P1 FXS October 11 2000 0 36 Annual Reviews AR118 15 Annu Rev Energy Environ 2000 25 537 66 HEALTH AND PRODUCTIVITY GAINS FROM BETTER INDOOR ENVIRONMENTS AND THEIR RELATIONSHIP WITH BUILDING ENERGY EFFICIENCY1 William J Fisk Indoor Environment Department Environmental Energy Technologies Division Lawrence Berkeley National Laboratory Berkeley California 94720 e mail WJFisk LBL GOV Key Words economics health productivity Abstract Theoretical considerations and empirical data suggest that existing technologies and procedures can improve indoor environments in a manner that significantly increases productivity and health The existing literature contains moderate to strong evidence that characteristics of buildings and indoor environments significantly influence rates of communicable respiratory illness allergy and asthma symptoms sick building symptoms and worker performance Whereas there is considerable uncertainty in the estimates of the magnitudes of productivity gains that may be obtained by providing better indoor environments the projected gains are very large For the United States the estimated potential annual savings and productivity gains are 6 to 14 billion from reduced respiratory disease 1 to 4 billion from reduced allergies and asthma 10 to 30 billion from reduced sick building syndrome symptoms and 20 to 160 billion from direct improvements in worker performance that are unrelated to health Productivity gains that are quantified and demonstrated could serve as a strong stimulus for energy efficiency measures that simultaneously improve the indoor environment CONTENTS INTRODUCTION AND OBJECTIVES METHODS RESULTS AND DISCUSSION Communicable Respiratory Illness Allergies and Asthma Sick Building Syndrome Symptoms 538 538 539 539 544 548 1 The US Government has the right to retain a nonexclusive royalty free license in and to any copyright covering this paper 537 P1 FXS October 11 2000 538 0 36 Annual Reviews AR118 15 FISK Direct Impacts of Indoor Environments on Human Performance The Cost of Improving Indoor Environments Limitations of Analysis Productivity Gains as a Stimulus for Energy Efficiency CONCLUSIONS APPENDIX DEFINITIONS OF STATISTICAL TERMS 553 556 557 558 560 561 INTRODUCTION AND OBJECTIVES Prior literature on the relationship of indoor environments to productivity has focused primarily on potential direct improvements in worker s cognitive or physical performance from changes in temperatures or lighting The published literature consists primarily of reports on individual laboratory or field studies or reviews the current literature e g 1 3 without estimates of the nationwide implications for health or productivity Prior reviews have generally not considered the current evidence suggesting that indoor environmental conditions also affect the prevalences of several very common health effects These health effects lead to health care costs plus the costs of sick leave and reduced performance during periods of illness Based on the available literature and statistical and economic data Fisk Rosenfeld 4 estimated the annual productivity gains in the United States potentially achievable from improvements in indoor environmental conditions that reduce these health effects or directly improve worker performance An updated and much longer review of this issue will be published as a book chapter 5 This article summarizes the updated analyses incorporates additional updates and reviews the implications for building energy efficiency METHODS Relevant papers were identified through computer based literature searches reviews of conference proceedings and discussions with researchers Evidence supporting or refuting the hypothesized linkages was synthesized based on these papers The categories of health effects identified for further consideration are communicable respiratory illnesses allergies and asthma and acute nonspecific health symptoms often called sick building syndrome symptoms The economic costs of these adverse health effects were estimated primarily by synthesizing and updating the results of previously published cost estimates The economic results of previous analyses were updated to 1996 to account for general inflation health care inflation and increases in population 6 Estimating the magnitudes of the decreases in adverse health effects and the magnitudes of direct improvements in productivity that could result from improved indoor environments was the most uncertain step in the analysis These estimates are based on the reported strength P1 FXS October 11 2000 0 36 Annual Reviews AR118 15 INDOOR ENVIRONMENTS 539 of associations between indoor environmental characteristics and health outcomes and on our understanding from building and engineering science of the degree to which relevant indoor environmental conditions could practically be improved Nationwide health and productivity gains were then computed by multiplying the estimated potential percentage decrease in illness or percent direct increase in productivity by the associated cost of the illness or by the associated magnitude of the economic activity With current information estimates of the health and productivity gains potentially attainable from improvements in the indoor environment have a high level of uncertainty Improvements in the indoor environment depend on changes to building design operation maintenance or occupancy Many of these changes will influence building energy use In 1998 a multi disciplinary international committee 7 developed a list of building energy efficiency measures and identified the most common impacts of these measures on indoor environmental quality IEQ The committee s assessment based on existing literature scientific and technical knowledge and professional experience is the source for the discussion of energy implications within this paper To make this article understandable to a relatively broad audience the use of potentially unfamiliar statistical terminology has been minimized For example as substitutes for the odds ratios or relative risks normally provided in the scientific literature this article provides estimates of the percentage increases and decreases in outcomes e g health effects that are expected when building related risk factors e g mold exposures are present or absent Measures of statistical significance are included only within footnotes The findings reported in this paper would generally be considered to be statistically significant e g the
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