The Health Aspect of Energy

Efficiency in Schools
 Table of contents

List of tables and visuals................................................................................................................................ 2

1. Introduction................................................................................................................................................. 3
1.1. Public buildings in Bosnia and Herzegovina in context to energy efficiency............................. 3
1.2. The health aspect of implementing energy efficiency measures................................................ 3
1.3. Bosnia Energy Efficiency Project (BEEP).......................................................................................... 6

2. Case Study.................................................................................................................................................... 8
2.1. BEEP’s contribution to the increase in comfort in FBiH educational institutions..................... 8
2.2. Sample and methodology................................................................................................................... 8
2.3. Results.................................................................................................................................................... 9
2.4. Application of energy efficiency measures in context to the female population................... 10

3. Conclusion.................................................................................................................................................. 11

List of Tables and Visuals

Visual 1 - The supposed causal links between poor indoor air quality and student productivity
Table 1 - Total investment amount per educational institution building that was part of the BEEP
Project
Table 2 - Cross section of student absences at institutions covered by the study
Figure 1 - Cross section of student absenteeism before and after implementation of energy
efficiency measures

2
1. Introduction

1.1. Public buildings in Bosnia and Herzegovina in context to energy efficiency

Out of the total number of energy-inefficient public buildings in Bosnia and Herzegovina, 32%
are schools, a total of 2,434 buildings, 60% of which are located in the Federation of Bosnia and
Herzegovina. The greatest reason for such a concernedly high number of inefficient buildings is
the time of their construction. Most of them were built over 30 years ago and have been partially
rehabilitated in terms of functionality, without the application of energy efficiency measures. Most
of these buildings do not have any (or have poor) thermal insulation, have older heating and lighting
systems, and, above all, their maintenance has been inadequate or unplanned for years.1 Ultimately,
due to the great loss of thermal energy, more energy is required to heat these buildings. Thereby,
higher amounts of energy sources are needed, which are used inefficiently, thus increasing costs
while polluting the environment.

Particularly for these reasons, energy efficiency measures are being implemented in these buildings,
with the aim of reducing energy consumption, costs and pollutant emissions. In the context of
the buildings themselves, this means using less energy for heating and cooling spaces, hot water,
ventilation and lighting, while maintaining comfort. Reducing energy consumption also results in a
reduction of costs, i.e. savings in the public budget.

The implementation of energy efficiency measures has multiple benefits. In addition to economic
savings, contributing to the reduction of carbon dioxide emissions, as well as protecting the
environment, there are benefits of a social nature that result from increased comfort. Considering
the profiles of the users of all public institutions, particularly educational institutions, it is clear why
suitable living and working conditions are of the utmost importance. Warmer and more comfortable
classrooms offer better working conditions for both teachers and the youngest generations in the
Federation of B&H, which automatically affects their health and learning outcome. Students are
less likely to inhabit damp and humid rooms, and to reside in the cold winter air. They are, therefore,
also less at risk to what these conditions bring, such as the cold and flu.

Bosnia and Herzegovina has exceptionally high energy efficiency potential. In fact, with as much
as 209 kgoe/$ 1,000 of its GDP, the energy intensity of B&H is not only the highest in the Western
Balkans region, but is also 37% higher than the average in Europe and Central Asia, and almost 60%
higher than the average in the European Union.2 Unlike in other countries in Europe and Central
Asia, this rate has increased by about 30% since 2005.3 Such a high energy and carbon intensity has
a negative impact on the country’s economic competitiveness, while also presenting an important
environmental challenge.4

1.2. The health aspect of implementing energy efficiency measures

During their stay in schools, children are exposed to a variety of factors that can pose a health
hazard, such as:
• poor air quality,
• hazardous building materials and poor construction,
• radiation,
• noise,
• microclimatic conditions - temperature, relative humidity, air flow, exposure to chemical and
biological hazards.
1
The World Bank
2
The World Bank
3
The World Bank
4
The World Bank

3
The large number of children in educational establishments, as well as the inadequate size of the
rooms they inhabit in relation to the number of occupants, contributes to an increased exposure to
negative impacts. Prevention of harmful environmental factors that can negatively affect children’s
health is most effective when the sources and effects of one or more risk factors are identified.

