Opened in 1991, the Kao­hsiung City Hall building is Kao­hsiung’s administrative center, and an essential place for Kao­hsiung residents to do official business.

However, not long after the building opened, employees and temporary visitors alike would start to feel lightheaded and drowsy in the afternoons, with some even complaining of sore throats, itching and postnasal drip. The worst area of all was the Public Works Bureau’s Building Administration Office on the first floor.

After this situation had persisted for a while, city officials asked National Cheng Kung University (NCKU) architecture professor and green architecture research pioneer Chiang Che-ming, along with experts in remodeling and architecture, to investigate. They found that within the tightly closed-off first-floor office space, the carbon dioxide concentration often reached 700–800 parts per million, while that in the conference room exceeded 1,000 ppm. Generally, when the CO2 concentration exceeds 600 ppm, people tend to feel stuffy and sleepy; over 1,000 ppm, and breathing, circulation and brain function are affected, even to the point of vomiting.

More astonishingly, the formaldehyde concentration in the Kao­hsiung City Hall building, which had been in use for nearly 20 years, exceeded the safety standard of 0.1 ppm. (Formaldehyde, rated by the World Health Organization as a Group 1 chemical carcinogen, is often used in construction materials.) This was a worrisome situation.

After looking into the issue, Tseng Pin-chieh, who heads the Building Administration Office of the Kao­hsiung Public Works Bureau and holds a PhD in architecture from NCKU, found that inadequate ventilation was the chief reason for the worsening air quality. Early on, energy conservation was the primary consideration in the design of the air conditioning system, and intake of outside air was minimized to reduce the burden on the air conditioners. Furthermore, the filters had not been cleaned in the decade or so since the air conditioners were installed.

With the passage of time, dust, molds and suspended particulates accumulated in the filters and ducts, not only reducing air conditioning efficiency, but also causing CO2 concentrations to soar and harmful substances to keep circulating with the air-conditioned indoor air.

To gain a full grasp of the problem, the Kao­hsiung City Government launched a series of environmental retrofitting projects in 2007 in a bid to remedy the air quality problems of the first-floor office space while improving conditions in four areas: sound, light, moisture and heat. They replaced the old air conditioning system, rerouted air vents and intakes, and set up a system of intakes equipped with smart indoor air sensors, so that when indoor CO2 or formaldehyde concentrations were too high, air from outdoors would be immediately drawn in to regulate contaminant levels.

The retrofitting project also involved installing anti-vibration equipment in the generator room as well as fitting noise absorption panels and replacing the lighting throughout the offices. This indoor air quality retrofitting program, the first of its kind in Taiwan for a government building, was subsidized by the Ministry of the Interior. It took three years and a total of NT$16.5 million to complete.

Shin Kong Wo Ho-Su Memorial Hospital nephrologist Chiang Shou-shan, known as “the house doctor,” leads the battle by testing the air quality in his patients’ homes.

The problem of poor indoor air quality is of course not limited to government buildings.

In 2005, the Consumers’ Foundation tested the air quality of 25 Tai­pei hospitals, finding that waiting rooms and dispensaries in 11 of them had CO2 concentrations of over 1,000 ppm, far above the 600 ppm limit recommended by the Environmental Protection Administration (EPA) for sensitive places such as hospitals. That year, the Legislative Yuan’s Zhong­xing Building was tested by NCKU professor of environmental and occupational health Su Huey-jen, who found that the formaldehyde concentration was 0.4 ppm, which translates to a lifelong carcinogenic risk rate of 9:10,000, 912 times higher than the standard acceptable risk value.

In 2008, the ABRI surveyed the air quality of 16 daycare centers around Taiwan, and found that 60% of them showed high CO2 concentrations, and 80% had unacceptable formaldehyde and total volatile organic compound (TVOC) concentrations. And the average concentration of dust mite allergens came to 9.27 micrograms per gram, far higher than the EPA’s recommended 2 μg/g safety standard. Clearly, many daycare centers suffer from poor indoor ventilation and high humidity. No wonder childhood allergy problems have become increasingly serious in recent years!

