Daylight and Health

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Lighting Res. Technol. 2013; 0: 1–22
Daylight and health: A review of the

evidence and consequences for the
built environment
MBC Aries PhD, MSca,c, MPJ Aarts MSca,c and J van Hoof PhD, MSc, Eur Ingb
a
Department of the Built Environment, Eindhoven University of Technology,
Eindhoven, the Netherlands
b
Centre for Healthcare and Technology, Fontys University of Applied Sciences,
Eindhoven, the Netherlands
c
Intelligent Lighting Institute, Eindhoven University of Technology, Eindhoven, the
Netherlands
Received 2 July 2013; Revised 20 September 2013; Accepted 24 September 2013
Daylight has been associated with multiple health advantages. Some of these
claims are associations, hypotheses or beliefs. This review presents an overview of
a scientific literature search on the proven effects of daylight exposure on human
health. Studies were identified with a search strategy across two main databases.
Additionally, a search was performed based on specific health effects. The results
are diverse and either physiological or psychological. A rather limited statistically
significant and well-documented scientific proof for the association between
daylight and its potential health consequences was found. However, the search
based on specific health terms made it possible to create a first subdivision of
associations with daylight, leading to the first practical implementations for
building design.
1. Introduction sometimes even appears as if daylight has

only an architectural value, and all other
Humans have evolved under the influence of daylight functions have been replaced by
daylight and the light–dark cycle. On the one electrical lighting solutions.
hand, the human skin provides a layer of Solar radiation is filtered through the
pigmentation to protect us from the highest atmosphere and radiation reaching the
radiation intensities when exposed to daylight Earth’s surface is mainly in the wavelength
almost every day. On the other hand, humans range 200–4000 nm; some visible, some invis-
have developed a variety of physiological ible to the human eye. The portion of the
responses to the varied characteristics of spectrum to which the eye is sensitive –
daylight. Daylight was the main light source commonly referred to as light – is electro-
until electric lighting became reliable and magnetic radiation with a wavelength in the
affordable. Since the introduction of electric range from about 380 nm to about 780 nm.
lighting, a large part of the population started Radiation with wavelength between 100 nm
spending most of its time inside buildings. It and 400 nm is called ultraviolet (UV) radi-
ation and is usually divided into UV-C (200–
280 nm), UV-B (280–315 nm) and UV-A
Address for correspondence: MBC Aries, Department of the (315–400 nm). Radiation with wavelength
Built Environment, Eindhoven University of Technology, Den
Dolech 2, 5612 AZ Eindhoven, the Netherlands between 780 nm and 1 mm is called infrared
E-mail: m.b.c.aries@tue.nl (IR). UV and IR are invisible to the human
ß The Chartered Institution of Building Services Engineers 2013 10.1177/1477153513509258
Downloaded from lrt.sagepub.com at University College Dublin on September 22, 2014

