The Health Benefits of a Workplace Built for Wellbeing

Esther Sternberg, MD, is a renowned expert on wellness and particularly wellness in the built environment. She pursued this track of interest in her career as she learned that the environments where we work, live, learn, and play have a direct effect on our health. In this column, she shares the beneficial components that must be considered when creating a built environment in order to optimize health.

Q: How does a healthy workplace environment contribute to improved health and wellbeing?

Esther Sternberg, MD: The potential health benefits of having a well workspace are many, including an enhanced mood, improved focus, better sleep, a healthy immune system, and lower physical and emotional stress. However, creating healthy environments doesn’t just refer to removing unhealthy elements from buildings such as toxins, pollutants, dust, allergens, etc. It also means adding healthy elements to improve wellbeing. To the extent that one can create healthy environments—where one spends over 90% of the day indoors—goes a long way toward helping mitigate stressors.

I have been studying the effects of the workplace environment on people’s health for almost 25 years and can tell you with great certainty that creating wellbeing in any workspace is important and became even more important after the Covid pandemic. We know that chronic stress and the cumulative load of stress on a person predisposes them to more frequent and severe viral infections. We also know that stress can slow wound healing, speed chromosomal aging and the growth of certain cancers. Certainly, if a person is on the front lines of medical care, he or she is experiencing a lot of stress, attending to many patients, often losing patients to death, and experiencing many things that are out of one’s control. However, one can have control over the environment and create spaces that evoke calm and reduce stress. The silver lining of Covid was that people became aware of how important the built environment is for health and wellbeing. For example, most of the focus at the beginning of Covid was on the importance of ventilation in buildings and that frequent fresh air and turnover is essential for preventing viral spread.

In my recent book, Well at Work: Creating Wellbeing in any Workspace, ¹ I talk about how, in order to have a wellbeing workspace, one needs to embed all seven domains of integrative health into the environment. The seven domains, as defined by the Andrew Weil Center for Integrative Medicine (AWCIM), are resilience, movement, sleep, relationships, nutrition, spirituality, and the environment. It is entirely possible to embed all seven of these domains of integrated health into the built environment. When initially designing or retrofitting a building or a space, one can ensure that by taking these domains into consideration that the health and wellbeing of the people working in those spaces will be enhanced.

Q: How did you begin working in this field and what did you initially discover?

Dr. Sternberg: I began this work with colleagues at the US General Services Administration (GSA) when I was at the National Institutes of Health (NIH), Bethesda, Maryland. I was an intramural Senior Research Scientist and Section Chief of Neuroendocrine Immunology and Behavior at the National Institute of Mental Health at the NIH, and my work focused on the brain’s hormonal stress center, the hypothalamus, which I had discovered is important in contributing to susceptibility to inflammatory diseases such as arthritis—in rats. Proving in rats that the brain–immune connection plays a role in disease gave credibility to the science of the mind–body connection in humans.

At that time, Kevin Kampschroer, then Research Director at the GSA (now GSA’s Chief Sustainability Officer and Director, Office of Federal High-Performance Green Buildings), approached me and asked if I could help him measure the impacts on health of the office spaces that his agency builds and maintains—more than 370 million square feet of office space for more than a million workers. He wanted a prescription for a healthy building and a design for spaces that minimized stress and illness and maximized productivity.

I agreed to join forces in the series of studies that followed over the next two decades, in which my colleagues and I used wearable devices to measure the impact of up to 11 different environmental attributes on health, wellbeing, and performance. Some of those attributes included sound/noise, the layout of a space, humidity, temperature, carbon dioxide airflow, and others. In our research, we were able to document objective data, demonstrating that the environment where one works affects many aspects of health. We used health tracking devices to monitor people in the workplace and measured heart rate, heart rate variability (the stress and relaxation response), physical activity, posture, and sleep quality. We also sent questions to their smartphones asking how they were feeling throughout the day, such as whether they felt stressed, focused, and/or happy.

One of the interesting things that we discovered after measuring these health parameters—in five different Federal buildings over two decades—was that most people were not subjectively aware of the extent to which the physical work environment was affecting their health. For example, the participants were not aware of the impact on their stress, sleep quality, or movement, and yet all of these behavioral, physiological, and psychological aspects of health are deeply affected by the spaces where they worked. In total, our studies included more than 300 participants, and we also conducted studies with private corporations where we measured another 600 participants’ health parameters.

