Wellness real estate: market growth, what is counted, and how buildings are used

What wellness real estate means

The sector is residential and commercial or institutional construction — offices, hospitality, mixed-use and multi-family buildings, medical and leisure properties — that puts intentional wellness into the design, materials and structure, and into the amenities, services or programming.

For a long time the product was read as a resort with a large amenity floor, or as a retirement community. The wider reading now includes air, sound, outdoor exercise, room to meet other people, and access to nature. People spend most of their hours indoors, so the building is treated as part of prevention, not only as shelter.

Homes, workplaces and everything in between

The same idea is applied to new buildings and to existing ones that are rebuilt. Residential work already covers master-planned communities, apartments and condominiums, urban districts, resort and spa residences, affordable housing, eco-communities, co-living and senior living.

Green construction, historically, aimed at energy, water and emissions. A healthy building moves the brief toward the person inside: air, light, sound, materials, movement and the chance to recover. Both agendas now sit on the same projects, and they do not always ask for the same engineering.

Global size and the 2028 outlook

The sector has been the fastest-growing part of the wellness economy for years. In 2023 it reached USD 438.22 billion, about 2.9% of global construction output. From 2019 to 2023 the compound rate was 18.1%. The outlook drawn to 2028 is USD 912.6 billion, at a 15.8% compound rate.

The chart for 2017–2028 labels USD 148.5 billion on the opening bar and USD 912.6 billion at 2028. Year-by-year figures that the text ties to a calendar year are the table below, not that opening bar.

Growth against construction output

From 2019 to 2023 wellness construction grew at 18.1% a year and all construction at 5.1%. In the pandemic year 2019–2020 the wellness series still rose 21.6%, while construction output fell 0.8% and global GDP fell 2.6%.

Construction then slowed, from 16.7% growth in 2020–2021 to 1.9% in 2022–2023. The wellness series slowed too, from 24.8% in 2020–2021 to 13.4% in 2022–2023, and stayed well above construction. In 2022–2023 construction output itself fell in Asia-Pacific (−1.3%), the Middle East and North Africa (−2.2%) and Sub-Saharan Africa (−7.6%).

In every region from 2019 to 2023 the wellness rate was about three to four times the construction rate, or more. Latin America and the Caribbean, and Europe, were the fastest wellness regions, in line with relatively strong construction there. North America’s wellness rate stayed high and then eased in 2022–2023 with construction. The Middle East and North Africa kept a fast wellness rate even when construction was slower, including a clear construction drop in 2022–2023. Asia-Pacific holds large fast markets — Australia, Japan, China, India — but the regional rate was held back by volatility and by construction declines in 2022 and 2023, including China, Japan and South Korea.

How concentrated the market is

North America, Asia-Pacific and Europe together are 99% of the global market. North America is the largest region in 2023, at 44%.

The twenty largest countries barely changed order after 2019. The United States is 41% of the 2023 world total. The United States and Canada, together with China, Australia, Japan, the United Kingdom, France and Germany, are 85%. Many of those countries grew faster than the world rate of 18.1%.

Twenty largest country markets

Europe’s 2023 market is USD 95.91 billion, with a 20.1% compound rate since 2019. The United Kingdom, France and the Netherlands each grew faster than 21% a year. Germany is seventh in the world, at USD 13.69 billion and 12.1%. Norway is thirteenth, at USD 3.35 billion and 13.1%.

WELL and Fitwel, 2016–2023

WELL and Fitwel are the two multi-country rating systems aimed at the health of people in the building. WELL issued its first certifications in 2014. Fitwel certified its first projects in 2016. From 2017 to 2023 the stock of fully certified projects rose more than forty-fold. At the end of 2023 there were 3,375 such projects. More than 55% are in the United States. Most are offices, hospitality or retail; about 19% are residential.

