Consumers are starting to understand more about their health and looking for cost effective and convenient ways to impact it. One way they are starting to understand how to do that is inside their home.

Many parties are involved in making this happen—from the design to material selection, and from the technology to the home’s operations. Some of the industry is looking at it from a scientific perspective and others have the commercial benefits in mind, but all of it is pointed at the better health and wellbeing that homeowners increasingly demand.

“We look at the home as a third skin,” said Erik Rosen, executive director at the Building Biology Institute. “It’s a complex series of systems, biological and mechanical, that create a balance. Indoor air quality is one component of it. Indoor environment quality is more expansive and includes air, water, color and light. So much of that is addressed by building more holistically.”

With design in mind, research is happening across the board, investors are paying attention, and building product manufacturers are launching products that will have a positive impact on homeowners in their mission for healthier living.

Where does it start? The biology of healthy homes is very dependent on using nature as a guide, said building biologist and consultant Stephen Collette.

“Building biology is understanding the building physics,” he said. “It’s about how moisture moves in the envelope. High performance creates more resilient wall systems, but when we make homes tighter, there are risks of off gassing, so chemistry plays a big role. Natural materials have more resilience and lower embodied carbon, so therefore there is a parallel path.”

With the various factors at play, mechanical ventilation is critical. Building biology also considers electromagnetic exposure, which has been increasing at a pace faster than our bodies can adapt.

“We are biochemical, electrical creatures,” Collette added. “We have chemistry happening in us and we have electrics in us with our nerves. We are not used to higher than average exposures. Our bodies haven’t had the time to adapt.”

He believes that we have the answer right in front of us with natural materials. As humans, we are drawn to the outdoors to experience natural materials in a natural environment. Natural materials are a critical part of a well designed home that delivers on health and wellbeing objectives.

“We are innately drawn to natural materials, the color, the polychromatics of them is healthy,” he said. “We are not used to flat and beige, that’s not natural. We prefer radiant heat because we are used to the big ball in the sky, but we have forced heat systems. There are spaces that feel amazing and those that don’t, both psychologically and physiologically, but builders are not purposefully harming people. It’s just the understanding that we have new abilities to test things that we couldn’t before.”

He’s taking that testing and transforming it into courses to help housing leaders build well designed homes that can be responsive to human health.

Those healthy home designs are being validated from a financial perspective as well.

The ROI Of Healthy Housing

Indoor air quality has immense impacts on occupants. The Asthma and Allergy Foundation of America’s recent report estimates that from 2019 to 2038, the cost of uncontrolled asthma will be nearly $964 billion. Sufferers visit the emergency department two times as often healthy individuals. They also report that asthma limits everyday tasks and affects personal relationships and emotional health. Plus, they miss more days of work and school and have difficulty performing tasks.

Dr. John McKeon started out as an emergency room doctor and saw many of those repeat visits. After treating too many children with asthma symptoms, he wanted to understand the impacts of the built environment on this chronic condition. He now serves as CEO of Allergy Standards to put what he learns into practice and develop a more proactive approach to managing the impacts of asthma.

A patient trying to proactively solve their ongoing issues has to navigate very technical language around a product or non-scientific claims that are meaningless, like the word hypoallergenic, for example, that has no scientific basis. Allergy Standard tests consumer products for performance criteria, suitability attributes, and if they pass scientific, independently published and validated criteria, they receive asthma allergy friendly certification, which is how McKeon brought the connection between the built environment and wellness outcomes to life.

“In medical school, we aren’t taught on how to keep people well, just how to treat people when they’re sick, but people want to stay well,” he said. “We need to be proactive to avoid exposure, and to remove allergens.”

To do that, McKeon puts the healthcare and homebuilding professionals on the same workflow to proactively treat health conditions. In the U.S., the spending on sickness reimbursement has reached astronomical levels and isn’t sustainable moving forward. The money that is now invested in sickness reimbursement can be shifted to invest in how homes are built. The design of homes has to be more of the conversation of keeping society well, he said.

“On straight dollar for dollar, architects and people designing spaces are on that line,” he said.

However, the healthcare and the homebuilding industry rarely ever intersect, and neither can provide a thoughtful solution without the other. A homebuilder has no exposure to a patient and a doctor has no connection to a resident.

“They’re not speaking to each other, and nobody is going to figure this out on their own," McKeon added. "It has to be multidisciplinary, interdisciplinary.”

