In his younger years, Rick Fedrizzi would become sleepy at his office at around 3 pm each day.

It was years before Fedrizzi, who now heads the International Well Building Institute, understood that his physical office environment may be contributing to this.

Over recent years, evidence about the impacts of indoor air quality (IAQ) not just on health but also on productivity has grown.

In terms of health, poor IAQ has been shown to increase the likelihood of chronic respiratory issues (such as asthma and shortness of breath), lung cancer and heart failure. All up, the World Health Organisation estimates that air pollution (outdoor and indoor) causes more than seven million premature deaths each year worldwide. With much of our time spent indoors, the quality of air to which we are exposed during this time is crucial.

Evidence of a link between IAQ and productivity is also growing. In the US, a 2015 Harvard study found that better indoor air quality led to improved performance in cognitive tasks. In China, a recent US-China study of more than 20,000 people has linked long-term exposure to pollution with lower test scores.

As a result, considerations surrounding indoor air quality are being incorporated into green building rating systems, although their weighting is relatively small.

In the Green Star – Design and As Built certifications, for example, up to four points are available for ventilation system attributes, provision of outdoor air and exhaust systems of the elimination of pollutants. This is out of a total of 100 points available across all categories.

This raises questions about how well Australia is performing at delivering healthy indoor air quality, where we can improve and how designers should approach IAQ in our buildings.

Adam Garnys, Principal Consultant Strategy at technical risk management consultancy CETEC, says Australia is doing well overall. This is particularly the case for premium and A Grade stock where high ratings for NABERS Green Star and WELL are commonly pursued.

Nevertheless, Garnys says there are several areas where improvements could be made.

First, whilst ratings goals are driving efforts at higher levels, challenges remain with older and lower grade stock.

Further challenges can be seen in hospitals, where there is a cohort of physically vulnerable people and a need for air conditioners to run constantly. Over time, Garnys says these can become affected by mould.

Whilst our outdoor air is generally good, Garnys says there are issues with how this is being monitored. In Sydney, the Environmental Protection Authority has 17 air quality monitoring stations across the metropolitan area. However, none of these are located within the CBD, which has a high concentration of well-paid office staff whose air is being sucked in from the immediate surrounds. The closest station to the CBD is nine kilometres away in Rozelle.

That matters, Garnys says, as air quality can vary through different parts of the CBD and at different times of the day. Whilst this is mainly due to car pollution, he says there can be other problems such as ozone production at ground level and nitrogen dioxide – the latter of which has a low threshold for acceptable limits which can often be exceeded during peak hour on busy roads. All this air is being drawn into buildings.

More needs to be done, Garnys says, to understand outdoor air quality in and around major employment centres.

With outdoor air, Garnys says a particular problem involves fine particulate matter – small particles of dust which are so fine that they do not settle and which penetrate deep into parts of lungs. What exactly is in this, Garnys says, is not known. It could be something innocuous such as pollen particles or toxic such as asbestos fibres.

Nevertheless, the effect should not be underestimated. In 2013, an analysis of 17 studies covering more than 300,000 people across nine countries in Europe found that merely increasing the concentration of fine particulate mater by five milligrams per cubic metre increased the likelihood of lung cancer by 18 per cent. Another analysis of 35 studies from 12 countries released on the same day revealed that the risk of death or hospitalisation due to heart failure increased by about two per cent for every ten micrograms per cubic metre increase in particulate matter.

In offices and buildings, Garnys says variations in particulate matter concentrations can hinge on straightforward decisions. These include the correct installation or otherwise of filters, the grades of filters which have been installed or the type of vacuum cleaner used (vacuum cleaners often recirculate dust as opposed to catching it).

Finally, Garnys says Australian buildings are notoriously leaky and can have gaps in windows and facades. This can enable uncontrolled ingress of outdoor pollutants.

According to Garnys, Australia does not suffer major clinical health problems when it comes to IAQ as limits on contaminants are well known and are rarely exceeded.

However, he says there is an effect on cognitive performance and productivity. These, he says, produces a ‘subclinical’ effect where contaminant levels are not making people sick but are sufficient to erode cognitive function and ability.

Evidence of this is growing. In 2015, A Harvard study subjected 24 participants to six full-time work days in an environmentally controlled office in the TEIQ lag at the Syracuse Centre of Excellence. During that time, they were subjected to conditions representative of conventional and green office buildings as well as green buildings with enhanced ventilation. Cognitive scores increased by 61 per cent when green building conditions were introduced and by 101 per cent when the enhanced ventilation was in operation.

Given the size of Australia’s wage bill, Garnys says there is growing interest in improving air quality as a means to help drive maximum value from companies’ investment in their staff.

Professor Lidia Morawska, director of the International Laboratory for Air Quality and Health at Queensland University of Technology (QUT), offers a less optimistic appraisal.

According to Morawska, assessing Australia’s overall performance in respect of indoor air is difficult because of a lack of IAQ monitoring in buildings. Whilst there have been a few research studies, Morawska says little if any monitoring of air quality takes place at an individual building level.

On a related note, Morawska bemoans what she says is a lack of interest in IAQ. Whilst rating tools take into IAQ into consideration, Morawska says the degree of work which is done on this is largely superficial.

