Cover: The Colorado Health Foundation building’s design enhances the health and wellness of its occupants. Above: Matt Trowbridge, associate professor of Emergency Medicine at the University of Virginia School of Medicine; Kelly Worden, USGBC; and Chris Pyke, chief strategy officer at Aclima. Photo: Ana Ka’ahanui

For all the progress that has been made to understand and reduce the negative impacts of the built environment on the natural environment, the important role that buildings have on human health has not been as actively pursued.

In recent years, however, health care and public health communities have begun to recognize the need to create spaces that promote the well-being of the people who occupy them. New strategies and practice-relevant tools have been established for owners, designers, and builders in the real estate market, including additional health-related credits in the U.S. Green Building Council’s (USGBC) Leadership in Energy and Environmental Design (LEED) green building rating system, and the advent of the WELL Building Standard, an evidence-based system that measures, certifies, and monitors features of a building that impact human health and well-being.

“It’s the right thing to do. We’re in the business of advancing good ideas,” explains Ben Kallechey, an architect with Davis Partnership, a Colorado-based architecture, land planning, and interior design firm.

Kallechey applied principles related to health, wellness, and sustainability as the lead architect for an office building in the uptown neighborhood of Denver that was commissioned by the Colorado Health Foundation and completed in December 2016. Designed with the physical health, mental health, and social equity of its occupants and surrounding community in mind, the building is pursuing both WELL and LEED certification, using a pilot credit within the LEED v4 BD+C rating system known as the Integrative Process for Health Promotion.

Made available as a pilot credit in May 2016, the new Integrative Process for Health Promotion credit was launched by the Green Health Partnership—a collaboration between researchers from the University of Virginia School of Medicine and USGBC that is funded by the Robert Wood Johnson Foundation.

Founded in 2012 by Dr. Matthew Trowbridge, an associate professor in the Department of Emergency Medicine at the University of Virginia School of Medicine and Dr. Chris Pyke, chief strategy officer at Aclima and formerly COO of GRESB and vice president for research at USGBC, the purpose of the partnership is to explore the appetite for increasing consideration of health within the built environment.

Today, along with Dr. Trowbridge, Kelly Worden, project manager of Health Research at USGBC; Megan Hazer, health research associate at the University of Virginia School of Medicine; and Daniel Lau, manager at the Build Healthy Places Network and part-time employee of the Green Health Partnership, make up the partnership’s team. They are working to transform the real estate market by encouraging real estate developers, designers, and portfolio managers to invest in and create a built environment that intentionally integrates health.

Ben Kallechey, architect with Colorado-based
Davis Partnership Architects.

“The green building movement has taken sustainability from a fairly broad-based goal and turned it into a successful and valuable focus of the real estate industry,” Trowbridge says. “The Green Health Partnership came from asking questions about whether that same template could be employed to more intentionally address health and well-being in the real estate industry, alongside traditional goals of sustainability.”

Influenced by the integrative process from the green building sector and health impact assessment from the public health sector, the Integrative Process for Health Promotion pilot credit is just one of the solutions developed by the Green Health Partnership. The pilot credit is designed to address the numerous health promotion tools and strategies that are evolving within the real estate market, and to provide a more formal framework that incentivizes project teams to promote health in the built environment.

“We have gone so far as to institutionalize the benefits of energy and environmental protection, but we don’t have the same set of tools for health. We don’t have equivalent guidelines. We don’t have commissioning standards. We don’t have monitoring protocols,” Pyke says. “If you want your building to stand out, we’re looking for new things, and one of the new things is health promotion. We understand from our work that our built environment is a strong predictor of health outcomes.”

Project teams who pursue the pilot credit are asked to partner with public health professionals in order to better promote health in the development of their projects. Beyond providing a central framework that connects the public health and real estate sectors, the pilot credit also guides project teams through a systematic consideration of health and well-being outcomes, and rewards teams that prioritize addressing existing health needs and opportunities.

“The pilot credit is also a symbol. The credit demonstrates that health promotion isn’t just a simple list of features. It’s about the process—your intention, what are the needs of your population, and how are you addressing those needs through the design and operation of your building,” Pyke says.

During its first phase of research from 2013 to 2015, the Green Health Partnership looked to the green building movement to understand its success in transforming the real estate market and analyzed LEED. The team performed a scan of the LEED 2009 rating system to better understand where health and well-being were represented within the system and the kind of language that was used to describe these topics.

