quality, light and thermal satisfaction. The layout of offices was also an important factor. [15] With an ageing workforce, it is also important to consider how building designs and workplace environments can help to sustain the health and wellbeing of staff. [12]
Green buildings
With a growing emphasis on the use of sustainable building design and construction, and the introduction of green building codes, researchers are starting to look at the impacts of green buildings on employee productivity and health. Preliminary findings indicate that green buildings may positively affect health. [15, 18]
An Australian study compared 22 ‘green design intent’ buildings and 23 conventional buildings [16], and found that the best green buildings consistently outperformed the best conventional buildings from the occupants’ perspective. Significant associations were also identified between overall comfort (lighting, ventilation, thermal comfort, and noise) and perceived productivity. [15, 16]
A similar study investigated the effects of improved indoor environmental quality on perceived health and productivity in occupants who moved from conventional to green office buildings, rated according to Leadership in Energy and Environmental Design criteria. [17] This study found that improved indoor environmental quality contributed to reductions in absenteeism and work hours affected by asthma, respiratory allergies, depression, and stress and to self-reported improvements in productivity. [17]
Finally, another study found workers in green-certified buildings had higher sleep quality scores, cognitive test scores and fewer symptoms (headaches, respiratory illness) than those in conventional buildings. [18]
Promoting physical activity
There is emerging evidence relating to the impact design changes in workplaces and office buildings can have in increasing physical activity and reducing sedentary behaviour. More investigation is needed, looking particularly at the relationship between the built (workplace) environment and physical activity. This evidence is needed to inform workplace interventions. Most of the evidence related to workplace physical activity has focused on workplace fitness and wellness programs rather than the design of spaces and facilities. These programs are normally introduced with the rationale that if employees are healthier, this may result in fewer sick days, better productivity on the job, better employee relationships, less turnover and lower absenteeism rates. [28]
Physical activity in the workplace can be promoted by providing exercise facilities. For example, a number of studies have found secure bicycle storage and showers at workplaces encourage cycling to work. [29-31, 33, 34] Providing walking, jogging and cycling tracks at or near work, and workplace exercise equipment can also support physical activity and active transport. [35]
The organisation of spaces, facilities and amenities within a building can increase physical activity derived from brief bouts of travel between them. [1] The organisation and grouping of commonly used facilities such as toilets, kitchens, mailrooms or breakout rooms can create routine travel breaks for office workers [36] thus increasing opportunities for social interaction.
Reducing sedentary behaviour
There is increasing recognition of the role that design features can play in promoting sedentary behaviour (time spent sitting) in the workplace. Large amounts of time spent sitting is a health risk factor, in addition to the risks associated with insufficient physical activity. [37-39] Interventions targeting workplace sedentary behaviour have had some success using environmental-based approaches, such as modifications to office furniture and layout. In particular, sit-stand workstations — those that allow workers to alternate between sitting and standing — effectively reduce time spent sitting. [40, 41]
Emerging evidence suggests that the layout of buildings influences the amount of time workers spend sitting during working hours. A recent Australian study found that office workers who reported greater visibility of co-workers and connectivity to other parts of the building, for example through walking routes, had more frequent breaks from sitting. [20] More broadly, several small-scale pilot studies have evaluated the effectiveness of office environments and features that are specifically designed to allow staff to be active. These include:
- Open and visually appealing stairs
- Centrally located amenities, such as printers, and
- Height adjustable tables in open plan shared spaces.
While the evidence is generally of low quality because it is based on small, pre-post natural experiments of building relocations, two studies from Australia [42] and Canada [43] suggest that environments that allow staff to be active and reduce sedentary behaviour can reduce sitting time by around 20 minutes per day.
Apartment building design
High-density apartment buildings now account for one third of all residential building approvals in Australia. [44] This apartment construction boom has raised concerns about the quality and amenity of the housing provided with possible health implications for residents. Several apartment design features have a strong impact on health outcomes.