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2 MBC Aries et al.
eye. Daylight is the solar radiation, visible to Radiation is increasingly administered and
the human eye, emitted by the sun and studied as a non-pharmacologic treatment for
perceived during daytime. The duration of a variety of health-related problems, includ-
daytime depends on our location on Earth ing skin problems (UV-radiation treatment),
and the time of year. Since daylight cannot be seasonal affective disorder (SAD), depression,
artificially replicated, it is often referred to as jetlag, as well as circadian rhythm sleep
natural light. disturbances and behavioural problems.11
Humans overwhelmingly prefer working Light therapy consists of exposure to daylight
and sitting near windows.1 However, nobody or to specific types of electric lighting.
can fully explain why. Potential reasons are Exposure is prescribed for a specific duration
the link with the view outside with its inex- and time of day. A little more than 50 years
haustible supply of information, the quantity ago, it was quite common for sunlight to be
of daylight (both high and low), the presence prescribed as part of the treatment of tuber-
of the full continuous spectrum, the (change culosis in sanatoria.12
in) directionality and/or the dynamics from The World Health Organization defines
milliseconds to months. Daylight provides health as ‘a state of complete physical, mental
variety and stimulation during the day and it and social well-being and not merely the
is widely believed that access to daylight absence of disease or infirmity’.13 Daylight is
reduces stress and increases productivity.2,3 widely believed to influence human health.
Weather in general is found to influence Daylight and daylighting have been asso-
people’s health and mood.4–7 In the multi- ciated with lower absenteeism, reduced
variate study of Denissen et al.,4 the effects of fatigue, relief of SAD, decreased depressive
six weather parameters (temperature, wind, symptoms, improved skin conditions, better
sunlight, precipitation, air pressure and vision, positive impact on the behavioural
photoperiod) on mood (positive affect, nega- disturbances seen in Alzheimer’s disease and
tive affect and tiredness) were examined. The multiple other health advantages. Some, but
results revealed important effects of tempera- hopefully not all of these claims are associ-
ture, wind and sunlight, with sunlight also ations, hypotheses or beliefs. Therefore, the
showing a mediating role. rationale of this paper is to present an
Daylight, however, because of its variabil- overview of studies on the proven effects of
ity, intensity and thermal component, can daylight exposure on human health, since
also lead to serious problems. It can cause an ‘light is the most important environmental
uncomfortable level of glare,8,9 or it makes input, after food, in controlling bodily func-
tions’.14 Moreover, we discuss the conse-
the building demand excessive amounts of
quences and applicability of the results of
cooling/heating energy if too much/little radi-
the literature review for the construction and
ation enters the building. When daylight is the
the renovation of buildings from a practical
cause of thermal or visual discomfort, the
and architectural point of view.
occupants’ wish for daylight is diminished.
Additionally, people do not switch electric
lighting off when there is enough daylight. 2. Methodology
This suggests that daylight is not superior, but
electric lighting is limited in creating neces- 2.1. Search process
sary variation, the provision of a view and Proven health effects of daylight were
space illumination.10 Besides, people’s prefer- examined on the basis of existing literature
ence for daylight may be partly due to their and the search followed a two-step process.
negative view of electric lighting. First, studies were identified with a search

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Daylight and health: A review 3
strategy across two (English language) litera- journal title (e.g. publications in the Journal
ture databases: PubMed and Scopus. In of Accident Analysis and Prevention or the
Scopus, the initial search terms in the article Journal of Public Health Dentistry were
title, abstract or keywords were: ‘daylight’, excluded) or topic (e.g. ‘fasting during
‘sunlight’ and ‘natural light’, in combination Ramadan’) was made prior to the eligibility
with ‘health’. In PubMed, ‘daylight’ was process of studies.
included in all fields and ‘health’ was entered
as MeSH Term. Species was set to ‘human’ 2.3. Data extraction
(PubMed) or the word ‘human’ was included The following data were extracted from the
in the search term (Scopus). In order to studies if available: (1) studied health effect(s);
eliminate most results related to daylight (2) light source (daylight only or a combin-
saving time, results with ‘saving’ and ‘acci- ation of daylight and electric lighting); (3)
dent’ (all fields) were excluded, and to elim- illuminance (including direction if possible);
inate most dental results, terms such as ‘oral’ (4) time of exposure (either time at which the
(all fields) were excluded, and to eliminate exposure occurred or the duration of the
results related to fasting during Ramadan, exposure); (5) number of subjects; (6) type of
‘Ramadan’ (all fields) was excluded. Table 1 study; (7) statistical evidence (including test
shows the exact search terms used. details and significance level) and (8) conclu-
Bibliographies of selected articles were sions related to daylight and health. Study
screened for other relevant articles. Second, quality other than completeness of requested
searches were performed based on ‘daylight’ data was not further assessed.
and a specific health effect (for instance,
headache), since it could be that only this 2.4. Limitations
specific term was used in the article instead of The study was limited to daylight only
‘health’. (visible radiation 380–780 nm). Known intra-
and interpersonal differences (i.e. gender,
2.2. Inclusion and exclusion criteria photoperiod sensitivity, and daily and
Included were published studies of daylight monthly rhythms) were not specifically
effects on human health. Actual eligibility was included in this literature search. This also
assessed by reading abstracts and, if neces- applies for potential health interaction effects,
sary, whole articles. Due to the large amount and the results or interactions due to electric
of hits in Scopus, a pre-selection based on the lighting.
Table 1. Search terms within the databases ‘PubMed’ and ‘Scopus’ (Date of last search: 20 September 2013)
Search terms
PubMed (daylight[Title/Abstract] AND health[Title/Abstract]) NOT saving[All Fields] NOT (‘oral’[All Fields]) NOT
(‘Ramadan’[All Fields]) NOT (‘accident’[All Fields]) AND (hasabstract[text] AND ‘humans’[MeSH
Terms] AND English[lang])
PubMed (natural light[Title/Abstract] AND health[Title/Abstract]) NOT saving[All Fields] NOT (‘oral’[All Fields])
NOT (‘Ramadan’[All Fields]) NOT (‘accident’[All Fields]) AND (hasabstract[text] AND
‘humans’[MeSH Terms] AND English[lang])
Scopus TITLE-ABS-KEY(daylight AND health AND NOT saving AND NOT oral AND NOT Ramadan AND NOT
accident) LANGUAGE(English) AND (LIMIT-TO(DOCTYPE, ‘ar’) OR LIMIT-TO(DOCTYPE, ‘ip’)) AND
(LIMIT-TO(EXACTKEYWORD, ‘Humans’))
Scopus TITLE-ABS-KEY(‘natural light’ AND health AND NOT saving AND NOT oral AND NOT Ramadan AND
NOT accident) LANGUAGE(English) AND (LIMIT-TO(DOCTYPE, ‘ar’) OR LIMIT-TO(DOCTYPE, ‘ip’))
AND (LIMIT-TO(EXACTKEYWORD, ‘Humans’))

