LEED certification aims to transform building design and operations to be environmentally and socially responsible through various project types and criteria like indoor environmental quality. Studies show LEED buildings can directly improve respiratory health and indirectly reduce health issues from lower emissions. They may increase occupant satisfaction, productivity by 38 additional work hours per year, and healthcare quality by lowering infections and mortality. As such, promoting LEED standards can benefit public health by enhancing indoor air quality and environments where people spend most of their time.

1. Leadership in
Energy &
Environmental
Design (LEED) and
Environmental
Health
Presentation
by Sarah Lyon

2. Where Does LEED Come From?
In 1993, the United States Green Building
Council (USGBC) created Leadership in Energy
& Environmental Design (LEED) certifications to
“transform the way buildings and communities
are designed, built, and operated, enabling an
environmentally and socially responsible,
healthy, and
prosperous environment that improves the
quality of life” (Rajendran, Gambatese & Behm, 2009).

3. How Do LEED Buildings Influence
Health?
 Directly at an individual level
◦ Provides healthier indoor environments
 Indirectly at a population level
◦ Reduces energy use, which then reduces air
pollutants that can cause health issues, like
cardiovascular disease and asthma attacks
◦ Reduces greenhouse gases contributing to global
climate change, which is associated with many
public health risks (Allen et al., 2015).

4. LEED Certified Buildings
 Reduce sick building syndrome (SBS),
multiple chemical sensitivity (MCS), and
building related illnesses (BRI) (Lee &
Guerin, 2009).
 Can provide health benefits with
optimized indoor environments
designed for human health and well-
being (Allen et al., 2015).

5. What Are the LEED Options?
LEED project types:
◦ Building Design and Construction
◦ Interior Design and Construction
◦ Building Operations and Maintenance
◦ Neighborhood Development
◦ Homes
Within each project type are 5-8 categories that
are scored, including Indoor Environmental
Quality (EQ) Category (U.S. Green Building Council,
2017).

6. Indoor Environmental Quality
(EQ) Category
Covers indoor air quality and thermal, visual, and acoustic comfort.
Below is a chart from the Homes project type.

7. Why is Indoor Environmental
Quality Important?
We spend an estimated 90% of our time
indoors! (Allen et al., 2015).

8. Pathways of Exposure
 Smoke from fires or
people smoking
 Indoor polluting
chemicals used in
household/work place
chores/maintenance
 Low-emitting materials
from furniture, paint, and
other products
 Germs from people
 Particulate matter/dust
from indoors and
outdoors
 Mold from poor
maintenance
 Pollen from indoor or
outdoor plants
 Gases from cars and
other machines
Contaminant(s) enter
indoors from cracks,
open windows/doors,
carried in on
people/pets or
originate from
indoors.
• Get into air
ducts/vents and
are distributed
throughout the
indoor
environment
• Located in the
indoor
environment and
are not filtered out
or disbursed by
proper air
Contaminant
Reaches a
Human
Receptor

9. Exposure Route
 Inhalation: This is the primary route for
exposure due to poor indoor air quality.
Once inhaled, some contaminants can be
filtered out through nasal passages, but
other contaminants can penetrate deep
into the lungs.

10. Alternative Pathways and
Routes
 Ingestion could be a less common route if
a pathway involves a contaminant in the
air landing on food that is ingested, such
as mold spores.
 Dermal could be a less common route if a
pathway involves a contaminant in the air
landing on a surface that is touched, such
as a harmful spray
household/maintenance chemical.

11. Relevant Study 1
“The national prevalence of childhood
asthma is 9.1%, compared with a 21.8%
prevalence found in New York City public
housing” (Garland et al, 2013).
An excessive asthma burden is seen in
low-income neighborhoods, would a
LEED Platinum-certified affordable
housing complex in the South Bronx
make a difference (Garland et al, 2013)?

12. Relevant Study 1
Yes! Results found reductions in everyday
asthma respiratory symptoms, symptoms
disrupting sleep in the past month, and
urgent visits to a healthcare provider or
emergency room in the past three months
(Garland et al, 2013).
Additional co-benefits are fewer days of
work,
school or daycare missed with asthma
symptoms (Garland et al, 2013).

13. Public Health Implications
With evidence that LEED-certified
housing improves respiratory health, by
applying and promoting it in low-income,
urban neighborhoods it will help combat
the health disadvantages of living in
those areas (Garland et al, 2013).

14. Relevant Study II
A study by Lee and Guerin looked to see if the
LEED indoor environmental quality criteria
could affect people’s perception of their overall
workspace satisfaction and performances:
◦ Indoor air quality
◦ Thermal comfort
◦ Office layout
◦ Office furnishings
◦ Lighting
◦ Acoustics
◦ Cleanliness and maintenance as of the
overall workspace (2009).

15. Relevant Study II
Major Findings: “The findings showed that
office furnishing quality has a significant
impact on occupants’ satisfaction and
performances; and indoor air quality
affected the occupants’ performances” (Lee &
Guerin, 2009).
An interesting note about lighting is the quality
of the sunlight needs to be considered. For
example, people with access to north-facing
windows still had low, inadequate lighting (Lee &
Guerin, 2009).

16. Effects on Well-Being and
Productivity

17. Effects on Well-Being and
Productivity
Inferior indoor environmental quality can
affect physical health through:
• Poor air quality (asthma and respiratory
allergies)
• Extreme temperatures, deficient ventilation,
and humidity (asthma and respiratory
allergies)
• Inadequate ergonomic design of workspaces
(stress)
• Insufficient lighting and acoustics (depression
and stress)
All of these issues affect productivity (Singh, Syal, Grady

18. Relevant Study III
Two retrospective/prospective cohort
design case studies in Lansing, Michigan
were conducted to evaluate the effects of
moves to LEED certified buildings on
perceived employee outcomes (Singh,
Syal, Grady & Korkmaz, 2010).