One way to bring them together, McKeon says, is a business model. A strong case study that proves return on investment will connect these two stakeholders and then provide incentive for lenders, states, municipalities to provide healthier housing.

Decades ago, a hospital in Pennsylvania did in home interventions to measure impacts to homeowners during a three-year period, proving a 100 times return on the investment. The study included very modest redesign of homes with a follow up study on ER visits and wellness diaries.

“Rather than those people going to ER, missing school, using steroids, putting on weight because they’re on steroids, stop playing sports, getting sick, they’re in a completely different place,” McKeon said. “You take that child’s journey out five years, and that delta, that cost for society is huge.”

But, it’s not clear who has the interest and motivation to pay for it, because one is an OPEX healthcare budget, and another is a CAPEX budget, such that it translates to a five-year actuarial policy or a one-year housing building budget where money can’t be moved from one to the other.

“So, if you can crack that nut and get the payers, the reimbursement people, the insurance companies, the mortgage lenders, society at large, to realize we should pay for this, we’ll all gain down the line,” he added. “That is the missing piece that nobody’s figured out.”

Taxpayers always scrutinize where their tax dollars are going and many don’t want to pay for someone else’s home improvement, but if the tax dollars don’t go in proactively, they will be needed to cover health care costs reactively as more people suffer from illnesses originating in their homes.

However it is measured, home design and material selection can play a large role in an individual resident’s health and in the financial ecosystem.

Part of that is being able to have the health benefits of a home’s design as part of the appraisal.

“The whole ecosystem is lacking education and we need to communicate with each other,” said Sandy Adomatis of Adomatis Appraisal Service. “Less than 3% of 30,000 appraisers have had any education in green or energy efficiency.”

She coaches appraisers to find homes with those features and the agents to list the features on the MLS so that they can be part of the home’s valuation.

There also is a path to offer a healthy home audits checklist, along with an occupational nurse or occupational therapist to go into homes to perform an assessment checking indoor air quality,

“The data is irrefutable,” McKeon said. “If you get more people to come do that, do people miss less days of schools, stop going to the ER, need less medication? Getting people healthy by going to their house has to be the future. The current system is not sustainable.”

Which, will also take policy changes.

The Policy Side of Healthy Homes

Without the business case, the policy side struggles. Jonathan Wilson is the deputy director at the National Center for Healthy Housing that works with communities and environmental organizations to come up with and advocate for better local and federal policies that lead to better housing.

The center works with home service agencies to provide support and guidance to those agencies and to the hospitals.

Wilson says that currently Medicare isn’t using this approach but is open to supporting it, and understand that there are issues in a home that can be monitored and adjusted to avoid future health issues. Plus, they understand the potential for lowering hospital costs--a step in the right direction.

Some of the interventions don’t have to be directly health related. Home performance upgrades also have positive health impacts.

What are Non-Energy Impacts?

When a home is designed well, it performs better, which lowers energy use. Better design also offers many non-energy impacts, such as improved comfort, better acoustics, weather resilience, and improved indoor air quality.

The Department of Energy’s Efficient New Homes Program (DENH) requires building above code for windows, wall materials, HVAC, appliances, water heating, R-values, U-factors, air leakage, duct leakage, installation quality, system efficiency, and smart technology. These homes have been able to perform better in areas like safety, noise, resiliency, comfort, and IAQ.

Chrissi Antonopoulos, senior building scientist at the Pacific Northwest National Laboratory reported that consumer data shows comfort and safety as the most important motivator for making a change to a home.

Homeowners find that home energy improvements have a positive impact on everything else. A homeowner that was part of the Department of Energy’s Efficient New Homes program said, “Air quality was immediately apparent in the dramatic reduction in my son’s asthma symptoms... dust is dramatically less... no lingering cooking smells.”

Another study simulated a one-week power outage during heatwaves and extreme cold in one of these efficient homes, modeling the hours of thermal safety and a home built to the 2009 code provided 29 hours of safety, versus the DENH home that offered 72 hours of safety.

Yet another study of a Chicago home measured indoor noise levels and thermal comfort before and after windows were replaced. With the new windows, air leakage was reduced by 36%. The new windows were able to maintain warmer, more stable interior surface temperatures. Plus, the homeowners reported significant improvements in air quality, temperature control, noise, and security.

While these studies are significant, the evidence needs to scale to be widely adopted.