“Health is a long-standing value of the green building movement and we found a number of existing strategies within LEED that either explicitly or implicitly addressed health. However, these strategies weren’t organized in a cohesive manner,” Worden says. “It wouldn’t have been easy for a project team to intentionally select and combine strategies to address specific health outcomes. We also found that the language and actual words used to describe health were quite different from the language and words used by the public health sector, creating a barrier to collaboration between the two sectors.”

The partnership determined that a cohesive system for applying health and well-being-related strategies within the real estate market was lacking, and noted a gap in how health was thought of between the two industries. So beginning in 2015 (and continuing until 2018), they launched a second phase of research aimed at creating tools that could be applied within the green building industry to address health in a more intentional manner.

“The value of LEED or other rating systems is they help the real estate market differentiate green property from nongreen. The observation of the Green Health Partnership was that we lacked a similar mechanism for differentiating health-promoting property. The real estate market doesn’t work efficiently to promote health and well-being because we don’t have the right kinds of information in the market to help distinguish property that promotes health from property that doesn’t,” Pyke says. “It was time to create a similar rich and robust set of processes to promote health. It is a natural evolution of the green building industry. The movement stemmed from a desire to create better buildings that benefitted both people and the environment.”

This second phase of research has focused on two scales: the project scale, or looking at individual building and neighborhood projects, along with the architects, designers, and engineers who work on them; and the portfolio scale, or understanding what controls the flow of institutional investment in real estate and establishing health metrics that could influence those decisions.

“It’s exciting that the real estate market and practitioners across all domains relevant to green building have realized there’s an opportunity to join in on efforts to create healthy places,” says Trowbridge. “It’s tempting to think that health will roll out identically to green building, but I think there will be some important differences. I think measuring health can be very complex. It’s also incredibly important to get it right. I think that’s part of the reason why we are inclined to promote, as a first step, a focus on process rather than purely a laundry list of specific design features. We feel the most important step will be to give project teams an ability to certify that they very carefully and intentionally thought about health throughout the process.”

Anne Torney is a partner at the design firm Mithun.

At the portfolio scale, the Green Health Partnership worked with GRESB—an investor-driven organization that sets the global standard for environmental, social, and governance (ESG) assessment of real estate portfolios and infrastructure assets—to help develop and launch the GRESB Health & Well-Being Module in March 2016.

“The intent of the GRESB Health & Well-Being Module is to inform and help investors understand the performance of their investment and build health into that understanding,” Worden says of the module, which is an optional supplement to the GRESB Real Estate Assessment.

Similar to the concept of how the Integrative Process for Health Promotion within LEED defines a process for project teams to prioritize actions based on existing health needs and opportunities, the GRESB Health & Well-Being Module assesses the existence of processes for health and well-being promotion at the scale of a real estate portfolio. The module considers how a company assesses the presence of processes to meet health needs and prioritizes action within their real estate products on the well-being of customers and the communities surrounding individual real estate assets.

Part of the rationale for focusing on these two different scales was recognizing that, in order for individual project teams to be innovative in applying new types of tools, there needed to be demand for those tools as well as capital funding available to address health in a more intentional manner at the individual project scale.

Many project teams are already beginning to work with the Green Health Partnership and pursue the pilot credit. Researchers from the Green Health Partnership also provide technical assistance to project teams pursuing the credit, and, in so doing, gain a better understanding of what additional resources and guidance are needed.

“The overall concept of health can sometimes be overwhelming, so we help teams think through the various ways that a given project could impact health,” Worden says.

Kallechey and his team, along with staff from the Colorado Health Foundation and the Green Health Partnership, are in the final phases of pursuing WELL and LEED certification for their project in Denver. Intentionally located in the uptown neighborhood, the building is in a prime, up-and-coming area.

“The Colorado Health Foundation wanted to have their building in a place that was prominently located in the communities in which they work,” Kallechey says. “They wanted their building to embody their mission of not only making Colorado the healthiest state in the nation but also an example for people in the neighborhood.”

Kallechey and his team were connected to the Green Health Partnership through the Colorado Health Foundation, and, as they began conceptualizing what the project might look like, formed principles focused on health, wellness, and sustainability. They started concept design work for the office building when the pilot version of the WELL Building Standard was released, and they discovered that many components of the WELL system were in line with the Colorado Health Foundation’s mission.

