About the Well certification 2.0
The WELL Air concept aims to ensure high levels of indoor air quality across a building’s lifetime through diverse strategies that include source elimination or reduction, active and passive building design and operation strategies and human behavior interventions.
People spend approximately 90% of their time in enclosed spaces– in homes, offices, schools or other building environments. During this time, inhalation exposure to indoor air pollutants can lead to a variety of poor health and well-being outcomes. Humans breathe more than 15,000 liters (530 ft3) of air every single day, consuming approximately four times more air than food and liquid together. Health effects associated with exposure to indoor air pollutants can be short- and long-term and can range in severity. Less severe symptoms of exposure can include headaches, dry throat, eye irritation or runny nose, while more severe outcomes can include asthma attacks, infection with Legionella bacteria, carbon monoxide poisoning and cancer.[3,4] Exposure to air pollutants has also been shown to increase the risk of respiratory and cardiovascular diseases, myocardial ischemia, angina, high blood pressure and heart disease. In the most recent global burden of disease study, household air pollution was rated as the third most important cause of ill health for the world’s population.
The most common indoor air contaminants are combustion sources, such as candles, tobacco products, stoves, furnaces and fireplaces, that release pollutants such as carbon monoxide, nitrogen dioxide and small particles into the air. Additionally, building materials, furnishings, fabrics, cleaning products, personal care products and air fresheners can all emit volatile organic compounds (VOCs) or semi-volatile organic compounds (SVOCs) into the indoor environment. Outdoor air pollution can also influence indoor exposure when pollutants diffuse indoors through building envelope openings, so there is a need to simultaneously address outdoor air quality.
Achieving the goal of clean indoor air requires both professionals and building users to engage not just in the conversation but also in the implementation of adequate approaches. Although indoor air quality can be properly managed primarily through eliminating individual sources of air pollution and through adequate design solutions and human behavior modification, some WELL features require installation of a specific treatment method or technology. Regular maintenance of selected air treatment systems is critical to ensure their optimal operation and expand their “life expectancy”.
It is evident that the impact of improving indoor air quality is substantial. The World Health Organization estimated that, globally, air pollution contributed to approximately seven million premature deaths in 2012. Around 600,000 of those were children under 5 years old. There is also emerging evidence that air pollution can disrupt human physical and cognitive development.
WELL seeks to implement holistic design strategies to promote clean air and minimize human exposure to harmful contaminants in order to maximize benefits to productivity, well-being and health.
The WELL Water concept covers aspects of the quality, distribution and control of liquid water in a building. It includes features that address the availability and contaminant thresholds of drinking water, as well as features targeting the management of water to avoid damage to building materials and environmental conditions.
Nearly two-thirds of the human body is composed of water; it is a major component of cells and the dominant component of fluid between the cells. Water is the medium for the transport of nutrients and waste throughout the body and helps to regulate the internal body temperature. The U.S. Institute of Medicine recommends that women consume approximately 2.7 L [91 oz] and men 3.7 L [125 oz] of water per day, while the European Food Safety Authority’s Adequate Intake recommendation is 2 L [49 oz] and 2.5 L , respectively. (These values include water from all sources including drinking water, other beverages and food.) These amounts are appropriate to offset what leaves the body through respiration, perspiration and excretion, aiding in the removal of toxins, byproducts and other waste. However, many people are inadequately hydrated, which is associated with higher rates of obesity.[3,4] One contributing factor to this is the real or perceived quality of drinking water, as people who mistrust the safety of their water can be more likely to have lower intake of water and higher intake of sugar-sweetened beverages.
Over the last hundred years, many parts of the world saw dramatic improvements in drinking water quality, especially related to infectious diseases. The U.S. Centers for Disease Control and Prevention recognize this as one of the ten greatest public health achievements of the 20th century.[6,7] However, the treatment and distribution systems that have made this improvement possible are also potential sources of contamination. For example, chlorine and chloramine are commonly added to water to kill pathogenic organisms, but can lead to the formation of disinfectant byproducts such as trihalomethanes (THMs) and haloacetic acids (HAAs); these are risk factors for cancer and other adverse health effects when exposure occurs at elevated levels.[8,9]
While developed countries have experienced improvements in reducing pathogens related to infectious diseases, there has been increasing risk from industrial, agricultural and pharmaceutical sources. For example, water with high levels of nitrate can impair oxygen transport in infants and lead exposure can impair neurodevelopment in children. As a result, the U.S. Environmental Protection Agency has warned that threats to drinking water are increasing and we can no longer take our drinking water for granted. Due to widely varying water quality across the globe, it is important to identify which (if any) contaminants are of concern on the local scale. Only then is it possible to design water treatment systems which address the necessary contaminants without adding undue complexity and wastewater.
