WELL and Fitwel – a comparison of health-focused rating

systems
Blake Jackson | 08 Jan 2019

This paper considers the value of various health-focused third-party certification systems, which offer useful tools for built
environment professionals to incorporate evidence-based approaches into design, construction and operations of buildings for
the promotion of better occupant health outcomes.

The emergence of health-focused third-party ratings systems began in 2015 with the launch of the WELL Building Standard by
Delos, a non-profit organisation that aims to transform the built environment through health-focused outcomes. Not long after, in
2016, another such standard, Fitwel, also entered the marketplace.

These systems differentiate themselves from established third-party sustainability ratings systems, such as LEED or BREEAM, by
transforming peer-reviewed, academic medical research into actionable steps that designers, contractors, owners and operators
of the built environment can use to promote better health outcomes. They differ from prior generations of multi-attribute, third-party,
sustainability-focused systems because instead of focusing solely on efficiency associated with water, light, ventilation, etc,
they’re focused on the quality of the associated water, light and ventilation being delivered. In turn, this shift promotes proven best
practices to enhance the efficiency – and potential – of the occupants of space. This shift from “efficiency” towards “people” has
reinvigorated the entire conversation around sustainability to account for human health impacts. This adjustment only makes
sense as the built environment is explicitly crafted as a place for people to thrive.

The purpose of introducing these systems into the market is not to shift the industry’s focus away from efficiency to health at the
sacrifice of the former. Rather, the goal is to begin a conversation about their synchronicity so that projects can strive for both as
measurable outcomes. Still, having so many systems in play has caused a great deal of confusion across the marketplace,
leaving consumers of these services questioning which is better, and whether they should adopt one over another, or use them in
tandem. This is also confounded by the fact that these systems are all evolving at a faster pace than the market can absorb them.
For example, according to the International WELL Building Institute, WELLv2 was launched on 31 May 2018 after being piloted
on fewer than 1000 projects across 34 countries.1 One must question how the industry can keep up with such rapid change,
considering that the architecture, engineering and construction (AEC) has a much slower metabolism than that of academic
research cycles or “tech companies”, as the US Green Building Council has recently referred to itself as mimicking.

This paper compares these two new health-focused rating systems to illustrate that, rather than being competitors for market
share, they represent a spectrum of potential for any project in stringency, difficulty and cost. This means any project should be
able to achieve some measurable, impactful level of “healthiness”.

It will look at each system’s evolution, fees, certification timeline, consultants needed, accolades to date, and audiences using the
standards. Additionally, it will look at how each system can be used in tandem with other leading sustainability systems. In 2017,
for example, BREEAM and WELL announced a strategic alliance so that strategies pursued for one standard awards credits in
both, where they have a strong overlap to incline clients to pursue health and sustainability outcomes together. The same alliance
has been built into LEED, whereby registered projects can elect to perform a WELL gap analysis to see whether or not a project
pursuing LEED may also be a good candidate for WELL. Similar alliances exist between Fitwel and other systems, particularly
LEED, as many credits within Fitwel pull from LEED standards for both building design and construction (BD+C), and building
operations and maintenance (O+M).

Emergence

Why did these standards emerge in the first place? While both came into being at roughly the same time, they both were under
development for up to a decade before launching. With the prevalence of fast food culture, car-centric urbanisation, and a
movement towards knowledge workers, healthy habits had increasingly been “designed-out” of the built environment, with the
result being people doing longer amounts of sedentary activities, exercising less, and consuming fewer healthy dietary options
owing to speed and availability. In addition, with the prevalence of steady, unchanging mechanical lighting and HVAC systems,
we’re continually decoupling knowledge workers from nature inside buildings. Although increasingly air-tight for energy
efficiency, these buildings’ design also resulted in indoor environments with two to five times the number of contaminants as
outdoor air.2 In many cases, a single-focus on efficiency had created unintended health consequences. Our bodies evolved under
natural, outdoor conditions; thus, staying within a constant temperature range and under non-changing artificial light has had
negative impacts on our mental wellbeing, the chemical and hormonal secretion in our brains, and even our behaviours, such as
sleep, outside of the workplace.
On a positive note, corporations have been the first to shift away from business as usual towards a more humanistic design ethos
around health and wellbeing promotion. It’s now commonplace for companies to publish annual corporate social responsibility
reports (CSRs) and/or adopt environmental, social and governance (ESG) structures. These public-facing documents allow
companies to tell the story of the positive steps they’re making on their communities and the environment through their goods and
services provided, many seeking to make continual improvements relative to the prior year’s benchmark. In addition, companies
are gaining a competitive advantage by promoting health, wellness and sustainability as factors that attract and retain top talent,
as well as supporting their productivity and happiness in and outside the workplace.