Sansome and Broadway Family Housing’s design, central location, supportive services, and large roof garden with a play area communicates a sense of permanence and dignity.

The building was designed with the physical and mental health, as well as social equity, of the people in the surrounding communities in mind. A grand circular stair placed at the focal point of the building’s design encourages tenants to use the stairs more often throughout the day, operable windows that allow for individual control over thermal conditions are installed within 25 feet of each work station and help maximize daylight.

Other features include vegetation inside the building, which helps connect its occupants with nature, an entry courtyard decorated with tables, chairs and planters that functions as both a welcome space before entering the building and as an extension of the office environment, two roof decks including one that is directly off of a fitness room with free weights, cardio equipment, and organized group classes, and a cherry tree orchard on the south edge of the site that serves as both a meeting place for employees and a recreational space for public use.

“As urban infill continues, and the neighborhood and city are built up over time, that’s one of those pocket parks that will be a celebration point going forward,” Kallechey says.

The Green Health Partnership has also collaborated with Mithun, a USGBC Gold-level member and Seattle-based integrative design firm that provides architecture, landscape architecture, interior and urban design, and planning services, to apply the pilot credit in a more informal manner in several affordable housing projects that Mithun is designing in California.

“It’s important that design firms like Mithun institutionalize the process for health promotion within their practice for building. The degree to which our partners have been institutionalizing those kind of processes in their practice, that’s what success looks like to me,” Pyke says.

One of those affordable housing projects, a mixed-use building to be located on a vacant lot near the Balboa Park Station in San Francisco, for which Mithun is in the process of doing a site analysis, will promote health and well-being.

“The way these [affordable housing] buildings are set up is to support a social network,” says Anne Torney, a partner at Mithun in San Francisco. “Right now, the site for this project is a big vacant lot. It’s noisy. It’s right next to a freeway. It’s kind of a placeless place. We’re thinking about this building as an opportunity to define a kind of plaza near the Balboa Park Station and to create a sense of place for the community.”

In addition to offices on the ground floor occupied by childcare and community development organizations connected with job training and mental health services for residents, Mithun is considering a café that would be open to residents and the public along with some neighborhood retailers, all of which are intended to help create a sense of community and place. However, Mithun plans to engage in community meetings for several months to determine what the community would like before beginning any detailed designs for the project.

Other health considerations include pedestrian safety issues, such as sidewalk design and how to make pedestrian crossings safer since the site is located near a large transit hub in San Francisco where multiple bus, subway, and metro lines converge; how to tackle noise pollution as the building docks on a freeway, and more. According to Torney, construction for the project will be completed in 2020.

Mithun’s Broadway and Sansome Family Housing provides affordable housing for families, including formerly homeless families, in the heart of San Francisco on a former Embarcadero Freeway ramp site. Photos: Bruce Damonte

“It’s a rich problem when viewed through the lens of health. Health is a great way to engage and determine what should be the priorities as we design this building,” Torney says.

The Green Health Partnership has been working with Mithun to better understand a design firm’s perspective and what kind of tools and resources are helpful for project teams to encourage these designs for health. For both the partnership and Mithun, it’s been an enriching experience.

“There’s a lot of value to the LEED pilot credit because it helps walk people through a process. It asks design teams to engage a public health professional. Public health professionals think in terms of metrics and research-based outcomes. If you undertake a certain design strategy, you want to know based on research that it’s going to be effective in terms of supporting health. Having a much more intentional formal process, I think that’s important if we’re going to transform industry,” Torney says.

“Having a public health person as part of the design team is a very direct path to getting there. Our expertise is design. It’s not all the important research that happens. It’s fabulous to have that link,” says Erin Christensen Ishizaki, a partner at Mithun.

While innovation in health within the real estate industry has, in the past, occurred by addressing health conditions on a more specific basis, from indoor air quality to material toxicity, the Green Health Partnership takes pride in having defined a process for health promotion that encourages project teams to take a more holistic approach to health while also meeting LEED standards.

“What we envision is a time where a project team can get credit as part of a LEED certification for showing that they have intentionally considered health and well-being impacts throughout the entire course of the project, from conception to land acquisition, planning and design, construction, ongoing maintenance and operation,” Trowbridge says.

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