Designs that provide inadequate natural light have been associated with falls and depression [45] and a higher prevalence of tuberculosis in Hong Kong. [46] Conversely exposure to excessive sunlight during extreme heat increases mortality risk, particularly for older populations. [47] Lack of thermal insulation and bedrooms located under but near the roof also increase the risk of mortality. [47] Improvements to thermal comfort, via insulation, help mitigate heat-related deaths and a range of other health conditions including:
- Blood pressure and upper respiratory tract infections [48]
- Hypertension, sinusitis and general health [49]
- Self-related health, wheezing, absenteeism, and visits to a general practitioner. [50]
In hotter climates home air-conditioning can further protect against heatstroke-related death. [51] However, there is strong evidence that natural ventilation is generally more supportive of health than mechanical ventilation. [52-55]
Noise from traffic and neighbours is another potential issue in apartment buildings that can be mitigated with good design practices. Studies have linked chronic noise annoyance to hypertension, migraines and depression in adults, and respiratory symptoms in children. [56] Noise from neighbours is generally perceived as more annoying than traffic noise [57] and has been associated with poor wellbeing and vitality. [58]
Designs that ensure good levels of acoustic privacy from traffic can help protect against:
Orientating rooms away from sources of noise can also mitigate negative health impacts. [59-61]
Poorly designed internal spaces that feel crowded are detrimental to health. [58, 62, 63] For instance, an evidence review concluded that there was sufficient evidence to link poor housing with poor psychological health. [64] The key risk factors included lack of communal and interaction spaces, and the size, layout, and depth of apartments.
However, there is some evidence to suggest that associations might change with increasing age. For example, one study found increased apartment size was positively associated with life satisfaction at 65-80 years, but negatively associated at 80+ years. [65]
Evidence on the importance of views out of buildings for health outcomes is less comprehensive. Nonetheless, studies have found a consistent link between access to nature and a range of positive psychological outcomes. [66-68] Natural views have been associated with:
- Wellbeing and satisfaction [69]
- A stronger capacity to direct attention [70], and
- Improved cognitive functioning in a small sample of children [68]
There has been limited research to date on the importance of communal space inside and around buildings for health and social outcomes. One study suggests that communal spaces help encourage social contact and reduce isolation and loneliness among female residents, as well as providing play spaces that can ease children’s distress. [64]
Gardens and green spaces have a range of benefits, including a perceived soothing effect on mental stress and improved quality of life [71], and enhanced community cohesion. [72] Scenic and activity spaces have been found to be most supportive of social interaction. [73] Similarly, designing building lift lobbies to encourage residents to linger may also facilitate social interaction between building residents. [74]
Summary of evidence
The design of apartment and office buildings and their relation to the street has the potential to increase natural surveillance which improves safety and feelings of safety.
Providing safe, well-lit building entrances that face the street and are directly accessible from the street and pedestrian networks (i.e., footpaths), car parks and public transport stops (within close proximity) is important to encourage active transport.
Workers’ performance, productivity, comfort and satisfaction is affected by building thermal comfort, indoor air quality, ventilation systems, levels of lighting, room and furniture layouts, access to nature, views and daylight, colour, and noise control. Office layout, particularly the amount of privacy, is especially important in open-plan offices, with the latter being a risk factor for adverse environmental perceptions.
Preliminary research findings indicate that sustainable building design and construction (i.e., green buildings) may positively affect employee productivity and health. For example, a recent study suggests indoor air quality in green-certified buildings is associated with enhanced cognitive function and fewer ill-health symptoms (headaches, respiratory illness) associated with poor building design.
The internal design of a building can promote or deter physical activity and sitting, and provide opportunities for social interaction and connection. Poorly designed open-plan offices with insufficient speech privacy (for making a phone call, having a meeting, or working in silence), may adversely impact environmental perceptions.
Providing sit-stand workstations can reduce the total amount of time workers spend sitting including prolonged bouts of sitting.
Point-of-decision prompts and making improvements to the stairwell environment encourage the use of stairs over elevators and escalators in a variety of settings including workplaces, shopping malls, bus and train stations, airports, healthcare facilities and universities.
End-of-trip facilities encourage active forms of travel, and other forms of physical activity before, during and after work.
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