Architecture affects human health and performance.

We combine architecture with science. From more than 15,000 published studies, we select the findings relevant to each type of building and the people who use it.

A figure in silhouette on an external stair, in a patch of sunlight on a white facade.
Our experience

Our areas of expertise

  • Architectural practice

    Our partners have practised architecture for twenty years and advised organisations and municipalities on their building projects. They know the risks that arise between the brief and the finished building.

  • Scientific research

    Our partners have an academic background in architecture and environmental psychology. We work from the archive of The Built Review, with more than 15,000 published studies on buildings and health.

  • Strategy and economics

    For more than fifteen years, our partners led strategy engagements for major international companies. We therefore consider the economic effect of every requirement as well as its effect on people.

  • Entrepreneurial experience

    Our partners have founded and led companies in international trade, held investments in the United States and Asia and developed real estate projects of their own. They look at a building project from the side of those who finance and own it.

  • Framework and evidence base

    Our co-founder, the architect Daiana Zamler, created Design for Blooming and its framework for prioritising design decisions around human health. Our co-founder Christian Huser publishes The Built Review, an evidence base on how buildings affect people.

  • Data and method

    We have developed our own systems for finding patterns in large bodies of research. With them, we identify quickly which findings apply to a project.

  • Independence

    As we do not design, build or certify and earn nothing from what gets built, we can always act in the interest of our clients.

  • Communication

    With The Built Review, we started Concrete Human, a photography exhibition on how the built environment affects human health. We use this experience to help our clients explain the changes a project brings to their own people.

The nervous system

How a room affects the body

The nervous system responds to light, sound, air and surfaces before people form a view of a room. It puts the body on alert or allows it to settle, and heart rate and blood pressure change accordingly.

Survival state

Sympathetic activation

Fear, anxiety, overwhelm.

In the body

Heart rate1
↑
Blood pressure1
↑
Cardiovascular strain2
↑
Immune function3
↓
Memory and attention4,5
↓

In the room

Daylight
None, or glare
Sound
Noise, no acoustic control
Air
Poor air, thermal stress
Materials
Hard, cold, artificial
Form
Repetitive high contrast
Space
Crowding, nowhere to rest
Nature
None in sight

Recovery state

Parasympathetic activation

Calm, clarity, energy.

In the body

Heart rate1
↓
Blood pressure1
↓
Cardiovascular strain2
↓
Immune function3
↑
Memory and attention4,5
↑

In the room

Daylight
Daylight and a view out
Sound
Acoustic balance
Air
Fresh air, thermal comfort
Materials
Natural materials, texture
Form
Human scale and proportion
Space
Places to rest and move
Nature
Planting, and a view of it

Both states are active at the same time, and the balance between them shifts. The arrows show the direction in which each measure changes.

  1. Ulrich and colleagues, 1991, Journal of Environmental Psychology, 10.1016/S0272-4944(05)80184-7
  2. Münzel and colleagues, 2014, European Heart Journal, 10.1093/eurheartj/ehu030
  3. Segerstrom & Miller, 2004, Psychological Bulletin, 10.1037/0033-2909.130.4.601
  4. Arnsten, 2009, Nature Reviews Neuroscience, 10.1038/nrn2648
  5. Thayer and colleagues, 2012, Neuroscience & Biobehavioral Reviews, 10.1016/j.neubiorev.2011.11.009
Grading

How The Built Review grades evidence

The Built Review grades the studies behind our requirements. Where the studies allow it, it applies GRADE, the international standard that the World Health Organization also uses. Otherwise, it judges their design, size and consistency by the same criteria.

There are three grades: Strong, Moderate and Limited. We look for the findings that help the project most. Where two findings help it equally, we prefer the one with the higher grade.

A glazed dome seen from below, its steel net radiating from a central ring.
The economic case

An example from the workplace

For most employers, staff costs are a multiple of the rent. The effect of a building on its staff therefore usually outweighs what the building costs. Sick days are one example, because every employer already records them as a cost.

In 2011 the occupational health researcher Jan Hyld Pejtersen and colleagues surveyed 2,403 Danish office employees. People in open-plan offices of more than six seats had 62% more days of sickness absence than people in cellular offices, adjusted for age, sex, socio-economic status, body mass, alcohol, smoking and physical activity.

Pejtersen and colleagues, 2011, Scandinavian Journal of Work, Environment & Health, DOI 10.5271/sjweh.3167

Pejtersen and colleagues compared office types. Their results link the number of people in a room with the number of sick days. The layout of an office therefore affects the larger of an employer's two costs.

Research

Our evidence base

Our co-founder Christian Huser publishes The Built Review, an independent publication on how the built environment affects the people who use it. Its archive contains more than 15,000 scientific studies.

Learn more about The Built Review →
A library seen through its glass facade, three storeys of shelves in daylight.
Shadows of a concrete sunscreen on a facade.
Evidence sheets

Selected evidence sheets

For each client, we compile the evidence for the project, the building type and the people who use it.