The Quest To Build A Business Model

In an effort to quantify a home’s health impact to a resident, researchers are using DALYs as a health currency. A DALY (Disability-Adjusted Life Year) measures both shortened life expectancy and lowered quality of life as health impacts. A health impact can be shown in the sum of YLL (years of life lost due to premature mortality) and YLD (years lost to disability).

By understanding DALYs from in home health hazards, Núria Casquero-Modrego a researcher at Lawrence Berkeley National Lab , wants to understand ways to improve the home environment and prioritize areas where there could be better health interventions.

The DALYs measurement allows indoor air impacts to be compared with other risks. She shared that indoor air harm would be about 2,200 DALYs per 100,000 persons per year, which compares to smoking that is 2,600; alcoholism at 1,200; and transport injuries at 1,000.

To reduce DALYs, Casquero-Modrego is studying home design interventions that would reduce noise exposure, reduce allergens, increase indoor winter temperatures, reduce outdoor contaminants, and decrease financial stress. Ultimately, the research is intended to improve physical and mental health, reduce healthcare usage, and lower winter mortality.

There are new products that are leaning into this opportunity.

Breathing Healthy Indoor Air

Air health monitoring company, Lution , reports that the air inside a home is often up to five times more polluted than the air outside and that poor air quality is associated with poor sleep health. Lution envisions a world where air health is recognized as a key pillar of overall health, and air health is visible, much like a nutrition label for air.

“You take in seven pounds of food and water, you take in 35 pounds of air,” said Michael Marino, co-founder at Lution. “The lungs are a filter and have a filtration system in the digestive tract, but we didn’t evolve for industrial pollution. Your body needs to defend all it breathes in.”

When these harms are not filtered, they can create inflammation that can then cause negative impacts to cognitive health, and weight gain.

As McKeon reported, there isn’t a direct relationship between the medical community and homebuilding, so doctors don’t understand what a patient is exposed to and then cannot understand the exposures as inputs to the disease. Lution solution is fuse together a suite of lab testing with home sensor data where every air monitor in the home acts like a scale weighing the danger in the air.

David Vivero, who suffered a long battle with mold-related illness, is also a former homebuilder and a technology entrepreneur. With his experience building software, he saw a clear opportunity to work on consumer applications that harness data to inform decisions.

To get to the level of a nutrition label, the company is exploring all the ingredients of the air and how those ingredients impact a body, including moisture, heavy metals, and cleaning chemicals, sorting through thousands of particles. Then, those particles are weighted by their individual level of toxicity on a human body, measured by the inflammatory impact.

A homeowner can receive a Lution kit to vacuum air filter particles, then send them to a lab for analysis. The homeowner also receives sensors that calculate the barometric pressure to capture what is going on with the building envelope and the pollution from external or internal sources that can include VOCs, combustion by-products, and carbon dioxide.

The data Lution is collecting it hopes to use to create a standard along with proper remediation programs. As data is collected, there will be new ways to understand the connectivity between health, comfort and the built environment. Much of that connectivity comes from just building higher performance housing.

Health, Comfort From Temperature And Lower Bills

Air temperature has a large impact on comfort in a home. Vivint launched Comfort IQ to create a comfortable home with lower energy bills, which also provides a level of financial comfort.

“It uses a baseline of activity in the home that gets smarter over time,” said Jim Nye, chief product officer at Vivint . “As energy costs continue to rise, the energy hog in the home is the HVAC system that accounts for half of the energy usage in a home. Comfort IQ is designed to learn what a customer’s preferences are and it can automatically save money on energy bills year round.”

The company studied 50,000 homes running Comfort IQ and on average across five climate zones saw between $210 and $300 of savings, a three times increase from a typical Energy Star certified thermostat. The system reduces HVAC run time by an average of 13% while still keeping the resident comfortable.

“Customers don’t separate a smart home and energy,” Nye said. “Our research indicates that customers really want a system that manages energy and also delivers peace of mind in other areas. It takes two weeks to learn from the sensors and adjust the system and what normal is in the home and start saving.”

A recent Vivint study showed that 77% of homeowners are interested in a smart home solution that provides holistic energy management and efficiency, which have indirect health benefits.

“Consumers understand the whole home as a system, not as hundreds of components,” said Jason Thorson, director of national accounts with air conditioning company Daikin. “The translate the whole experience to harmony, wellbeing, the value that they receive physical and mental wellbeing.”

Homeowner options don’t stop there.

