Policy and Regulatory Roadmap to Achieve Health-Based Indoor Air Quality Standards

Poor indoor air quality (IAQ) is one of the world’s largest unmet public health threats. Although we spend 90% of our time indoors, building codes base IAQ requirements on comfort and harm prevention rather than health and wellness. Post-construction, there is little regulation of IAQ. The cost of unhealthy indoor air is massive, with US healthcare spending of >$45B for respiratory infections and >$39B for allergies and asthma. Yet, while health risks from unhealthy indoor air are increasing due to increasing wildfire frequency, longer allergy seasons, and new respiratory viruses, the momentum for developing and implementing mandatory health-based IAQ standards in the aftermath of the COVID-19 pandemic has waned, with little evidence to date of concrete policy and regulatory advances. In response, this paper outlines a practical, feasible, and actionable policy and regulatory roadmap to achieve health-based IAQ standards, anchored in a bottom-up approach linked to a strategic plan that can scale nationally. First, we review the public health, economic, and national security case for health-based IAQ standards. Second, we establish guiding principles, primary goals, and current state assessment of health-based IAQ standards relative to our guiding principles and primary goals. Third, we present two mini-case studies focused on national energy and life safety codes, which are possible models of the road ahead for health-based IAQ standards. Fourth, we define an action-focused critical path, with clear phases and key stakeholder roles and responsibilities, to achieve health-based IAQ standards. Finally, we conclude with a call to action to provide clear direction for future efforts.