Light

Daylight at work 7 studies 5–6% Offices with more daylight let for 5–6% more in Manhattan. People who get more daylight at work sleep better, and hospital patients on the bright side of a unit need less pain medication. Openness and the view out 5 studies 6% A view out improves short-term memory by 6% compared with closed blinds. Without blinds, people find their views twice as satisfying. The view from the window 5 studies 3× Patients with a view of trees leave hospital sooner and need fewer strong painkillers. The more daylight in a patient's room, the shorter the stay.

Air

Air, noise and a day's output 5 studies 23% Stale and polluted air lowers output in offices, call centres and classrooms. In European offices, noise is among the main complaints. Deciding in bad air 5 studies 1,000 ppm Even moderately stale air lowers the quality of decisions. In rooms above 30 °C, people take more risks. Ventilation and sick days 5 studies OR 0.62 Insulated homes led to fewer days off work and school. Better air in offices and schools and a move into a building designed for health went with fewer symptoms and less sick leave. When mistakes happen 5 studies 26.3% Fine dust in the air of a room raises the number of mistakes people make.

Acoustics

How far speech reaches 5 studies 15 m → 7 m In open-plan offices, speech distracts people up to 15 metres away. Masking sound halves that distance. A single nearby talker lowers short-term memory by a quarter. How private a workplace feels 5 studies 95% Employees who have the privacy they need, at home and in the office, report less burnout. Intelligible speech and concentration 5 studies 21.9% Intelligible speech lowers performance by up to 45%, depending on the task. Employees who moved from an open-plan area into an office of their own did 22% better on a concentration task. Measuring speech privacy 5 studies 25% Office workers are more bothered by a lack of speech privacy than by noise. 70% say that overhearing colleagues makes it hard to concentrate, in shared offices as much as in open-plan ones.

Temperature

Personal control over the workspace 5 studies 26 °C People who can adjust fans, blinds and temperature themselves are more satisfied with their workplace. With a personal fan, people in the tropics are as comfortable at 26 °C as at 23 °C. Temperature, air and performance 6 studies R² = 0.05 In a well-ventilated building with low emissions, office workers scored twice as high on cognitive tests. Room temperatures between 20 and 30 °C showed no effect on office work. The same room in different countries 5 studies 21.2–24.8 °C The same room feels different depending on where people live. In European classrooms, most people are comfortable between 21 and 25 °C, in Darjeeling, India, between 16 and 22 °C.

Layout

Being visible to other people 5 studies 58% A move to open plan can cut face-to-face contact by about 70%. The more desks lie in a person's line of sight, the less the workplace supports concentrated work. Ceiling height 5 studies 64% People link low ceilings with anger and fear, and high ceilings with joy. Vaulted and other varied ceilings feel more restorative than flat ones. Finding your way through a building 5 studies 153.82 s A floor plan that is hard to read costs more time than a longer walk. Stairs that are easy to see and reach are used more often. How closed a room is 5 studies 47% Visual privacy is what employees miss most in activity-based offices. Of fifteen factors, it ranks third in how satisfied people are with their workspace.
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How crowded a place feels 5 studies 3.7–18.3% Whether people feel crowded at home depends on more than how many of them share the space. Housing policy, funding and the allocation of public housing are nevertheless based on that count. Moving from a cell into open plan 5 studies 2× After a move from individual offices into open plan, the loss of performance that employees reported from noise doubled. People in open plan report more discomfort and more health complaints. Moving into an activity-based office 6 studies 36.4% Satisfaction with an activity-based office falls steadily in the eighteen months after the move. Employees who attend preparation sessions understand far better how to work in it. Open plan and cellular offices 5 studies −0.86 Open-plan offices make contact with colleagues easier. Employees are nevertheless less satisfied with them, because they lose acoustic and visual privacy. Sick days and leaving early 5 studies HR 1.95 Office workers in open plan retire on disability almost twice as often as those in individual offices. The shape of a room 5 studies d = 0.82 In a curved room, people report a better mood and have a lower heart rate than in a rectangular one. What pushes people out of the office 5 studies 923 Employees stay at home when the office lacks quiet rooms, meeting rooms and space of their own. They come in for the facilities and for the people. Working near each other 5 studies about 70% Researchers who move into the same building write more than twice as many papers together. In coworking spaces, nearly three quarters of members have developed new products since moving in, half of them together with other members.

