Mould spread through Anna-Lindh primary school in Berlin-Wedding for twelve years, affecting 750 children. Over that time the school relocated twelve classes, and it eventually closed one of its buildings. The renovation now underway costs around 60 million euros, more than a new building would have cost.
As for the building owner who planned the building in a way that allowed moisture to enter, probably nobody has heard from them since. I don’t know. I only learned about this through the media. My impression is this is how it often goes: whoever decided how a building would handle moisture and ventilation is rarely the one who ends up paying for what that decision costs the people who use the building afterwards.
Anna-Lindh is one building. Across the WHO European region, air pollution costs 1.6 trillion US dollars a year, indoor and outdoor together. In ten of the 53 countries in that region, the figure reaches or exceeds 20 percent of GDP (WHO Europe, 2015).
The arithmetic behind the neglect
The mechanism behind that bill is simple arithmetic. Joseph Allen, an environmental health scientist at the Harvard T.H. Chan School of Public Health, and his co-authors calculated that doubling the fresh air rate in an office costs less than 40 dollars per person a year. The productivity gain that follows runs to around 6,500 dollars per person a year (MacNaughton et al., 2015). The person who pays the 40 dollars and the person who gains the 6,500 dollars are rarely the same person. Economists call this a split incentive: whoever controls the ventilation budget answers to a different balance sheet than whoever benefits from the air it produces.
Allen describes a hospital that had paid millions to settle a Legionella lawsuit. When someone proposed spending 20,000 dollars on prevention, the hospital turned it down. The lawsuit had been paid out of the liability insurance budget. The 20,000 dollars would have come out of a different one.
Two earlier precedents
Indoor air is not the first case of a decision-maker walking away from what a decision cost someone else. For fifty years, tobacco companies shifted the health costs of smoking onto smokers, insurers and public health systems, until the Master Settlement Agreement of 1998 made the industry pay 206 billion dollars (Schroeder, 2004).
Lead paint is the closer parallel, because like a building’s ventilation it is something builders installed rather than something people chose to buy for themselves. Manufacturers had known since the early twentieth century that lead paint harmed children. The ban did not arrive until 1978, seventy years later, and in that time manufacturers were never made to pay for remediation or treatment. The economic benefit of removing lead paint later came to between 181 and 269 billion dollars per birth cohort. Every dollar spent on remediation returned between 17 and 221 dollars (Gould, 2009).
An exception in the law
Outdoor air has a legal answer to this problem that indoor air does not. The polluter pays principle has applied to outdoor air pollution in EU law since the Single European Act of 1987, now Article 191 of the Treaty on the Functioning of the European Union: whoever pollutes shared air answers for the cost. Indoor air has no equivalent. Legally and culturally, it counts as a private matter rather than a shared resource, so no one is designated to answer for it.
Where a country has put a number on that gap, the number becomes hard to ignore. Britain’s Building Research Establishment calculated in 2021 that poor housing costs the National Health Service 1.4 billion pounds a year, and that 2.6 million homes in England, 11 percent of the housing stock, count as a health hazard. Members of the British Parliament have cited that figure (BRE, 2021). France has its own calculation: poor indoor air costs the country 19 billion euros a year, about 1 percent of GDP (Kopp et al., 2014). Germany has no comparable calculation, and without a number there is no political pressure to produce one.
The German gap
I ran into that gap while collecting studies for Concrete Human, a photography exhibition on what built spaces do to people. The collection grew to hundreds, then thousands of studies, and at some point I built a system just to sort and use them. Most of the individual findings were what I expected. What surprised me were the gaps. France has a national calculation. Britain has one. For Germany, I found nothing. Either the number exists and stays unpublished, or nobody has actually worked out what bad buildings cost the German health system. Either would be remarkable.
The deeper I dug, the more that suspicion hardened: nobody is asking who pays for the health consequences of how buildings get built, least of all on behalf of children, who spend most of their waking hours in school buildings and have the smallest lobby of anyone.
In 2023, six former US Surgeon Generals wrote an open letter arguing that policymakers have largely ignored what buildings do to health, despite people spending 90 percent of their time indoors (IWBI and American Public Health Association, 2023). An article in Health Affairs states the consequence directly: this neglect “shifts the costs of poor health from inadequate housing onto the medical profession.”