In addition to providing hydration for building users, water plays a large role in other aspects of building design and operation. It is frequently used in heating and cooling systems, irrigation, pools and baths and general appliances. These instances are associated with various concerns for contamination, such as the need to control Legionella in cooling systems and hot tubs. Additionally, if water from any source wets building materials that are not intended to come into contact with water, it sets up prime conditions for mold growth. Careful building design and an operations team responsive to inspections and sensors can mitigate the risks from water in these other aspects of buildings.
WELL aims to increase the rate of adequate hydration in building users and reduce health risks due to contaminated water and excessive moisture within buildings through better awareness and maintenance of water quality and management.
The WELL Nourishment concept requires the availability of fruits and vegetables and nutritional transparency and encourages the creation of food environments where the healthiest choice is the easiest choice.
Nutrition and health are closely related. Poor nutrition is a top contributor to the global burden of noncommunicable diseases and a modifiable risk factor for numerous preventable chronic diseases. While fruits and vegetables are critical components of a healthy eating pattern, most individuals around the world do not consume the daily recommended five servings (400 g). Worldwide, diets are generally low in fruits, vegetables, whole grains and nuts and seeds. In fact, the leading risk for DALYs were low intake of whole grains (2.6% [2.7-6.3]), fruits (2.6% [1.6-3.7]), and nuts and seeds (2.6% [1.8-3.6]) , and 14% of gastrointestinal cancer deaths, 11% of ischemic heart disease deaths and 9% of stroke deaths are attributable to this insufficient fruit and vegetable intake. Diets around the world are characterized by an increasing consumption of highly refined and packaged foods and higher intakes of sodium, sugar and refined fats. These dietary patterns contribute to poor diets and poor health outcomes, including an increased risk of diet-related diseases. Diet-related health problems, which include cardiovascular disease, high blood pressure, type 2 diabetes and some cancers, continue to persist at high levels, alongside the increasing global prevalence of overweight and obesity. In 2010, nutritional deficiencies contributed more than 1.2 billion disability adjusted life years (DALYs) to the global burden of disease, while overweight and obesity were estimated to cause over 3 million deaths worldwide. Fortunately, food purchase and consumption decisions, dietary patterns and food preparation practices all represent avenues for health improvement. From restaurants and supermarkets to cafeterias and vending machines, a variety of interventions and strategies exist that can positively affect individual food choices and global dietary patterns.
Dietary patterns around the world are influenced by a complex mixture of personal, cultural and environmental factors, including the buildings and communities where we spend our time. The way our food environment is designed and operated as well as the availability and access to foods and beverages in this environment plays a role in supporting healthy choices and promoting healthy eating behaviors. The variety of settings in which we make our daily food choices, including our homes, workplaces, schools and communities, should empower healthy choices. Research shows that individual change is more likely to occur when environmental conditions and influences are aligned to support individual behaviors.[6,7] Thus, improving nutrition and eating behaviors requires complementary efforts that span both policy and environmental change.[8,9] This includes organizational policies to improve the availability, accessibility and consumption of healthy food choices for everyone, including individuals with dietary restrictions and food allergies. It also includes food advertising and marketing policies to support healthy eating and help normalize minimally processed, nutrient-dense foods. Environmental interventions include designated eating spaces that allow for social and mindful eating as well as food production and agriculture spaces that reconnect individuals to food and increase access to produce. Finally, strategies to increase nutritional knowledge and health literacy can complement existing environmental and policy interventions.
WELL supports healthy eating patterns by increasing access to healthier food and beverage choices, limiting access to highly processed foods and ingredients and designing environments that nudge individuals toward healthier choices.
The WELL Light concept promotes exposure to light and aims to create lighting environments that are optimal for visual, mental and biological health.
