Review of health and productivity gains from better IEQ Page: 3 of 14
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relevant indoor environmental conditions could practically be improved. Nationwide health
and productivity gains were then computed by multiplying the estimated potential percentage
decrease in illness (or percent direct increase in productivity) by the associated cost of the
illness (or by the associated magnitude of the economic activity).
Improvements in the indoor environment require changes to building design, operation,
maintenance, or occupancy. Many of these changes will influence building energy use. A
multi-disciplinary international committee  has developed a list of building energy
efficiency measures and identified the most common impacts of these measures on IEQ. The
committee's assessments are the primary source for the discussion of energy implications
within this paper.
To make this article understandable to a broad audience, potentially unfamiliar statistical
terminology has been minimized. The findings reported in this paper would generally be
considered to be statistically significant (e.g., the probability that the findings are due to
chance or coincidence is generally less than 5%). Fisk and Rosenfeld  and Fisk  provide
the statistical information on which this conference paper is based.
RESULTS AND DISCUSSION
Communicable Respiratory Illness
A portion of the transmission of common respiratory illnesses, such as common colds and
influenza, occurs via infectious aerosols containing virus. Disease transmission via airborne
infectious aerosols is theoretically reduced by more efficient or increased rates of air
filtration, increased outside-air ventilation, and reduced air recirculation. Air temperature and
humidity, which affect the period of viability of infectious aerosols, may also modify rates of
disease transmission. Additionally, indoor environmental conditions, for example high mold
exposures, may influence occupants' susceptibility to respiratory infections. Field studies,
summarized in Table 1, provide consistent and strong evidence that building characteristics
significantly influence the prevalence of respiratory illness among building occupants.
In the U.S., four common respiratory illnesses cause about 176 million days lost from work
and an additional 121 million work days of substantially restricted activity . Assuming a
100% and 25% decrease in productivity on lost-work and restricted-activity days,
respectively, and a $39,200 average annual compensation , the annual value of lost work is
$34 billion. The total annual cost of providing health care for upper and lower respiratory
tract infections is about $36 billion . Thus, the total annual cost of respiratory infections is
approximately $70 billion.
A number of existing, relatively practical building technologies, such as increased ventilation,
reduced air recirculation, improved filtration, ultraviolet disinfection of air, reduced space
sharing (e.g., shared office), and reduced occupant density have the theoretical potential to
reduce inhalation exposures to infectious aerosols by more than a factor of two. The studies
in Table 1 suggest that changes in building characteristics and ventilation could reduce
indexes of respiratory illness by 15% (absence from school) to 76% (influenza in nursing
homes). The amount of time spent in a building should influence the probability of disease
transmission within the building. If efforts to reduce disease transmission were implemented
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Fisk, William J. Review of health and productivity gains from better IEQ, article, August 1, 2000; Berkeley, California. (digital.library.unt.edu/ark:/67531/metadc782978/m1/3/: accessed February 17, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.