SOCIO-ECONOMIC RELEVANCE OF SICK BUILDING SYNDROME: A LITERATURE STUDY

Transcription

1 SOCIO-CONOMIC LVANC OF SICK BUILDING SYNDOM: A LITATU STUDY G Bas 1, D Srecec 1, W Weißbach 1, C Hornberg 2, W Dott 1 and GA Wiesmüller 1* 1 Institute of Hygiene and nvironmental Medicine, University Hospital Aachen, Germany 2 Department of nvironment and Health, School of Public Health, University Bielefeld, Germany ABSTACT The purpose of this paper was a review about the socio-economic knowledge of SBS by analyzing scientific literature. Totally, 34 publications dealing with socio-economics, productivity and cost-benefit analyses were conclusive. An SBS-associated economic loss was estimated about billion US$. Gains about 4-70 billion US$ were calculated by improving indoor environments. SBS-caused productivity decrement was claimed by 20-55%. Productivity losses were guessed between %. Objective performance tests showed poorer results in SBS-affected persons. Improving indoor air quality resulted in a decrease of SBS-associated symptoms, a reduction of sick-leaves about % and an objectively measured productivity increase up to 6.5%. Cost-benefit analyses suggested a profitability of improved indoor environments. The gains resulted in a benefit-to-cost ratio of at least ten. Based on estimations and subjective data the knowledge of the socio-economic relevance of SBS is uncertain. An objective research in this field is necessary to support indoor air quality improving approaches. INDX TMS SBS, productivity, economic effects, indoor air, review INTODUCTION The main symptoms of Sick Building Syndrome (SBS) are irritation of the eyes, nose, throat and skin, headache, lethargy, irritability and difficulty to concentrate (aw and Goldman 1996). Beside the adverse health effect of SBS the influence on productivity and socio-economy become aware and is supported in study results. Poor indoor air climate causes job dissatisfaction and leads to performance and productivity decreases and absenteeism of office workers (Pasagui 2003). The costs and economic losses caused by SBS are considerable (BMG and BMU 1999). The aim of the present study was to analyze available information about the socio-economic relevance of SBS. Based on scientific literature SBS-associated economic costs, productivity decrements and the increase of sick leave due to SBS were revealed. Potential savings by providing better indoor environments were pointed out. SACH MTHODS A literature research was performed in Medline and the Proceedings of Indoor Air available since the conference in The following keywords were used to find nglish or German language studies published between 1981 and 2003: socio-economic, economic, sick building syndrome, building related illness, building related syndrome, office, indoor, indoor air quality, indoor air problems, school, and hospital. The resulted 2,903 hits were sorted with Microsoft xcel 5.0 and duplicates and not nglish or German language papers were eliminated. SULTS Information about the study aim gave 34 of 220 publications. Out of these articles, 18 came from urope, 12 from USA, two from Canada and one from South Africa. Nineteen articles dealt with productivity, four with cost-benefit analyses and 11 with socio-economics. The results are summarized in Table 1. The first four papers showed the association between SBS and productivity. In the papers five to seven, the percentage of office workers who claimed a productivity loss was presented. The articles eight to eleven showed the magnitude of self-estimated productivity decrements, the articles 12 to 14 illustrated the objectively measured productivity loss. In the articles 15 to 17 the benefits on SBS and productivity due to improved indoor environments were demonstrated. The articles 18 and 19 presented comparisons between two buildings and their effect on SBS and productivity. Cost-benefit analyses, shown in the articles 20 to 23, suggested a profitability of an improved indoor air climate. The great magnitude of SBS on the socio-economic was listed in the articles 24 to 34. Corresponding author ga.wiesmueller@post.rwth-aachen.de 402