As of March 2024 another 1,800 projects were in progress (Fitwel) or pre-certified (WELL), mostly in the United States, China and Canada. These certificates are only a slice of the market as defined above. Large occupiers also copy the criteria across a portfolio and certify only a headquarters.

WELL registration and certification runs at about USD 0.16 per square foot (about USD 1.72 per square metre), with a floor near USD 8,000 and a cap near USD 98,000 depending on area. Fitwel is described as starting around USD 6,500–7,500 per project, without a mandatory on-site performance test. One compared sample put average rents at USD 52.53 per square foot for WELL and USD 55.26 for Fitwel; the gap may be the locations, not the label.

Other ratings, including green standards

Other tools lean toward sustainability or regenerative design rather than wellness alone, among them the Living Building Challenge and One Planet Living. LEED and BREEAM have been adding indoor environment and occupant health. In Japan, a health certification for offices inside CASBEE had evaluated its first projects in 2019 and, as of April 2024, 153 properties.

Projects can now follow a combined path for WELL and LEED. In 2020 a health and wellbeing framework from the green-building side extended the brief beyond emissions to health, equity and resilience.

WELL v2

The current WELL version scores ten concepts: air, water, nourishment, light, movement, thermal comfort, sound, materials, mind and community. What sets it apart is on-site performance verification by an independent assessor: volatile compounds, reverberation, the spectrum of light, the chemistry of water, and many other readings.

The extra capital cost — filtration, low-emission materials, advice, and the verification itself — is why it shows up most often on prime offices, headquarters and high-end homes.

Fitwel

Fitwel is described as the more scalable of the two, including for whole portfolios. Scoring is documentary: stairs that people will actually use, the walking network around the building, rooms for parents and infants, a no-smoking rule, and other strategies with a published rationale. There is no mandatory instrument test of indoor air.

A social-performance tool tied to the same family of ratings links reporting to six financial-risk themes: environmental health hazards, climate resilience, stakeholder engagement, equity, physical activity and active travel, and biophilic elements.

DGNB

On German-speaking markets DGNB is a single system for environment, cost, sociocultural and functional quality, and technical quality, rather than a split between a green label and a health label.

For interiors and new buildings it highlights indoor air. For the top award, in mechanically ventilated buildings, the limit is 1,000 µg/m³ for total volatile organic compounds and 60 µg/m³ for formaldehyde, measured on site no later than four weeks after the fit-out.

More fresh air, and the energy it costs

A low-energy brief seals the envelope, cuts heat loss and recirculates air. A health brief raises air changes, cuts recirculation and adds fine filters that the fans must push against. Heating or cooling that larger outdoor-air volume uses more energy.

Post-occupancy reviews often find LEED and BREEAM buildings 15–30% off their energy model because of how people use them, while buildings held to a strict indoor-air brief can sit more than 30% above a baseline energy figure. The practical way through that tension is heat recovery, façades that can still open, and ventilation that follows whether anyone is actually in the room.

Why demand keeps widening

Consumer expectations and a better understanding of buildings are what the report expects to carry the market across homes, offices, hospitality, institutions and other types. The shift that started in 2020 is still the frame: people now look for buildings that protect health, not only for a gym on the ground floor.

