**2.2 Roles played by Building Medicine**

94 Health Management – Different Approaches and Solutions

Building Medicine is a new management perspective, which is mainly applied to the management of buildings' health (including home living environments.) In the field of engineering, the discussion on building health management used to be only limited to proposals of ideas that the engineering field should learn from health management practices of human medicine. In contrast with these general ideas, the discipline of Building Medicine not only fully defines how to apply the model of human health management analogously, but also develops application tools based on its theories, such as Building Diseases Classification (BDC), Building Medical Record (BMR), Building Doctor Navigation System (BDNS), Building

The management concept of Building Medicine is that the behaviours and management models of human health and building health are similar in terms of their structures, functions, life cycles, and service years. Theories, methodologies, mechanisms or roles played medical science can be applied analogously to building health management. The analogous application considers theories and practices of the building construction and maintenance, evaluates constraints and limitations in applying human medicine approaches to building health management. The goal of building health management is to uphold the health and safety of the buildings and their occupants or even to promote the sustainability, environment friendliness, artistry or economical benefits of the buildings. Furthermore, the study will further explore how the theories of medical science can be applied analogously to buildings at different stages of their life cycles, such as its health system, legal framework, health promotion activities, emergency treatments, diagnosis procedures, patient care,

Fig. 1. Reverse thinking: Enhancing the research strength of technological and engineering

Computer Science College of Engineering

College of Public Health

College of Medicine

Institute of Biomedical Engineering

Dept. of Civil Engineering

As shown by Figure 1, except for the pubic health field, which has a close tie with the medical field, the currently available educational and technological applications are more oriented toward the field of electrical engineering, computer science, or civil engineering. Applying these technologies to medical treatment or research is part of the trend of crossdisciplinary collaboration, which can be also seen in the organization restructuring of academic institutions. For example, in National Taiwan University, the Institute of Biomedical Engineering was founded under the College of Engineering in 1988, and Graduate Institute of Biomedical Electronic and Bioinformatics was created under College of Electrical Engineering and Computer Science in 2006. The two institutes were established to enhance the research strength of the medical science field. In contrast with the support lent to the medical field by the engineering field, the concept of Building Medicine takes a

Physiology Information System (BPIS) and Building Health Diagnosis (BHD).

health administration, pathology or misdiagnosis (Chang, 2006).

fields by borrowing concepts from medical filed

**2. Building Medicine** 

**2.1 The theory of Building Medicine** 

College of Electrical Engineering and

Graduate Institute of Biomedical Electronic and Bioinformatics

In medical science, cares and treatments are provided to humans from their birth and death. Based on its development trajectory, three roles are played by medical science. First, patients' pain is relieved and their health is restored through 'health care'. Second, through 'scientific researches,' causes and mechanisms of the diseases are investigated, and new treatments are discovered and developed. Third, through 'medical education,' knowledge of medical science and technology is passed down, and the bedrock of health care service and medical researches is constituted (Hsieh, 2003). The same principles are also applied to Building Medicine. Although the subject managed by Building Medicine is a building, Building Medicine also play similar roles as medical science does. It maintains a building's health through health care, scientific researches, and medical education of buildings. The safety and health of the occupants can only be safeguarded on the condition that the occupied buildings are in a healthy state. See Figure 2 for the roles played by Building Medicine. Pathology is one of the discipline under meidical education. Similarly, building pathology (Watt, 2007) is also devloped in the filed of civil engineering. Wang & Yau (2002) pointed out in their book, *Building Pathology*, building health can be compared analogously with human health. Therefore, a large amount of human pathology studies have been carried out to understand the essence of diseases and find their treatmeant and prevention methods.