Children are the healthiest, but also the most vulnerable group of the population. A child’s organism
grows and develops intensely, accompanied by intellectual and emotional development. In order for
a child to reach their maximum potential in each of these areas, he/she needs to be provided with
the best possible living conditions and a safe environment. Therefore, investing in children’s health
is one of the most important elements of human and economic development. Healthy children
have the best chance of achieving and maintaining health in the future, as well as a productive and
fulfilling life.

At ministerial conferences on environment and health, member states from the European Region
of the World Health Organization (WHO) emphasize the importance and pay regard to the topic of
protecting children’s health in schools, including air pollutants, the most important of which are:
• moisture and mold,
• insufficient ventilation,
• exposure to particular chemical pollutants in the classroom air,
• consumption of tobacco products in schools and outside of schools.

Considering that people spend 90% of their time indoors, indoor air is one of the most serious
environmental risks to human health, particularly to the health of children.

As a result of indoor air pollution, in the past decade there has been an increase in allergies, asthma,
infectious diseases, irritations and damage to the mucosa of the respiratory tract, headaches,
attention disorders, problems with concentration in all age groups, and decreased mental function.

Indoor air can be contaminated with many pollutants including: PM10 and PM2.5, ozone (O3),
nitrogen oxides (NOx), sulfur dioxide (SO2), volatile organic compounds (VOC), ammonia (NH3),
carbon monoxide (CO), asbestos, as well as other fibers, allergens and molds.

The impact of unhealthy environments and poor air quality in schools is reflected through increased
absenteeism, respiratory problems and costs of treatment, as well as poorer productivity, motivation
to learn and test results.5 Some of the health problems caused by the effects of unhealthy indoor
environments include asthma and allergies; respiratory infections such as fever, flu, legionellosis,
sinus infections; as well as neurological symptoms such as headaches, difficulty concentrating, and
fatigue.6

5
Kats, G., (2006), Greening America’s Schools: Costs and benefits, A Capital E.Reports, dostupno na: https://www.usgbc.org/Docs/Archive/General/
Docs2908.pdf
6
Mendell, M.J., Heath, G.A., (2005), Do Indoor pollutants and thermal conditions in schools influence student performance ? A critical review of the
literature, Indoor Air 2005, 27-52

4
 Reduced
attendance

Health
Poor indoor problems
air quality
HVAC system
and building
characteristics

Poorer
results
Project, operations
and maintenance, Pollutants, Lack of
activities, users, thermal comfort
locations conditions,
noise, lighting

Visual 1. The supposed causal links between poor indoor air quality and student productivity6

The visual shows the supposed causal link between poor indoor environment quality and productivity
and student attendance. The characteristics and condition of the building’s heating, ventilation
and air conditioning (HVAC) systems significantly affect the quality of the environment. Internal
environment parameters can affect the health of students and teachers. This further affects the
productivity of students directly through absenteeism, as well as through discomfort or distraction.6

Measurements taken in eight school buildings over three weeks have shown that students and staff
were exposed to quite high concentrations of carbon dioxide (up to 5000 ppm), well above the
recommended values (1500 ppm) and the preferred level (1000 ppm). All schools have been built
in the last 20-40 years, and in some classrooms, despite the windows being opened, the ventilation
rate did not exceed 3 l/s per person. Under such conditions, the breaks were too short to reduce the
carbon dioxide concentration until the next class session starts.7