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4 MBC Aries et al.
3. Results parameters and the fact that the group of

Feinglass et al.19 suffered from arthritis can
In this section, an overview is given of health explain the difference. Since significant (not
effects related to daylight exposure. After clinically meaningful) results were found
comparing and pre-selecting the literature between days with less sunlight and arthritis
search results (Table 2), an in depth pain severity, this could also be an explan-
abstract-based selection showed that 18 ation for the difference in activity level. It is
unique studies from both literature databases generally not clear from the existing studies if
seem to be eligible and were further analysed. the mixed results are due to limited statistical
Subsequently results of additional studies power (such as small sample sizes and vari-
(and their limitations) are reported. ability in weather indices).
Bodis et al.20 used also daylight hours to
3.1. Step 1: Databases ‘PubMed’ and ‘Scopus’ study the effect on heart attack and infarc-
Table 3 shows the results from the search tion. They found a (weak) negative correl-
within the PubMed and Scopus databases. ation: the more daylight hours, the less
Mottram et al.15 reported the best sleep infarctions. They also found a positive cor-
timing, duration, efficiency and quality relation between timing and infarctions. The
under natural light conditions. The study influence of daylight hours was investigated
included questions and measurements (both by Hansen et al.21 and Murray and Hay22, as
actigraphy and lighting measurements) and well in relation to SAD and mental distress.
used daylight as a control condition (3-week Both concluded that the (self-reported)
period at the beginning and end of the depression was most likely not photoperiod
Antarctic winter). specific, since ‘human seasonality may have a
Four studies focused on the relationship broader psychological component’.22 This
between daylight hours and physical activity. preliminary conclusion seems consistent with
Three studies16–18 found no significant effects, Björkstén et al.23 who tried to relate the
while the fourth study19 found a significant daylight photoperiod to suicide levels.
association. Next to the difference in meas- Surprisingly the suicide rate in Greenland
urement devices between those four studies peaked in midsummer and was lowest in the
(pedometers vs. accelerometers), there was period with the least daylight hours (winter).
also a difference in the amount of daylight Since month of birth can influence people’s
hours per day (from 8.7 hours to 15.1 hours). life after, Jewell et al.24 researched the season
The studies of Feinglass et al.19 and Klenk of birth with length of day as a representative
et al.18 both compared long (15–16 hours) to variable and postpartum depression. They
short (9 hours) photoperiods using acceler- found no significant relationship.
ometers and found contradictory results. Electric lighting at night and daylight
However, corrections for additional weather photoperiod were linked to breast cancer by
Table 2. Hits per search term for the databases ‘PubMed’ and ‘Scopus’ (Date of last search: 20 September 2013)
Source Search term ‘daylight’ Hits Eligible after pre-selection

or ‘natural light’
PubMed Daylight 56 16
PubMed Natural light 12 4
Scopus Daylight 42 20
Scopus Natural light 23 7

Table 3. Results of eligible studies (from 1989 until 20 September 2013)
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Reference Health effect Light source Illuminance (lx) Exposure Study type N Statistical test Conclusion
(hour)
Robertson Work-related Natural light and Not reported Not reported Health questionnaire 106 Not reported Those with work-related
et al.39 headache fluorescent study headache found the
electric lighting less comfort-
lighting able (p ¼ 0.059) and
perceived more glare
(p50.05). The study
suggests the need to
maximize the use of
natural light from
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untinted windows
Hansen Mental distress Daylight and Not reported November to Questionnaire study: 7759 2 tests The prevalence of self-
et al.66 electric February, three questions reported depression
lighting including about depression, was surprisingly low in
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darkness coping problems winter considering the

(LRT)
in and insomnia lack of daylight.