Light is the main driver of the visual and circadian systems. Light enters the human body through the eye, where it is sensed by photoreceptors in the retina that are linked to the visual and circadian systems. The photoreceptors include rods, cones and intrinsically photosensitive retinal ganglion cells (ipRGCs). Cones and rods facilitate vision whereas ipRGCs do not have a visual response and function only to facilitate circadian synchronization and other non-visual responses to light.[3,4] Humans are diurnal, meaning they are innately prone to wakefulness during the day and sleepiness at night. Light exposure stimulates the circadian system, which starts in the brain and regulates physiological rhythms throughout the body’s tissues and organs, such as hormone levels and the sleep-wake cycle. Humans and animals have internal clocks that synchronize physiological functions on a roughly 24-hour cycle called the circadian rhythm. The circadian rhythm is synchronized with the natural day-night cycle through different environmental cues, the main cue being light. IpRGCs are non-image-forming photoreceptors in the eyes that contain the pigment melanopsin and are responsible for circadian synchronization. Disruption or desynchronization of the circadian rhythm has been linked with obesity, diabetes, depression and metabolic disorders.[7,8,9,10,11,12] Exposure to bright light at night is associated with circadian phase disruption, which in turn can cause negative health effects, such as breast cancer and metabolic and sleep disorders.[1,10,13,14] High lighting levels at night including light from bright screens can contribute to the disruption of the circadian rhythm.
All light—not just sunlight—can contribute to circadian photoentrainment. Given that people spend much of their waking day indoors, insufficient illumination or improper lighting design can lead to drifting of the circadian phase, especially if paired with inappropriate light exposure at night. Humans are continuously sensitive to light, and under normal circumstances, light exposure in the late night/early morning will shift our rhythms forward (phase advance), whereas exposure in the late afternoon/early night will shift our rhythms back (phase delay). Phase delays and phase advances in the circadian rhythm can impact sleep-wake cycles and desynchronize circadian rhythms. To maintain optimal, properly synchronized circadian rhythms, the body requires periods of both light and darkness.[3,16]
Additionally, studies have shown that light exposure has an impact on the mood and reduces symptoms of depression in individuals.[17,18,19] Exposure to light has also been directly linked with health and can affect how we recover and heal. Rooms with large, sun-facing windows reduce recovery time for patients suffering from severe depression and those recuperating after heart attacks, compared to similarly afflicted patients in rooms with windows facing buildings or other obstructions. Reduced exposure to daylight has been linked to the onset of depression and impairment of cognitive function in individuals.[21,22] Studies show strong links between better views, brighter light and better performance in office environments.[23,24]
The lighting environments where humans spend their time impact their visual, circadian and mental health. Currently, lighting conditions in most spaces are designed to meet the visual needs of individuals but do not take into account circadian and mental health. This presents an opportunity for projects to provide lighting conditions required by humans for optimal health and well-being.
Integrating daylight and electric light to create lighting strategies focused on human health, along with traditional requirements for visual acuity and comfort, can lead to healthier and more productive environments. Understanding the specific needs and preferences of users in a space is integral to creating effective lighting environments. For example, patients in a hospital ward have different lighting requirements than individuals in an office environment. Understanding user needs in a space is key to creating a healthier space. Environments that take into account these lighting strategies and user needs can contribute to improvement of the overall mood and increase the productivity of employees.[1,7]
WELL aims to provide a lighting environment that reduces circadian phase disruption, improves sleep quality and positively impacts mood and productivity.
The WELL Movement concept promotes movement, physical activity and active living and discourages sedentary behaviors through environmental design strategies, programs and policies.
Physical activity, or rather, inactivity, has emerged as a primary focus of public health due to a rise in premature mortality and chronic diseases attributed to physical inactivity, including type 2 diabetes, cardiovascular disease, depression, stroke, dementia and some forms of cancer.[1,2,3] Despite the widely understood benefits of regular physical activity, the most recent global estimates from 2016 that present data from 146 countries, representing about 93% of the global population, show that nearly a quarter (23%) of the adult population are physically inactive. There are also evident disparities between developed and developing countries, where 29% and 15% of the population are estimated to be inactive, respectively. Compared to adults, adolescents and older populations exhibit even higher levels of physical inactivity—about 80% and 53%, respectively. Compared to adults, much less is known about successful interventions to improve physical activity in youth and older populations. Most recently, the research community has focused on classroom-based interventions and community-scale interventions to fill gaps in our understanding for adolescents and older adults. In 2013 alone, it is estimated that physical inactivity cost the healthcare systems globally about $54 billion (converted for purchasing power parity) and contributed to nearly $14 billion in productivity losses. Despite an international call to action emphasizing the need for policies that combat physical inactivity, the global response has been generally poor. The first international policy focused on physical activity was not put forth until 2004, and although 90% of the 160 countries assessed by the World Health Organization had a policy in place in 2015, only 75% are operational.[3,6]
In addition to a rise in physical inactivity, sedentary behavior has also increased and has been linked to health outcomes including obesity, type 2 diabetes, cardiovascular risks and premature mortality.[7,8,9,10,11] In fact, an analysis of 54 countries worldwide found that sitting time alone was responsible for 3.8% of all-cause mortality. Sedentary behavior differs from physical inactivity and is characterized as very low-intensity, low-effort activities such as sitting. A recent review found that 6-8 hours of sitting per day increased the risk for mortality from all-causes and cardiovascular disease, and 3-4 hours of television viewing being particularly risky. In a study published in 2011, self-reported time spent sitting ranged from three to as many as nine hours per day among adults, globally. While inactivity and sedentariness are distinct behaviors and risk factors, researchers note that those who report low physical activity levels are more likely to report higher levels of sedentary activity than their more active counterparts. The rising trends in sedentariness have led the global public health community to call for targeted efforts to reduce sedentary behavior and make evident a continued need to address physical inactivity at a population scale.