The 117 Kendrick Street project illustrates how flexible spaces can accommodate a series of varied, yet, simultaneous
working styles, allowing occupants to adapt to their own preference for seating, privacy and lighting.

According to the “1-10-100 Rule”,3 if one looks at the 30-year lifecycle cost of a building, the total cost breakdown is as follows:

1-2 per cent: cost to design and construct a physical facility;

6-9 per cent: cost to operate and maintain a physical facility; and
90-92 per cent: cost of occupants’ salaries, benefits, recruitment, productivity, etc.

When viewed in this way, sustainability standards that focus on operational savings only, through more integrated design and
construction, miss the mark on the major potential impacts for a building owner – the “people” costs. By redirecting the
conversation to be about “people efficiency”, health-focused standards attest that small investments in the design, construction
and operations of buildings, which impact “people costs”, will bring substantial savings potential and positive impacts on the
culture of these adopters over the life of a project.

It’s difficult to communicate energy savings, water savings or lower VOCs emissions to regular building occupants. The strategies
for health, however, create major visual cues and engage people more directly; for example, healthy food and vending options,
corporate benefits packages, and building amenity spaces become major attraction/retention tools, architectural hallmarks, and
marketing magnets. In this light, it’s no wonder why this trend continues to grow globally.

Overview of WELL

WELL emerged in 2015 as the first health-focused rating system in the world, with its first major update (WELLv2) in 2018. Other
standards, such as BREEAM, LEED and the Living Building Challenge, have overlaps and/or portions of their strategies where
health related issues are discussed. WELL, however, was the first standard to explicitly prioritise health through 100 “features”
across seven “concepts”: air, water, nourishment, light, fitness, comfort, and mind.4 Each concept requires compulsory
preconditions to be met, while offering voluntary “optimisations” as a means of accruing points for scoring. In WELLv2, ratings are
more aligned with LEED scoring, where projects earn up to 110 possible points on three project types: new and existing
construction; new and existing interiors; and core and shell projects. Scoring levels are as follows:

Certification: 40-49 points (available for WELL core projects only);

Silver: 50-59 points;
Gold: 60-79 points; and
Platinum: 80+ points.

WELL, authored by Delos, is administered by the Green Business Certification Institute (GBCI), the same organisation that
certifies LEED buildings and accredits LEED professionals. It was developed over seven years by the Mayo Clinic and Cleveland
Clinic, two leading US health institutions. Any project can pursue WELL, except for single-family dwellings.

WELL is designed for the workplace, but WELLv2 features pilots for commercial kitchens, educational facilities, and multifamily
residential buildings. Projects are initially certified after a performance verification – a field-verified onsite inspection, conducted
by a WELL Assessor after one year’s occupancy, assigned to the project on registration. In WELLv2, the WELL Assessor can be
either GBCI-assigned or, for price competitiveness, selected from a list of approved GBCI vendors. A project is certified for three
years, after when it must undergo recertification, offering an opportunity to add new features to a project over time and, potentially,
elevate the certification level. The recertification component acknowledges that health and wellness are not completed at
certification but are ongoing design, construction, operational and tenant policy challenges, which need constant attention.

The standard is designed to work in conjunction with leading systems, particularly with LEED, where there are 36 areas of
overlap in the original version. Finally, there is a credential for WELL, known as the WELL Accredited Professional (AP). WELL
APs are automatically enrolled in a bi-annual continuing education regimen, where they must spend 30 hours in continuing
education during that period through project work, authorship, volunteering, etc. For LEED APs also enrolled in credential
maintenance, the continuing education requirements can apply to both systems, whereby one must complete six LEED- and six
WELL-specific hours within a total of 36 hours to maintain both credentials.

