Your Building Is Making People Ill and You Don't Even Know It

World Health Day rolls around every April. Schools might cover a topic or two in classrooms. Care homes might put up a poster.

Then nothing changes.

I walk into schools every week. On the surface, everything looks fine. Corridors are tidy. Classrooms appear clean. But behind the scenes? Poor ventilation, missed touchpoints, damp areas hiding in plain sight.

Things that quietly increase illness and absence.

The disconnect between global health campaigns and what actually happens in buildings is staggering. The WHO promotes "health for all" whilst headteachers choose between heating costs and air quality. Policy talks about prevention whilst facilities budgets force reactive maintenance.

I've spent years in facilities management across schools, care homes, and commercial properties. What I've learnt is this: health campaigns create noise at the policy level but rarely reach the people responsible for maintaining the spaces where health actually happens.

The £13.8 Billion Problem Nobody's Talking About

The National Audit Office identified a £13.8 billion maintenance backlog in English schools as of October 2024. That figure has doubled from £6.7 billion in 2017.

Around 700,000 pupils learn in schools that need major rebuilding or refurbishment. About 24,000 school buildings—38% of the total—are beyond their design life.

This isn't just about crumbling infrastructure. It's about health outcomes.

Here's what I see when budgets are broken:

• Cleaning standards vary wildly because contracts are awarded on price, not outcome

• Ventilation in older buildings fails because windows don't open properly or nobody opens them in winter

• Damp and mould hide behind furniture, in corners, under floor coverings—expensive to resolve, easy to ignore

• Toilets deteriorate with failed floor seals that trap water, urine, and contaminants

• Touchpoints get cleaned once daily despite hundreds of hands touching them throughout the day

• Grounds maintenance waits months for deep cleans whilst mud, allergens, and slip hazards build up

The industry cleans based on hours at the beginning or end of the day. This allows hours of build-up throughout each day when buildings are actually occupied.

Most schools think "health" equals "students." They focus on handwashing posters and fruit at break time.

The building itself? That's making people ill.

The Invisible Crisis: CO2 and Cognitive Performance

Smell often gives away mould or damp. Bubbling paint signals water ingress. Dirty touchpoints reveal inadequate cleaning schedules.

But the biggest health issue in schools? You can't see it, smell it, or touch it.

Carbon dioxide levels in classrooms directly impact learning, attention, mood, and wellbeing.

Research shows that reducing classroom CO2 from 2,100 ppm to 900 ppm increases the speed of performing school tasks by 12%. When CO2 levels double in controlled studies, cognitive performance scores drop by 23%.

That's the difference between understanding a new maths concept and giving up entirely.

In poorly ventilated classrooms, CO2 levels commonly reach 2,500 ppm or even 3,000 ppm by late morning—precisely when students are expected to perform their most challenging mental tasks.

Only the most modern, recently built schools have CO2 monitors. Even when they're retrofitted, they're rarely checked. Batteries run out. Someone forgets. The data sits unused.

We're currently trialling a different approach in two of our schools. We're integrating CO2 monitoring into our cleaning and hygiene inspection regime.

Why us? Why facilities managers?

Because we're already in the buildings. We check fire safety, remove slip hazards, monitor heating and lighting, inspect playground equipment. We're responsible for the physical environment.

Air quality affects cognition more than poor lighting, yet it falls off the radar because it's invisible.

We measure CO2 when classrooms are vacated in winter, then again an hour later once windows have been opened for ventilation. The data will inform our facilities schedules across all seasons.

This isn't a cleaning issue. But it's a measurable thing that cleaning and site teams can track daily.

The Energy vs Health Dilemma

Here's where policy meets reality.

Winter is particularly concerning in older buildings. Tight budgets mean doors and windows stay closed to conserve heat. CO2 levels climb throughout the day.

A 2022 UK survey revealed that 42% of schools worried about energy costs when opening windows for ventilation. Only 26% actively monitored CO2 levels in all classrooms.

Staff resist opening windows because they're letting heat out and cold in. Heating costs are significant. There's pressure to reduce them as much as possible.

So you choose: warm classrooms or oxygenated brains.

This is the heart of the disconnect between health campaigns and facilities reality. World Health Day promotes prevention. Our daily reality involves choosing between competing priorities with broken budgets.

The UK has ageing premises in education and healthcare with no additional funding for energy improvement. Old buildings have roof space for solar panels that sit empty. No sign of heat pumps. Decaying windows that schools must fund themselves despite spiralling energy costs.

Research shows that annual HVAC energy costs to maintain infection risk below 1% in schools average £308 per capita with improved ventilation. One case study found fuel oil consumption increased by 50% when implementing natural ventilation strategies.

But researchers concluded: "It's worth the economic cost if the health and performance of teachers and students are improved."

That's the trade-off nobody wants to make explicit.

Practical Solutions When Budgets Are Broken

When you present a headteacher with data showing significant CO2 spikes affecting learning, they'll often say: "I can't afford to fix the ventilation system."