Early work in this field focused largely on personal factors and influencers of physical activity behavior. However, more recently, we have come to understand that our environment, including our sociocultural environment and communities, plays a significant role in active living and physical activity.[2,15,16,17,18,19,20] Over time, our homes, schools, workplaces, communities, jobs and transportation systems have been physically designed to demand less movement and require more sedentary activities.[3,21] In response, sectors that have not traditionally collaborated, such as design, planning and public health, have come together. The result is a growing body of peer-reviewed literature, evidence-based design guidelines and more progressive standards, codes and best practices that support environmental design for physical activity and active living at a building and community scale. Alongside the focus on building- and community-scale design interventions that support physical activity and active living, there is a continued need for interventions that address long-term behavior change and maintenance. Research and development in the field of physical activity behavior continue to produce a more refined body of literature on effective and scalable physical activity interventions such as incentives and structured programs.[22,23]
WELL aims to promote movement, foster physical activity/active living and discourage sedentary behavior by creating and enhancing physical activity opportunities through the spaces where we live, learn, work and play. The impact of changing the global physical activity narrative is substantial. Worldwide, if physical inactivity were reduced by just 10%, more than half a million deaths could be averted, while over one million deaths could be averted if physical inactivity were reduced by 25%.
The WELL Thermal Comfort concept aims to promote human productivity and ensure a maximum level of thermal comfort among all building users through improved HVAC system design and control and by meeting individual thermal preferences.
Thermal comfort is defined as “the condition of mind that expresses satisfaction with the thermal environment and is assessed by subjective evaluation." Thermal comfort in the body is provided through a homeostatic system that balances heat gains and losses to maintain the body’s core temperature within its optimal range, 36-38 °C [97-100 °F], and is regulated by the hypothalamus.
The indoor thermal environment not only impacts our buildings’ energy use, as cooling and heating in developed and many developing countries account for approximately half of a building’s energy consumption,[3,4] but also plays a large role in the way we experience the places where we live and work. Thermal comfort is linked to our health, well-being and productivity[6,7,8] and is ranked as one of the highest contributing factors influencing overall human satisfaction in buildings.[9,10] Due to its influence on the integumentary, endocrine and respiratory body systems, thermal comfort can impact multiple health outcomes. For example, exposure to cold air and sudden temperature change can trigger asthma in adults. Leading research also indicates employees perform 6% poorer when the office is overheated and 4% poorer when the office is cold. Thermal discomfort is also known to play a role in sick building syndrome symptoms, which will similarly cause decreases in productivity.[13,14] Thermal comfort is an issue in most building types, and similar outcomes have been studied in a wide variety of settings, including educational institutions[15,16] and residential buildings. In contrast to those who are dissatisfied with thermal conditions, office workers who are satisfied with their thermal environment can be more productive in the workplace.
Despite technological advancements and great improvements in our understanding of thermal comfort in buildings, many people still feel uncomfortable during the work day. Studies have also shown that only 11% of the office buildings surveyed in the U.S. provided thermal environments that met generally accepted goals of human satisfaction. Similarly, as many as 41% of office workers have expressed dissatisfaction with their thermal environment.
This is due to the complexities involved in controlling the interaction between people and the buildings in which we live, learn, work and play. Thermal comfort is subjective, meaning that not everyone will be equally comfortable under the same conditions. This highlights that a one-size-fits-all approach to thermal comfort in buildings invariably fails for large numbers of people.
