The importance of accelerating healing and healthy space creation has never been more at the forefront of our collective consciousness than today. But the past holds an abundance of knowledge that is often forgotten. What can the lessons our ancestors so intrinsically knew, along with the discoveries of the last century, offer up to us in this post-pandemic landscape?
Let the light back in.
The healing hand of light in hospitals.
Image: Ryder Architecture / Laing O’Rourke
“Second only to fresh air… I should be inclined to rank light in importance for the sick. Direct sunlight, not only daylight, is necessary for a speedy recovery.”
This quote from Florence Nightingale, writing in 1859, is more prescient than ever in 2021.
Together, fresh air and natural light are some of our main weapons in the fight against the spread of Coronavirus. Daylight, in particular, is fast becoming understood as a way of disinfecting buildings (helping to prevent damp, mould and bacterial growth). Add this to the fact that it enhances our levels of Vitamin D (significant in helping battle the impact of the virus on our bodies), as well lowering the risk of asthma and other respiratory diseases, and it’s clear lighting has an untapped yet vital part to play in our post-pandemic world…
Yet while our knowledge of how daylight supports our health, wellbeing, and recovery has been understood since Florence Nightingale and the Crimean War, it still feels like an untapped resource when it comes to buildings and – in particular – healthcare environments.
A short history of sunlight.
From the birth of human civilisation, we have revered the sun as a giver of light and of life. From as early as the 14th century BC, the sun god Re was worshipped and solar temples were erected in his honour from the 24th century BC. These sun temples were designed with an understanding of the orientation of sun movements and focused around a central obelisk.
By the 12th century BC, the ancient Greeks were worshipping Helios as the personification of the sun and, later, the Roman Empire used daylight to great effect within their buildings: from the central atriums in Roman villas, to the use of glass to create heat and solar energy for homes and greenhouses.
“The Roman’s had an intrinsic understanding of the importance of light,” explains Jonathan Rush, Partner for Lighting Design at Hoare Lea. “The central oculus of the famous Pantheon in Rome allowed sunlight to penetrate the space in dramatic ways, but it also trapped the solar energy within the building, heating the space. The use of this ‘heliocaminus’ became so popular in buildings within Rome that people started demanding protected views of the sky, which led to what can be described as an early form of ‘right to light’ legislation familiar to us today.”
As civilisations developed, the use of daylight within buildings became ubiquitous. As early as 1550BC, nearly all civilizations had an almost inherent understanding of the value of daylight and sunlight in healing. Our understanding of our natural ‘body clock’ and the benefits of a healthy sleep and awake cycle likely developed from seeing the impacts of sleep deprivation or lack of exposure to light.
Yet, it wasn’t until people started considering the science of healing and humans spent the majority of our time indoors that the use of light became more prominent in healthcare facilities.
Central oculus of the Pantheon, Rome. Photo by Tony Grady
While our knowledge of how daylight supports our health, wellbeing, and recovery has been understood since Florence Nightingale and the Crimean War, it still feels like an untapped resource when it comes to buildings and – in particular – healthcare environments.
Images above:
The Hotel Dieu hospital in Paris This was one of the first to use the pavilion style and was built between 1867 and 1878. The central courtyard provides an attractive Parisian garden with large accessible colonnades at each side for patients. Around the central rectangular building a series of smaller wings branch off – each with their own access to daylight and views.
Paimio Sanatorium, Paimio, Finland. Alvar Aalto 1928-1932 The vast sun deck on the top floor allowed patients to bask in natural light while enjoying the surrounding forest landscape. Daylight penetration was also considered throughout the interior, with large windows in all areas.
Solarium Terrace. Photo: Gustaf Welin, Alvar Aalto Foundation. 1932
Pavilion popularity.
“The benefits of daylight within hospital design grew around the time of Florence Nightingale,” notes Ruth Kelly Waskett, head of daylight design at Hoare Lea. “This was most notable in the ‘Pavilion Plan’ hospital layout, which became popular in the mid-19th century. Designed around a central courtyard, this layout and orientation was about achieving good daylight and fresh air throughout the hospital wards.”
The pavilion style of hospital design became prolific across Europe, with John Robertson and George Godwin popularising the method in the UK.
A brighter future for fighting disease.
Once there was an improved standard of general healthcare available to the masses, attention turned to the use of light for other medical issues and diseases. Tuberculosis (TB) had become part and parcel of life in the 19th century, but as it drew to a close, a series of important scientific breakthroughs had advanced understanding and tracking of the disease. This included the building of large TB Sanatoriums so that sufferers could be isolated and cared for until the condition had passed. The drive for good design within these buildings saw many top architects become involved in their creation. Buildings such as the 1932 Paimio Sanatorium in Finland (a seven-story building designed for daylight and sunlight orientation, with access to balconies on each level) became a benchmark for great use of daylight.
