Abstract
Excerpted From: Lynette B. Martins, The Next Public Health Frontier with Indoor Air Quality, 60 Tulsa Law Review 153 (Fall, 2024) (286 Footnotes) (Full Document)
Optimism is not a word often associated with health, specifically in the context of public health. The past several years have been a gut punch to the field, particularly in public health law. Countless headlines have relayed devastating news about public health the lack thereof--and tributaries of misinformation have meandered in wider circles, with ideologies like anti-vaccination movements now more mainstream than ever before.
Despite the heightened despair over the past four years, which have been steeped in death and sickness, there are reasons to be optimistic that should serve to fuel any public health efforts. First, there have been meaningful societal shifts. On baseline, our general awareness about indoor air quality (specifically ventilation and air cleaning as tools to ensure optimal health) has increased and is favorable. Second, multidisciplinary communities have come together without prompting to educate and advocate for clean air. The public health ethos is built on the pillars of community and solidarity, and effectuating policy often depends on the relevance or significance of a subject to populations versus individuals. Third--and perhaps the most significant--two of arguably the most influential entities in indoor air quality gave reasons to celebrate. The American Society of Heating, Refrigerating, and Air-Conditioning Engineers and the Centers for Disease Control and Prevention both took a step unseen for over thirty years and revised their ventilation standard for indoor air quality in buildings. Additionally, they included an articulation of a standard for the control of infectious aerosols. While this standard is reactive--it relies on the resilience of buildings to react effectively during an infectious disease outbreak rather than proactively preventing it--it is nonetheless a notable step forward. Further, the Centers for Disease Control and Prevention (CDC) released its first-ever guidelines for indoor air quality as it relates to the control of infectious airborne diseases. Fourth, the Biden administration has signaled the importance of optimizing indoor air environments through several initiatives, including hosting the White House Summit on Indoor Air Quality, providing funding for public schools to optimize their indoor air environments through the American Rescue Plan, and advancing indoor air improvement informational initiatives through the EPA. Fifth, sales for portable indoor air quality monitors have increased, indicating a desire for people to know more about indoor air and how to best optimize it for their health.
These considerations are fundamentally rooted in the fact that the problem of poor indoor air quality is tractable. While most recommendations for optimizing indoor air quality will factor in room dynamics and setting, including its size and use, there are some tools at our disposal that can be applied to all situations. The tools to counter the ongoing negative impacts of poor building health exist. If health is political and politics are local, then approaches can first be implemented at the municipal level. And if the public health approach to indoor air quality can be distilled into a lack of political will, then community power can be tremendously influential in codifying standards into law. In addition, engaging with private enterprise through public-private partnerships can similarly be valuable. It is with this optimism that I proceed on this exploration of the regulatory framework for indoor air quality by describing why we need better indoor air quality--including the public health importance--what we currently have in terms of regulation, why it is inadequate, and what could be a viable path forward.
Broadly, this Article has two main objectives. First, it endeavors to expand on the work of public health scholars by advancing systemic changes or interventions required particularly in infectious disease outbreaks. This ensures equity in a way that minimizes the disparities that often predispose communities to bear the brunt of pandemics. Second, it plans to advance a paradigm shift in the public health approach to airborne diseases toward being consistent with counterparts such as waterborne and foodborne pathogens.
As such, Part I begins by describing the public health impacts of poor indoor air quality that necessitate a shift in the current framework. It will include a discussion of the public health challenges with airborne diseases (transmission dynamics, nomenclature, etc.) and the racialization and over-medicalization of healthcare. Part II delves into the patchwork of governing federal, state, and municipal laws and regulations regarding indoor air quality, including the agencies that have jurisdiction over indoor air quality. This will involve a detailed discussion of the deficiencies. Part III discusses the path forward by exploring the incorporation of ventilation standards consistent with evidence-based practice into state and municipality building codes. It examines the prospects of implementation through community power and potentially partnering with federal agencies to expand the scope of existing building certification.
Ultimately, I hope that this Article lends itself to the corpus of literature on health and indoor air quality in the United States and carves a path forward for its optimization.
[. . .]
Information about indoor air quality has now entered our homes in ways that can advance our fundamental understanding of its significance to health. Drawing on lessons from prior infectious disease pandemics indicates that contemplating an ecological approach to addressing indoor air environments may counteract the racialization and burden of the most vulnerable in any future outbreaks. Further, past lessons may ensure that the indoor air quality is optimal for commonly ongoing health issues, such as allergies to dust or particulate matter that continue to linger in both indoor and outdoor environments.
Optimal indoor air quality can be achieved in an incremental way, by first approaching municipalities to address and implement ventilation, air filtration, and cleaning as tools catered toward disease mitigation. For various reasons, including disruption due to disease outbreaks, municipalities may have more buy-in than states. Nevertheless, the approach would eventually endeavor to expand to the states once more evidence supported the initiatives and spurred adoption.
Despite the despair heightened in the past four years, which have been steeped in death and sickness, there are reasons to be optimistic that should continue to fuel any public health efforts. Public health professionals should center on the positives in trying to effectuate public health policy by looking at the meaningful societal shifts and general awareness of indoor air quality (specifically ventilation and air cleaning as tools to ensure optimal health), and how much they have increased in favorability. It is critical to harness the community power in the multidisciplinary communities who have convened to educate and advocate for clean air without prompting. Indeed, the public health ethos is built on the pillars of community and solidarity.
Health and access to health care necessarily plays out locally, and so building off of the community power initiatives and focusing on municipalities likely empowers the residents who will most benefit from the policy implementation. These types of proposals will expand on the work of public health scholars by advancing systemic changes or interventions required particularly, but not necessarily, in infectious disease outbreaks. Furthermore, a systemic approach may ensure equity in a way that minimizes the disparities that often predispose communities to bear the brunt of pandemics. Similarly, it may signal a transformation in thoughts about air and its impact on health that leans away from an individual rights perspective, toward a more communitarian one of public health. Ultimately, the events of recent years may advance a paradigm shift in the public health approach of airborne diseases as whole, subsequently ushering in a new era of indoor air regulation.
Associate Research Scholar, Yale Law School; Senior Research Fellow, Solomon Center for Health Law & Policy; LL.M. Georgetown University, M.B.E, University of Pennsylvania, PGDip, University of Manchester School of Population Health.