2 No. 1 2 Table 1. Socio-economic aspects in Sick Building Syndrome (SBS). Study design: : case-control, : cross-sectional, : cost-benefit-analysis, : experiment, s: estimation, F: field experiment, : review esults Clements-Croome at al. 1999: Productivity and well-being (SBS) is affected by environmental con-ditions. Improving personal control over the working environment improves self-rated productivity. Whitley et al. 1996: A hypothesised model indicates that job satisfaction and environmental control are mediated by office satisfaction in their effect on SBS and self-reported productivity. Study design 3 Fanger 2001: Better indoor air quality improves the productivity and decreases SBS symptoms. 4 Preller et al. 1990: Absenteeism because of SBS symptoms is related to several building, workplace and job related factors, which may lead to considerable economic loss. 5 Woods et al. 1987: 20% of the interviewed office workers described SBS symptoms and perceived their performance to be hampered by indoor air quality. 6 Fidler et al. 1990: The predominant work-related symptoms were SBS symptoms. 44% of the respondents reported that the symptoms reduce their ability to work and 35% stated that the symptoms had caused sick leave aw and Goldmann 1996: 55% of staff in air-conditioned buildings were affected by SBS and perceived a negative effect on their productivity. Whitley et al. 1996: A hypothesised model indicates that environmental control and office satisfaction affect SBS, office satisfaction and SBS influence self-reported productivity. A change in productivity was measured for the sick and healthy building (-4% and 1.5% resp.). aw et al. 1990: The number of SBS symptoms had an effect on self-reported productivity. More than two symptoms led to decrease in productivity (e.g. 2, 3 or 6 symptoms and 2.8%, 5% or 10% decrement resp.). Wyon 1993: Six SBS symptoms were associated with a 10% decrease in self-estimated efficiency. Sick leave due to SBS was reduced by 34% when individuals can control their own thermal environment. Menzies et al. 1997: The effect of an individually controlled ventilation system, which regulate the temperature and the air velocity, resulted in fewer reported SBS symptoms (p<0.05). The indoor air quality improved the productivity of the case group workers by 11%, compared with a 4% reduction of productivity among the control group. Nunes et al. 1993: Workers, who reported any SBS symptoms had significantly higher response times (p<0.001) in a computerized neurobehavioral test and higher error rates (p=0.07) in another computerized neurobehavioral test. Myhrvold et al. 1996: SBS symptoms were increased and the performances of the pupils in a computerized reaction time test were decreased with higher concentrations of carbon dioxide. Wargocki et al. 1999: Low indoor air quality raised SBS symptoms (e.g. headache, p<0.04) and reduced productivity in performance tests (e.g. 6.5% less typed text, 5% more typing errors). Hedge et al. 1993: A breathing-zone filtration showed improvements in perceived air quality, reduction of SBS symptoms over 50% and decrement in sickness absence about 61%. This was equivalent with a 3.1% increase in productive time per worker. Wargocki et al. 2002: Increasing out door air supply rate and a new supply air filter alleviated SBS symptoms such as tiredness (p<0.01) and difficulty to concentrate (p<0.01) that are likely to affect productivity. Nilsen et al. 2002: Improved cleaning quality may reduce SBS symptoms and improve productivity. Sickness absence was lessened by 12.5% in intervention offices and increased by 3.9% in control offices. Heslop 2002: The environmental satisfaction affected the total number of SBS symptoms, respondents in the sick building stated that they had more days absent from work (t=2.14) and experienced greater productivity decrements (t=-1.99). obertson et al. 1990: The prevalence of work-related symptoms (SBS) was found to rise after moving from naturally ventilated (NV) to air-conditioned (AC) buildings and fall slightly from AC to NV. The overall sickness absence rates were higher in AC office workers. osenfeld 1990: nergy conservation which effects the IAQ have an adverse reaction on the office workers performance and leads to absenteeism (e.g. one lost day due to IAQ problem equals 0.4% of the employees annual working hours, which correspond to 60% of the annual cost of energy to operate a building). F 403

3 Djukanovic et al. 2002: The annual benefit due to improved air quality and increased productivity was at least 10 times higher than the increase in annual energy and maintenance costs. (e.g. initial HVAC and annual energy and maintenance costs due to improved air quality: 31.8 US$/m² US$/m²; increase in productivity: US$/m²). Kempski von 2002: Performance based buildings care for well-being of building occupants, resulting in enhanced productivity, reduced absenteeism and health risks. (.g. total building and employees costs for a low technology building is 7,366,329 and for a high technology building with better indoor environments 7,080,800 because of lower absenteeism). Tuomainen et al. 