A growing number of international standards promote Healthy Built Environment (HBE) principles which aim to enhance occupant and user health and wellbeing. Few studies examine the implementation of these standards; whether and how they affect health through changes to built-environment design, construction, and operations. This study reviews a set of sustainability and HBE standards, based on a qualitative analysis of standard documents, standard and socio-technical literature on normalization and negotiation, and interviews with 31 practitioners from four geographical regions. The analysis indicates that standards can impact individual, organizational, and market-scale definitions of an HBE. Some changes to practice are identified, such as procurement and internal layout decisions. There is more limited evidence of changes to dominant, short-term decision-making practices related to cost control and user engagement in operational decisions. HBE standards risk establishing narrow definitions of health and wellbeing focused on building occupants rather than promoting broader, contextually situated, principles of equity, inclusion, and ecosystem functioning crucial for health. There is a need to improve sustainability and HBE standards to take better account of local contexts and promote systems thinking. Further examination of dominant collective negotiation processes is required to identify opportunities to better embed standards within organizational practice.

Keywords: built environment; health; implementation; negotiation; standards; urban sustainability; wellbeing.