Indoor Air Cartoon Journal, October 2020, Volume 3, #111.

Buildings are a complex organisation like humans with systematically arranged systems into a unified, organic whole. The healthiness or performance level of the systems and their integrations is a function of the body make-up, thinking, impacts of environmental factors, consumption, and the body’s usage and maintenance.

Thus, if someone has physiological or psychological health problems, a good doctor will not solve the gap in healthiness status, i.e., problem. This will be tantamount to providing want instead of need. Want is the solution provided to a problem. Need is the solution provided to the root cause of a problem. 

A good doctor will strive to provide the need. The provision of want may be provided to buy the doctor more time to diagnose the root cause of a complex organic structure’s health problem before providing a solution to the root cause for a suitable and reliable health condition.

To diagnose the root cause of a health problem, doctors look into the history of how physiological and psychological conditions contributed or could deepen the health problem.

The history documents doctors consult are professionally called case history or medical history. The use of case history is especially important for a complex and unified organic structure because not only does the poor integration of the performance affect the health problem, one health problem may also lead to another health problem.

A case history is not only essential for accurately diagnosing the root cause of the health problem and identifying the accurate remedy to the root cause; it aids effective risk assessment of short and long term health conditions for effective risk management and risk aversion.

A little or no consideration of case history adoption could lead to serious health implications or death. Medical professionals could be liable to the criminal case of negligence or incompetence when information and knowledge inherent in case history are not given due consideration. A case history is as useful as the information it contains and the knowledge it facilitates.

Thus, knowledge and information management are essential to a case history development, considering the complexity inherent in integrating human body systems and the performance they deliver for human well-being.

How is case history relevant to buildings with the same complexity and integration of systems and delivered performance as the human body? Could the negligence in the usage of case history affect building performance, i.e., the building health? Specifically, how does case history affect the quality of indoor air building occupants or users exposed to and indoor air quality management?

The healthiness or performance level of the systems that constitute buildings is a function of the environmental impact, occupants or users’ impact, and quality of work done, information, and knowledge management during the building performance delivery process. The three key contributors to a building’s healthiness form the basis of a building’s case history.

The environmental impact is a function of the conditions of the climate, topography, geography, and biology of living things in the place the building is located. The occupants’ or users’ impact is a function of the building type and limit of acceptability of the building’s occupants and users.

The limit of acceptability includes how physiological, psychological, social, and economic conditions determine how and the extent to which occupants and users relate to or use the building. The quality of work done, information, and knowledge management at the design, construction, and facility management stages of the building delivery process will contribute to the usefulness of the case history provides to healthy building delivery.

Like good doctors, good facility managers or other building professionals tasked with diagnosing and providing remedies to building health problems should take case history seriously. This is especially important for delivering healthy indoor air, as building occupants or users cannot do without breathing of indoor air.

When the building’s unhealthiness status leads to indoor air pollutants’ emission or presence, building occupants or users may experience poor health, comfort, and work performance and productivity.

Aside inhalation, the indoor air pollutants could find their way to human bloodstream through the skin (dermal uptake) or deposition on food or drink we consume (ingestion). The negative impact of the environmental factors, occupants or users, and building delivery process could compromise each building system and the integration of the systems. Compromised systems can be the source of indoor air quality (IAQ) problems.

The dilution and filtering or cleaning of polluted air can also be compromised when building systems do not function well. Building systems include interior (e.g., materials and equipment, furniture, partition walls, ceilings, etc.), envelope, structural, and mechanical, electrical, and plumbing (MEP) systems.

In this journal, several articles provide information on how environment, human, and building systems can compromise indoor air.  Read and reflect on the importance of case history in making an informed decision for effective IAQ management.

Identifying or preventing the root cause of the problem arising from compromised indoor air or building systems leading to poor indoor air can be very difficult if there is no accurate and complete account or documentation of the building health case history even for experienced and qualified facility managers or building professionals.

Poor case history or lack of case history consultation will lead to poor building pathology. Facility managers or building professionals in charge of diagnosing or providing health remedy to the cause of IAQ problems will be unable to effectively assess current or potential hazards that could increase the risk of poor indoor air occurring.

It will also make it difficult for facility managers or building professionals in charge to effectively assess the building’s vulnerability due to exposure to hazards or its inherent physical conditions before and after IAQ problems occur. Hazard could result from the environment’s impact, building occupants or users, and the low quality building delivery process.

The difficulty in hazard and vulnerability assessment is not peculiar to indoor air quality management. The difficulty can also compromise the management of other indoor environment quality (IEQ) conditions and building integrity. Thermal, acoustic, light or visual, spatial conditions are other examples of IEQ conditions of concerns. Refer to article number 104 in this journal for the meaning of building integrity.

Let us consider a situation where a building frequently experiences a wall paint bubbling on the wall. One way to solve the problem is to scrap the paint, clean any possible mould growing on the wall’s surface, and repaint the wall. Problem solved. However, the problem here is that the solution is provided to the IAQ problem but not the root cause.

The problem with solving the IAQ problem is that the bubbling paint and mould growth on the wall will keep reoccurring. What is needed is not a suitable solution for the moment but suitable consistently, i.e., a reliable solution.

To provide a suitable and reliable solution to an IAQ problem, the adoption of case history in diagnosing the root cause of the problem and letting the knowledge of the IAQ problem’s root cause inform the decision made on the solution provided.

To make good use of a well and accurately developed, maintained, and updated case history, building professionals must cultivate the habit of asking questions to direct the objectives needed to provide a suitable and reliable solution.

Building professionals can ask several questions relating to mould growth, including some of those given below. What are the usual temperature and relative humidity of the indoor space? This kind of question is essential as moist air encourages mould growth.

Building professionals should explore the possible contributions of the environment, occupants or users, and the building performance delivery process to determine a possible and persistent unhealthy temperature and relative humidity that possibly contribute to mould growth.

Other examples of questions that could be asked are, what is the wetness status of the surface? Is there a water leakage or condensate sipping on the material surface? What are the possible sources of wetness? Building professionals should also explore possible sources of wetness, and the frequency of the sources contributing to the wetness.

Even history sequel to materials used, installation methods, contractors involved, operation and maintenance schedule and methods, etc., may also be explored. It is possible to explore the direction of wet surfaces as they encourage mould growth.

Another possible avenue for exploration when using case history to solve mould problem example given is ventilation. The investigation on the ventilation rate effect is important because a lack of adequate ventilation rate can lead to mould growth if moist air exists or surfaces are constantly wet.

Building professionals can question the ventilation rate in the affected indoor space. What is the ventilation rate operation like every day, weekly, monthly, or over the years in the affected indoor space?

What is the history of diagnosis of mould problem, if any? What actions were taken, if any? What were the outcomes of the actions taken, if applicable, should also be explored in the case history usage? Without an understanding of the importance of case history to healthy buildings or healthy indoor air delivery and issue to consider in the development, building processionals may not know or appreciate how digital solutions can be developed or adopted to enhance the process of using case history.

The understanding is especially crucial for the delivery of healthy indoor air, which is a fundamental human right for every building occupant or user. Do you share my sentiment on the importance of case history to delivering healthy indoor air and buildings? If yes or no, why? What are the possible challenges to its development and adoption? What can be done to overcome these challenges? What is the role of data science and analytics and digital solutions in case history development and usage?

Read Zadik et al. (2012) to get insight into how non-usage and ineffective usage of case history would compromise prognosis and diagnosis of the cause of a health problem of a complex and unified organic structure. Read Crump (2013) and Singh et al. (2010) to know more about the complexity involved in resolving IAQ problems due to the impact of environment, occupants, and users, and the building performance delivery process.