Whilst daylight rooms or areas where patients could get some light treatment became commonplace in these sanatoriums, the use of artificial light therapy also grew.
The work of Niels Finsen – who in 1903 won the Nobel Prize in Physiology or Medicine for his work on artificial light sources as a treatment for various diseases – inspired light rooms that utilised filament lighting. “For most of the history of healthcare, the importance of light on our wellbeing was not supported by scientific research,” explains Jonathan. “It was just something that either worked or was perceived to work because of an intrinsic understanding about our physiological needs for light.”
It was not until the 1980s that some of the first empirical evidence of the positive impacts of light became known. In his 1984 study, environmental psychologist Roger Ulrich demonstrated that patients who sat near a window, received daylight, and had a view of nature suffered fewer clinical complications, reported reduced pain, and healed faster than those who did not.
What followed was a flood of studies that built upon Ulrich’s work and – ultimately – have proved the anecdotal ideas suggested by Nightingale back in 1859.
Alder Hey in the Park Photo: David Barbour
There is solid evidence that managed light exposure can support recovery rates, aid sleep, improve drug efficacy, reduce stress and make better, more comfortable environments for patients, visitors and clinical staff.
A – Quality daylight & a view of the exterior provide the primary source of wellbeing for patients and staff. B – On duller days or deeper floor plates, artificial light replicates aspects of daylight through illuminated simulated “skylights”. C – Personalised light provides additional illumination and a more “domestic” feel.
A – As daylight dims, artificial light is needed. B – Light that is softer and warmer in colour creates a more relaxed environment for patients and visitors. The light gets warmer and dimmer as night falls to enhance sleepiness in patients. C – A localised light provides more light at the bed head for reading and clinical inspection.
A – Black Out Blinds stop ingress of light from outside. B – Other artificial light is off to help settled sleep. C – If clinical inspection is required the localised light is amber in colour. D – A low level amber floor wash reduces falls and helps staff read catheter bags without disturbing patient.
Circadian cycles.
The understanding that light plays a vital role in our body clocks was finally clarified with the confirmation that the hormone Melatonin (originally discovered in 1958) is released and suppressed via the Pineal gland in the central nervous system, which forms a trigger for our sleep/wake cycle.
Fast forward to 2002, and Samer Hattar, David Berson and colleagues found what are known as the Intrinsically Photosensitive Retinal Ganglion Cells. These cells use light (particularly blue spectrum light) to send messages via hormones through the brain to trigger sleep or wake cycles.
We now know that the key to an aligned and healthy sleep cycle is good exposure to light throughout the day and reduced light at night to support healthy sleep. A healthy circadian rhythm can reduce illness, help recovery and improve wellbeing. As Ruth notes: “Light, but most simply, natural light regulates our body’s circadian rhythms. In fact, studies have shown that exposure to natural light during the day leads to an average of 46 minutes more of sleep each night, and sleep obviously has a major impact on our overall health and the healing process. Within a healthcare building,
insufficient light exposure or exposure to light at night is likely to disrupt patient and staff circadian rhythms, making it more difficult to maintain healthy sleep patterns. Considered use and exposure to light offers amazing opportunities for most healthcare environments.”
Age-old lessons.
More than 150 years on since the importance of daylight and light exposure was postulated by early medical pioneers, we now have the understanding, research and tools to create natural and circadian-led lighting environments within hospital spaces, but are we seeing this as much as we should?
As noted in the recent World GBC Health & Wellbeing Framework report: “The focus on productivity in the built environment has left other areas of health & wellbeing underdeveloped. The financial co-benefits of a healthy built environment have created such a powerful driver for sustainable buildings that the focus of design interventions for health have inadvertently shifted into one sector of society (in many cases, the people who may not have been most in need of dedicated health interventions).”
Will it take the Covid-19 outbreak for society to re-remember what we previously prioritised about light and wellbeing?
Ruth for one is passionately committed to promoting a resurgence in this understanding: “There is solid evidence that managed light exposure can support recovery rates, aid sleep, improve drug efficacy, reduce stress and make better, more comfortable environments for patients, visitors and clinical staff. And yet it feels that rarely do modern hospital designs consider use of light over a 24-hour cycle.
“Ultimately, exposure to daylight and to darkness is arguably our most basic natural form of healing. In my mind, there’s no better approach to the design of our healthcare spaces than utilising it effectively to support the mission of all health providers: helping people heal. It’s time we shed more light on what’s possible.”
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