In the studies my colleagues and I carried out after I came to the University of Arizona, called “Wellbuilt for Wellbeing,” we engaged a large multidisciplinary research team including myself, a physician, psychologists, engineers, architects, building science and data science experts, and other collaborators. We found that the people who worked in “open office” design spaces were significantly more active during the day than people in cubicles and private offices; in fact, the increased activity amounted to the equivalent of about 1000 steps more per day. The term “open office” is actually a misnomer—it really should be called “active office design,” meaning no cubicles or private offices but many different types of spaces to work in.

We also found that the people who were more active during the day were significantly less physiologically stressed when they went home at night: their heart rate variability showed that they had 14% less stress compared with people working in private offices or cubicles. Those who were more active and less stressed also experienced better sleep quality, fell asleep more quickly, had a better mood the next morning, and were less fatigued the next day as well.

Q: What are some additional health benefits or important elements to consider when creating a well workspace?

Dr. Sternberg: There are a number of other benefits and elements to consider:

For example, circadian light, another attribute of environmental space, is an important component of health. Exposure to sunlight in the morning to bright circadian, full spectrum sunlight from 8 AM to 12 noon, allows one to fall asleep more quickly, improves the quality of sleep, and again, better movement the next day.

Windows also provide a view of nature. It’s been known for decades that people who have a view of nature such as people who have a window view in a hospital helps people heal faster. They have less need for pain medication and an improved mood compared with people who have no view or have a view of a brick wall.

Reducing noise levels is an important issue and very relevant to hospital settings. There were studies in intensive care units in Sweden, where they found that by simply replacing the ceiling tiles that were more absorptive in intensive care units and emergency rooms, the nurses experienced better quality of sleep, even though they weren’t aware that the ceiling tiles had been changed.

Humidity levels are another important aspect of the environment. We found in our studies that when relative humidity was between 30 and 60 percent, the stress response was 25% less compared with those spending their time in drier conditions. We believe the reason that low relative humidity (less than 30%) increases the stress response is because one’s mucous membranes dry out and become more susceptible to infection. It has also been shown in hospitals that there is a higher rate of viral infection when the relative humidity is low. One can control the humidity. It may be difficult to achieve because it is expensive, but it can be done.

Access to nature and being able to walk in nature improves health parameters. Being able to walk 30 minutes a day is beneficial, but the benefits are enhanced particularly when walking outdoors. We know that forest green light reduces pain. Nature sounds are calming and reduce anxiety and help one fall asleep. There are also beneficial organic compounds that are released in the forest, which effectively provide a natural aromatherapy when outdoors. So, when one thinks about a workspace, one shouldn’t only think about the inside room or the rooms where one works but the surroundings of the building. For example, the Mayo Clinic in Scottsdale, Arizona, has a walking path in the desert that surrounds the Clinic. It enables people to go out for a few moments during the day or at lunchtime and get some exercise.

To get the benefits of daily exercise, you don’t need to be on a treadmill. Just 30 minutes a day of walking in a quiet, calm setting is important. Spaces that enable people to go offline for a moment to meditate or just be in a quiet space in nature are always a good idea. In the new AWCIM building, we have desert gardens and a Spirit building. We also have a labyrinth for walking meditation.

Q: If people in the workplace don’t have much access to the outdoor environment, how can one enhance the indoor environment?

Dr. Sternberg: People need to have access to nature or be in nature. There’s a term called biophilia which means the attraction to living things such as plants. Being around natural life such as indoor plants reduces stress and anxiety. If you can’t be outside in nature or don’t have regular access to windows with views of nature, you can bring elements of the outdoors to the indoors through art on the walls. There are studies that show that art is beneficial for one’s health. My previous book, Healing Spaces: The Science of Place and Wellbeing, ² inspired a patient who had been in and out of the hospital throughout her life to endow original art to be placed in every patient room and hospital in the state of Vermont. There is quite a bit of evidence that art is beneficial. This may not be as effective as being in nature and experiencing all of the dimensions of the outdoors such as the sounds, smells, and fragrances of nature. However, I was at a doctor’s office where they had wallpaper that made the enclosed examination room seem like a jungle. The wallpaper had birds and lush green plants and trees, and it was beautiful. Obviously, it would be better if one had real trees in the examination room, but that is often not possible.