Such problems are not confined to enclosed public spaces; they also occur in public transportation systems with high passenger throughput. In 2007, the Institute of Occupational Safety and Health conducted tests on five major Tai­pei MRT stations, and of these, Tai­pei Main Station and Zhong­xiao–Fu­xing Station had the worst air, with fungi concentrations exceeding the EPA’s recommended colony count of 1,000 per cubic meter throughout the day, and skyrocketing to a shocking 10,512 during morning and evening rush hours!

Since indoor air quality is usually related to the layout of the ventilation system and the building itself, in academic circles buildings with poor indoor air quality are called “sick buildings.”

Hsieh I-chun, an attending physician of environmental and occupational medicine at Taiwan Adventist Hospital who holds a Class 2 sick building diagnostician’s certificate, notes that there are three general ways in which buildings affect human health. The first is Sick Building Syndrome (SBS), in which various nonspecific symptoms such as headaches, coughing and nausea are presented. According to a 1982 definition by the World Health Organization, SBS is a series of physical symptoms induced by poor building air quality. In this category, sufferers usually experience an alleviation of symptoms upon leaving the problem building.

More worrisome are the second and third categories, Building-Related Illness (BRI) and Multiple Chemical Sensitivity Syndrome (MCSS). BRI refers to certain pollutants in the building air that can directly cause illness or death, such as dust mites and molds, which can cause allergies, and carbon monoxide poisoning, which can be fatal. The PM2.5 suspended particulates (with diameters up to 2.5 microns) from oil fumes in the kitchen are a major culprit behind lung cancer.

As for MCSS, this refers to long-term indoor exposure to certain low-dose chemical substances, such as perfumes, air fresheners or cleaning fluids. This can affect the immune system, resulting in reactions such as headaches, fatigue, irritability, and lack of concentration.

“The symptoms of MCSS and SBS are similar, the difference being that the former can lead to deeper poisoning. The symptoms won’t dissipate even after people leave the problem building. And the cause of the illness usually can’t be found even after batteries of tests,” explains Hsieh I-chun.

As crowds descend on the anniversary sale of a department store, carbon dioxide concentrations often soar, leading to insufficient oxygen levels.

Chiang Che-ming points out that indoor air quality can be managed according to three general factors: physical (such as ventilation, lighting, climate control), biological (fungi, molds, dust mites) and chemical (formaldehyde, volatile organic compounds, ozone, suspended particulates).

Of these, the physical factors are usually related to building ventilation design. For instance, executives are customarily located in the farthest reaches of an office space. These places are the farthest from the front door and are often at the far end of the air conditioning ducts where ventilation conditions are usually the worst, and concentrations of CO2 and other contaminants can easily soar.

In his book Don’t Let Your House Murder Your Health, nephrologist Chiang Shou-shan of Shin Kong Wo Ho-Su Memorial Hospital writes that there are a lot of problems regarding layout planning in the postpartum care centers that are popular these days. Postpartum care centers are usually designed according to a cloistered layout, with well-lit maternity rooms by the exterior windows, while the nurseries are concentrated in the center.

“Many mothers complain that while their babies slept quietly and were easy to handle in the postpartum care centers, they would stay awake screaming after they went home,” says Chiang. He explains that small babies have very fast metabolism, exhaling a lot of carbon dioxide. But in postpartum care centers, they’re kept together in closed, unventilated nurseries; naturally they’ll be drowsy all the time.

The biological factors are related to weather patterns and user habits in Taiwan. Taiwan Association of Sick Building Consultants (TASBC) director Ruan Han-cheng notes that in humid, rainy Taiwan, the relative humidity is often over 70%, conducive to the growth of microorganisms. If homeowners neglect cleanliness, their homes can easily become breeding grounds for dust mites, molds and bacteria.

As to chemical factors generally considered highly toxic, these are often found in building materials. For example, formaldehyde, also called formalin, has excellent preservative properties and sells at a low price; it’s often found in plywood, adhesives and new furniture.

Another compound posing high carcinogenic risk is the volatile organic compound benzene, a substance often used in paints and varnish for wooden furniture.