• Indoor air is becoming a basic requirement, in homes and in workplaces, schools, hospitals, shops and industry. Wildfire smoke sharpened the same concern. A growing set of studies links air with cognition, mood and output.
• Projects are adding parks, outdoor recreation, trees and public green space, and there is pressure to share those assets with people who have had less access.
• Green space and biophilic design are tied to stress, mood, cognition and healing. Work on neuroaesthetics treats beauty, sound, scent and touch as design inputs. Pro-social layouts are used against loneliness: street life, places to gather, unplanned meetings.
• Where health care is publicly funded, healthier features in affordable housing are argued as a way to spend earlier and treat less later. Features that started in this sector are expected to leak into ordinary planning.
• In luxury property, wellness has moved past the gym, the spa and the pool toward nature, attention, sleep and social life. The report expects the same features to show up in the middle of the market and in purpose-built rental housing.
• A stay at a wellness resort is described as a path to buying a home with the same daily rhythm: primary homes, second homes, timeshare and other shared ownership. Destination spas and hospitality brands have been adding residences, including in cities, and developers are expected to partner with established wellness brands.
• After remote work, a healthier office is one of the few practical reasons to come back. In a soft office market, tenants can ask for those features in the lease.
• Reporting rules have weighed the environmental side of ESG much more than the social side. The rise of wellness is pulling attention toward the social side. Assets under management in that style of investing are described as tens of trillions of dollars, with tighter disclosure rules.
• Human health and environmental health are treated as one subject. Policy already pushes efficiency, codes, appliances, emissions and green finance. Buyers also want lower running costs and a healthier room.
• The formats people ask for are already diverse: high-rises, family suburbs, rentals, student housing, senior living, co-living, and short stays for people who work on the move. Megacity demand clusters around air, water, noise, mental health, green space and fitness. Suburban demand clusters around walking, transit, bikes, outdoor recreation and neighbours. Sites add their own assets: a park, a shore, a spring, a historic centre, or a clinic nearby.

Ageing and the household decision

In Southeast Asia the population aged 65 and over to grow by 32.7 million people by 2035, to 11.6% of the population. Higher incomes shift spending toward prevention, and a home is bought as a way to stay independent, with monitoring and a healthier interior rather than as a one-off trip.

Six aspects a project can address

There is no checklist that decides what counts. A project can take some of the six aspects below and ignore others. Certifications are a template and a signal to tenants. They are not the boundary of the market.

• Physical: non-toxic materials, clean air and water, sleep, exercise, active travel, healthy food, and preventive services. Examples include trails, parks, daylight, circadian light and thermal comfort.
• Social: plans, shared rooms and programmes that make neighbours known to each other, and a location that leaves time for that. Examples include multi-generational homes and shared events.
• Mental, emotional and spiritual: nature, culture, beauty, a purpose, and room for rest and for a life that is not only work. Examples include water, art and a quiet room.
• Environmental: non-toxic, renewable, low-waste, efficient materials, and a life that drives less, wastes less and keeps habitat. With harder weather, resilience joins this list: open space, wetlands, on-site energy, green roofs, reflective materials, native planting, a garden.
• Community: mixed uses, incomes, ages and cultures, and a layout that builds trust past one’s own circle. Examples include a range of prices, a public square and a community room.
• Economic: daily life — work, school, shopping, recreation — within a short distance and by more than one mode, housing that more than one income can afford, and a path to move up. Examples include mixed-use rules, a walkable centre, live-work units and transit.

Healthy places that are not in the construction figure

The construction figure does not count communities that are already healthy without a purpose-built wellness project. Places known for long lives are cited as one example: habits and a shared way of living, not a new building. In Japan, cities in a smart-wellness programme work on parks, sidewalks, fitness, digital tools, transit and walking so that older residents stay active and social. A district in Romagna links local businesses and events around movement, food, nature and culture.

When a city invests in transit, parks, trails and community rooms, a private wellness project is less necessary. Until that access is ordinary, the report expects demand for purpose-built projects to keep rising.

The 1-9-90 cost split

A working shorthand for a typical employer, per square metre, is 1% energy and utilities, 9% rent and basic occupancy, and 90% people: pay, benefits and related taxes.

Cutting energy use by 10% then saves about 0.1% of that stack. Raising people’s output, or cutting sick days, or keeping them, by 10% moves about 9% — on the order of the rent itself. That is why the brief moves from the energy meter to the quality of the room.

Indoor air and cognitive performance

CogFX is the empirical pair to the 1-9-90 split. In the laboratory stage, people in a high-comfort green condition — higher ventilation and very low volatile organic compounds — scored about twice as high on cognitive tests as in a conventional office, a 101% difference. Higher air-change rates, finer particle filtration and tighter control of carbon dioxide were tied to speed, attention and planning.