A comfortable thermal environment that satisfies all occupants is challenging to achieve due to individual preferences and possible spatial and temporal variations in the thermal environment. Therefore, there is a need for a holistic approach to thermal comfort that can satisfy the individual preferences of all (or nearly all) building users. Correctly sized HVAC equipment is essential for optimal thermal comfort. Building HVAC systems should be designed to monitor and control for variations in indoor temperature, radiant heat transfer through the building envelope, relative humidity and air movement. Ultimately, the design should enable the people who live, work, learn, and play to easily make system adjustments for individual thermal preferences. Systems should always be designed with human-centric thermal zoning in mind, helping to optimize the system’s thermal performance.
Due to the difficulties of setting temperature levels that suit all individual preferences, thermal comfort conditions should create baseline satisfaction for the largest number of people. Where zoning allows, individually accessible thermostats that enable users to set their own thermal conditions independent of other zones should be used. In larger spaces such as open offices, it may be necessary to provide localized control to people who work in cubicles and other work areas. It is important, however, that energy-efficient devices are selected and that employees are educated about how to use these devices effectively and safely. Similar solutions can be implemented in other spaces, such as residences and schools. A significant benefit for users is the ability to control and adjust their environment to maintain comfort. New building control apps allow people in commercial buildings to “vote” and to directly influence the operation of HVAC systems without use of thermostats or intervention by building operators.[24,25] These systems offer promise to enable highly granular individual control in new and existing buildings. Additionally, when possible, personal thermal comfort devices should be used; these have been shown to improve self-reported productivity rates, decrease symptoms associated with sick building syndrome and increase thermal comfort.
WELL takes a holistic approach to thermal comfort and provides a combination of research-based interventions to help design buildings that address individual thermal discomfort and support human health, well-being and productivity.
The WELL Sound concept aims to bolster occupant health and well-being through the identification and mitigation of acoustical comfort parameters that shape occupant experiences in the built environment.
The acoustical comfort of a space can be quantified by the overall level of satisfaction of an occupant in a given environment.[1,2] The word “sound” itself is generally defined as the human response to mechanical vibrations through a medium such as air. By this definition, human perception of sound is paramount in shaping a sonic environment. Only in recent years has it been determined that exposure to noise sources such as traffic and transportation have been shown to hinder the health and well-being of people in a number of different ways.[3,4] For instance, the effects of exterior noise from transportation or industrial sources have been linked to sleep disturbance, hypertension and the reduction of mental arithmetic in school-aged children.[5,6] In one study taken from a sample size of 4115 participants, it was found that the risk for myocardial infarction was elevated in men from road traffic noise at night and in women by air traffic noise at night. A number of studies have also indicated that internally generated noise is a major cause of complaint and ultimately results in occupant dissatisfaction.[1,8,9,10,11] Sound within an enclosed space from sources such as HVAC equipment, appliances and other occupants has been shown to hinder productivity, focus, memory retention and mental arithmetic in school children, university students and workplace occupants.[12,9,10,13,14,15,16] In addition to airborne noise sources, impact noise from adjacent activity such as footfall, exercise or mechanical vibration can create uncomfortable environments for occupants in receiving locations.[13,17] Another common acoustical issue is the overall level of privacy within and between enclosed spaces. For instance, research has indicated that occupants are generally dissatisfied when conversations can readily transmit between rooms or across an open office, thus hindering confidentiality or creating distraction from tasks. Inappropriate reverberation times and background noise levels in a space can impede speech intelligibility and cause strain for occupants who may possess hearing impairments.[19,20,21,22] Speech intelligibility is also a crucial element in educational facilities where information is being presented to large audiences and aural comprehension is vital for memory retention and task completion. With the rise in hearing impairments and various other health concerns as a result of over-exposure to noise, designing a single space to meet the acoustical comfort needs of every individual is challenging. However, existing research into the effects of best-practice acoustical design within a space suggests that a holistic approach to addressing the issue of acoustical comfort in the built environment is achievable.[10,13,24] The planning and commissioning of an isolated and balanced HVAC system provides a firm baseline for the anticipated background noise level in a given enclosure. The fortification of façade elements can ensure that exterior noise intrusion is subdued much to the benefit of occupant comfort, health and productivity.[5,25,26,27,28,29,30,31,32] Adding mass and glazing to partition elements, sealing gaps at connections and doors and providing airspace between enclosed spaces bolsters sound privacy and increases occupant comfort.[30,33,34] Replacing areas of hard surfaces in a space with absorptive materials can reduce reflected sound energy and better facilitate acoustical privacy or, conversely, improve speech projection.[19,24,35,36] Consistent background noise levels can be introduced into a space using a sound masking system, thus improving the signal-to-noise ratio in favor of acoustical privacy between occupants.[11,37]
WELL aims to provide a comprehensive and holistic approach to addressing the concerns of acoustical comfort through research-based design considerations that buildings can accommodate for the purposes of improving occupant health and well-being.
