Health as a Decision Problem in BioCognitive Architectural Design: A Critical Review and Physiological–Regulatory Perspective

BioCognitive Architectural Design (BCAD) positions architecture as an active modulator of human biological and cognitive processes, yet the operational status of health within architectural decision-making remains unclear. Although evidence linking built-environment conditions to physiological, cognitive, behavioral, and psychosocial outcomes continues to expand, health rarely functions as a structured design parameter in architectural practice. This study argues that the weak operationalization of health in architecture and BCAD is not only an evidence problem, but also a decision structure problem. A critical narrative review combined with conceptual analysis was conducted across the literature on regulatory physiology, built-environment health, neuroarchitecture and BCAD, healthy building frameworks, and architectural decision support systems. Our analysis identified five interrelated structural challenges to health operationalization in architectural decision-making: (1) the absence of a decision-relevant model of health, (2) weak translation of evidence into architectural decision logic, (3) cognition-centered reductionism, (4) limited cumulative exposure logic, and (5) the facultative status of health within design trade-offs. The study introduces a physiological–regulatory perspective on health as a conceptual basis for future decision-oriented BCAD frameworks, emphasizing cumulative exposure, adaptive regulation, vulnerability, and recovery rather than proposing a universal model for all architectural decision-making.