Fig. 2. Roles Played by Building Medicine

Building Medicine is not a discipline of pure theories. It has already been practiced on real cases. The author has already undertaken the three roles of Building Medicine outlined in Fig. 2. For the role of Health Care of Buildings, the previous position held by the author in the asset mangement industry was a consultant for household health diagnoses. Even though he is an assistant professor in Feng Chia University now, he teaches a service-learning course (Course Title: Building Diagnosis Technology) and leads students to provide test service of hazard factors in public environments of communities. For the role of Scientific Researches of Building, recent researches on application technologies are shown in Section 2.3 of this paper. The author also advised many master's theses which discuss diagnoses and solutions on health hazard factors in household environments, such as detection of EMF in living environments (Ma, 2010). As to Medical Education of Buildings, he opens many courses to teach students how to plan, make diagnoses, manage, and maintain a healthy living

Making a Healthy Living Space Through the Concept of Healthy Building of Building Medicine 97

4. BPIS: Physiology signs of human bodies are a basis for human health checks. From the viewpoints of Building Medicine, physiology signs of buildings (temperature, humidity, stress, strain) hold the same importance to building health management. Since a significant amount of human power and time can be saved by using computer systems to maintain buildings' functions and performances and extend their service years, Chang (2010) built a computer system: BPIS. After smart humidity/temperature information materials being installed inside buildings, signals detected by the materials are sent to BPIS wirelessly. Then, building managers are able to consult the detection data through the user interface of BPIS, and quickly learn about the temperature and humidity values inside the building structures (just like temperature and blood pressure measurement of human bodies.) Therefore, BPIS makes buildings become smart buildings with selfdetection ability. Furthermore, BPIS also provides auto-alert function which can help

managers discover problems right when they arise (see the right picture on Fig. 3).

5. BHD: Building Health Diagnosis is one link of preventive maintenance management of Professional Maintenance Management (PMM). BHD is conducted by personnel with building diagnosis training background. Based on their knowledge and techniques, they make diagnoses periodically or sporadically on various aspects of building maintenance and management, such as safety, health, performance, environmental impacts, appearance, energy conservation, and sustainability, etc. When it is necessary, maintenance and renovation works are carried out to safeguard users' safety and health, maintain the proper function of the buildings, protect environments, conserve energy and improve the urban aesthetics (Chang et al., 2007). Due to these considerations, the author has opened two courses related to BHD-Building Health Diagnosis and Building Diagnosis Technology—in order to teach building diagnosis knowledge and technology under the concept of BHD and train students to equip with

BDNS via iPad or Smart Phone BPIS user interface

the fundamental knowledge for becoming building doctors in the future.

Healthy Building of Building Medicine is a concept which combines medical science, public health, civil engineering, architecture, environmental engineering, and it stresses on

prevention strategies, etc. See the left picture of Fig. 3.

Fig. 3. User control panels of BDNS (left) and BPIS (right)

**2.4 Healthy Building of Building Medicine** 

in cloud database via mobile devices. By doing so, they can obtain real-time and correct information regarding to diagnoses on building diseases, treatment measures, and

environment, including Building Medicine (post-graduate programs), Building Health Diagnosis (undergraduate program), Building Diagnosis Technology(undergraduate program), and Intelligent Living Space(undergraduate program).

#### **2.3 Implements for Building Medicine**

Until now, several analogous studies based on the concepts of Building Medicine have been conducted. For example, a Building Medical Record (BMR) is designed analogously to medical records used in medical science; a Building Diseases Classification (BDC) is designed analogously to WHO ICD-9-CM(The International Classification of Diseases, Ninth Revision, Clinical Modification) Codes; a Building Doctor Navigation System (BDNS) is designed analogously to electronic diagnosis systems used in hospitals; a Building Physiology Information System(BPIS) is designed analogously to measuring blood pressure, pulses and temperature of human bodies; and a Building Health Diagnosis (BHD) is designed analogously to regular health checks taken by people.


environment, including Building Medicine (post-graduate programs), Building Health Diagnosis (undergraduate program), Building Diagnosis Technology(undergraduate