Tests were carried out at the Faculty of Civil Engineering in Bucharest under different conditions:
dimly lit classroom (50 lux of the recommended 400 lux), very high noise level (61-64 dB of the
recommended 35 dB), higher indoor classroom temperature (25,2OC), lower temperature (20.5OC),
ideal conditions (respecting the recommended values) and high carbon dioxide concentration
(>1600 ppm of the recommended <800 ppm). Test results showed that air quality and lighting level
had the greatest impact on students’ intellectual performance.8

6
Mendell, M.J., Heath, G.A., (2005), Do Indoor pollutants and thermal conditions in schools influence student performance ? A critical review of the
literature, Indoor Air 2005, 27-52
7
Bako-Biro et al., (2012), Ventilation rates in schools and pupils performance, Building and Envrionment 48, 215-223
8
Catalina, T., Banu, T. (2014), Impact of indoor enviromental conditions on students intellectual perfomance, Publicat de Universitatea Technica
„Gheorghe Asachi“ din Iasi Tomul LX (LXIV), Fasc.

5
Achieving adequate ventilation to provide a healthy and comfortable environment in classrooms
without impairing students’ productivity can affect the energy performance of the building if
heat is not able to recover through the ventilation system. There is a delicate balance for every
designer in ensuring that the project meets the ventilation and energy requirements, which should
not be achieved at the cost of ignoring human needs.9 Buildings of educational institutions should
be designed bearing in mind the principle of sustainability and that energy and natural resource
savings should not worsen classroom conditions and negatively affect student productivity. That
kind of implementation of energy efficiency measures has a counterproductive effect.10

Studies have shown that residing in cold, humid and moldy conditions has a negative impact on
people’s health, especially that of children.11 The same studies have also shown that children residing
in rooms visibly filled with moisture demonstrated more symptoms of illness.12

Most people are aware that outdoor air pollution is a threat to their health, but they are not so familiar
with the fact that indoor air pollution also has a significant impact on health. The concentration of
pollutants in indoor air can be 2-5 times, and sometimes up to 100 times, higher than in outdoor
air. This is worrying because people spend most of their time inside of buildings. It is particularly
for this reason that a great impact on health and quality of life is noticeable. Good indoor air in
buildings of educational institutions is an important component of a healthy environment because
it contributes to improving students’ surroundings, productivity, as well as their sense of comfort,
health and well-being.13 Unlike other buildings, educational institutions have more users and more
space used than administrative buildings.

1.3. Bosnia Energy Efficiency Project (BEEP)

In order to achieve energy savings and educate the population on the importance of energy-efficient
behavior, Bosnia and Herzegovina has launched the BEEP - “Bosnia Energy Efficiency Project”,
which is implemented by the Federal Ministry of Physical Planning in the Federation of Bosnia and
Herzegovina, with World Bank borrowings. The project is committed to construction that renovates
public buildings through the implementation of energy efficiency measures on them, as well as
educating the general public about the importance of energy efficient behavior. Ultimately, the
project aims to preserve energy, improve comfort, reduce pollutant and carbon dioxide emissions,
as well as increase awareness of energy efficiency.

As a part of this project, a total of 37 buildings have been reconstructed so far, 24 of which belong
to the educational sector, 8 belong to the health care sector and 5 are buildings of other public
institutions. A total of 18,347,847.22 BAM was invested in the implementation of energy efficient
measures, with savings estimated at 2,022,270 BAM per year, and a reduction of carbon dioxide
emissions by 4,900 tons per year.

Of the 37 refurbished buildings, a total of 24 were educational institutions, in which 10,892,882.63

BAM was invested. Investments were for the implementation of energy efficient measures - such
as the installation of new windows, setting up insulation on facades and roofs, and energy changes
using renewable energy sources. Savings were estimated at 2,061,315 BAM / year, and reduction of
carbon dioxide emissions by 2,986 tons per year.