A later stage in real offices found a meaningful link between fine particles and slower cognitive responses. On the money, the productivity gain per person exceeded the extra electricity for the ventilation by more than 150 times.

Materials, nature and light

Biophilic design here is a spatial system, not a plant in the lobby: direct contact with daylight, water, plants and moving air; indirect contact through wood, stone, fractal patterns and biomorphic form; and rooms that offer both a refuge and a view.

In the field study it cites, moving from a concrete office to one dominated by wood was associated with a fall in hair cortisol from 317.2 pg/mg to 286.4 pg/mg, and with a near doubling of self-rated productivity. The same pages link wood-rich rooms to lower sympathetic activation, faster recovery after stress, and a restored ability to pay attention.

Fixed artificial light flattens the circadian rhythm and is tied to sleep, metabolic and mood problems. The systems it describes shift the spectrum through the day: a stronger blue component in the morning, a warmer and dimmer light in the evening.

Rent and price premiums

Certified European offices show an average 21% rent premium over uncertified buildings across 2016–2021, and 26–29% in some markets. In that material, 67% of the European investors and tenants would pay more for features that improve physical and mental health.

For homes, sale premiums run from 5% to 35% and rent premiums from 7% to 10%. A full healthy-building package is given an overall return of 129%, with a payback of about 4.36 years. These premiums are not a second figure for the 2023 market size.

Valuers still struggle to put a number on circadian light or a cognitive gain until a lease is actually signed at the higher rent. The counterweight is obsolescence: a building that cannot meet a health or social test faces faster vacancy and weaker liquidity, while one that can is treated as a core asset.

Calculators

Three calculators already on this page stay here: a development yield, a workplace model built on the 1-9-90 split, and a load total for a set of treatment rooms. They apply the steps built into those calculators. They do not replace the market tables above.

Resorts and hotels

The sector splits into a living-and-hospitality vector and a care vector. Hotels are grouped by how large the wellness offer is. Major wellness, in that grouping, is an offer above USD 1 million or under 10% of revenue: both thresholds are given together, and this page does not choose one. The operating ratios are below. Non-room income (spa, memberships, food) is what lets the major group hold margin. The minor group gained more occupancy, and its converted profit was about 21% worse, because it could not sell the high-margin memberships and treatments.

Homes and senior living

In longer-stay housing, medical-grade air cleaning, low-allergen materials, acoustic separation and a community programme are the practical standard of the premium end.

Senior living, in the same pages, is housing for people over 50 that combines a hospitality service with ongoing clinical monitoring — rehabilitation, medication, nursing — and a social programme aimed at isolation and cognitive decline.

Clinics, care hotels and residences

The care side is the overlap of a clinic and a resort. Longevity clinics, aimed at biological age, sequencing and therapies that slow cellular ageing, saw a sharp rise in venture funding: about USD 57 billion by 2022, with many new sites in the United States, Switzerland and the United Kingdom. Care hotels near large hospitals are described as a cheaper bed for rehabilitation and for people who travelled for treatment.

The newest step is the same medicine inside the apartment. Named examples include SHA residences on Al Jurf, with a prevention clinic, a low-toxin interior and monitoring in the home, and Lanserhof’s expansion, including Sylt at EUR 120 million and Tegernsee. The longevity market, long built around protocols framed for men, is turning toward women’s physiology in both the programmes and the rooms.

Weather, heat and the people who build

Extreme heat, storms, rain and floods are now part of the brief. The minimum the report states is protection from unhealthy air, contaminated water, extreme temperatures and storms: low-carbon homes, on-site renewable energy, reflective materials, green roofs, planting that fits the climate, and the habitats, wetlands and watersheds around the site. Microgrids and a regenerative, circular way of living are the further demand. A community that is easier on the land is also described as a way to ease climate anxiety.

