Health as a Decision Problem in BioCognitive Architectural Design: A Critical Review and Physiological–Regulatory Perspective

Abstract

BioCognitive Architectural Design (BCAD) positions architecture as an active modulator of human biological and cognitive processes, yet the operational status of health within architectural decision-making remains unclear. Although evidence linking built-environment conditions to physiological, cognitive, behavioral, and psychosocial outcomes continues to expand, health rarely functions as a structured design parameter in architectural practice. This study argues that the weak operationalization of health in architecture and BCAD is not only an evidence problem, but also a decision structure problem. A critical narrative review combined with conceptual analysis was conducted across the literature on regulatory physiology, built-environment health, neuroarchitecture and BCAD, healthy building frameworks, and architectural decision support systems. Our analysis identified five interrelated structural challenges to health operationalization in architectural decision-making: (1) the absence of a decision-relevant model of health, (2) weak translation of evidence into architectural decision logic, (3) cognition-centered reductionism, (4) limited cumulative exposure logic, and (5) the facultative status of health within design trade-offs. The study introduces a physiological–regulatory perspective on health as a conceptual basis for future decision-oriented BCAD frameworks, emphasizing cumulative exposure, adaptive regulation, vulnerability, and recovery rather than proposing a universal model for all architectural decision-making.