9
Bako-Biro et al., (2012), Ventilation rates in schools and pupils performance, Building and Envrionment 48, 215-223
10
Catalina, T., Banu, T. (2014), Impact of indoor enviromental conditions on students intellectual perfomance, Publicat de Universitatea Technica
„Gheorghe Asachi“ din Iasi Tomul LX (LXIV), Fasc.
11
Diana Wilkinson, „Poor housing and ill health“ (https://pdfs.semanticscholar.org/5499/eff1f5d86fd9ea78a6debb36348600ff95a3.pdf)
12
Diana Wilkinson, „Poor housing and ill health“ (https://pdfs.semanticscholar.org/5499/eff1f5d86fd9ea78a6debb36348600ff95a3.pdf), s.4
13
Hall et al., (2003), School Indoor Air Quality Best Management Practices Manual, Washington State Department of Health

6
 Year of
Investment
implementation
Name of educational institution Canton value
of the measures
(BAM)
EE
Elementary School “Prva osnovna škola”,
1 ZDK 362.783 2016
Zavidovići
Elementary School “Musa Ćazim Ćatić”,
2 ZDK 455.782 2016
Zenica
Elementary School “Hamdija
3 ZDK 332.628 2016
Kreševljaković”, Kakanj

4 Elementary School “Crnići”, Stolac HNK 254.539 2016

High School of Civil Engineering

5 HNK 565.846 2016
“Jurja Dalmatinca”, Mostar
Elementary School “fra Didaka Buntića”
6 HNK 474.331 2016
Čitluk
Elementary School “IV Osnovna škola
7 HNK 761.532 2016
Mostar”, Mostar
“High School Konjic”,
8 HNK 849.601 2016
Konjic
“High School Čapljina”,
9 HNK 996.063 2016
Čapljina
Elementary School “Zahid Baručija”,
10 KS 267.573 2016
Vogošća
Elementary School ”Srednje”,
11 KS 488.870 2016
Ilijaš

12 High School Žepče ZDK 170.792 2016

Elementary School “Hašim Spahić”,

13 KS 450.273 2016
Ilijaš
Elementary School “Isak Samokovlija”,
14 KS 601.044 2017
Sarajevo
Elementary School „Gazi Ferhat-beg“,
15 ZDK 284.841 2017
Jablanica
Elementary School „Vareš Majdan“,
16 ZDK 533.970 2017
Vareš
Elementary School “15 april”,
17 ZDK 298.415 2017
Kakanj
High School “Rizah Odžečkić”,
18 ZDK 327.266 2017
Zavidovići
Elementary School “21. mart”,
19 ZDK 141.183 2017
Doboj jug
Elementary School “Ivana fra Frane
20 ZDK 86.484 2017
Jukića”, Usora
Elementary School “Silvija Strahimira
21 HNK 1.092.523 2018
Kranjčevića”, Mostar
Elementary School “Kardinala Stepinca”,
22 HNK 211.683 2018
Neum
“High School Jablanica”,
23 HNK 448.456 2018
Jablanica
Elementary School “Drežnica”,
24 HNK 440.404 2018
Drežnica
TOTAL INVESTED UP UNTIL NOW: 10.892.883
Table 1. Total investment amount per educational institution building that was part of the BEEP Project

7
2. Case study

2.1. BEEP’s contribution to the increase in comfort in FB&H educational institutions

After the two-year implementation of the BEEP Project on the territory of the Federation of Bosnia
and Herzegovina, with the aim of researching the current state and recording the progress made, a
study was conducted focusing on buildings of educational institutions. The aim of the study was to
investigate whether implementing energy efficiency measures, in order to achieve better comfort,
had affected a reduction in student absenteeism.

Student absence reports, in the periods before and after the implementation of the project, were
used as a quantitative measure that could point to the effects of implementing energy efficiency
measures in buildings of educational institutions.

Given the nature of the academic calendar, the academic year was the time period observed. The
first works on buildings of educational institutions, within the framework of the BEEP Project,
were carried out throughout 2016. The data from the academic year in which there were no works
on buildings were therefore used for comparison, i.e. 2014/2015. Furthermore, data from the
2017/2018 academic year was used to measure student absenteeism after implementing energy
efficiency measures. In this way, use of data from the year during which the works were being
implemented was avoided.