Until now, several analogous studies based on the concepts of Building Medicine have been conducted. For example, a Building Medical Record (BMR) is designed analogously to medical records used in medical science; a Building Diseases Classification (BDC) is designed analogously to WHO ICD-9-CM(The International Classification of Diseases, Ninth Revision, Clinical Modification) Codes; a Building Doctor Navigation System (BDNS) is designed analogously to electronic diagnosis systems used in hospitals; a Building Physiology Information System(BPIS) is designed analogously to measuring blood pressure, pulses and temperature of human bodies; and a Building Health Diagnosis (BHD) is

1. BMR: The problem-oriented medical record (POMR) which has been generally adopted in medical science was derived from the problem-oriented recording(POR) proposed by Dr. Laurence Weed in 1964. After 1968, the POMR was gradually formed (Chen, 2001). The problem-oriented medical record (POMR) is widely used in medical science. Cheng at al. (2007) adopts the concept of POMR analogously and develops Building Medical Record (BMR) in order to make diagnostic process for building health become more

2. BDC: When doctors around the world make diagnoses and give treatments to patients, the classification coding of human diseases, ICD-9-CM, is an important common language for communication between them. ICD-9-CM also serves as a reference guide for governments to determine reimbursement rates for medical services, and it is also a universal basis for statistical analyses within medical database systems. Therefore, ICD-9-CM is crucial to research and practices in the medical field. Similarly, diagnoses and statistical analyses of building diseases require a common communication language. Chang (2008) follows the logic of ICD-9-CM and applies it to the development of Building Diseases Classification (BDC) suitable for diagnosing building diseases. BDC

3. BDNS: The design logic of medical records aims to make records more organized, cohesive, credible, and easier to track and verify. In operation/maintenance stage of building life cycle, maintenance records are important reference data for on-site building managers when diagnosing the condition of facilities and making treatment decisions. However, three common problems often arise in the use of maintenance records. First, the inputs and updates of maintenance records and knowledge from internal sources may be unorganized and they may not be verified by practices on actual cases. Second, data and knowledge obtained from external sources may lack credibility. Third, the large quantity of data may not be able to be processed. As a result, Building Doctor Navigation System (BDNS) has been developed based on the author's BMR research. Through knowledge extraction method that combined the semantic indexing and the clustering analysis technology, BDNS can make up for the shortcomings of the systems built by private property management companies and help on-site building managers to solve the aforementioned problems encountered when building database of maintenance records. Managers or users can look up information

program), and Intelligent Living Space(undergraduate program).

designed analogously to regular health checks taken by people.

systematic and complete, similar to that for human health.

includes Disease Code, Treatment Code and Supplement Code.

**2.3 Implements for Building Medicine** 

in cloud database via mobile devices. By doing so, they can obtain real-time and correct information regarding to diagnoses on building diseases, treatment measures, and prevention strategies, etc. See the left picture of Fig. 3.

4. BPIS: Physiology signs of human bodies are a basis for human health checks. From the viewpoints of Building Medicine, physiology signs of buildings (temperature, humidity, stress, strain) hold the same importance to building health management. Since a significant amount of human power and time can be saved by using computer systems to maintain buildings' functions and performances and extend their service years, Chang (2010) built a computer system: BPIS. After smart humidity/temperature information materials being installed inside buildings, signals detected by the materials are sent to BPIS wirelessly. Then, building managers are able to consult the detection data through the user interface of BPIS, and quickly learn about the temperature and humidity values inside the building structures (just like temperature and blood pressure measurement of human bodies.) Therefore, BPIS makes buildings become smart buildings with selfdetection ability. Furthermore, BPIS also provides auto-alert function which can help managers discover problems right when they arise (see the right picture on Fig. 3).