Choosing the right indoor plants can reduce concentrations of formaldehyde, ozone, suspended particulates and other pollutants, and also beautifies the indoors, making them an ideal way to address air quality problems. Shown here is a “green wall” at Taipei’s Q Square shopping center.

Indoor air pollution, whether caused by physical, biological or chemical factors, can be harmful to human health over the long term. To address this, the EPA began drafting the Indoor Air Quality Management Act in 2008; it was passed in November­ 2011 and is expected to come into force in November 2012.

Says Hsieh Yein-rui, head of the Department of Air Quality Protection and Noise Control, the Indoor Air Quality Management Act is aimed at public places where people gather, such as buildings and stations where people frequently enter and exit. In June 2012, the targeted sites will start to be announced: sites such as government offices, hospitals, schools, daycare centers and shopping centers may be included in the first batch.

Once placed under management, these public spaces must designate special personnel in charge of maintaining air quality, who have to undergo training at regular intervals by an environmental agency. Concentrations of pollutants including carbon monoxide, carbon dioxide, formaldehyde, volatile organic compounds, bacteria, fungi, ozone, and suspended particulates in the indoor spaces must also meet EPA standards, or else they may incur fines from NT$50,000 to NT$250,000.

“Taiwan is only the second country in the world, after South Korea, to enact a special law aimed at indoor air. We estimate that after the new law comes into effect, the National Treasury will save NT$4 billion a year in health expenses,” says Hsieh optimistically.

Modern glass-paneled office buildings may look spiffy on the outside, but health hazards may be concealed within their airtight walls.

Still, the Indoor Air Quality Management Act only pertains to public spaces; it doesn’t extend to housing or private offices, leading many experts to criticize it as inadequate.

Also known as “the house doctor,” Chiang Shou-shan says that the seriousness with which indoor air affects human health is related to exposure times and the amounts of pollutants involved. People usually don’t linger long in public spaces, while the law does nothing to manage the places that have the most effect: homes and offices. “It seems a big piece is missing, and that’s a pity,” he says.

Chiang Che-ming states that though more advanced places like Western countries and Japan don’t have a special act directly addressing indoor air quality management like Taiwan does, they do have various legislative provisions aimed at managing indoor air quality. For example, in the summer following the SARS scare of 2003, Japan amended its building code, requiring all newly built residences and office buildings to have a 24-hour uninterruptible ventilation system to ensure that outside air will be constantly drawn and circulated indoors to reduce the risk of contaminant and virus buildup.

As for how the public should ensure the air quality of their living areas, Chiang Che-ming believes that poor indoor air is oftentimes the result of erroneous thinking. For instance, for the sake of keeping warm or preventing theft, many people shut their windows tight, but this stops indoor pollutants from dispersing. The proper way is leave the window open a crack even when running the air conditioner, to make sure the air circulates.

Also, when boiling water on a gas stove, many believe that since there are no cooking fumes it means there’s no need to turn on the range hood. But carbon monoxide is produced when natural gas burns incompletely, and water vapor can also create condensation on the walls.

Judicious selection of building materials when decorating is a prime means of ensuring nontoxic air.

Chiang Shou-shan remarks that when redecorating, many people focus on style or luxury while overlooking health. He was sent to investigate two superluxury apartment complexes, where the homeowners had spent around NT$45 million on interior decoration; in each room, the readings for formaldehyde and volatile organic compounds were off the scale, enough to cause endocrine dysfunction, infertility, and a litany of other ailments among their families. They had spent big money on a fengshui master to no avail. Only later did they discover what the problem was: it was a “scientific fengshui” issue!

TASBC director Ruan points out that there are over 3,000 products on the market that bear the ABRI’s Green Building Material mark. The prices are only around 10–20% higher than traditional materials, but many consumers and designers don’t understand the need to use them, which is a shame. It is imperative to strongly promote these healthy materials.

We spend some 80–90% of our lives in the great indoors. For every breath of air we breathe to be safe is something we should expect, and it is imperative for our health.