2002: The costs of a deteriorated indoor environment caused by symptoms, sicknesses, sick leave, reduced comfort and losses in productivity are high. Increasing the ventilation rate reduces SBS symptoms and is cost-effective. (e.g. the ratio of the benefits of increased ventilation, i.e. higher productivity, compared with the costs of higher energy consumption result in 135 per worker per year/17.7 per worker per year = 11.5 ). Friedman et al. 1992: Air-conditioned buildings caused beside SBS symptoms also an increase in absenteeism. The employees in such buildings make more mistakes, have more accidents and take longer to do tasks. Alberta Union of Provincial mployees has estimated that 40,000 members lose more than 100,000 work days per year because of SBS. Wiesmüller 1998: The economic effect of SBS is considerable. In Germany one million SBS-affected persons are estimated. The productivity loss due to SBS in the USA is estimated among 150 million sick leave days per year. Seppänen 1999: It is assumed that 15% of the total absenteeism (16 million days) was caused by inferior indoor climate and the expenses are 0.3 billion for Finland. Improving indoor air climate decrease number of SBS symptoms. The value of raised productivity is 0.2 billion a year. Laird 1994: SBS syndrome is a consequence of poor indoor air quality. Achieving good indoor air quality can be cost-effective. PA estimated that indoor air pollution costs tens of billion dollars annually in medical care, lost work time, reduced productivity and damage on materials and equipment. Passon et al. 1996: IAQ problems cost the USA 10 billion US$ annually. The cost is divided in 1.5 billion US$ medical costs, 5 million US$/year lost earning, 3% estimated productivity loss per employee and 0.6 hours added sick days annually. Brownson 1999: SBS caused beside health problems lost work time, reduced productivity and disability. SBS symptoms affect million workers in the USA. The costs of industry have been estimated to be tens of billions of dollar each year. Milton et al. 2000: Increased sick leave is associated with lower levels of outdoor air supply and indoor environment quality (IQ) complaints. The risk of sick leave among workers exposed to lower outdoor air supply rates was 35%. Net savings of 400 US$/employee/year may be obtained with increased ventilation. Currently recommended levels of outdoor air supply may be associated with morbidity. The lost of productivity on a national scale could be 22.8 billion US$/year. Fisk and osenfeld 1997: The productivity decrease caused by SBS equals 2%. The estimated annual costs of SBS are for the USA 50 billion US$. The reduction of SBS symptoms by improving indoor environments in office buildings is assumed to be 20-50%. The corresponding annual productivity increase is in the range of billion US$. Bischof 1995: Annual loss due to illness and loss of productivity from SBS in the U.S. was estimated to be 55 billion US$ for commercial buildings. The initial cost for rehabilitation due to ASHA standards is estimated about 88 billion US$ and the maintenance cost is about 4.8 billion US$ annually. Because of higher productivity a positive balance would be reached in the second year. Fisk 2000: Objective measurements and self-estimated productivity decrements showed that SBS caused productivity loss is on an average of 4%. Based on an estimated 2% decrease in productivity caused by SBS symptoms, the annual nationwide cost of SBS for the USA is 60 billion US$. The existing evidence suggests that reductions in SBS symptoms, on the order of 20-50%, should be possible through improvements in individual indoor environmental conditions. The corresponding annual productivity increase is on the order of billion US$. Mendell et al. 2002: SBS have been associated with absenteeism, adverse health effects and impaired performance on work-related tests. It is estimated that million workers in the USA have SBS symptoms. Improving work environments resulted in a potential reduction of the adverse health effects among 20-50%. So the annually assessed cost is about billion US$ and the benefits from improvements are about 4-70 billion US$., s, s, s, s, s DISCUSSION The percentage of SBS suffering office workers is about 20-55% (Fisk 2002). The self-estimated productivity 404