Buildings that had construction work completed in a later period, i.e. as early as 2017, are still not
subject to this quantitative testing, given that not enough time has passed since the completion of
the works. In other words, buildings implementing measures in 2017 will only be able to undergo
this or similar research when data for the 2018/2019 academic year is available.

2.2. Sample and methodology

As explained earlier, the study population is comprised of all educational institutions whose buildings
were part of the BEEP Project in 2016. The study sample consists of a total of 9 institutions, from
which absenteeism data was collected. Statistics on absenteeism from all of these institutions were
collected from primary sources, that is, the administration of the institution. The sample of the
study consists of Elementary School “Fra Didaka Buntića” Čitluk, Elementary School “Crnići” Stolac,
Elementary School “Musa Ćazim Ćatić” Zenica, Elementary School “Zahid Baručija”, “High School
Konjic”, Konjic, Elementary School “Hašim Spahić”, “Fourth Elementary School” Mostar, Elementary
School “Srednje” and Elementary School “Vareš Majdan”.

The methodological approach of the research involves counting the hours spent by students absent
from class, as well as comparing the numbers from the period before, with those from the period
after the implementation of energy efficiency measures. As noted earlier, data was collected with
the academic year as the time period measured, based on the nature of the education system in
B&H.

The basic unit of measurement used for comparison among educational institutions is the hours of
students’ absence.

Teachers or employees of educational institutions were not included in this research, given that
they constitute a smaller population of the institution.

8
2.3. Results
The data collected showed that 7 out of 9 institutions saw a decrease in the number of hours
students spent absent from class in the academic 2017/2018 year, compared to the academic
2014/2015 year.
Absence of the Absence of the
Time of the students in the students in the Percentage of
Name of the Educational
Implementation academic year academic year Reduction of
Institution
of the Work 2014/15 (in 2017/18 (in Absenteeism %
hours) hours)
Elementary School “Fra Didaka
2016 53.758 50.571 -5,93
Buntića” Čitluk

Elementary School “Crnići” Stolac 2016 12.836 9.617 -25,08

Elementary School “Musa Ćazim

2016 36.459 35.898 -1,54
Ćatić” Zenica
Elementary School “Zahid Baručija”
2016 15.071 20.895 38,64
Vogošća

High School Konjic 2016 68.305 62.341 -8,73

Elementary School “Hašim Spahić”

2016 22.821 27.381 19,98
Ilijaš

“Fourth Elementary School” Mostar 2016 19.086 14.473 -24,17

Elementary School Srednje 2016 10.928 10.010 -8,40

Elementary School “Vareš Majdan” 2016 11.435 8326 -27,19

Table 2. Cross section of student absences at institutions covered by the study

The highest rate of reduction was in “Vareš Majdan” Elementary School, and amounts to 27.19%.
Quantitatively speaking, in this school, 3,109 fewer hours of student absences were recorded in
2017/2018 than in 2015/2016.

On average, in these 9 institutions, the absentee rate was reduced by 4.71%. This rate is slightly
higher when observing the average of all institutions that saw a decrease, with that rate being
13.22%.
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
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Figure 1. Cross section of student absenteeism before and after implementation of energy efficiency measures

9
It should be emphasized that for a more reliable analysis of the impact of implementing energy
efficiency measures on student absenteeism, the following factors should be considered too: a
longer timeframe (several years before and after the implementation of the energy efficiency
measures), changes in the number of students, weather conditions in the different years (e.g. one
year may be extremely rainy which can affect the health of the students), as well as outbreaks of
certain viruses.

