Transforming health: The WELL Building Standard’s role in sustainable development

The COVID-19 pandemic exposed how built environments impact health. Building standards like WELL, which integrates well-being with sustainability, have gained traction. While challenges exist in implementation and adaptation, evidence suggests such frameworks provide an approach for designing healthier, more resilient, and sustainable spaces that benefit both occupants and the environment. The COVID-19 pandemic exposed how built environments impact health. Building standards like WELL, which integrates well-being with sustainability, have gained traction. While challenges exist in implementation and adaptation, evidence suggests such frameworks provide an approach for designing healthier, more resilient, and sustainable spaces that benefit both occupants and the environment. In recent years, many advocates for sustainable development have started to emphasize the indispensable role of human health and well-being for sustainability. This outlook is bolstered by the understanding that stable and healthy human societies are necessary for maintaining ecological integrity, that promoting human well-being is vital for ensure public buy-in for sustainability practices, and that human well-being is an intrinsic good and a moral right. The COVID-19 pandemic brought the profound impact of built environments on public health to the forefront, spotlighting issues such as indoor pollution, which can exacerbate respiratory diseases, stress, and other health problems, thereby catalyzing increased attention to these aspects in design and construction. There is growing evidence that the sustainable building sector needs to focus on more than just energy and emissions outcomes. The systematic review by Ige and colleagues1Ige J. Pilkington P. Orme J. Williams B. Prestwood E. Black D. Carmichael L. Scally G. The relationship between buildings and health: A systematic review.J. Public Health. 2019; 41: e121-e132https://doi.org/10.1093/pubmed/fdy138Crossref Scopus (69) Google Scholar and the exploratory international study by Pineo and Moore2Pineo H. Moore G. Built environment stakeholders' experiences of implementing healthy urban development: An exploratory study.Cities Health. 2022; 6: 922-936https://doi.org/10.1080/23748834.2021.1876376Crossref Scopus (11) Google Scholar further illuminate the vital link between building design and health outcomes. Their findings reveal a shift toward prioritizing health in the built environment and emphasize the challenges of aligning health objectives with broader sustainability goals. Such research advocates for a systemic integration of health into urban planning, reflecting the WELL Standard's comprehensive strategy to merge health and ecological sustainability, thereby addressing the urgent need for building standards that mitigate negative health impacts and improve human and planetary well-being. The WELL Building Standard, launched in 2014, developed and overseen by the International WELL Building Institute (IWBI), provides such a method. Its purpose extends beyond just buildings to measure, certify, and monitor the impact of both built environments and organizational practices on human health outcomes, thus embedding health and well-being into the core of sustainable design, construction, and operational strategies. Unlike traditional sustainability frameworks that often prioritize energy and environmental metrics, WELL places a strong emphasis on human health outcomes as central to sustainable development. This broader emphasis on the well-being of individuals, whether in buildings, organizations, or communities, drives significant changes in the decision-making processes that underpin the design and operation of sustainable environments, cultivating a wide-ranging approach to health and sustainability.3Tao Y.X. Zhu Y. Passe U. Modeling and data infrastructure for human-centric design and operation of sustainable, healthy buildings through a case study.Build. Environ. 2020; 170106518https://doi.org/10.1016/j.buildenv.2019.106518Crossref Scopus (19) Google Scholar The IWBI promotes a recalibrated vision of sustainable development that it describes as "people first" and has gathered compelling evidence quantifying the impacts of healthy buildings through metrics such as improved productivity and life satisfaction, among others.4Hartke J. Yang M. Gray W.A. Worden K. Investing in Health Pays Back: The Growing Research behind the Business Case for Healthy Buildings and Healthy Organizations. International WELL Building Institute, 2022https://wearewell.com/health-pays-backGoogle Scholar As of February 2024, WELL's influence extends to accrediting roughly 20,000 professionals and certifying approximately 30,000 locations worldwide, covering over 5.12 billion square feet in 131 countries.5International WELL Building InstituteHome.2024https://www.wellcertified.comGoogle Scholar For comparison, Leadership in Energy and Environmental Design (LEED) has certified around 100,000 buildings in 180 countries, emphasizing energy efficiency and environmental sustainability. Meanwhile, Building Research Establishment