How Buildings Impact Student Health

An Interview with Harvard Public Health researcher Erika Eitland

October 2012, Hurricane Sandy took New York by storm. Erika Sita Eitland was a recent college graduate and newcomer to the city, conducting needs assessments for public housing projects. As she met with kids and families, she came to the sad realization of how big an impact these crumbling buildings had on their well-being, even before Sandy hit.

This week, we got to sit down with Erika and chat about her journey as a Harvard PhD student studying the impact of buildings on student health, and what she’s learned in putting together the Healthy Schools Report.

R2L: How did you first make the connection between school buildings and health? Why did you decide to dedicate your career to this topic?

ESE: My background was in genetics, and at UConn I was looking at early embryonic development. I realized this is a really sterile environment to work in and doesn’t lend itself to helping people in the present. At the molecular level, I wasn’t connecting to people. So I moved to new York, and did needs assessment for public housing in the fall that Superstorm Sandy hit. I realized that even prior to Sandy, the conditions of those buildings were in such terrible shape, and had direct impact on people’s well-being. That would be exacerbated by climate change, so we have to do something.

Our built environment determines our exposure to certain health outcomes. In urban areas, we spend 90% of our time indoors. Students are some of the most vulnerable people, in terms of physiology, decision-making, and the unique spaces they occupy. When they’re learning on the floor, for example, kids are more exposed to the heavy metals and dust we’ve tracked on our shoes.

When I started my PhD, I wanted to study buildings, and realized I loved schools. These communities already exist with great qualitative stories, and just need scientific support to pull it off. Plus, there was 30–40 years of research sitting there, needing to be translated and discussed. I wrote the Schools Health report to translate what the science was saying for a broader audience. I thought, how valuable would that be, to get this information to people who really need it?

R2L: What does the science say about school buildings and health?

ESE: There are these nine foundations to a healthy building, especially in a school. I’ll talk about some of the key things we’ve looked at.

Indoor Air Quality

In the U.S., 60,000 schools don’t have an indoor quality manager — to respond to mold outbreaks, etc. Across the board, we found incredibly high CO2 levels. When a building can’t breathe (i.e. has a poor ventilation system), CO2 concentrates indoors. That sleepy feeling kids get after lunch? That’s not from lunch — it’s from built-up CO2! This leads to asthma and respiratory problems, and we call that the Sick Building Syndrome.

Toxic Substances

Most schools are over 50 years old, which predates a lot of environmental and health policies. Back in the 1970’s, the Toxic Substances Control Act (TSCA) removed PBC’s, asbestos, and lead-based paint from our building materials. Yet, teachers in Malibu are still getting cancer because of exposure to PCB’s in the last 30 years. Our school building renovations aren’t happening fast enough to catch up with policy changes.

In 1991, the EPA established the Lead and Copper rule, which regulated these minerals in drinking water. Yet, in schools you still see schools with elevated lead levels. You can have the best treatment plants in a city, but if lead is leaching out of pipes as they sit overnight or over the summer, a kid can get poisoned by coming in and sniffing it in the air.

Thermal Comfort

Thermal comfort is coming up in big ways. Before 2004, none of the schools in Massachusetts had air conditioning. We focused on keeping kids warm in winter, but now you’re seeing this important need to stay cool as well. The science is showing that the fluctuations in early spring are most detrimental, when our bodies haven’t acclimatized to big seasonal changes. You’re seeing big impacts of temperature on standardized test scores in Math and English. You also see behavioral changes from teachers, who end up not taking their students outside, so kids not as physically active even though their metabolism is faster.

Technology adds an interesting layer of complexity. Take the temperature and test score relationship. As of this year, 500,000 students took the MCAS online. That’s hundreds of computers adding heat to the building load on top of a bunch of hot, sweaty kids! Technology is not separated from that lived experience. What do schools need to look like in the next 30 years?

R2L: How are kids’ bodies different from adults? How do buildings affect kids differently?

ESE: Kids breathe 50% more air than adults, have larger pupils, are more sensitive to circadian rhythm triggers, and are more acoustically sensitive as they’re still picking up language. If you and I read a paragraph with the vowels removed, we could understand it, but a kid couldn’t.

Kids also have Immature immune systems, thinner skin, and lungs developing till age of 18. They have less lung volume so they’re more susceptible to air pollution. If you’re near a highway, a school building with good air filtration can be public health intervention.

Airport schools are another interesting subset as kids are much more sensitive to ambient background noise. High levels of chronic noise impacts sleep quality, distractibility, and there’s a whole series of studies of just that.

