During extreme air pollution events, such as bushfires, public health agencies often recommend that vulnerable individuals visit a nearby public building with central air conditioning to reduce their exposure to smoke. However, there is limited evidence that these “cleaner indoor air shelters” reduce exposure or health risks. We quantified the impact of a “cleaner indoor air shelter” in a public library in Port Macquarie, NSW, Australia when concentrations of fine particulate matter (PM_2.5) were elevated during a local peat fire and nearby bushfires. Specifically, we evaluated the air quality improvements with central air conditioning only and with the use of portable high efficiency particulate air (HEPA) filter air cleaners. We measured PM_2.5 from August 2019 until February 2020 by deploying pairs of low-cost PM_2.5 sensors (i) inside the main library, (ii) in a smaller media room inside the library, (iii) outside the library, and (iv) co-located with regulatory monitors located in the town. We operated two HEPA cleaners in the media room from August until October 2019. We quantified the infiltration efficiency of outdoor PM_2.5 concentrations, defined as the fraction of the outdoor PM_2.5 concentration that penetrates indoors and remains suspended, as well as the additional effect of HEPA cleaners on PM_2.5 concentrations. The infiltration efficiency of outdoor PM_2.5 into the air-conditioned main library was 30%, meaning that compared to the PM_2.5 concentration outdoors, the concentrations of outdoor-generated PM_2.5 indoors were reduced by 70%. In the media room, when the HEPA cleaners were operating, PM_2.5 concentrations were reduced further with a PM_2.5 infiltration efficiency of 17%. A carefully selected air-conditioned public building could be used as a cleaner indoor air shelter during episodes of elevated smoke emissions. Further improvements in indoor air quality within the building can be achieved by operating appropriately sized HEPA cleaners.

Considerable evidence exists regarding the role housing plays in the determination of health and well-being outcomes. Despite the scale of health concerns arising from housing considerations, there are very few economic analyses of housing programs that seek to improve health outcomes by addressing the physical infrastructure of the living environment. The NSW Housing for Health (HfH) program is an environmental health initiative funded and administered by NSW Health, that addresses health-related hardware in residential accommodation to ensure the home environment supports healthy living practices to ultimately improve health outcomes for residents. This study reviews the economic methods that have been applied to comparable programs and identifies relevant costs and benefits that should be addressed. Founded on the requirement from decision makers, and the insights from the review, the paper outlines a protocol for a cost-benefit analysis that accounts for the disparate health, social, economic and intangible benefits generated from the HfH program and the resources utilised to realise these outcomes.