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Chapter 1: Introduction 

'I work in a clean area in a sealed building with air conditioning. I am always ill and tired, with headaches and sore eyes. We have no windows and all fluorescent lights. There are about 90 of us who work in this place, and we are all stuck in this atmosphere since there is no other work on the island.' (Cowes, Isle of Wight)

This letter to the London Hazards Centre requesting information on sick building syndrome is typical of complaints received from people around the country. What must it be like to go to work knowing that you'll feel lousy by the end of the day, drained of energy and perhaps with sore eyes, respiratory problems and a headache to cap it all? Yet this is just what happens to an increasingly large number of workers in supposedly 'clean' jobs and industries, such as office workers and those in the micro-chip electronics industry. Problems of fluctuating temperatures, draughts, stuffiness, bad lighting and noise have always been found in offices but the energy-saving measures introduced in the 1970s with the rise in oil prices have exacerbated them.

Re-circulation of air and pollutants

Many buildings are now designed to reduce the intake of 'fresh' outside air because it is cheaper to re-circulate air that has already been warmed up in winter, or cooled in the summer, than to take in outside air and heat or cool it. Doors, window frames and other seals in the building are made as air-tight as possible, windows cannot be opened, and the amount of outside air brought into the ventilation system may be reduced - perhaps to zero, so that only recirculated air is being breathed. Such buildings are known as 'sealed' or 'tight' buildings. Sometimes air inlets have been found to be bricked up. And the power of fans that distribute air from the air handling unit into the distribution ductwork may be reduced, or some fans may be turned off altogether for periods of time to save on energy costs.

Other changes have also taken place in the past two decades. More synthetic materials are used in construction, insulation and furnishings. Synthetic materials may release a variety of toxic chemicals, the best known being formaldehyde. The increasing use of machines also adds to indoor pollution, for instance the ozone from photocopiers, the noise from printers, and the electromagnetic radiation from visual display units. With the lack of fresh air resulting from energy-saving measures, chemical pollutants are not diluted and are continually recirculated throughout the building. And, of course, 30 per cent or so of the workforce may be smokers...

Air-conditioning systems themselves can harbour pollutants and micro-organisms and so add to the contamination of the workplace. For example, dirt enters with the air supply and builds up in the ductwork over time, or may have been lying in the system since it was installed. Often there is no-one in an organisation who really understands how the systems work. In addition, maintenance and cleaning of systems seem to be the exception rather than the rule, through negligence or because the various parts of the system are inaccessible (Wilson et al 1987; Jones and O'Sullivan 1988; Robertson 1988). The possible causes of sick building syndrome are discussed more fully in Chapter 4.

In the following chapters, much emphasis is placed on air-conditioning and ventilation systems since inadequate ventilation has been considered to be a causal factor in 50 per cent of sick buildings in the United States and in 68 per cent of Canadian investigations (Melius 1984; Collet and Sterling 1988). However, precise causal factors are rarely found in sick building investigations. Many reports conclude that inadequate ventilation was the cause of sickness because no other factor could be found, and improving the ventilation helped to remedy the situation. But improving the ventilation would in turn reduce the amount of contamination with chemicals or micro-organisms, so that increased ventilation can be seen as an effective treatment rather than a cause (Jones 1989).

Taking symptoms seriously

The symptoms of sick building syndrome are discussed in Chapter 2. They include eye and nose irritation, runny or stuffy nose, fatigue, headache, nausea, sore throat and general respiratory problems. Environmental tobacco smoke is often blamed for these symptoms, particularly since it can be seen or smelt, but many other less visible pollutants, as well as environmental conditions, can cause similar problems. For example, identical symptoms to those described above are suffered by people who are exposed to formaldehyde, ammonia, nitrogen oxides, cotton dust and fibreglass particles; by those who are allergic to dusts and microbial spores; and by those exposed to low relative humidities for long periods of time (Robertson 1988).

Sick building syndrome is often not taken seriously by the management since managers are less likely to suffer the symptoms. Managers often have larger offices, furnished with more expensive materials such as natural wool and real wood which are less likely to give off noxious gases, less equipment such as photocopiers and word-processors, and the freedom to move about and out of the building. Since the symptoms of sick building syndrome are common in any population, managers may wrongly treat the complaints as mere whingeing by workers. One example is given of a building where people working in the basement had been complaining for some time that the atmosphere was hot and stuffy with no fresh air and with heat and odours emanating from an adjacent kitchen. It wasn't until a senior executive fell asleep during a meeting in the basement that the employers decided to do something about the problem (Tong 1989).