Environmental Assessment Method (BREEAM) has issued certificates for more than 600,000 buildings in 93 countries, focusing on sustainable design and operation. Despite the broader certification reach of LEED and BREEAM, WELL distinctively centers on human health and well-being, promoting a holistic approach to sustainability that integrates environmental factors with the overall wellness of individuals in buildings, organizations, and communities. This commentary discusses the WELL v2 Building Standard, officially launched in 2020, focusing on its methods, its international applications, and the growing empirical evidence from research studies supporting its effectiveness. Health-centric design principles represent a fundamental advancement for the sustainable building industry and should become more widely recognized and adopted. This approach brings together interdisciplinary knowledge and allows for necessary versatility across different cultural and geographical contexts. But challenges have emerged in implementing WELL and the related policy implications. The ten core concepts of WELL v2 bring together disparate areas of knowledge encompassing air, water, nourishment, light, movement, thermal comfort, sound, materials, mind, and community (refer to Table 16International WELL Building InstituteWELL v2 Building Standard: Overview.2024https://v2.wellcertified.com/en/wellv2/overview/Google Scholar). One of the valuable aspects of this concept-based approach is that it allows for nuanced implementations and priority adjustments in relation to a project's location. For example, the ways in which water is managed in a building could reasonably differ between desert and wetland environments, and the ways in which community engagement is promoted could differ between various regions, cultures, and building types. While some aspects of the WELL Standard are absolute, such as the quantities of allowable contaminants in a building's drinking water, others are more flexible and allow credits to be obtained in varied ways.Table 1Summary of the WELL v2 Building Standard's ten core concepts and their interdisciplinary connectionsConceptDescriptionDisciplinesAirtargets improving indoor air quality by removing pollutants, applying design innovations, and promoting behavioral changes, emphasizing the health and economic benefits of clean air through collective actionenvironmental health, building engineering, occupational health, environmental toxicology, epidemiology, economic analysisWaterfocuses on ensuring quality and access to water within buildings to support hydration and health while preventing environmental damage by addressing water contamination and promoting responsible water management practicepublic health, environmental science, hydrology, chemistry, building engineering, environmental engineering, public health policyNourishmentemphasizes the importance of easy access to nutritious foods and nutritional transparency, promoting diets that boost personal health and advocate for a shift toward sustainable food practices, underscoring the link between human well-being and environmental sustainabilitynutrition science, public health, behavioral economics, food science, sustainable food systemsLightpromotes lighting that supports visual, mental, and biological well-being, optimizing exposure to improve circadian rhythms, mood, and productivity, while balancing light and dark to align with natural physiological needsneuroscience, environmental psychology, architectural design, chronobiology, occupational healthMovementencourages active lifestyles and counters sedentary habits by designing environments that facilitate physical activity to active furnishings aiming to improve health and extend lifespan through interdisciplinary collaborationergonomics, exercise science, urban planning, architecture, behavioral science, public health, epidemiologyThermal comfortaims to optimize productivity and satisfaction by designing adaptable HVAC systems that cater to individual preferences and spatial variations, personalized solutions for optimal health, well-being, and productivityHVAC engineering, environmental psychology, building engineering, human factors and ergonomics, energy managementSoundfocuses on acoustical comfort in the built environment to support occupant health and well-being, employing strategic design to mitigate noise and optimize sound quality for individual needsacoustical engineering, environmental psychology, building engineering, occupational healthMaterialsaims to minimize human exposure to hazardous chemicals in buildings by promoting the use of safer alternatives and low VOC-emitting products, enhancing indoor air quality, and ensuring environmental sustainability through material literacy, ingredient disclosure, and optimized product compositiontoxicology, environmental health, green chemistry, building engineering, environmental science, occupational healthMindfocuses on enhancing mental health and well-being by integrating design, policy, and programming to address determinants of mental wellness, promote stress management, and improve access to mental health services, while also reducing