Fees for WELL certification in version 2 are based on the location of a project, the project type, the project gross area, and
whether or not a GBCI-appointed WELL Assessor is selected. This restructuring from the original version was done so that
wellness could be closer in reach for projects that are non-profits, in developing countries, and for building types where health
should be a first priority but where strong budgetary obstacles exist – for example, schools and hospitals. The success of a WELL
project relies on the integration of three key entities:

the design and construction team (strategies/amenities);

the owner, facilities manager, and the operations team (protocols/procedures); and
the tenant/s (policies/behaviour).

Currently, WELL is gaining momentum across the globe, with the majority of projects being tenant improvement projects,
particularly on the US West Coast. Some mission-driven clients using the standard are CBRE Los Angeles, Lyfe Kitchen
(multiple locations), the Phipps Conservatory in Pittsburgh, and ARUP’s Boston office. To date, there are 136 certified projects
(995 registered) in 42 countries, totalling more than 226 million square feet, as well as 3820 WELL APs (3175 registered).4

Overview of Fitwel

In 2016, shortly after the emergence of WELL, Fitwel came on to the market as another viable health-focused rating system
option. It, too, complements standards such as BREEAM and LEED, and, as with WELL, is supported by evidence-based
research. Fitwel has 63 “criteria”, synonymous to “features” in WELL, across 12 categories: location; building access; outdoor
spaces; entrances and ground floor; stairwells; indoor environment; workplaces; shared spaces; water supply; cafeterias and
prepared food retail; vending machines and snack bars; and emergency preparedness.

Most project types are eligible for certification (exceptions include casinos, hospitals and single-family dwellings), with versions of
the standard available for both new and existing multifamily, core/shell, interiors, and new construction projects. The scoring
system features no prerequisites or preconditions; instead, projects must simply score sufficient points to earn certification, out of
144 possible points:

1-star certification 90-104 points;

2-star certification 105-124 points; and
3-star certification 125+ points.

Fitwel is authored by the Center for Active Design, a non-profit based in New York City that has created standards to promote
physical activity across the built environment. It was developed over ten years by piloting the standard prior to public release at
more than 89 facilities for the General Services Administration (GSA) and the US Centers for Disease Control (CDC), the US
government’s real estate arm, and a major national public health institution.

Projects are initially certified soon after completion, similar to how other major standards’ protocols and timelines adhere. Like
WELL, recertification is required every three years, with recertification offering an opportunity to increase a project’s scoring and
certification level. The standard is designed to work with other leading systems, particularly LEED suites, which are directly
referenced in both its design and operations standards. Finally, there is also a credential for Fitwel – the Fitwel Ambassador.
Unlike WELL and LEED, which require a monitored, closed-book exam and a credential maintenance programme, Fitwel
Ambassadors are certified after watching a webinar and completing a 50-question, open-book examination. On completion, they
are armed with information to help them market the standard and implement it on their clients’ projects.
Hook and Loop places both active circulation and mindful eating spaces directly within close proximity of the regularly
occupied workspaces to encourage physical activity and informal collaboration.

The cost of Fitwel certification is a flat fee of $6500 for non-champion organisations ($5500 for Fitwel Champions), regardless of
project type or size. This price point makes Fitwel a much more affordable alternative to WELL, particularly for sizeable projects
where the administrative fees, based on area and location, might become a budgetary obstacle.

Like WELL, the success of a Fitwel project relies on the integration of design and construction, operations, and the tenant of the
space; however, it can be more readily applied since there are no requirements built into the standard, whereby one party’s lack
of buy-in would restrict the ability of the whole project to meet certification. Currently, Fitwel is gaining momentum across the
globe, with 150 certified projects, plus more than 600 projects committed during this year, across 35 countries.

Additionally, Fitwel has 870 ambassadors and 23 organisational “champions”. These champions are early adopter organisations
that have formed strategic alliances with the Center for Active Design. In return for agreeing to promote the standard on their own
real estate and/or clients’ projects, they get preferential pricing for certification, marketing support, and free ambassador trainings
– one per registered project. These include several major design firms (Perkins+Will, WSP and Stantec), health institutions (CDC
and Harvard Pilgrim Health Care), and real estate investment trusts (Alexandria Real Estate Equities, Tishman Speyer, and
Vornado Realty Trust) – all with multiple locations. While WELL seems appropriate for more mission-driven clients, Fitwel seems
more attractive to large real estate holdings, and/or companies with multiple locations – even global footprints. This is not
surprising because of the level of predictability, affordability and flexibility it offers, particularly relative to WELL, and the ability to
make standardised commitments, rather than each property being a “special” project.

