With the advent of the concepts of efficient energy use focus has shifted towards buildings becoming more air tight and having lower levels of ventilation. This is due to the fact that as buildings become better insulated and conduction heat loss is reduced the proportion of heating and air conditioning load due to ventilation has increased and may offer the largest scope for reducing energy demand. This may have a detrimental effect on internal air quality (IAQ) and compounds existing environmental issues such as out gassing from materials in new buildings. At the same time environmental standards and expectations have risen as has the technical capability to evaluate their effects through epidemiological studies. Good environmental quality is a fundamental human need, absence of which affects health and productivity. Many occupants express annoyance about modern buildings and terms such as sick building syndrome (SBS) are used to describe the problem. Deterioration of IAQ has been evident from an increase in occupant complaints and an increase in breathing related sicknesses in recent years. With predicted substantial growth of the urban environment the problem will only be exacerbated in the future. A simple and effective solution to the problem of deficient IAQ is increasing ventilation but increasing the amount of inlet fresh air has direct bearing on energy load. Another important factor is the ventilation scheme (mechanical, natural, mixedmode). This paper looks at the relationship between good IAQ, ventilation, associated energy overheads and carbon emissions. Also identified are best practices that optimise the performance of a building in relation to this issue.