stigmapsychology, environmental psychology, public health, behavioral science, organizational behaviorCommunityprioritizes inclusive design and stakeholder engagement to create environments that support diverse needs, promote health equity, and strengthen community well-being and resiliencepublic health, urban planning, social work, environmental psychology, occupational health Open table in a new tab A growing body of research literature has shown the impacts of WELL certification across multiple outcome measures, demonstrating the standard's effectiveness in enhancing occupant health and well-being. For instance, in the case of the "Housing and Development Bank" project in New Damietta, Egypt, the WELL Rating System was utilized to evaluate the lighting design of an economic housing project, focusing on the impact of both external and internal lighting on residents' health.7ALBaz H. Evaluation of the lighting design of an economic housing project using WELL Rating System (Study Case: Housing and Development Bank Building in New Damietta).Int. J. Architect. Eng. Urban Res. 2023; 6: 203-245https://doi.org/10.21608/IJAEUR.2023.227595.1045Crossref Google Scholar This case illustrates the adaptability of WELL's light concept to meet the specific needs of a community, aiming to improve both physical and mental well-being while addressing local challenges such as "sick building syndrome" in densely populated areas. A recent extensive study by Marzban and colleagues8Marzban S. Candido C. Avazpour B. Mackey M. Zhang F. Engelen L. Tjondronegoro D. The potential of high-performance workplaces for boosting worker productivity, health, and creativity: A comparison between WELL and non-WELL certified environments.Build. Environ. 2023; 243110708https://doi.org/10.1016/j.buildenv.2023.110708Crossref Scopus (1) Google Scholar compared 10 WELL-certified vs. 4 non-WELL-certified offices in Australia, New Zealand, and Hong Kong using a post-occupancy survey approach. The WELL-certified offices were associated with higher reported levels of environmental satisfaction, productivity, and creativity and with fewer reported symptoms of musculoskeletal discomfort and sick building syndrome (headache, skin irritation, nasal congestion, etc.). However, Marzban and colleagues noted that complaints about the physical environment among these office occupants remained fairly high even in the WELL-certified buildings, suggesting that there is still room for further improvement and potentially better adherence to the WELL principles. Another recent study by Ildiri and colleagues9Ildiri N. Bazille H. Lou Y. Hinkelman K. Gray W.A. Zuo W. Impact of WELL certification on occupant satisfaction and perceived health, well-being, and productivity: A multi-office pre- versus post-occupancy evaluation.Build. Environ. 2022; 224109539https://doi.org/10.1016/j.buildenv.2022.109539Crossref Scopus (17) Google Scholar surveyed more than 1,300 participants from six North American companies that had transitioned from non-certified office buildings to WELL-certified buildings. This study used a pre-occupancy vs. post-occupancy method to evaluate changes in environmental satisfaction, health perceptions, and productivity after moving into the new offices. The findings for satisfaction and mental health in this study were particularly strong, with perceptions of features such as cleanliness, lighting, and access to nature showing high significance and large effect sizes. The findings related to physical health impacts and productivity were also positive and significant but with more modest effect sizes. This is to be expected, as the physical health impacts of a building may take longer to manifest compared to satisfaction levels. However, the effectiveness of these standards post-construction remains an area ripe for further research. Studies that evaluate the long-term health impacts of buildings certified under these standards are essential to validate their benefits and guide future improvements. In addition to WELL, standards like the Living Building Challenge (LBC) and Fitwel are also shaping the context of healthy urban development. A comparison between WELL and other sustainability certification systems was conducted by McArthur and Powell.10McArthur J.J. Powell C. Health and wellness in commercial buildings: Systematic review of sustainable building rating systems and alignment with contemporary research.Build. Environ. 2020; 171106635https://doi.org/10.1016/j.buildenv.2019.106635Crossref Scopus (69) Google Scholar These researchers examined the extent to which various systems, including LEED and BREEAM, among others, stacked up in terms of adhering to current health and wellness science. Analyzing data from a vast array of projects—including 2,149 WELL-certified facilities and 102,634 LEED-certified facilities across numerous countries—this study found that WELL was the most comprehensively aligned with critical health areas such as indoor air quality and psychological well-being. Along with additional studies, too numerous to cite here, these findings illustrate the importance of the WELL Standard in foregrounding human health and well-being in sustainable design and its effectiveness at the international level in promoting positive human outcomes. One of the most common critiques regarding the implementation of sustainability certification systems is their cost and complexity, which may deter widespread adoption particularly in resource-constrained regions. The comparative study by McArthur and Powell10McArthur J.J. Powell C. Health and wellness in commercial buildings: Systematic review of sustainable building rating systems and alignment with contemporary research.Build. Environ. 