Fair enough. So we build it into the daily schedule instead.

Break times, lunch times, start and end of day—we open windows and doors to get ventilation into buildings. If children are kept active during these times, they won't feel the heat loss as much when they return.

This is for older buildings. It's just the start.

Older buildings could be fitted with strategically placed CO2 monitors throughout the school that are actually checked and levels recorded. It needs to be scheduled and documented as part of the overall compliance and inspection regime—treated with the same rigour as fire safety checks.

Simple measures work. Analysis shows that existing 10-minute breaks aren't enough to fully ventilate classrooms. They should increase to at least 15 minutes.

These are scheduling changes. They don't require capital investment.

The annual incremental energy and capital costs of increasing ventilation rates to meet current standards range from a few pounds to about ten pounds per person. Small compared to the benefits in terms of student health and academic performance.

The 1% Improvements That Compound

Being obsessive about standards and outcomes for the end user drives innovative thinking.

I don't mean big changes. I mean small incremental improvements. 1% at a time. All contributing to an overall impact in the right direction.

Re-thinking cleaning strategies:

• Midday touchpoint cleans instead of once-daily schedules

• Table wipedowns during the day when they're actually being used

• Indoor and outdoor footwear to reduce soiling and contaminants

• Data-driven schedules based on actual usage and foot traffic

These disrupt the traditional "clean before or after hours" model. There's a belief they'll require additional hours to pay for.

But how many commercial building cleans go through the motions regardless of whether something really needs cleaning?

Toilets are non-negotiable. But do all classrooms need vacuum cleaning every day, regardless of foot traffic?

How many buildings monitor and record usage to inform a flexible cleaning schedule?

Not many. Because it's easier to have set times and hours.

We could redesign facilities management based on actual data about usage, foot traffic, and health outcomes. Instead of "set times and hours," we'd measure what actually matters.

I would track:

• Usage and footfall patterns

• Indoor air quality with continuous CO2, VOC, and particulate matter monitoring

• Temperature and humidity levels

• Real-time data accessible via apps to identify pollution sources and optimise ventilation

This would transform how we think about healthy buildings.

Why I Keep Trying When the System Seems Broken

The system does seem designed to make genuine health improvements nearly impossible.

Ageing infrastructure. Shrinking budgets. Rising energy costs. A £13.8 billion maintenance backlog that doesn't even include structural or asbestos-related issues.

So why innovate with CO2 monitoring trials and 1% improvements?

To help children get the most from education.

Environments play such an important part in a child's experience at school. We all remember teachers who were brilliant. Favourite classrooms. The library, drama room, music room—how they made us feel.

A lot of what shaped that experience was the environment, operating at an almost subconscious level.

The right environment impacts how teachers perform and, by default, the experience of children.

I see care homes with ageing assets that you wouldn't want to live in. We must invest more in the environment. The government has to play their part and make funding available upfront to help change things.

The paybacks may not be immediate. But they will impact wellbeing, productivity, learning outcomes, and health profiles of those in care.

We work with a particular group of care homes that have got it right. We work in partnership. They just get it and find ways to make it happen.

We work with schools doing all they can despite broken budgets. All run by people who are passionate and determined to do the best they can with what they have.

What "Just Getting It" Actually Looks Like

When you walk into a care home or school that "just gets it," the difference is immediate.

Standards are higher and non-negotiable. Something that truly resonates with us.

People are passionate about what they do. They try their best to deliver their purpose every single day. They're focused on outcomes for the end user.

Schools without a major maintenance backlog have higher average daily attendance by 4 to 5 students per 1,000. They have lower annual drop-out rates by 10 to 13 students per 1,000.

That's the real-world impact of environmental conditions.

Eight out of 11 studies reported statistically significant improvements in at least some measures of student performance with increased ventilation rates or lower carbon dioxide concentrations. Improvements typically ranged from a few per cent to as high as 15%.

Yet this evidence rarely translates into action at ground level.

Bridging the Gap Between Campaigns and Reality

World Health Day creates awareness. It launches advocacy programmes. It highlights priority areas for the WHO.

But it doesn't reach the caretakers checking fire alarms, the cleaners wiping touchpoints, or the facilities managers monitoring heating systems.

We're the ones responsible for maintaining spaces where health happens daily. Yet we're rarely included in health strategy conversations.

The WHO's preventative healthcare focus mirrors what effective facilities management should be: proactive, not reactive.

But budget structures incentivise the opposite.

Global health themes—mental health, air quality, infectious disease prevention—directly correlate with facilities decisions. Ventilation rates. Cleaning protocols. Environmental design. Maintenance schedules.

The facilities sector holds untapped potential to deliver on World Health Day objectives through everyday work.

We just need to be part of the conversation.

And we need the data to prove what we already know: your building is making people ill.

The question is whether anyone's ready to measure it.