The two main reasons why sufferers of sick building syndrome know that it is not an individual problem but one connected with the workplace are, first, that a substantial proportion of fellow workers will be suffering from similar symptoms (hysteria, the management might say) and, second, the timing of the symptoms. A cardinal feature of sick building syndrome is that symptoms become worse after the person has been in the building for a few hours, particularly after the weekend or a break away from the workplace, and improve after leaving the building and at weekends. Humidifier fever, another building-related illness, also follows this pattern, and for this reason humidifier fever is considered together with sick building syndrome; the two may well be interconnected.

Air monitoring

Getting management to take the problem seriously may be the first hurdle, but other pitfalls can arise when 'experts' are brought in to monitor the air. There may be literally thousands of chemicals in the air, so the cost of measuring the levels of all of them is out of the question. Consequently, a few of the more common pollutants may be looked for, depending on the situation and likely causes of pollution. The levels of pollutants that are considered 'acceptable' are derived mainly for industrial exposures (and are in any case considered by many to be too high) and rarely in cases of sick building syndrome are these levels exceeded. So, say the experts, our results show that the levels of ozone, nitrous oxides, formaldehyde etc. are well below toxic levels, and chemical exposure is not the problem here. However, such an approach ignores the fact that effects of chemicals are additive or may even be synergistic, i.e. the combined effect of being exposed to two (or more) agents may be greater than the sum of their individual effects. The health risks of long-term exposures to low levels of a variety of pollutants are poorly understood.

Camden Housing Aid Centre

The following story of conditions at Camden Housing Aid Centre in London gives a good example of the pitfalls - and delays - that can occur when piecemeal testing for chemicals is carried out.

For some years in the early 1980s, NALGO (National Association of Local Government Officers) reps at the Housing Aid Centre complained to the management that workers were suffering from headaches, sore throats, muscular aches, sinus problems and cold and flu symptoms. The workers believed that their problems were due to a combination of poor fluorescent lighting and a faulty ventilation system. In particular, the air inlet drew in fumes directly from a car park at the rear of the building.

In 1984, the Council's Environmental Health Department was called in to measure the levels of various components of vehicle exhaust fumes. The survey showed that levels were below those required for 'safety' in Health and Safety Executive Guidance Notes. However, these surveys did not take account of the peak exposures or of possible synergy between the various contaminants - lead, carbon monoxide, carbon dioxide, nitrogen oxides, sulphur dioxide and hydrocarbons.

In 1985 the union contacted the London Hazards Centre and in early 1986 independent surveys of the ventilation system and lighting were arranged. These showed that complete overhaul and improvement of the ventilation system was needed and that lighting should be totally re-designed. Eventually, later in 1986, the office was relocated to another Council building while refurbishment was carried out.

As this story shows, measuring potential pollutants in isolation can be pointless. It also shows how 'scientific' results may be used to undermine the position of workers whose common sense tells them what is likely to be amiss in their environment. These workers suffered for years - a situation that is not unusual in cases of sick building syndrome.

How do buildings get to be sick?

In the UK speculative office building prevails: the office is seen as a device for multiplying the cost of land and as much office space as possible is squeezed into a building to increase the lettable area (Duffy 1988). Particularly in the 1950s and 1960s property developers dominated the UK office market. Their interest was in the exchange value of the building - what it would sell for in the short term. This resulted in speculative office building of very low quality (Marriot 1979). In such a system, the use value of the building is given little priority, since the building is for profit first and for consumers second. Often more attention is paid to the outside 'look' of the building than to its internal use: most offices are not user-friendly and do not incorporate in their planning the changing needs of the organisations that will occupy them.

In the 1970s, following the development slumps of the 1960s, financial institutions took over the market and there was a shift to longer-term criteria of providing more adaptable spaces and building services to accommodate changing occupational needs (Wilson and Ellis 1985). Investors were forced to pay more attention to tenants' needs because of the over-supply of office space and also to allow for the introduction of new technology.