2.4. Application of energy efficiency measures in context to the female population

Along with the youngest generations, it is important to emphasize that the implementation
of energy efficiency measures is of particular importance for women as well. Women are more
biologically sensitive to the cold, so staying in cold places has greater consequences for them.
Studies have shown that women, first of all, have a higher body temperature,14 but also that their
extremities are warmer than those of men by as much as 3 degrees.15 It is therefore understandable
that females, with higher temperature norms, feel cold more than men. In other words, women
feel the cold quicker (and more often), which results in greater health risks. Studies by the American
Institute of Health have also shown that the symptoms of the cold and flu last longer in women
than in men, and that women are more vulnerable to the development of many chronic diseases,
such as fibromyalgia, joint and back pain, headaches, arthritis, and more. Studies on the differences
in pain sensitivity16 on the other hand, have shown that women are generally more sensitive, which
is consistent with the relative frequency of chronic pain in women. Thus, women’s predetermined
sensitivity to cold, which carries increased health risks, is a concrete indicator of the high importance
of implementing these measures for members of this sex.

14
Philip A. Mackowiak, MD i drugi, “A Critical Appraisal of 98.6°F, the Upper Limit of the Normal Body Temperature, and Other Legacies of Carl
Reinhold August Wunderlich” (https://jamanetwork.com/journals/jama/article-abstract/400116)
15
Han Kim i drugi, “Cold hands, warm heart” (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)78875-9/fulltext)
16
Berkley KJ., „Sex differences in pain“ (https://www.ncbi.nlm.nih.gov/pubmed/10097000/)

10
4. Conclusion
In addition to economic savings and a reduced negative impact on the environment, the
implementation of energy efficiency measures also has social benefits, which are reflected through
improved comfort for users of public institutions. Considering the specificity of users of public
institutions, both in terms of their number and characteristics, it is clear why this topic is of utmost
importance.

A study was conducted on the possible impact of implementing energy efficiency measures in
schools included in the BEEP project in the Federation of BiH, based on the absence of students,
i.e. on the improvement of user health. Research results at 9 elementary schools have shown that
absenteeism has declined following the implementation of energy efficiency measures. The average
rate of reduction in absence during the 2017/2018 academic year, compared to 2014/2015, was
4.71%. However, in order to reliably assess the impact of energy efficiency measures on student
absenteeism, it is necessary to conduct more comprehensive studies covering a longer period of
time (several years before and after implementation of energy efficiency measures), taking into
consideration changes in the number of students, weather conditions in the different years (e.g.
one year may be extremely rainy which can affect the health of the students), as well as outbreaks
of certain viruses. Such research should also analyze the impact on students’ success. This would
provide reliable parameters for quantifying the social benefits of implementing energy efficiency
measures in educational institutions.

Better working conditions will certainly facilitate and enhance day-to-day teaching for both
students and their teachers. Also, reducing student absenteeism will also have an impact on the
community by breaking the traditional chain of reactions to health problems amongst the youth.
This will automatically reduce the number of parents who are absent from work due to the state of
their child’s health, as well as the number of patients examined at health care facilities, which may
ultimately result in a reduction / stoppage of the spread of viral diseases. From an environmental
perspective, this also means less non-routine car usages, that is, a reduction of pollutant and carbon
dioxide emissions.

It is important to note that all public use buildings, including those that were part of the study,
still have room for improvement. Thus, for example, care should be taken to ensure that indoor air
quality of schools is satisfactory, given that students and staff spend most of their time in them.
Air quality depends on a number of factors, such as the material used to build and clean the room,
as well as the manner and frequency of its ventilation. It is recommended to continuously measure
carbon dioxide concentration, temperature and humidity in refurbished buildings.

Poor indoor air quality can have a negative impact on health, especially that of children. We are seeing
more and more people with allergies and asthma. It is for these reasons that it is important not to
stop with what has been done so far, but to continue to make our classrooms better. Ultimately,
healthier and more comfortable working conditions will certainly be an additional motivation for
students and teachers to achieve even better results in new premises.

11