R2L: What is your day in a life as a researcher? How do you collaborate with architects, facilities managers, and others?

ESE: The first 60% of the battle is getting the data, and connecting with people with the data. One day I might be asking, “How does temperature affect test scores?” I would call up the Massachusetts Facilities Administrators Association (MFAA) and ask what I would need to answer this question from a facilities standpoint. I would then email people at the DOE for student-level data on test scores. Then I’m going through NASA’s website for daily temperature data. If I don’t have accurate enough data, I’d look for geographic analysis data from weather stations or airports, on the day students took the test.

The next 10% of the struggle is standardizing the data. Some of it hasn’t been digitized. For example, test score dates are in a series of PDF’s, so I have to manually find test dates that matter. I’m a public health researcher, not an educator, so when I see five different test dates, I have to go back to DOE and ask for the one that matters.

Then, we know this question isn’t just about temperature and test scores. I would look through the literature on everything from sociology and environmental health to find crime data, household income, how many kids are eligible for Title 1 schools… The amount my vocabulary has had to grow and shift is another 10% of the battle.

The last 10–20% is doing good science in terms of the assumptions I can make while making sure I’m answering this question acutely.

Once I learn something interesting, like how much green space a kid needs, I would call up my architect friends and say, “This is what the research is showing. What can we do about this?” They might say, “You have to think about structural soil. It’s not just about planting more trees, but optimizing the trees you’re planting.” Working with architects makes me think about innovative ways of solving a problem. I could then include that in a peer-reviewed paper and bring it to the public health committee to shift policy.

R2L: What have you found most rewarding about your work?

ESE: I present a lot at non-public health conferences. In schools, people use energy efficiency as a way to save money, but that might not have the most impact on health. I get to go in as a public health professional and show facilities managers how they’re more important to kids than their primary care physicians. I can offer people something that validates and defends their budget to maintain their school in a certain way. In our country, we under-fund our schools, and they are for sure not ready for the 21st century. Now we can show 30 years of research saying that school buildings matter.

Sometimes, though, kids just need a safe space to be. When MDS Architects worked on the Codman Academy, they focused on trauma-informed design. Kids were coming from communities of domestic abuse, homelessness… In the hierarchy of what’s important to that kid, air quality may not be as important as a meal to eat and trusting the adults you’re with.

R2L: How do we as educators and designers move forward in this work?

ESE: The best thing we can do is to go back and check in with teacher and students. They are the best sensors for any school! They’ll know when they’re not feeling the way they should feel. How do we do this better? We can’t ignore that this has an impact on productivity. If your teachers are too hot, in bad air quality, they can’t teach even if they’re the best teachers in the school. A healthy building is a way to unlock everyone’s full potential.

Teachers as Advocates

My friend in Connecticut is faculty chair at her school. When she read the report, she put together a simple school-wide survey and asked teachers and students, “What would you change in your school?” This was in a pretty well-off school, yet kids were saying the school building felt like a prison. They wanted more windows, green space, and said they felt hot and stuffy in the rooms. Students are very perceptive, if you ask them! But how often do we ask them to things other than, “What’s the answer to Question 8?”

A lot of schools don’t have school nurse, so how can we all be a bit more of a health professional? When was the last time teachers talked to facility managers and asked what they used to clean the floors with? Do the new furniture pieces have flame retardants or phthalates? These have reproductive health implications. These are single line item operational changes — swapping out one product for another — that make a huge impact on exposure to chemicals. We need to be more aware of the products and chemicals we’re putting into schools.

Designers as Health Providers

As for designers, monitoring and evaluation is as important as programming! Make sure what you designed is used as intended because real students will be occupying these spaces. Firms that really connect with facility managers make a huge difference. It doesn’t matter how fancy and high-tech your building is if the person in there doesn’t know how to manage it. Engage those people early in design process, with intent and how-to, to reduce negative exposures later on. At best, the architect can act as a preventative health provider, troubleshooting issues before they arise.


Erika Eitland is a 3rd Year Doctoral Student in the Department of Environmental Health at the T.H. Chan School of Public Health. She is the program leader for Healthy Schools in the Healthy Buildings Program. Her research focuses on the impact K-12 schools buildings have on student and teacher health in the United States. Erika is deeply interested in creating tools that translate scientific research findings into user-friendly information that promote short and long-term success of students. Previously, her research has focused on climate change, food access, low-income housing, and gender inequality. Erika holds a B.S. in Molecular and Cell Biology from the University of Connecticut and MPH in Environmental Health Sciences from Columbia University Mailman School of Public Health.

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