Healthy Indoor Air Gains Global Spotlight with Landmark UN Commission

Most of us spend the overwhelming majority of our lives inside homes, schools, offices, and shared public buildings. Indoor pollutants, ranging from particulate matter to volatile organic compounds and biological aerosols,can reach levels several times higher than outdoors – especially in spaces where insufficient ventilation enables airborne contaminants t o accumulate. Dr. Joseph Allen of the Harvard T.H. Chan School of Public Health stated in his address at the UN Clean Air Event, “Because outdoor air penetrates into our buildings and we take nine out of ten breaths indoors, the majority of outdoor air pollution we breathe happens indoors. Outdoor air pollution is an indoor air pollution problem.” Exposure to these airborne pollutants in indoor spaces is a major risk factor in the development of chronic illnesses such as asthma and cardiovascular disease – with children, older adults, and disabled people being at the highest risk [2].

IAQ in Schools

Schools and the impact of poor IAQ on children was a major focus of the speeches at the event – including that of the representatives from Montenegro and France who helped spearhead the event. Children spend over half of their day in classrooms, and when the IAQ in these congregate spaces is poor due to aging infrastructure, there can be serious impacts on children’s attendance, ability to pay attention and focus on their work, and even their long-term health. Anđela Jakšić-Stojanović, the Minister of Education, Science, and Innovation for Montenegro, described how Montenegro was the first country to not only adopt, but to enforce clean indoor air standards for schools through the installation of air monitoring devices. The data from these monitoring devices is used to populate a national database of school air quality, which is then used to guide infrastructure upgrades and establish reporting standards. 

A similar approach was taken by Boston Public Schools, which invested in over 4,400 air quality sensors across their school district to report the air quality in every classroom, nurses office, and administrator office, as well as rooftop units to monitor outdoor conditions. As shared by BPS representative Katherine Walsh, live data from these sensors is publicly available through an online dashboard. This data has allowed BPS to quickly detect and fix HVAC and other building issues – leading to energy savings and bringing in over $20 million in grants to help fix school infrastructure across the district.

The success stories shared by Montenegro and Boston Public Schools in tackling poor IAQ in schools outlines a path for how others can put clean air science into practice. A crucial piece underlying these initiatives was a large up-front investment in air quality sensors and monitoring devices. These devices enabled detailed IAQ data to be collected down to the classroom level, which guided administrators and building managers on where specific HVAC repairs and infrastructure upgrades were needed. Having this repository of data was essential to convincing policy makers to invest in infrastructure upgrades, and provided a valuable guide on where to start fixing the widespread problem of poor IAQ.

IAQ as a Public Health Issue

“If you cannot rely on the air that you breathe, what can you rely on?” – Anna-Maria Arabia, Australian Academy of Science

The COVID-19 pandemic was the first time in many people’s lives where they had a reason to think about their indoor air quality – at all. This dangerous novel pathogen suddenly transformed the air that we all breathe from an invisible non-entity – something so ubiquitous that it is barely worth a second though – to a potential vector for a then-unknown disease. However, clean indoor air as a public health issue did not start with COVID-19. As many speakers at the UN event emphasized, since we spend approximately 90% of our time indoors, we breathe in the majority of airborne contaminants there. The link between air pollution and both communicable and non-communicable diseases has been known for centuries, and the fight to improve building standards as a part of public health has been going on for decades.

Dr. Lidia Morawska of the Queensland Institute of Technology – and a leader within the Clean Air movement – draws a line back to the Clean Air Act of 1963, in which the first regulations for outdoor air quality were enacted as a result of widespread air pollution and the environmental movement. This type of legislation focuses on outdoor air pollution, such as that from automobile exhaust and industrial emissions, with little to no focus on the airborne pollutants that accumulate in indoor environments. Although the tools for monitoring and improving indoor air quality are well-understood, a lack of standards and regulations means that these tools are not being effectively used – and individuals are left to mitigate the health impacts of a problem that desperately needs a collective, policy-based approach.

Outdoor and indoor air pollution is a major contributor to the development of non-communicable diseases such as cardiovascular disease, asthma, and cancer. Alison Cox of the Non-Communciable Disease Alliance stated that the global healthcare burden of these diseases totals $6 trillion dollars, or over 5% of global GDP. The nature of indoor air quality issues varies by country, with much of the IAQ disease burden in rural parts of low- and middle-income countries coming from the unsafe use of coal, wood, animal dung, and other biomass as fuel for cooking and electricity. In high-income countries and urban areas, people suffer the ill effects of automotive, industrial, and other pollution from fossil fuel combustion infiltrating into indoor spaces; as well as uniquely indoor pollutants such as ambient chemicals and VOCs from the built environment, mold, and respiratory viruses. Regardless of where people live, there are numerous public health issues tied to poor IAQ that better monitoring, regulation, and the establishment of a global standard could help alleviate.