Construction workers are among the occupations most exposed to heat. The report notes deaths from heat stroke, and says the count is likely low because heat also sits behind accidents. Buyers do not see that harm. The report still puts it on the builders: a wellness project that injures the people who build it contradicts the claim.

The gap between the top of the market and an ordinary home

At the top of the market the list is a private gym and spa, recovery equipment, a meditation room, a hyperbaric chamber, an infrared sauna, a cold plunge, sensors in the bathroom, heavy filtration, circadian light, a view, outdoor sport, food and a private social club. At the middle and the bottom the list is no lead and no mould, protection from polluted air, noise and light, a bus, a grocery, a green space, and a neighbourhood that is safe and stable. Prices and interest rates have made that second list harder to buy.

The report’s point is that an affordable version does not need the expensive amenities. It needs non-toxic materials, ventilation, daylight, biophilic elements, outdoor space, a place to gather, and a link to the local economy. In some cities that will not happen unless local rules pay for the extra time or require it.

Rules that block a healthier plan, and buildings that make people ill

Codes have not kept up with what is known about buildings and health. The report cites zoning that bans mixed use and higher density, street and parking rules that block walking and lock in cars, and exclusionary rules that sort people by income, age and race. Delay at the permit desk is time and money, so teams that must fight the code often do not.

A separate failure is the building itself: contaminated water, a tower collapse, quake damage, cladding fires, sick offices, mould in schools, lead and asbestos, materials that off-gas, and indoor pollution from solid or gas cooking fuel. Causes named in the text are rules behind the science, rules that are not enforced, and too little money to fix what is already known. The report’s line is blunt: a wellness amenity does not help if the structure or the materials can make people ill or kill them.

Claims without the engineering

The matching failure on the marketing side is health-washing: a health claim that the ventilation, the acoustics and the operations do not support. A green wall in the lobby, a standing desk, free fruit or a yoga mat can be the whole of the claim, while formaldehyde or fine particles stay above a sane limit and an open office stays loud.

Because full verification is expensive, many teams design “in line with” a standard and skip the independent audit. Without a review after people move in, and without monitoring in use, the design claim fades. The same pages note the conflict with a buyer who wants the return immediately and the capital cost as low as possible.

European disclosure and the German housing push

The European disclosure stack — sustainability reporting, sustainable-finance disclosure, and the taxonomy, including the social module still being shaped — is a reason a health certificate is now used as evidence, not only as a plaque. Funds that classify products under the stricter articles have to show that a building does no significant environmental harm and that it contributes to health, access and safety.

On the German market there is a shortage of specialised healthcare property, harder financing while rates are high, and a housing-acceleration law in force through 2030 that is meant to cut permit friction, including for healthier housing.

A campus that made the stairs the obvious path

One worked example is a Berlin technology campus that combined retained historic halls with new offices and took a WELL Gold precertification together with a top DGNB score and a digital-connectivity certification.

Sensors watch volatile compounds, carbon dioxide, temperature and humidity, and the ventilation adds filtered outdoor air to a room when it fills up. Stairs are placed where people see them, ahead of the lifts. Courtyards are planted, materials are natural, and the underground garage is for more than 600 bicycles and e-bikes, with showers, instead of a conventional car park of that scale. Acoustic panels and light that changes through the day are there to cut sensory overload.

Where this leaves the sector

The sector is already large, concentrated, and still growing faster than construction, and certification is a signal rather than the definition. The price of a building is starting to include what the room does to attention, stress and breathing, and that a claim without measurement will not survive contact with disclosure rules.

The engineering tension is this: a sealed, low-energy building and a building with a lot of clean outdoor air are not the same machine. Heat recovery, air that is supplied only where people are, and materials that do not off-gas are the practical answer. Ignoring that shift is how a portfolio goes obsolete. Building it is how the same portfolio keeps a return and a social result.