Nature

Getting outside during the working day 6 studies 40 min People spend 87% of their day inside buildings. Working outdoors for part of the week lowered the stress of office workers by 15%. Green around the workplace 5 studies 14.6 vs 13.5 min More green space goes with less depression and anxiety. After 90 minutes in a forest, people cycled 8% longer before exhaustion than after 90 minutes on an industrial site. Green walls and living facades 5 studies 1/3 A green wall can lower the carbon dioxide in an office by 14%. At a desk beside it, negative moods build up at a third of the speed. Greenery in the room 6 studies 6.5 mmHg Plants that cover about 12% of a workspace calm the people in it, and 20% is too much. In planted offices, people report better air and better concentration.
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How much nature is enough 4 studies 25% The better the view, the smaller the window can be. An attractive view satisfies people through a window covering a quarter of the wall; a poorer one needs about 40%. Nature sound in the office 4 studies 86% With nature sound in the background, twice as many people rate an office as pleasant. When a colleague's voice is masked with nature sound, it no longer disrupts memory. Nature where there is no window 6 studies 22.2% Employees in windowless offices hang more than twice as many pictures on their walls, mostly landscapes. With an artificial window, people completed attention tests 14% faster. Taking a break 5 studies 10 min Ten minutes of sitting or walking in nature improves mood and lowers physical signs of stress. A guided relaxation works as well on a screen as in virtual reality. Water in the built environment 5 studies up to 2.5× A visible water feature makes an open-plan office sound up to 2.5 times better to the people in it. People who have been by a canal or river in the past day report higher wellbeing.

Materials

Wood in the room 5 studies 5–16 s In rooms clad in wood, people completed cognitive tests faster than in a concrete room. Office workers in a timber-rich office had lower levels of the stress hormone cortisol.

Furniture

Sit-stand desks and prompts 6 studies 82 min A sit-stand desk reduces sitting at work by up to 100 minutes a day. Reminders to stand up add to the effect.

People and use

Attachment to a place 5 studies 60% People who live within 200 metres of a recreation area feel a stronger sense of belonging. Attachment to a neighbourhood grows with how well cared for it looks. Autistic people and the buildings they use 6 studies −1.71 vs −0.85 Autistic adults avoid buildings far more often than others, mostly because of people, noise and glare. In a sensory-adapted room, 68% of autistic children could be treated at the dentist, against 20% in a conventional one. Feeling safe enough to go out 5 studies 50% vs 17% Trees, planting and a reason to be in a street make people feel safer there. People who live on streets that feel safe sleep better. Half of women over 50 fear falling outdoors. Green space and loneliness 4 studies 29.4% Lonely people who spend one to two hours a week in nature find relief from loneliness more often. In greener cities, older adults are less lonely.
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Growing old in the neighbourhood 5 studies 21% The design of a neighbourhood is linked to memory and the risk of dementia in old age, most strongly among women and people on lower incomes. How full an office is 5 studies 20% Asked to choose between office designs, employees preferred a floor at a quarter of its capacity. Plants mattered more to them than any other feature. Living alone 7 studies OR 3.08 Poorly maintained stairs more than double the risk of a fall for older people who live alone. For older people who live with others, no feature of the home raised that risk. Loneliness measured where people live 5 studies 27.44% Older residents of dense housing estates are less lonely in neighbourhoods rich in sights and sounds. Such places help them feel at home and part of a community. Men and women in the same room 5 studies −0.61 vs 0.23 In the same office, men work best when it feels slightly cool and women when it feels slightly warm. Two thirds of complaints about cold offices come from women. Older people and the same building 6 studies 30% In the same room, older people understand 30% less speech than younger people. Background noise affects them more than the echo of the room. Personality and the room 5 studies −13% Conscientious employees are more satisfied with their jobs in cellular offices than in open plan. For the other personality traits, the type of office made no difference to job satisfaction. Satisfaction in the office 5 studies 81% Four in five office workers are dissatisfied with at least one aspect of their workspace, most often the acoustics. Having enough space matters most to them, and it does not depend on the floor area per person. Sensitivity to noise and light 5 studies 25% More than half of remote workers report sensitivity to noise. People differ in how much flicker they see in the same lamp. Steps in a working day 5 studies 1,029.99 Desk workers walk for 13% of their working time and would like to walk for 23%. A lunchtime route through trees and grass adds twice as many steps as a route through built-up areas. Taking the stairs 5 studies 52% Signs that encourage people to take the stairs raise stair use by about a quarter. The effect lasts after the signs come down. The public space people stay in 5 studies about half Children play twice as much on outdoor spaces with trees and grass as on bare ones. Young adults feel less lonely on squares with people, trees and grass. Which place supports the work 5 studies 57,286 Whether people work at home or in the office depends on how well each place supports the task. At home, they need a workspace of their own, daylight and a view. Working from home during the pandemic 4 studies 56% During the pandemic, people working from home full time felt 56% more isolated than colleagues in the office. Splitting the week between home and office cut that isolation to less than a third.
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Next step

Starting a project

Our work on a new project begins with the three-week Decision Brief. From there, we develop the Strategic Project Blueprint and the Decision Rulebook. You can also commission the Brief Review, the Evidence Review or the Building Assessment on its own.

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Seen from above, a person reading a sheet of paper at the foot of a pale staircase.

ConcreteHuman

Loneliness in the
built environment.

With The Built Review, we started Concrete Human, a photography exhibition on how the built environment affects human health. Its first series, by the Norwegian photographer André Clemetsen, has 39 photographs and 25 poems.

Concrete Human →
A woman in a dark coat lying on the ground in a forest clearing, in black and white
Concrete Human: 'Do not leave me where I lie', from the series Adjacent Solitude by the Norwegian photographer André Clemetsen.