2020; 171106635https://doi.org/10.1016/j.buildenv.2019.106635Crossref Scopus (69) Google Scholar emphasized this factor, as did recent research conducted by Ebbini and Al-Assaf11Ebbini G.W. Al-Assaf A. Assessing contextual factors for sustainable development: A case study of LEED-certified projects in Jordan.Archnet-IJAR. 2023; 17: 628-647https://doi.org/10.1108/ARCH-12-2021-0368Crossref Scopus (1) Google Scholar regarding LEED certification in Jordan. The concern is equally applicable for the WELL Standard, which even more than other building certification systems requires extensive testing and monitoring to ensure ongoing compliance with its requirements. While sustainable buildings tend to pay for themselves in the long run through efficiency gains and greater human health, financial barriers remain salient not only in the up-front cost of construction but also in the efforts required to document adherence, complete certification, and train industry professionals. Sustainability programs may also confront challenges in securing the ideological buy-in of building owners, occupants, and the general public, particularly if these initiatives come to be associated with top-down or "foreign" impositions on existing cultural norms. These challenges necessitate tailored educational and promotional strategies to effectively bridge cultural gaps, which can again add significant costs to the up-front program implementation. To address these challenges and increase the accessibility of WELL certification, I recommend a policy focus on three key areas: cost and complexity, education and promotion, and alignment with the United Nations' Sustainable Development Goals (UN SDGs).12United NationsThe 17 goals Internet.2024https://sdgs.un.org/goalsGoogle Scholar Table 2 provides a detailed look at the policy areas recommended, detailing each policy's focus and its intended outcomes to improve adoption rates of WELL standards.Table 2Policy areas for enhancing the adoption of the WELL Building StandardPolicy areaDescriptionIntended outcomeCost and complexityadvocate for policy interventions that reduce the financial and procedural barriers to WELL certification, such as subsidies, reduced fees, or technical assistance programs, especially targeting regions with limited resources or unique regulatory environmentsmake WELL certification more accessible to a broader range of regions and organizationsEducation and promotionsupport the development of educational programs and promotional campaigns that are culturally sensitive and region-specific, working with local partners whenever possible to bolster authenticityincrease awareness and understanding of the WELL Building Standard, encouraging its adoptionAlignment with Sustainable Development Goalscraft policies that align with and support the United Nations' Sustainable Development Goals, particularly those related to health, well-being, and sustainable urban developmentleverage the U.N.'s agenda and national commitments to sustainability and public health initiatives to generate support for WELL Building Standards Open table in a new tab Because up-front financial costs are one of the biggest challenges that discourage stakeholders such as owners, architects, and developers from seeking WELL certification, any cost-reducing incentives from governments, non-governmental organizations (NGOs), and private partnerships, such as subsidies, reduced fees, or technical assistance programs, will encourage the Standard's broader adoption. Acknowledging this, IWBI (WELL) offers discounts for projects in lower-middle and low-income countries, as defined by the World Bank Atlas Method, and for key project types including government buildings, schools, and non-profits, aiming to lessen financial barriers and advance wider adoption. However, addressing only the financial and complexity barriers overlooks broader concerns. Financial incentives alone are insufficient, however, when there is a widespread lack of public buy-in. Fezi13Fezi B.A. Health engaged architecture in the context of COVID-19.J. Green Build. 