In the late 1980s, the shell-and-core approach, in which as little fitting out as possible is done before the first tenant or owner takes up occupation, became more common. In theory, this approach should provide a better environment since it allows end-users to organise the interior in their own way, but in practice problems of poor air quality are just as likely. The experience of local authority workers around the country who have been moved into vast new civic centres pays testimony to the fact that purpose-built and designed office complexes have their share of problems:

'Mansfield District Council have been moved into a new fully air conditioned Civic Centre for about two years now. There are about 350 people employed within the building. The old office accommodation we vacated had no air conditioning. Shortly after moving into the new centre I began to receive complaints from members of staff about the working environment within the new building. Complaints about dry eyes, sore throats and headaches etc.' (Director of Central Administration and Legal Services, Mansfield District Council)

In fact it has been shown that people who work in public sector buildings tend to have more building sickness than those in the private sector (Wilson and Hedge 1987).

Chain of events

The number of different people and professionals involved in the design and construction of an average building provides much scope for poor decision-making leading ultimately to unhealthy working conditions (Vischer 1989). The developer might assign 'quality control' decisions to the architect, who is then at the mercy of the engineers brought in to design heating and ventilation systems and lighting. Architects are not engineers, so they have to rely on engineers' design specifications. Routine formulae are used to calculate air distribution systems throughout a building, and standard systems are cheapest to design and install. If specific user requirements are not known, or are not taken into account because of cost constraints, a standard system is installed which turns out to be inappropriate to the ultimate users of the building. In a similar way uniform lighting is often fitted, with little attention paid to the need for local lighting for particular tasks.

Architectural and engineering decisions may be made with little reference to each other. For instance, an attractive architectural space such as a high, glassed-in sunny atrium may have no means of exhausting the heated air that collects at the top of it.

Once building starts, responsibility for quality control shifts by default to the contractor. Many changes are made as the building is constructed, so that design specifications are altered. For instance, chunks of concrete in the air mixing chamber of the ventilation system may be left there if the cost of their removal is too high. Concrete may not be given enough time to dry out before a screed coating is applied. Plastic parts may be substituted for metal ones in the ventilation ductwork if the specified parts cannot be obtained in time or are too expensive. Waiting for parts costs time and money, so short-cuts are taken.

Once the building has been constructed, the space is prepared for office use. Walls and partitions are put up and finally equipment and machines are installed, often with no notice being taken of the siting of ventilation inlets and outlets or assumed pathways of air flow across a space. So printing equipment and photocopiers are installed without any special ventilation. An office may be walled in with a supply air vent but no extract outlet. And to make matters worse the air-conditioning system may never be properly 'commissioned' by the installation engineer once the building has been occupied so that the system is not correctly balanced. A catalogue of errors and poor decisions may mean that problems are 'built in' to the structure, only to be added to by incorrect operation and poor maintenance.

In some European countries - Sweden, Germany and Holland - workers have a statutory right to be involved with employers' plans for changes in the workplace. Building regulations stipulate, for example, that everyone has the right to a window, that no-one should work in deep space, and that the thermal environment must be of good quality. These rights lead to elaborate negotiations about environmental matters: 'before the northern European architect draws a single line, the users are already crowding around the drawing board' (Duffy 1988).

About this book

This book is written primarily for office workers since most reported cases of sick building syndrome are associated with office buildings, but workers in schools, nurseries, hospitals and factories - in any industry - may be affected. The sickness depends on the workplace not on the worker. Humidifier fever, for instance, is more common in industrial premises than in offices.

Humidifier fever is quite distinct from sick building syndrome but the two problems are considered together here since problems of humidifier fever often come to light only during investigation of sick buildings. There is also some overlap between humidifier fever and another building-related illness, legionnaires' disease, since both arise from breathing in contaminated water droplets and both are readily preventable. However, the cause of legionnaires' disease and the measures that need to be taken to prevent it are specific, so it is discussed separately in Chapter 3.

As the reader will by now be aware, there is often no simple solution to the problem of sick building syndrome. However, buildings can always be made more habitable - if money is spent on doing so.

All buildings and building services are different. This book aims to help people to look with a critical eye at the building they work in, to ask appropriate questions about design, construction and maintenance, and to take steps to improve their working environment.