The WELL Materials concept aims to reduce human exposure to hazardous building material ingredients through the restriction or elimination of compounds or products known to be toxic and the promotion of safer replacements. Compounds known to be hazardous to the health of occupational workers and/or known to bioaccumulate or aggregate in the environment are also restricted and in some instances not permitted.
The chemicals industry is a central part of the global economy and is integral to a number of sectors that have played a major role in improving life expectancy and the quality of life over the past 150 years. However, the health and environmental impacts of most chemicals in circulation, despite their ubiquity, are unknown. For example, an estimated 95% of chemicals largely used in construction lack sufficient data on health impacts.
As the global population grows and urban centers expand in size and number, the demand for material goods and the rate of chemical production is expected to rise. The global chemicals output grew by 54% between 2000 and 2010, with emerging economies accounting for 65% of the increase, and is expected to grow at a rate of 35% from 2012-2020.[2,3] Many of these chemicals will be used in the construction industry, one of the largest and most active sectors globally. Building materials and products are not only an integral part of our lives but, unlike most consumer goods, have a much longer use phase, making their chemical composition, and potential impact on indoor air quality, significant.
Volatile organic compounds (VOCs) comprise a large group of chemicals abundant in indoor environments due to various source materials, including insulation, paints, coatings, adhesives, furniture and furnishings, composite wood products and flooring materials. Both VOCs and semi-volatile organic compounds (SVOCs) have a wide range of health effects, from respiratory irritation to cancer. Similarly, legacy chemicals are typically toxic, persistent and prone to bioaccumulation. These include lead, asbestos, mercury, chromated copper arsenate (CCA) and polychlorinated biphenyls (PCBs). Although these chemicals are largely restricted in manufacture and use, they continue to pose dangers not only in older structures but also through environmental contamination.[6,7,8] For example, the blood lead burden of today’s population is 500 to 1,000 times greater than our pre-industrial counterparts. Today, exposure to lead accounts for approximately 0.6% of the global burden of disease. Global lead contamination across soil, water and air is still a significant issue, even in countries that regulate the production and use of the heavy metal, and is especially problematic in developing countries.[9,10]
Additionally, hazardous waste that is improperly handled can be detrimental to both human health and the environment. Land contamination poses significant public health concerns. The World Health Organization maintains a list of chemicals of major public health concern in relation to soils, including arsenic, asbestos, dioxin, pesticides and heavy metals (mercury, lead and cadmium). These chemicals of concern are found abundantly across the globe and are linked to various health impacts. Many pesticides, in particular, pose exposure risks to vulnerable populations such as children due to the fact that they are used across various space types, both indoors and outdoors.[8,12] Wood treated with biocides can leach arsenic and preservative components into the soil where children can be exposed.[13,14] Children’s playground equipment and artificial turf can also pose dangers, as these materials wear and tear over time, forming dust or flakes containing chemicals like lead at levels that can be detrimental.[15,16]
One area of focus for advancing health through the Materials concept mandates emissions and content thresholds for building materials and products. This is particularly important for indoor air quality (IAQ) and health, especially for compounds known to be both hazardous and volatile under ambient conditions. Low-hazard cleaning products, the use of effective cleaning equipment, and design and furnishing guidelines that promote efficient cleaning practices also ensure good indoor air quality. To further mitigate environmental contamination and protect public health, WELL includes guidelines for the safe disposal and recycling of hazardous waste. Legacy chemicals must also be safely handled through protocols and best practice guidelines for abatement, in-place management and protective action during repair, renovation or demolition. The application of Integrated Pest Management (IPM) and use of low-hazard pesticides, along with signage and notice of application, further works to protect health. Soil, water and air contamination is also addressed through the testing and redevelopment of contaminated sites. Remediation of such sites removes toxic hazards and can work to support environmentally responsible growth and prevent sprawl. Outdoor structures that contribute to toxic leachates and soil and air contamination are addressed through WELL, while new materials and products used outdoors must meet ingredient restrictions or thresholds. Lastly, third-party certification and labeling schemes serve to differentiate products with safer ingredients and help support consumer education and market demand for safer goods.
