Healthy Buildings: How Indoor Spaces Drive Performance and Productivity
About this book
Joseph G. Allen and John D. Macomber bring together two distinct but complementary disciplines — public health science and real estate finance — to make a compelling case that the buildings we inhabit every day are among the most powerful determinants of how well we think, work, and live.
Published by Harvard University Press in 2020, Healthy Buildings: How Indoor Spaces Drive Performance and Productivity draws on Allen's decade-long research program at the Harvard T.H. Chan School of Public Health and Macomber's expertise in capital markets and built assets to reframe how owners, developers, and occupants should evaluate the value of a building. At the heart of the book are nine foundational dimensions — what the authors call the Nine Foundations of a Healthy Building.
These are: ventilation, air quality, thermal health, moisture, dust and pests, safety and security, water quality, noise, and lighting. Rather than treating each as an isolated engineering checkbox, Allen and Macomber argue that these nine factors operate as an interconnected system that continuously shapes occupant physiology and cognition. A building that scores poorly on even one dimension can undermine performance across the board, while optimizing all nine creates measurable gains in productivity, creativity, and health outcomes.
Ventilation occupies a central position in the framework. The authors draw heavily on a series of landmark studies known as the COGfx (Cognitive Function) Studies, conducted by Allen's team at Harvard. In the first phase of this research, office workers were placed in controlled environments that simulated different air quality scenarios — conventional buildings with elevated CO2 and volatile organic compound (VOC) levels, green buildings with improved ventilation, and enhanced green environments with even higher ventilation rates and lower chemical concentrations.
Participants completed a standardized battery of cognitive tests across multiple domains including crisis response, information processing, and strategic planning. The results were striking: cognitive function scores were roughly 61 percent higher in simulated green building conditions and more than double — approximately 101 percent higher — in the enhanced green condition compared to conventional baselines. Follow-on research extended these findings into real-world green-certified office buildings across multiple countries, consistently showing that workers in certified buildings outperformed peers in conventional offices on objective cognitive metrics while also reporting fewer sick-building symptoms.
The COGfx findings are integrated into a broader business case argument. Allen and Macomber point out that employee salaries and benefits dwarf energy costs in the operating budget of any organization. Even modest productivity gains attributable to better indoor environments — gains on the order of a few percentage points — translate into financial returns that far exceed the incremental cost of upgrading ventilation, filtration, and thermal systems.
The authors quantify this relationship and show that the productivity premium associated with higher ventilation rates is more than 150 times greater in dollar value than the additional energy required to deliver that air. Beyond ventilation, the book explores each of the remaining eight foundations with a blend of epidemiological evidence, engineering principles, and practical recommendations. Thermal health addresses how temperature and humidity interact to affect comfort and alertness; moisture management concerns the prevention of mold and dampness that can trigger respiratory disease; dust and pest control speaks to the persistent allergen loads in poorly maintained interiors.
Water quality examines the risks posed by aging plumbing infrastructure and pathogens such as Legionella. Noise and acoustics receive careful treatment, with the authors noting that chronic exposure to unwanted sound suppresses concentration and elevates stress hormones. Lighting design, particularly access to daylight and circadian-aligned artificial light, is shown to influence sleep quality, mood, and overall well-being.
Allen and Macomber situate the healthy building movement in relation to the better-known green building movement, which has historically focused on energy efficiency, water conservation, and material sustainability. They argue that while green building has made undeniable environmental contributions, it has tended to overlook the most economically significant asset inside any building: the people. Rating systems like LEED have begun to evolve, and the newer WELL Building Standard — which maps onto Allen's nine foundations quite closely — places human health at the center of certification requirements.
The authors advocate for building owners and tenants to use Health Performance Indicators (HPIs), analogous to the Key Performance Indicators used in business management, to continuously monitor and report on indoor environmental quality. The book closes with a forward-looking discussion of how smart sensor technology, real-time data dashboards, and occupant feedback loops can transform building operations from reactive to proactive. Allen and Macomber envision a future in which buildings actively demonstrate their health credentials, attracting premium tenants and commanding higher asset valuations — making the case that healthy building is not merely a moral obligation but a sound financial strategy for the twenty-first century built environment.