Fig. 3. User control panels of BDNS (left) and BPIS (right)

5. BHD: Building Health Diagnosis is one link of preventive maintenance management of Professional Maintenance Management (PMM). BHD is conducted by personnel with building diagnosis training background. Based on their knowledge and techniques, they make diagnoses periodically or sporadically on various aspects of building maintenance and management, such as safety, health, performance, environmental impacts, appearance, energy conservation, and sustainability, etc. When it is necessary, maintenance and renovation works are carried out to safeguard users' safety and health, maintain the proper function of the buildings, protect environments, conserve energy and improve the urban aesthetics (Chang et al., 2007). Due to these considerations, the author has opened two courses related to BHD-Building Health Diagnosis and Building Diagnosis Technology—in order to teach building diagnosis knowledge and technology under the concept of BHD and train students to equip with the fundamental knowledge for becoming building doctors in the future.

#### **2.4 Healthy Building of Building Medicine**

Healthy Building of Building Medicine is a concept which combines medical science, public health, civil engineering, architecture, environmental engineering, and it stresses on

Making a Healthy Living Space Through the Concept of Healthy Building of Building Medicine 99

Households must be equipped with sufficient ability to withstand natural disasters

 Since building materials contain toxic volatile organic compounds, so it is not inhabitable some time after completion of construction. During this period, the newly

In contrast with the focuses and definition of the fields of traditional civil engineering, architecture, public health or medicine, Healthy Building of Building Medicine covers a wider range of issues. Except for the discussion of health management activities for protecting building users' health and safety, Building Medicine also concerns itself about management projects which prevent receptors from contracting diseases as a result of unhealthy buildings. Receptors which may be affected by unhealthy buildings include users, buildings, and the environments of the affected zone. The purpose of physical health management of buildings is to prevent building damages and concerns of user safety caused by building deterioration. Proper management of indoor environmental health can also prevent users from contracting environment-related diseases, such as Legionnaires' disease, allergy triggered by particles, or cancers induced by strong electromagnetic wave or radiation. Finally, Building Medicine is also dedicated to eradicate harmful environmental impacts caused by improper management or inappropriate choices of building materials (such breaking the sustainability of green buildings or adopting building materials of higher

Environmental impacts to human health have long been confirmed by the medical field. An epidemiological model that supports health policy analysis and decisiveness must be broad, comprehensive, and must include all matters affecting health. Consequently, four primary factors have been identified: (1) System of Health Care Organization; (2) Life Style (selfcreated risks); (3) Environment; and (4) Human Biology. Taking the analysis of cancer causes as an example, the impact degrees of the four factors are 10%, 37%, 24% and 29% (Dever, 1976). The impact degree of environment factor in cancers is 24%. People are highly concerned about cancer prevention when it comes to their health management. Many cancer insurance policies are on offer in the market. However, the possible health hazards caused by the environment factor have been often overlooked in the education and training of architects and civil engineers who design and construct physical structures and interior environments. Not only recently do the issues of green buildings and non-toxic building materials gradually become more and more important in the fields of civil engineering and architecture, and these fields start to take steps to build healthy environments for the

Living space is closely related with human health problems. From the viewpoint of civil engineering field, the issue can be explored initially by looking into building materials, building physics, and building management and maintenance and searching which factor

The household design must be suitable for nursing elderly and handicapped

Concentration of CO2 must be under 1,000 ppm

Noise volume must be under 50 dB (A)

Install lights of sufficient illumination

completed house must be ventilated

carbon footprints.)

general public.

Concentration of suspended particles must be under 0.15mg/m2

The house should be lit by the sun for at least 3 hours/per day

Sufficient floor area per capita, and ensure privacy of the occupants

**3. Interrelationship between living space and health problems** 

maintaining the physical health of buildings, including the health of their indoor environments, because healthy buildings are prerequisite for maintaining users' safety and health. Furthermore, from the point of view of sustainability, impact to the environment must be lessened as much as possible by current technology. See Fig. 4.