Evolution

Both standards are living documents and are continually updated to take into consideration market feedback, new practices, and
input from champions, accredited professionals, and users.

In May 2018, WELLv2 was launched, which overhauled the system substantially, including restructuring of the “concepts” from
seven to ten, restructuring pricing based on building type and market location, and adding tiered scoring for various features.
These attributes are designed to make the standard more approachable and user-friendly, and to garner greater market uptake to
promote better health in more places.

Fitwel is served by an advisory council, made up of key stakeholders and representatives from champion organisations. While the
standard has yet to evolve past the first release, it’s only a matter of time before it happens to keep up with the ever-changing real
estate market. Incremental changes to Fitwel have been released through their website and their online project certification
interface, such as the change from a one-time only certification model to a three-year recertification model, similar to WELL
(summer 2018).

WELL has the most overlap with other rating systems (indoor air quality, light, thermal comfort, and materials), while Fitwel
focuses more on awarding points for location, shared spaces/amenities affixed to a building (both indoors and outdoors), and
healthy eating (also a priority of WELL). With the tiered points approach and the awarding of partial credit for features in WELLv2,
it’s difficult to pinpoint areas of maximum impact beyond these broad areas of emphasis. In WELLv1, points were assigned on the
basis of one per feature, which failed to acknowledge equitable compensation per feature per the cost and complexity of the
strategies to be employed. In WELLv2, points are weighted to reward teams pursuing costlier or more complex strategies.

The Institute for Improved Health features biophilic elements – natural materials, fractal patterns, and colours – to enliven
the space, along with sit-to-stand desking to encourage regular movement to break up prolonged intervals of sedentary
inactivity.

Fitwel is different, in that scoring has always been tiered and is based on: the amount and strength of the evidence supporting the
strategies; and the benefit a strategy has for the end users. For example, an occupant commuter survey soliciting feedback
regarding alternative transportation options employed would only earn 0.33 points, while a mothers’ room would earn 5.66 points.
This is because the survey, while a useful tool, offers very little benefit, pending actions taken thereafter (which are implied), while
the mothers’ room benefits are supported by evidence and have a positive impact on the company overall through promoting
equity. There are benefits to the health of the mother by providing her comfort and convenience, and to the child through the
provision of nutritional support.

Fitwel’s largest points-earning criteria are for the following strategies: mothers’ rooms; having a high WalkScore; providing
healthy food and vending; zero asbestos; having an indoor air quality management plan; and through the design and layout of
stairs to promote physical activity. Still, WELL is much more robust and broad in its scope, not only requiring verified performance
but also addressing (through preconditions and optimisations) many key areas omitted from Fitwel, including: air and water
quality testing; materials supply chain optimisation and ingredients disclosure; thermal comfort; ergonomics; acoustics;
organisational transparency; and circadian lighting – to name a few. Additionally, WELLv2 has evolved to include aspects once
specific to Fitwel, including its section on emergency preparedness. Clearly, as stated before, they’re not equals in the
marketplace; yet, they exist so that any project can have some measure of sustainability and health incorporated into them,
appropriate for the level of stringency, time, commitment level, and budget available.

Conclusion
This comparison of health-focused systems illustrates the growing importance of acknowledging our place as built environment
professionals in regard to supporting increased efficiency and public health. These two health-focused systems exist as useful
tools to support the incorporation of evidence-based approaches for the benefit of all, presenting different levels of complexity,
cost and scope along a spectrum of potential, in conjunction with established ratings systems. These systems, and the
conversation about health, will continue to be an important trend. It will evolve as feedback from user groups, global application,
and, most importantly, the standards are informed by and infused with new peer-reviewed, academic medical research in
perpetuity.

Further information

i. Fitwel. ‘Fitwel is the world’s leading certification system that optimises buildings to support health’. 2018 [cited 10
December 2018]. Available from: https://fitwel.org/
ii. Fitwel. Fitwel champions: companies leading the movement. 2018 [cited 10 December 2018]. Available from:
https://fitwel.org/champions

Author

Blake Jackson AIA, LEED/WELL Faculty is a Fitwel ambassador and sustainability design leader at Stantec Architecture and
Engineering, USA.

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