“If the act of breathing in a space makes someone sick, access isn’t equitable.” – Plum Stone, The Safer Air Project

No event in recent history has illustrated indoor air quality as a public health, accessibility, and equity issue as starkly as the ongoing COVID-19 pandemic – which continues to spread globally and induce long COVID, long-term illness, economic losses, and a reduced quality of life for a portion of those infected. Public health advocates Plum Stone, of the Safer Air Project, and youth advocate Violet Affleck spoke passionately about the continued need to recognize COVID-19 as a major public health threat, and to put the lessons learned from this catastrophic global event into practice. Drawing from their lived experience with COVID-19 and the chronic illness it can cause, Stone and Affleck lambasted the lack of policy to mitigate COVID-19 and the repeated infection of children with this virus as “neglect of the highest order”, and a severe accessibility issue for something as fundamental as breathing to be the reason why millions of disabled, high-risk, and otherwise COVID-conscious people are unable to return to public life after 5 years.

“It is neglect of the highest order to look children in the eyes and say, “We knew how to protect you, and we didn’t do it.” -Violet Affleck, Youth Advocate

A common sentiment reflected by speakers throughout the event was that we do possess the tools to monitor and clean indoor air. The science and methods for doing so are well-established and understood, and once in place, cleaning the air is a passive, effective, and common-sense public health tool. The problem lies in a lack of standards, regulations, and collective will to put this science into practice. However, the launch of the Global Pledge on Healthy Indoor Air is an important first step in changing this.

IAQ as an Labor Issue

Clean indoor air is not just a public health issue. The ability to breathe safely indoors – whether that be at home, in public spaces, or on the job – is an issue that touches upon many established rights and justice issues. Caroline Frederickson of the International Labor Organization (ILO) spoke specifically about IAQ as a workplace safety issue. Access to a safe and healthy working environment is a fundamental workplace right, but IAQ is frequently overlooked as a part of this – even though failing to account for airborne health risks can have serious consequences in some working environments. Previous conventions on worker safety and airborne risk mitigation have focused on chemical and biological hazards that workers may be exposed to in the workplace. However, even more mundane IAQ issues, such as poor ventilation and respiratory illness spread, can be detrimental in the workplace: leading to greater rates of employee illness, absenteeism, and turnover, as well as reducing workers’ attention and focus on their work and increasing the likelihood of accidents, mistakes, and sloppy work. Everyone can and should benefit from having healthier indoor air regardless of the environment they work in, and the ILO provides guidance to governments, employers, and workers to help make this happen.

IAQ as a Climate Resilience Issue

Climate experts have issued stark warnings about the accelerating pace of climate change, and now, an increasing number of people around the world are seeing the impacts of climate disasters in their own backyard – and in their air. Climate change results in complex alterations to global weather patterns, which not only increases the severity of weather disasters such as wildfires, droughts, floods, and storms, but causes them to occur in places that have historically not experienced such threats. One very visible example of this are the massive wildfires that have taken place in Canada, California, Siberia, Australia, Hawaii, and more – resulting in plumes of smoke that span entire continents and turn the skies of cities thousands of miles away into an orange haze. Indoor spaces are not impervious to this smoke, which can infiltrate into buildings through unsealed cracks and HVAC systems. 

As wildfire smoke becomes a seasonal event in many parts of the world, cities and communities must adapt to the presence of this new threat [12]. One important aspect of doing this is establishing indoor air quality monitoring, to monitor and visualize smoke and particulate matter, as well as improving IAQ infrastructure to flush smoke particles out of buildings instead of allowing them to accumulate. Standards such as ANSI/ASHRAE Standard 62.1, the baseline for acceptable IAQ and minimum ventilation rates in most nonresidential buildings, should be adopted to guide construction for new and refurbished buildings – especially buildings that are already being built to abide by LEED and other green building standards. Reducing carbon emissions and improving energy and resource efficiency in our built environments is an important goal, and one that does not have to work in opposition to IAQ monitoring and improvements. Establishing and enforcing global IAQ building standards will provide clear metrics for architects and builders to work towards – making our built environment safer for all and more resilient to looming climate threats.