WELL promotes the identification, evaluation and management of hazardous ingredients across building materials, cleaning products, waste, outdoor spaces and landscaping. Through all of this, WELL aims to reduce risk of exposure, whether direct or through environmental contamination. Lastly, by enabling informed decision-making, WELL helps to bridge data gaps in the supply chain, supports innovation in green chemistry and advances market transformation.
The WELL Mind concept promotes mental health through policy, program and design strategies that seek to address the diverse factors that influence cognitive and emotional well-being.
Mental health is a fundamental component of human health across all stages of life and is vital for the physical and social well-being of all individuals, communities and societies. Mental health is not simply the absence of a mental health condition. Rather, it is a state of well-being in which individuals are able to live to their fullest potential, cope with the normal stresses of life, work productively and contribute to their community. Mental health is determined by a range of socioeconomic, biological and environmental factors, such as work conditions, lifestyle and health behaviors and genetic components that influence chemicals in the brain. Through a diverse set of interventions, the WELL Mind concept seeks to address and support these drivers of mental health with the goal of improving the cognitive and emotional health and well-being of those living, working, learning and spending time in WELL spaces.
Mental health and substance use conditions are a widespread global health concern. Collectively, they account for 13% of the global burden of disease and an estimated 32% of years lived with disability. Alcohol and drug use contribute significantly to the global burden of premature death and disability, with alcohol alone accounting for 3.3 million deaths per year (or 6% of all deaths) and 5% of the global burden of disease. Depression and anxiety disorders are among the leading causes of global burden of disease, ranking first and sixth, respectively. Depression alone accounts for 4% of the global burden of disease and is considered to be among the largest causes of disability worldwide.
An estimated 18% of adults will experience a common mental health condition, such as anxiety, depression or substance abuse, over a 12-month period, and over 30% of adults will experience a mental health condition during their lifetime. Approximately two-thirds of individuals experiencing common mental health conditions are employed. The impact of mental health in the workplace is profound, with depression and anxiety alone costing the global economy an estimated USD $1 trillion due to lost productivity. Despite its enormous global impact, worldwide spending on mental health is less than USD $2 per person. Although treatments for these conditions exist, they are often unavailable or vastly underutilized. In high-income countries, 35–50% of people living with mental health conditions receive no care or treatment. This gap widens in low- and middle-income countries, where 76–85% of people living with mental health conditions do not receive necessary treatment.
If left unmanaged, mental health conditions – especially depression – can place an individual at risk for suicidal thoughts, attempted suicide and completed suicide. Suicide results in a tragic and preventable death, accounting for more than 800,000 deaths per year worldwide. Young adults and adolescents are particularly at risk: globally, mental health conditions are among the leading causes of disability in youth, and suicide is the second leading cause of death among adolescents and young adults (15–29 years old).
It is increasingly recognized that a complex relationship exists between the mind and the body and that this interplay can significantly impact health and well-being. Mental and physical health impact each other across some of the most common chronic diseases, including HIV, cardiovascular disease and diabetes. Furthermore, states of chronic stress are associated with increased risk of numerous adverse health consequences, such as depression, cardiovascular disease, diabetes and upper respiratory infection. Depression alone is associated with increased risk of disease, including diabetes, cancer, cardiovascular disease and asthma.
Additionally, individuals with mental health conditions are at higher risk for engaging in adverse health behaviors, including tobacco and substance use, physical inactivity and poor diet. In turn, these behaviors contribute to the high rates of chronic medical conditions among people with poor mental health, such as cardiovascular disease, diabetes, HIV and cancer.[5,9] Unfortunately, these disease are at higher risk of going unaddressed or not being sufficiently treated among individuals living with mental health conditions.[5,9] Due to the numerous ways in which mental health impacts physical health, people with mental health conditions experience a mortality rate 2.2 times higher than the general population and a median of 10 years of potential life lost. It is estimated that 14.3% of deaths worldwide (approximately 8 million people per year) are attributable to mental health conditions.