19. Relevant Study III
Results: “We found substantial reductions in self-
reported absenteeism and affected work hours as a
result of perceived improvements in health and well-
being” (Singh, Syal, Grady & Korkmaz, 2010).
Perceived productivity improvements could translate to:
An additional 38.98 work hours per year for each
occupant of a LEED building
(Singh, Syal, Grady & Korkmaz, 2010).

20. Public Health Implications
LEED-certified homes and workplaces can
help the United States gain a positive
economic advantage by reducing healthcare
costs and increasing productivity and well-
being.
◦ Occupants reported less absenteeism and
work hours affected by asthma, allergies
and depression
◦ Associated with lower employee turnover
and a decrease in the length of open
positions (people want to work where they
obtain higher satisfaction) (Allen et al.,
2015).

21. Relevant Study IV
One green and one conventional hospital’s
records were studied for multiple years to see if
there were any impacts on patients, employees,
and quality of care (Allen et al., 2015).
Results: The green hospital showed improved
quality of care with fewer blood stream
infections, better record keeping, and lower
patient mortality (Allen et al., 2015).

22. Public Health Implications
If additional studies can support that
LEED-certified healthcare facilities can
improve quality of care, then it has the
potential to improve health and reduce
healthcare costs.
◦ Note this study didn’t mention it, but my
hypothesis, based on the other studies, is
that it should be a double win with green
healthcare facilities improving both
employee and patient health!

23. Summary
 LEED certification includes five types of
projects and includes the Indoor
Environmental Quality category
 LEED-certified buildings have direct and
indirect impacts on health
 We spend the majority of our time indoors,
which results in indoor air contaminants
having a significant impact on our health and
well-being

24. Summary
 There are many indoor air contaminants and
the pathways to exposure include poor air
circulation/distribution
 The primary exposure route is inhalation
 The health benefits of LEED-certified
buildings, particularly respiratory and asthma
improvements, can be used in low-income
areas to off-set the negative health effects
from the environment

25. Summary
 LEED-certified buildings can improve
worker productivity and the satisfaction
and well-being of employees
 In a green hospital setting, increased
quality of care has been shown

26. Conclusion
Leadership in Energy & Environmental
Design (LEED) has a positive effect on
Environmental Health
As public health professionals we should
continue to research the connection,
promote LEED certification, and
incorporate the certification or concepts
of green building into public policies.

27. Image References
 Slide 1& 26: https://www.usgbc.org/articles/materials-strategies-
leed-v4
 Slide 6: https://www.usgbc.org/guide/homes
 Slide 8: Microsoft Office Clip Art “1024px-Emblem-person-
red.svg.png”
 Slide 13: Microsoft Office Clip Art “asthmasmall.jpg”
 Slide 15: Microsoft Office Clip Art “sun.png”
 Slide 16:
 Slide 18: Microsoft Office Clip Art
“LEED_Certification_(9578633104).jpg”
 Slide 21: Microsoft Office Clip Art “farmacia-espac3b1ola.jpg”
Singh, A., Syal, M., Grady, S. C., & Korkmaz, S. (2010). Effects of
green buildings on employee health and productivity.
American Journal of Public Health, 100(9), 1665-1668.
Retrieved from
http://ajph.aphapublications.org.ezproxy2.library.arizona.ed
u/doi/pdf/10.2105/AJPH.2009.180687

28. Content References
Allen, J. G., MacNaughton, P., Laurent, J. G. C., Flanigan, S. S., Eitland, E. S., &
Spengler, J. D. (2015). Green buildings and health. Current Environmental Health
Reports, 2(3), 250-258. Retrieved from https://link-springer-
com.ezproxy2.library.arizona.edu/content/pdf/10.1007%2Fs40572-015-0063-
y.pdf
Garland, E., Steenburgh, E. T., Sanchez, S. H., Geevarughese, A., Bluestone, L.,
Rothenberg, L., & Foley, M. (2013). Impact of LEED-certified affordable housing
on asthma in the South Bronx. Progress in Community Health Partnerships:
Research, Education, and Action, 7(1), 29-37. Retrieved from https://muse-jhu-
edu.ezproxy2.library.arizona.edu/article/503316/summary
Lee, Y. S., & Guerin, D. A. (2009). Indoor environmental quality related to occupant
satisfaction and performance in LEED-certified buildings. Indoor and Built
Environment, 18(4), 293-300. Retrieved from
http://journals.sagepub.com.ezproxy2.library.arizona.edu/doi/pdf/10.1177/14203
26X09105455
Rajendran, S., Gambatese, J. A., & Behm, M. G. (2009). Impact of green building
design and construction on worker safety and health. Journal of Construction
Engineering and Management, 135(10), 1058-1066. Retrieved from
http://ascelibrary.org.ezproxy2.library.arizona.edu/doi/abs/10.1061/(ASCE)0733-
9364(2009)135:10(1058)
Singh, A., Syal, M., Grady, S. C., & Korkmaz, S. (2010). Effects of green buildings on
employee health and productivity. American Journal of Public Health, 100(9),
1665-1668. Retrieved from
http://ajph.aphapublications.org.ezproxy2.library.arizona.edu/doi/pdf/10.2105/AJ
PH.2009.180687
U.S. Green Building Council. (2017). Better buildings are our legacy. Retrieved from
https://www.usgbc.org/leed