ARCHITECTURE & DESIGN


There are clinical (day/night) cycles, seasonal cycles, and, importantly, biological clock cycles called circadian clocks, which are recalibrated daily by exposure to daylight.


increasingly interrupt this relationship and dialogue. Sunlight is a major protagonist in the theory of Biophilia. This natural element has to navigate through transitional spaces, increasingly solar sophisticated attenuating building skins, public-to-intimate spaces, and, finally, to be absorbed through our individual sensory receptors within our body envelope. This exposure, in turn, affects our physiology, emotions, psychological disposition, and, ultimately, our physical condition. This may be further attenuated and exacerbated by illness and medication. Evidently, architecture has to deliver permeable design elements that allow this vital, beneficial, and symbiotic dialogue to occur.


Evidence-based research clearly provides us with compelling data in terms of the true benefits of full spectrum and diurnal daylight. It is clearly an essential deliverable within the healthcare setting – in areas ranging from diagnostic to treatment and recovery spaces – resulting in beneficial and accelerated patient outcomes for all.


Historical background


Throughout history, luminaries such as Homer, Plato, and Pliny, paid homage to the sun. The ancient Babylonians, Egyptians, Greeks, Romans, Mayans, Aztecs, and Incas, all recognised that sunlight could be harnessed to promote health. Hippocrates, for instance, believed it to be beneficial in the treatment of most ailments. However, medical interest in sunlight truly took hold at the turn of the 20th century, when research discovered that sunlight kills bacteria, and that a deficiency is associated with rickets – a condition that affects childhood bone development. As far back as 125 years ago, Scandinavian physician, Niels Ryberg Finsen, treated diseases including smallpox with daylight, and this earned him the Nobel Prize for Medicine. By the late-1920s, sunlight was being touted as a cure for pretty much every illness under the sun, and a suntan had become an emblem of wealth and status.


Sun-focused healing architecture varied from spas, sanatoriums, revolving patient


80 Health Estate Journal October 2019


‘Dermatological’ and ‘Cardiovascular’ are just two aspects of an individual’s health that research suggests are impacted by sun exposure, or a lack of it.


wards in the former Edinburgh Hospital City Hospital, and the Papworth Tuberculosis Shelters, to Swiss Alps Child Sanatoria, the Neonate Balconies in Berlin, highly glazed Nightingale Wards, and a plethora of District General Hospitals offering patient bed access onto balconies, terraces, and winter gardens.


Diagnostic, treatment, and recovery spaces


Healthcare environments are essentially composed of clinical spaces and activities related to diagnostic, treatment, and recovery processes. All three of these main types of clinical space require a good distribution of natural daylight, or a full spectrum equivalent in terms of artificial light:


Diagnostic spaces


A diagnostic procedure is an examination to identify a patient’s specific area of weakness and strength in order to determine a condition, disease, or illness. This procedure will occur within A&E triage spaces, in Clinical Assessment, or at regular intervals by the bedside and throughout the patient journey before final discharge. The skin, the body’s largest organ, offers insights into internal conditions and diseases. Doctors say that


‘the skin offers a window into what is going on inside’. Daylight on the skin of the patient, especially at the head end, affords the best diagnostic setting. Skin pallor can be often diagnosed by sight, but it can be made considerably more difficult with incorrect artificial ambient light, and/or adjacent coloured surfaces, which may confound diagnostic procedures, and create opportunities for errors. For example, infants with jaundice may exhibit yellow skin, and cardiac patients with poor blood circulation will exhibit a blueish complexion which, if incorrectly diagnosed, could result in a cardiac event. It is known among clinicians that children typically have reflective skin, which may further confound diagnostics.


Treatment spaces


Treatment spaces such as operating theatres and Minor/Major surgery also require daylight penetration. In recent years, new guidance has been published, making ‘daylight’ a statutory deliverable into such high-tech environments. This proves difficult at times to achieve, since some treatment spaces are highly M&E- serviced spaces, and populate deep plans. Guidance notes such as HBN 26, Facilities for Surgical Procedures, and HBN 10-02,


Some of the impacts of buildings’ spaces and the outdoor environment on health.


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