2020; 15: 185-212https://doi.org/10.3992/1943-4618.15.2.185Crossref Scopus (31) Google Scholar stresses the critical need for adaptability in health and wellness building standards, such as the WELL Building Standard, particularly in response to global health crises like COVID-19. Fezi advocates for moving away from a rigid, one-size-fits-all approach to building design, proposing instead more occupant-centric and contextually adaptable strategies that can better meet individual and collective needs. This perspective suggests that while financial and educational initiatives are essential, the WELL Standard's ongoing refinement and regional adaptation are equally important to ensure its effectiveness and accessibility in diverse contexts. Early involvement of local partners in the planning and implementation phases is crucial, ensuring WELL initiatives are shaped by those who understand the community's unique needs and cultural nuances. Region-specific educational programs and promotional campaigns are thus important. Advocates should work with local partners whenever possible to develop culturally sensitive and authentic materials discussing the value of implementing WELL Standards, illustrating not only the immediate benefits such as improved occupant health and productivity but also the long-term advantages including potential for increased property value and operational savings. Featuring successful case studies and testimonials can help to demystify the certification process and showcase the tangible impacts of WELL principles in action, making a compelling case for their integration into sustainable development projects worldwide.14Callway R. Pineo H. Moore G. Understanding the role of standards in the negotiation of a healthy built environment.Sustainability. 2020; 12: 9884https://doi.org/10.3390/su12239884Crossref Scopus (8) Google Scholar Building certification systems can often rely on the impact of the UN SDGs to help convince local authorities and publics of their value. This is particularly true of the WELL Standard due to its affiliation with both environmental and public health improvements. WELL provides a robust and integrated strategy for attaining UN sustainability targets, particularly in regard to SDG #3 on "Good Health and Well-being," SDG #6 on "Clean Water and Sanitation," SDG #11 on "Sustainable Cities and Communities," and SDG #12 on "Responsible Consumption and Production."12United NationsThe 17 goals Internet.2024https://sdgs.un.org/goalsGoogle Scholar In the broadest sense, the philosophy underlying the WELL Standard, that environmental protection and immediate human well-being are interconnected, is in close alignment with the UN's formulation of its sustainability agenda as encompassing both human and ecological factors. The WELL Health-Safety Rating, a limited certification designed to respond to the COVID-19 pandemic, may offer a practical and accessible entry point for some building owners and governing agencies.15International WELL Building InstituteWELL Health-Safety Rating: Overview Internet.2024https://v2.wellcertified.com/en/health-safety/overviewGoogle Scholar This rating includes measures to maintain cleanliness, provide health services to occupants, communicate safety advice, prepare for emergencies, and ensure air and water quality. It is adaptable across various spaces, including office buildings, hotels, healthcare facilities, and educational institutions. It also enables facilities to transition toward full WELL certification, which may be more financially feasible to obtain if the building has already implemented the health and safety requirements. Finally, robust future research endeavors can help to confirm the effectiveness of the WELL Standard, assess its impacts, and identify areas for further improvement. The current literature in this area tends to rely on interviews and surveys of building occupants, which are useful for establishing satisfaction levels (an important aspect of well-being) but somewhat weaker for affirming objective health and productivity impacts. Additional investigations employing both qualitative insights from interviews and quantitative objective measures would strengthen the empirical evidence supporting the benefits of WELL certification. Ongoing inquiries should also continue to focus on the localization of WELL in specific regional contexts, helping to identify local needs, challenges, and strategies for achieving certification. Continued exploration is essential to evaluate the effectiveness of various incentives and educational programs at the regional level to help identify best practices for encouraging builders' interest in pursuing WELL certification. Advancing human health and well-being has become increasingly important in sustainable building design, necessitating integration across all standards and practices. Systems like WELL and LEED have led this industry shift by incorporating health guidelines, indicating a move toward designs that both respect the environment and support human flourishing. While the inclusion of health-focused design principles has shown effectiveness, there remains considerable work in creating fully adaptable and culturally sensitive designs. Recent environmental challenges and health crises have emphasized the interconnectedness of human well-being and ecological sustainability, prompting a reevaluation of our built environments. Moving forward, it is evident that the principles of health, well-being, and sustainability must be central to all building design and development efforts. These principles should transcend specific standards, aiming to create spaces catering to human and planetary needs, marking an essential step toward sustainable development.