London 7th September 1854, amidst a deadly cholera outbreak that kills five hundred people in 10 days, Doctor John Snow is convinced that the deaths are due to contaminated water.
Snow collects data from local hospitals and asks residents if they use the public water pump on Broad Street. From the data, he creates a dot map to illustrate the cluster of cases around the pump and eventually persuades officials to remove the handle.
The outbreak ends, and the handle is promptly replaced!
Doctor Snow presents his views on cholera and its spread to the Medical Society of London who reject his ‘germ’ theory of disease, that only gains traction decades later, with enormous public health and economic benefits.
The UK is now faced with another John Snow moment but this time the threat is not cholera but polluted indoor air which is responsible for premature deaths and billions of pounds of health and care expenditure.
We spend more than 90% of our lives in buildings, breathing contaminated indoor air about twelve times a minute.
Numerous studies have quantified the negative impact of poor air quality in buildings on health, well-being, and productivity. The World Health Organization estimates that 4.2 million people die prematurely due to indoor air pollution every year. Indoor air quality is on average +10 times worse than outside air.
In our homes, offices, and places of leisure we are breathing a toxic mix of hazardous gases and particles (both biological and non-biological) most virus particles, including COVID, Monkeypox, TB, SARS, and the flu, are extremely small, in the 0.1 to 0.3 microns range.
These tiny virus particles, expelled in respiratory droplets, can circulate in the air for hours, lingering even after an infected person has left the space.
Florence Nightingale’s solution to this age-old problem was to remove contaminated air and replace it with clean air.
In ‘Notes on hospitals’ in 1858, the lady with the lamp wrote, “Unless the air within the ward can be kept as fresh as it is without, the patients had better be away.”
In other words, we need to remove respiratory effluents at a sufficiently high rate in relation to their production, so they do not accumulate.
So why centuries later, is clean indoor air not considered of utmost importance to our health and well-being?
The answer lies in political and policy failure.
Dealing with IAQ presents a complex political, social, and legislative challenge.
In most countries, there is no single authority with responsibility for IAQ, nor any agreed performance standards.
An added complexity is that there is no clear answer to the question of which parameter or pollutant should be selected as the basis for a standard targeting airborne infection transmission, a critical factor, given that new Covid variants, influenza and other airborne pathogens continue to attack us.
We need to identify and agree on a set of pollutants that can be measured.
The WHO recommends a minimum ventilation rate for non-residential settings of 10L/s per person, a starting point, but what we really need is a transparent, independent, systematic, and harmonised approach. A consistent multinational regulatory infrastructure for clean indoor air, underpinned by enforceable IAQ standards and impartial managed benchmarks.
Education is as important as legislation and rigorous enforcement.
Board members, shareholders, Non-Executive Directors, CEOs, and HR Executives have little or no understanding of the importance of good indoor air quality.
We have to convince them that clean air is a competitive advantage, with performance and productivity benefits. Protecting your workforce and your business does not have to cost the earth.
As consumers, we must also demand clean air, just as we expect clean water from our taps. If a business does not offer it, we will spend our money with one that does.
Property developers, management companies, public bodies, and other organisations such as housing associations should be compelled to take responsibility for the air their residents and occupiers breathe, ensuring it is the best it can be.
When we have confidence that organisations and institutions take our well-being seriously, we can live our lives as close to normal as possible, using public transport, visiting gyms, theatres, hairdressers, restaurants, and pubs, staying in a hotel, and returning to the office.
Investing in air quality is money well spent, with benefits that go far beyond easing health and operational challenges.
The economic losses of a ‘normal’ US flu season cost $11.2 billion, and the cumulative economic cost of the Covid-19 pandemic is estimated to be $15 Trillion globally in 2022.
We can ill afford another John Snow moment.
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