Science is Knowledge Shop Now

PU BLI C H E A LT H | O P I N IO N

What Florence Nightingale Can Teach Us about Architecture

and Health
The 19th-century nurse and public health researcher understood the importance of light in fighting and
preventing disease

By Steven Lockley on March 18, 2021

Florence Nightingale, late in life. Credit: Getty Images
In the late 19th century, Florence Nightingale revolutionized hospital design in what became
known as Nightingale wards. The signature innovation of these wards was large windows that
allowed cross-ventilation and abundant natural light. Nightingale believed that the light and
air quality in a hospital's environment play an important role in speeding patient recovery.

In the decades since, numerous studies have shown that Nightingale was right: daylight is a
critical determinant of human health and wellness. Patients in rooms with daylight and views
of the outdoors have quicker recovery times and need fewer painkillers. Natural light has
been shown to decrease heart rate, lower blood pressure, and even treat depression faster
than antidepressants. Importantly, just as Nightingale theorized, daylight can also decrease
harmful bacteria and viruses.

Our understanding of how these benefits of light are delivered has advanced dramatically in
the past two decades. Up until the end of the last century, it was assumed that all responses to
ocular light exposure were mediated by the rods and cones we use to see, located at the back
of the retinae. About 20 years ago, however, that assumption was completely transformed
when research from many laboratories culminated in the discovery of light-sensitive cells in
the ganglion layer at the front of the retinae that can function separately from the visual
system.

These cells, dubbed “nonvisual photoreceptors,” play an important role in maintaining our
sleep, productivity and overall health. The cells are particularly sensitive to the short-
wavelength blue light corresponding closely to peak wavelengths found in sunlight. Exposure
to this short-wavelength light stimulates us, keeping us alert, improving reaction times,
learning and a range of other cognitive functions. Light, particularly short-wavelength light,
also elevates mood, and, in clinical patients, can be used treat depressive disorders and
fatigue. Many artificial light sources emit a greater proportion of longer-wavelength light,
however, which can undermine the benefits of daylight when indoors.
 Florence Nightingale inspects a hospital ward during the Crimean War. Credit: Getty Images

These nonvisual cells are also the primary timekeeper for our biological clocks—our circadian
rhythms—located in the suprachiasmatic nuclei, a region of the hypothalamus in the brain.
The circadian system regulates many of our bodily functions, including hormone levels, body
temperature and metabolism, among many others. We take this synchronizing effect of light
for granted. People who are totally blind—whose eyes cannot detect light—develop a
debilitating condition called non-24-hour sleep-wake rhythm disorder, where their biological
clocks run in and out of sync with the 24-hour day in a never-ending cycle. We experience a
similar but temporary disconnection from the light-dark cycle when we work night shifts or
travel quickly across time zones (jet lag).

In no part of our lives does this disconnect manifest itself more clearly than our sleep, as the
circadian system strongly influences the timing and quality of sleep. A recent NIH-funded
study found that nearly a third of Americans sleep six hours or less each night. According to
the Centers for Disease Control and Prevention, sleep disorders are so common in the United
States, they now constitute a public health epidemic. Lack of sleep is associated with many
chronic health conditions, including heart disease, diabetes, depression and even some forms
of cancer. Productivity losses due to poor sleep cost the economy billions of dollars every
year. Exposure to a more robust light-dark cycle will help maintain better circadian
synchronization and sleep, while greater daytime light exposure will also improve alertness
and performance through its direct stimulant properties. In one recent study, office workers
provided with increased daylight exposure slept 37 minutes longer compared to when they
worked in a similar office with blinds, and exhibited 42 percent higher scores on a cognitive
test taken at the end of the workday.
There are a number or ways to improve our access to daylight and improve our health in the
process. In an office setting, architectural design can introduce more daylight deeper into
buildings through larger windows and low desk partitions. Innovations such as smart glass
make it possible to control the amount of daylight that enters through a window by
automatically tinting based on cloud cover and the angle of the sun, eliminating the need for
blinds and shades, allowing for views of the outdoors. Unlike opt-in employee wellness
programs that require people to change their behavior, like gyms, natural light in the office
provides wellness in a passive manner, benefiting all occupations equally. In places that are
unable to provide ample natural light, workplaces should install daylight-mimicking LED
lights with a spectrum peaking in the short-wavelength blue range.

During the COVID-19 pandemic, the same strategies should be applied to our home offices.
We can promote our personal sleep quality and daytime productivity by working near a
window or outside. In the evening, we can reduce our exposure to light by using dimmer
lights, choosing blue-depleted warmer-looking lights, and minimizing use of light-emitting
electronic devices for as long as possible before bed.

The benefits of regular exposure to daylight are clear and relatively easy to achieve. Yet, such
innovations are implemented too rarely. While building developers and owners may not
receive the direct benefit of better lighting, their tenants will, and providing a better
environment may differentiate them from their competitors. Tenants, while often unable to
design their own spaces, can include daylight access as a deciding factor in selecting real
estate so that they reap the benefits of the greater productivity brought about by better
lighting design. Bright days and dark nights support the body’s circadian functions, enhance
alertness and improve productivity. Simply put, greater access to daylight is the first simple
step to better health. Nightingale grasped this more than a century ago. It’s time to put her
advice to work.

This is an opinion and analysis article.

ABOUT THE AUTHOR(S)

Steven Lockley is an associate professor of medicine at Harvard Medical School who studies circadian rhythms and
sleep.

Scientific American is part of Springer Nature, which owns or has commercial relations with thousands of scientific publications (many of them
can be found at www.springernature.com/us). Scientific American maintains a strict policy of editorial independence in reporting developments
in science to our readers.

© 202 3 SCI ENT I FIC A ME RI C AN , A D IVISION OF SP RINGER NA TU RE A ME RICA, INC.