School building energy efficiency and NO2 related risk of childhood asthma in England and Wales: Modelling study

Filiz Karakas*, Duncan Grassie, Yair Schwartz, Jie Dong, Zaid Chalabi, Dejan Mumovic, Anna Mavrogianni, James Milner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Climate change legislation will require dramatic increases in the energy efficiency of school buildings across the UK by 2050, which has the potential to affect air quality in schools. We assessed how different strategies for improving the energy efficiency of school buildings in England and Wales may affect asthma incidence and associated healthcare utilization costs in the future. Methods: Indoor concentrations of traffic-related NO2 were modelled inside school buildings representing 13 climate regions in England and Wales using a building physics school stock model. We used a health impact assessment model to quantify the resulting burden of childhood asthma incidence by combining regional health and population data with exposure-response functions from a recent high-quality systematic review/meta-analysis. We compared the effects of four energy efficiency interventions consisting of combinations of retrofit and operational strategies aiming to improve indoor air quality and thermal comfort on asthma incidence and associated hospitalization costs. Results: The highest childhood asthma incidence was found in the Thames Valley region (including London), in particular in older school buildings, while the lowest concentrations and health burdens were in the newest schools in Wales. Interventions consisting of only operational improvements or combinations of retrofit and operational strategies resulted in reductions in childhood asthma incidence (547 and 676 per annum regional average, respectively) and hospital utilization costs (£52,050 and £64,310 per annum regional average, respectively. Interventions that improved energy efficiency without operational measures resulted in higher childhood asthma incidence and hospital costs. Conclusion: The effect of school energy efficiency retrofit on NO2 exposure and asthma incidence in schoolchildren depends critically on the use of appropriate building operation strategies. The findings from this study make several contributions to fill the knowledge gap about the impact of retrofitting schools on exposure to air pollutants and their effects on children's health.

Original languageEnglish
Article number166109
JournalScience of the Total Environment, The
Publication statusPublished - 25 Nov 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 The Authors


  • Childhood asthma
  • Energy retrofit
  • Health impact assessment
  • Indoor air quality
  • School buildings


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