There have been wonderful adaptations of new technologies to create natural environments indoors. An amazing example of this is a story I tell in Well at Work, about a young woman, Mirelle Phillips, who was in the video game industry and experienced a serious accident. After her recovery, she decided to utilize her video game skills to help others. She set up a studio in New York City in 2019 to create immersive virtual reality nature experiences for people. Then the pandemic happened, and she realized that New York City was ground zero for burnout and even high suicide rates amongst health care providers. So, she quickly ramped up her efforts to create these immersive nature reality “Recharge Rooms” in hospitals, first at Mount Sinai Hospital in New York. Now, she has over 70 different rooms in hospitals across the country with over a million users. Her research demonstrates that immersion in these virtual reality nature experiences for only 15 minutes a day significantly reduces anxiety, depression, burnout, and improves sleep quality. When you are in one of the rooms, you can call out “Take me to a quiet mountain lake,” and all of a sudden, a whole virtual reality wall becomes a quiet mountain lake. You can hear the waves lapping and the birds chirping, and you feel as if you are actually there. These types of nature experiences created indoors are very beneficial. It’s a form of guided imagery that takes one offline and away from stressful situations.

Bringing nature to the workplace environment by bringing living plants indoors is also very important, and it is doable. We are working with the College of Agriculture here at the University of Arizona, to have a vertical hydroponic garden at our new AWCIM buildings. One can also create roof decks with plantings. There are an increasing number of such rooftop gardens in cities around the world. In Healing Spaces, I describe an amazing Japanese roof deck garden in a hotel in downtown Los Angeles, California. It is incredible, and when you are there, you don’t realize you are in a big, noisy city with traffic and crowds many stories below.

There are many creative ways to bring nature to the place where one works if one doesn’t have the luxury of being able to be in it, or to have access to nature green spaces in the areas surrounding the office building. This may require working with city planners to create small “pocket parks,” or reclaiming parts of a parking lot, the way the University of Arizona College of Architecture, Planning & Landscape Architecture did to create a Sonoran Desert garden, which provides respite for all.

Q: In addition to your new book and your speaking engagements, how are you helping people and organizations improve their environment?

Dr. Sternberg: I continue to work with the GSA, given that they are the largest real estate owner in the country and set standards and requirements for designing and operating office spaces. The information that we have derived from our studies is going directly into the GSA’s guidelines for post-Covid reentry across the entire Federal Government, and it can be used by any number of organizations that want to create wellbeing healthy spaces for their workers.

I also speak to groups of CEOs who are vitally interested in how to maintain a workforce that is happy, healthy, and productive. One of the big goals behind writing my current book is to spread the word to people who have the means, resources, and the power to implement these changes and create healthy wellbeing work spaces.

Another organization with which I work closely is the American Institute of Architects (AIA), Washington, DC. The AIA has implemented health and wellbeing as a primary goal across all of their knowledge communities, not only for health care design, but also for the design of any kind of built environment.

While these principles are not widespread in the manufacturing industry, there are some companies that are working to improve their working environments. One such company, Herman Miller, has many windows that bring in circadian light onto the factory floor. The people in charge make sure that their employees can go offline and rest or exercise—and provide the spaces to do so. The buildings are surrounded by meadows, where pollinator plants attract bees, and the company actually harvests the honey to give to visitors. So, there are some far-seeing manufacturing organizations that are doing this. But there is a significant need to enhance this momentum.

Q: What are your hopes for the future of your cutting-edge work?

Dr. Sternberg: I hope that every building will become a wellbeing building. I think that the principles I have described are certainly doable. My current book is about being well at work and creating wellbeing work spaces, but the exact same principles are applicable to educational spaces such as schools and colleges and to home environments. In fact, in the book, I provide many tips on how to make your home a wellbeing space.

Covid helped shine a light on needing to design spaces that help people become resilient, because whether you become sick from a virus depends on the dose to which you’re exposed, the duration of exposure and one’s own resilience. If we can improve people’s resilience by including these wellbeing aspects of the built environment, it will go a long way toward reducing susceptibility to many illnesses.

Q: Are there any final comments that you would like to share with our readership?

Dr. Sternberg: I live near many world-class spas, and these spas are not mandating people to visit them. They are designed intentionally in order to attract people, and when people go, they feel better physically and emotionally. I believe that the solution to attracting people to come back to work is to create spaces that will keep people happy and healthy. We need to design and program our workspaces, whether they are office spaces or hospitals or clinics or educational institutions and operate them with the same mindset as the spas do. In the book, I also give the example of Disney theme parks, which worldwide attract over 100 million people a year. Disney Imagineers’ mantra is that they design these spaces on purpose to take people from a place of fear and anxiety to a place of hope and happiness. We need to design all of our spaces to do exactly that.▪

To Contact Dr. Esther Sternberg

Esther Sternberg, MD

Professor of Psychology, Architecture, Planning & Landscape Architecture, University of Arizona, Tucson

Website: https://esthersternberg.com/