The built environment serves as a powerful tool to help mitigate these adverse mental health outcomes through policies, programs and design. Given the high prevalence of mental health conditions among the working population, the workplace is increasingly being seen as an important target for mental health promotion, prevention and interventions. Broad strategies for mental health promotion and prevention of poor mental health include the following: improvements to mental health literacy and efforts to reduce stigma; provision of healthy living and working conditions for all, including organizational improvements to promote positive work environments and provision of stress management programs; and strategies that address gaps in access to and use of care by supporting access to mental health, substance use and addiction services and treatment. Additionally, improving opportunities for restoration through mindfulness programming, restorative spaces and support of optimal sleep, can have marked impact on physical and mental well-being, including relief from negative symptoms associated with anxiety, depression, pain and stress, as well as enhancements in overall perceived health.[11,12] Lastly, design strategies, such as access to indoor nature, as well as design that supports productivity and focus can help relieve workplace stress and anxiety, reduce absences and enhance overall perceived health status.[13,14]
WELL implements design, policy and programmatic strategies that support cognitive and emotional health through a variety of prevention and treatment efforts. In combination, these interventions have the potential to positively impact the short- and long-term mental health and well-being of individuals of diverse backgrounds throughout a community.
The WELL Community concept aims to support access to essential healthcare, workplace health promotion and accommodations for new parents while establishing an inclusive, integrated community through social equity, civic engagement and accessible design.
Communities are characterized by groups of people with diverse characteristics who are linked by social ties, share common perspectives and engage in joint action and experiences in shared settings or locations. Within every built space there exists a unique community, one where people live, age, work, socialize, play and learn. These communities develop social networks, cultural norms and organizational structures. The global, national and local conditions that surround an individual are known as the social determinants of health, which include physical determinants, or the physical and built conditions that impact the health of an individual.[2,3] Addressing these determinants of health can have a profound influence on the health and well-being of not just individuals but also communities at large. This includes addressing health disparities, which are the differences in health status between population groups resulting from unequal distribution of power and resources as a function of gender, race, ethnicity or socio-economic status. Designing built spaces in a way that enables all individuals to access, participate and thrive within the systems and structures of each community is essential to shaping individual and collective health outcomes.
Supporting the health and well-being of the community in a building must begin with addressing the fundamental factors that influence health and well-being, such as access to health services, protection and promotion of health and equitable spaces and employment conditions. Individuals who have a reliable source of healthcare experience better health outcomes, fewer health disparities and lower overall healthcare costs. Yet many people around the world still struggle with access to basic health services, and access varies based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity and residential location. Much of the global population also lacks sufficient health knowledge and skills, leading to lower health literacy, which contributes to greater health disparities.[6,7] Moreover, though support systems for caregivers—such as adequate paid parental leave, breastfeeding support and policies to support eldercare—also form a key pillar of inclusive environments, these services are not universally provided.[8,9]
Workplaces have the potential to promote health and encourage healthy behaviors through policies and programs. Successful workplace health promotion programs can improve job satisfaction, sense of well-being, self-esteem and overall health status, while also reducing health risks.[11,12] Organizational benefits include lower healthcare costs and absenteeism and improved productivity, recruitment, retention, culture and employee morale. [11,12] For example, immunization programs can minimize health costs and productivity loss caused by seasonal influenza and other vaccine-preventable diseases. Health risk assessments combined with education can lower medical claims costs, reduce absenteeism and enhance productivity. Furthermore, supporting working caregivers through offerings like flexible scheduling, child- and eldercare support, and spaces for breastfeeding can provide numerous benefits. Paid parental leave, for example, is associated with higher rates of breastfeeding, long-term achievement for children, reduced infant mortality and maternal postpartum depression and decreased risk of low birthweight infants.[15,16,17,18,19,20] Companies that foster civic engagement can help increase employee attraction and retention while enabling individuals to make positive contributions in their local community.
In addition to policies and programs that support healthy, equitable environments, it is key for project teams to consider design approaches that address the physical determinants of health and well-being by making buildings inclusive, accessible and safe for all. Accessible spaces are not just compliant with code but also incorporate universal design principles that support diverse ability and mobility and encourage people of all backgrounds to use a space.
WELL implements strategies that address public health issues through a social determinants framework, focusing on the social components that drive and shape health to form built spaces that truly create a foundation for equitable, inclusive and healthy environments.
Innovation features pave the way for projects to develop unique strategies for creating healthy environments.
Innovation features address a novel concept or strategy not already included in WELL or achieve results above and beyond the existing requirements in a WELL Feature. Projects may receive up to 10 points in Innovation.
Projects should use Feature I01: Innovate WELL to submit innovation proposals. This feature provides guidelines on the requirements that must be met in order for an innovation proposal to be considered for approval. Other Innovation features represent strategies pre-approved by IWBI.