Home Health And Comfort From All Angles

Martha Stewart and her brand are the epitome of home and comfort. She recently partnered with some technology entrepreneurs to launch Hint , a home intelligence platform.

“It will be the blueprint for the home to really help organize, run and live in the home,” she said. “We want to make it the place for our families to enjoy. Plus, it will raise the value of the home.”

With the Hint app, homeowners have access to information on hourly air quality and pollution levels, along with the temperature and humidity forecast.

“You can just ask, is today a good day to air out my home by keeping the windows open?” said Kyle Rush, a co-founder and the CTO at Hint.

An answer would look like this: Yes—for a short airing, today looks good. Outdoor air quality is Good (AQI 19), it’s dry and mild at about 69°F, and there are no active weather alerts. I’d open a few windows briefly for a cross-breeze, then close them before the evening chill sets in—the forecast low is 52°F, and gusts are reaching 24 mph.

While these are great inputs for resident health, there are other ways Hint help surface health threats, like radon, which ranks as the second leading cause of lung cancer in the U.S. Hint flags a home’s risk the day it is set up, also walking the user through testing along with guides on the importance of measuring it over time.

The app uses 1,300 data points to learn the home and provide expertise and reminders. It can ping a homeowner on when to change filters, check carbon monoxide and smoke detectors, and then find local pros to do the work if needed.

Some legacy solutions are now being replaced with the hopes of providing healthier, more effective solutions.

Revamping Antiquated HVAC For Home Comfort

Panasonic is focused on solving some of the indoor health and comfort concerns with its product OASYS . The company has been manufacturing and installing traditional HVAC systems with air handlers and ducts, which it set aside to develop an innovative, easier to maintain solution that breaks industry norms.

“We’re taking a mini split and cooling a box in essence and we use a two ton system to maintain the home,” said Bill Meyers, group manager of technical sales at Panasonic Eco Systems North America. “We cool that box with that mini split system and transfer it to each room of the house with a fan. If anything should fail, the beauty of OASYS, you may get one room that isn’t getting cooling, but everywhere else is still cooling. A new fan could be picked up anywhere, it’s not hard to find and not special order if anything goes down. But, with a traditional system if it goes down, the whole home is crippled.”

The system is presented as an alternative to current HVAC equipment to bring more consistency across the whole home and a higher level of comfort to occupants. It’s being tested in a Houston home where sensors have collected a year’s worth of data around indoor air quality and humidity.

The data pulled on the Houston concept house, showed that OASYS kept every room between 53 to 55% relative humidity while outside humidity levels reached 89%. Temperatures on the first floor stayed between 70.2 and 71.1 degrees all week and the second floor stayed consistent between 70.4 to 71.4 degrees. The two floors never drifted more than about half a degree apart.

Indoor air quality is often dependent on the level of humidity. Meyers said that human activity in the home contributes to the humidity, with cooking, showers, and just living in the space, which means there is always a need for a dehumidifier.

“OASYS is a complete system with range hood, bathroom fan, fans, that is going to protect the integrity of the build,” he said. “Having the ERV will maintain the build and protect the health and human safety of the occupants. It protects the investment and the people living there.”

These innovative breakthroughs could define the future of healthy homes , but what else is in store and how far into the future can we plan?

While most home builders are not considering the full lifetime of their homes, Jen Jobart, building science educator and consultant at Practical Health homes and a Building Biology Institute board member, is going next level. She explores how to keep homes healthy 100 to 200 years into the future and how we will think of the human species at that time.

“What can we do now to acknowledge the risks that we know now,” she asked. “We can’t look out that far, but we are building systems that we hope and expect to last. A lot of mold problems with existing homes is because homes are only designed to last as long as a mortgage lasts. They are making occupants sick. One of the best things we can do is to build homes that we think can last longer and can be maintainable.”

Most experts agree that nature provides solutions and suggest looking to the outdoors now and in the future.

“Building biology looks at how the built environment looks at both the impacts to planetary health and human health,” said Collette. “If it is healthy for us, it is healthy for the planet. If we are using natural materials, it has to be better for the planet. Lowering the footprint of the built environment. If it is healthier for us to be in those spaces, that is how we have to move forward. We need to start looking at planetary health and human health at the same time because they are absolutely connected.”

More connections mean better health and comfort in our homes. Connecting healthcare and home design, connecting nature and the built environment is the future that can provide the business case worthy of investment.