In the case of one building in Queensland worth several hundred millions, she says QUT was asked to submit a proposal to undertake modelling and assessment of air quality. After a quote in the order of $80,000 was too much for the client, a lower quote was put in for $20,000 for an assessment based just on the existing information – a tiny portion of the overall construction cost. This, however, was still not accepted. Such an attitude, Morawska said, demonstrates how small the interest in IAQ actually is.

With this kind of thing going on, Morawska says there could well be a number of smaller problems with regard to indoor air quality about which we are unaware.

“The simple answer is that we don’t know because we don’t do any monitoring of indoor air quality,” Morawska says.

“There have been some research projects conducted in Australia, but not that many. Otherwise, there is absolutely no monitoring of any aspects of indoor air quality in any Australian buildings.”

Morawska says the importance of IAQ should not be underestimated. Poor IAQ, she says, can impact well-being, our respiratory and cardiovascular systems and – when it comes to carbon dioxide – our level of concentration.

Whilst many studies have shown what the impacts are, she says the main question now surrounds the concentrations within specific buildings. Air quality, she says, is impacted first by the quality of air which comes in from the outside and then the emissions occur within the building. These latter emissions, she says, depends upon the type of products which are brought into the building as well as the adequacy of building maintenance and ventilation. This is not just in terms of physical and chemical pollutants but also microbiological pollutants where bacteria grow within the ventilation system.

In terms of strategies, Morawska and Garnys talk of several areas.

First, there is the building’s position on the site. Ideally, Morawska says, buildings should be set back a considerable distance from main roads. This might be possible, for instance, in the case of schools with significant sized yards.

Next, effective filtration is needed to prevent pollutants from outside from entering the building. On this score, Morawska and Garnys talk of a conundrum. It is all well and good to bring in air from outside and remove pollutants from inside, but it is also necessary to avoid bringing in pollutants from outside as much as possible.

Third, an adequate system of ventilation must be in place to remove pollutants which are generated from within the building. This includes the carbon dioxide which we breathe out.

Fourth, Morawska says attention should be afforded to the design of the building itself and the use of low-emitting materials used in the interior.

Finally, to prevent the build-up of microbiological pollutants and to prevent moisture (which supports the build-up of microbiological pollutants), an effective program of cleaning and maintenance is needed.

Going forward, Garnys and Morawska say there will be a trend toward more active monitoring as buildings are increasingly connected through the internet of things and there is now a number of low cost sensors available which can produce significant volumes of data from different locations.

Particular emphasis, Garnys says, will involve better understanding of baseline performance and monitoring of actual performance against defined parameters of acceptable performance in order to detect problems. It will also shed light on differing performance levels across various parts of buildings and thus any areas within specific buildings where problems might be happening.

Morawska cautions, nevertheless, that the effectiveness of all this depends on the ability of building managers and occupants to use this information effectively. In the area of temperature control, she says many times people are stuck in freezing cold rooms when the temperature outside is very warm.

She also cautions that this needs to be accompanied by adequate levels of awareness about the importance of IAQ.

Anne Steinemann, professor of Civil Engineering, chair of Sustainable Cities at the University of Melbourne, and adjunct professor of Science and Engineering at James Cook University, offers a complementary approach.

According to Steinemann, considerable improvement in indoor air quality can be achieved through looking at the products that both go into the construction of our buildings and those that are used within buildings.

Notwithstanding the importance of filtering air coming in from outside, Steinemann says many pollutants to which people are exposed are actually generated indoors. Of particular concern are volatile organic compounds (VOCs) – a group of carbon based chemicals which easily evaporate at room temperature.

In terms of VOCs, Steinemann says we need to think about the products that go into the building’s construction. VOCs are often found in products such as paints, manufactured wood products, glues/adhesives and carpets. In this area, Steinemann has found in her studies that many products going into buildings which are considered to be sustainable for an environmental perspective actually contain chemicals which are hazardous for human health.

Beyond this, she says VOCs are found in products which are brought into the building from outside. This can include fragranced cleaning products, air fresheners and personal care products.

This, Steinemann says, is an area where building managers have a significant role. Whilst dictating what fragrances people wear is difficult, the cleaning products and air fresheners used within buildings are a different story.

Of particular concern, Steinemann talks of a trend toward of dispensing fragrances though HVAC systems or using air fresheners in the belief that doing so will improve indoor air quality.

This, she says, is not the case. All air fresheners and fragranced cleaning products that she tested in her research emit hazardous air pollutants. This is the case even for those products which are marketed as being organic, green, and all-natural.

Also concerning is a trend toward pumping in essential oils. A study which Steinemann recently completed on essential oils reveals that they also emit hazardous pollutants.

The problems, Steinemann says, should not be understated. According to her national studies, around half of those with asthma and 33 per cent of the population experience problems around fragranced consumer products.

Rather than cover up problems with fragranced products, she says air quality problems should be addressed at the source.

All this is particularly important, Steinemann says, as buildings become more airtight.

For both productivity and human health, good indoor air quality is essential.

With a few simple strategies, Australia can improve its performance in this area.