4 decrements between 2.8% and 11% supported the influence of SBS and poor indoor air quality on productivity. The objective measured productivity losses up to 6.5% were evidence for the productivity effects beside the health affects. With higher ventilation rates, better cleaning quality and maintenance of the HVAC systems indoor air quality could be improved. This resulted in lower SBS symptoms over 50% and a decrease of sickness absence up to 61%. A reduction of SBS symptoms, on the order of 20-50% through improvements in individual indoor environmental conditions should be possible (Fisk 2002). Cost-benefit analyses suggested also profitability. The cost of increasing indoor air quality compared with the productivity gains results in a benefit-to-cost ratio of at least ten. However, the number of investigations about the socio-economic relevance of SBS is small and the knowledge is uncertain. It is mainly based on estimations and subjective data. The reason therefore could be the difficulty to measure the objective impact on productivity. CONCLUSION AND IMPLICATIONS It is concluded that more objective research with conclusive study design like case-control studies in this field is necessary to support indoor air quality improving approaches. FNCS Bischof W Indoor behavior, Allergologie. 18: BMG (Bundesministerium für Gesundheit) and BMU (Bundesministerium für Umwelt, Naturschutz und eaktorsicherheit Dokumentation zum Aktionsprogramm Umwelt und Gesundheit: Sachstand - Problemaufriss Optionen. Bonn: self-publisher. Brownson K Breathing hospital air can make you sick, Health Care Management. 18: Clements-Croome D. and Kaluarachchi Y An assessment of the influence of the indoor environment on the productivity of occupants in offices. Proceedings of the 8 th International Conference on Indoor Air Quality and Climate - Indoor Air 99. London: Indoor Air 99, Vol 4, pp Djukanovic.,Wargocki P. and Fanger PO Cost-benefit analysis of improved air quality in an office building, Proceedings of the 9 th International Conference on Indoor Air Quality and Climate - Indoor Air 02, Monterey, California: Indoor Air 02, Vol 1, pp Fanger PO Human requirements in future air-conditioned environments, Int J efrig Int Froid. 24: Fidler AT., Wilcox TG., Leaderer BP. and Selfridge OJ Library of congress indoor air quality and work environment study: health symptoms and comfort concerns, Proceedings of the 5 th International Conference on Indoor Air Quality and Climate - Indoor Air 90, Toronto: Indoor Air 90, Vol 4, pp Fisk WJ. and osenfeld AH stimates of Improved Productivity and Health from Better Indoor nvironments, Indoor Air. 7: Fisk WJ Health and productivity gains from better indoor environments and their relationship with building energy efficiency, Ann ev nergy nviron. 25: Friedman JM. and Davis TS Controlling pollution of indoor office air, Occup Health Safety. 61: Hedge A., Mitchell G., McCarthy JF. and Ludwig J ffects of a furniture-integrated breathing-zone filtration system on indoor air quality, sick building syndrome, productivity and absenteeism, Proceedings of the 6 th International Conference on Indoor Air Quality and Climate - Indoor Air 93. Helsinki: Indoor Air 93, Vol 5, pp Heslop K Personal and environmental characteristics, occupational factors and psychological correlates of sick building syndrome, Proceedings of the 9 th International Conference on Indoor Air Quality and Climate - Indoor Air 02, Monterey, California: Indoor Air 02, Vol 4, pp Kempski von D Increasing the value of a building by addressing well being - the principal tools: thermal and olfactory comfort, Proceedings of the 9 th International Conference on Indoor Air Quality and Climate - Indoor Air 02, Monterey, California: Indoor Air 02, Vol 3, pp Laird Sick building syndrome and building related illness, Occup Health Safety. 61: Mendell MJ., Fisk WJ, Kreiss K, Levin H, Alexander D, Cain WS, Girman J, Hines CJ, Jensen PA, Milton DK, exroat LP, and Wallingford KM Improving the health of workers in indoor environments: Priority research needs for a national occupational research Agenda, Am J Public Health. 92: Menzies D., Pasztor J., Nunes F., Leduc J. and Chan CH ffect of a new ventilation system on health and well-being of office workers, Arch nviron Health. 52: Milton DK., Glencross PM. and Walters MD isk of sick leave associated with outdoor air supply rate humidification and occupant complaints, Indoor Air. 10: Myhrvold AN., Olsen. and Lauridsen O Indoor environment in schools pupils health and performance in regard to CO 2 concentrations, Proceedings of the 7 th International Conference on Indoor Air Quality and Climate - Indoor Air 96. Tokyo: Indoor Air 96, Vol 4, pp Nilsen SK., Blom P., ydock J., Nersveen J. and Fostervold KI An intervention study of the relationships between indoor air-related health problems, productivity and cleanliness in an office setting, Proceedings of 405

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