Fig. 4. Concept of Healthy Building in Building Medicine

Traditionally, the field of civil engineering focuses on buildings' physical health, for example, shock resistance of the structures. The architecture field emphasizes the aspect of architectural physics, such as acoustics, lighting, thermal environment, air quality, and humidity. For example, Chiang (2001) defines healthy buildings as 'A way of experiencing indoor environment of buildings, which includes physical measurements (such as temperature and humidity, ventilation aeration efficiency, noise, light, and air quality), and subjective psychological factors (such as layouts, environment colour, lighting, space, building materials, job satisfaction, and interpersonal relationship).' Furthermore, the field of green architecture has also discussed the subject of healthy buildings. For example, healthy buildings promoted by the Healthy Building Network (2011) also stressed the impact of hazardous building materials to environmental health. Health Care Without Harm is a medical organization concerned about issues of healthy buildings. Until 2010, 494 organizations in 53 countries have joined force to promote green hospital buildings and devote attention to the impact of hazardous materials to human health (Health Care Without Harm, 2010). Also, 15 planning standards are recommended by Healthy Household Guidelines of World Health Organization:


maintaining the physical health of buildings, including the health of their indoor environments, because healthy buildings are prerequisite for maintaining users' safety and health. Furthermore, from the point of view of sustainability, impact to the environment

Traditionally, the field of civil engineering focuses on buildings' physical health, for example, shock resistance of the structures. The architecture field emphasizes the aspect of architectural physics, such as acoustics, lighting, thermal environment, air quality, and humidity. For example, Chiang (2001) defines healthy buildings as 'A way of experiencing indoor environment of buildings, which includes physical measurements (such as temperature and humidity, ventilation aeration efficiency, noise, light, and air quality), and subjective psychological factors (such as layouts, environment colour, lighting, space, building materials, job satisfaction, and interpersonal relationship).' Furthermore, the field of green architecture has also discussed the subject of healthy buildings. For example, healthy buildings promoted by the Healthy Building Network (2011) also stressed the impact of hazardous building materials to environmental health. Health Care Without Harm is a medical organization concerned about issues of healthy buildings. Until 2010, 494 organizations in 53 countries have joined force to promote green hospital buildings and devote attention to the impact of hazardous materials to human health (Health Care Without Harm, 2010). Also, 15 planning standards are recommended by Healthy Household

In order to meet the requirement in the first point, avoid using ply-woods or wall

 Install ventilation system of high ventilation function to emit indoor pollutants to outside. Central ventilation systems with air-supply ducts must be installed in spaces of

The temperature of living rooms, bedrooms, kitchens, toilets, hallways, bathrooms must

Local exhaust ventilation systems must be installed in kitchen or smoking areas

must be lessened as much as possible by current technology. See Fig. 4.

Fig. 4. Concept of Healthy Building in Building Medicine

Guidelines of World Health Organization:

be kept at 17℃~27℃ year-round

air-tightness or thermal insulation design

Low concentration of chemicals which may trigger allergies

Indoor humidity must be kept between 40%~70% year-round

renovation materials containing chemicals not easy to vaporize


In contrast with the focuses and definition of the fields of traditional civil engineering, architecture, public health or medicine, Healthy Building of Building Medicine covers a wider range of issues. Except for the discussion of health management activities for protecting building users' health and safety, Building Medicine also concerns itself about management projects which prevent receptors from contracting diseases as a result of unhealthy buildings. Receptors which may be affected by unhealthy buildings include users, buildings, and the environments of the affected zone. The purpose of physical health management of buildings is to prevent building damages and concerns of user safety caused by building deterioration. Proper management of indoor environmental health can also prevent users from contracting environment-related diseases, such as Legionnaires' disease, allergy triggered by particles, or cancers induced by strong electromagnetic wave or radiation. Finally, Building Medicine is also dedicated to eradicate harmful environmental impacts caused by improper management or inappropriate choices of building materials (such breaking the sustainability of green buildings or adopting building materials of higher carbon footprints.)