December (within heart disease
and study)
January
Murray and Seasonal Daylight photo- Not reported Not reported Questionnaire study: 526 Pearson Photoperiod cannot
[PREPRINTER stage]
[1–22]
Hay22 affective period (the SPAQ, GHQ, CES-D correlations underlie the springtime
disorder timing and and STAI-T reports of mood prob-
duration of lems measured in the
daylight) CES-D, STAI-T and GHQ
scales. The findings of
the present study sug-
gest that the diathesis
for seasonal affective
disorder/seasonality
may not be photoper-
iod-specific. At least in
Australia, there is pro-

visional support for the
proposal that human
seasonality may have a
broader psychological
component
Hansen Seasonal Daylight Not reported Not reported Questionnaire study 3736 Mantel-Haenzel The prevalence of self-
et al.21 affective Photoperiod with four questions procedure reported depression
disorder (the timing regarding seasonal and logistic was surprisingly low in
and duration changes after winter regression winter considering the
of daylight) (2 months no day- analysis lack of daylight.
light) in April/May
and after summer (2
months 24 hours
daylight) in

September/October
Continued.
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Table 3. Continued.
(hour)
Davis et al.25 Breast cancer Light at night No numbers, Year around Case control study 203 Linear regres- Light-at-night as an expos-
and daylight ambient light with to sion models ure measures was not
photoperiod measured measure- with corre- associated with noctur-
every 30 ment lated error nal urinary 6-sulphatox-
seconds moments structure to ymelatonin concentra-
(three dif- account for tion
ferent the correl- Lower nocturnal urinary
seasons) ation of the 6-sulphatoxymelatonin
[30.10.2013–1:24pm]
repeated level was associated

measure- with more hours of
ments on daylight
each subject
Björkstén Suicide Daylight photo- Not reported Not reported Database study using 833 Rayleigh test A significant seasonal
(LRT)
et al.23 period (the official computer- variation in suicides in

timing and ized registers on West Greenland with a
duration of causes of death and peak about midsummer
daylight) population registers time and low rates in
(WHO International the winter. Impulsive
[PREPRINTER stage]
[1–22]
Classification of aggressiveness
Diseases) mediated by a seroto-
nergic imbalance
related to seasonal
changes in light is pro-
posed to be a biological
component
Alimoglu and Job burn-out Daylight Not reported Less than 1 Questionnaire study: 141 2 tests and stu- Daylight exposure showed
Donmez29 hour, 1–3 the Maslach Burnout dent t-tests no direct effect on burn-
hours and Inventory, the Work out but it was indirectly
3 hours or Related effective via work-
more Strain Inventory and related stressand job

the Work satisfaction. Exposure
Satisfaction to daylight at least 3
Questionnaire hours a day was found
to cause less stress and
higher satisfaction at
work
Park et al.28 SRSL Daylight and Mesor (mm, 6 or 7 days Questionnaire and acti- 384 Multiple linear The best-fit model to pre-
electric light- log10 lx): graphy study regression dict SRSL was light
ing (at home) M ¼ 1.11.26Am- analysis exposure, GAF scale
plitude (mm, and use of anti-hyper-
log10 lx): tensive drugs
M ¼ 1.16 0.62
Continued.
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Table 3. Continued.
(hour)
Grimaldi Health related Daylight and Not reported Not reported Interview and 12-item 7979 Multivariate The HRQoL was influenced
et al.27 quality of electric light- GHQ (GHQ-12) study regression by both the seasonal
life ing (at home with yes/no question changes in mood and
and at work) about home lighting behaviour (p50.001)
and no problem/ and the illumination
some trouble/signifi- experienced indoors
cant trouble about (p50.001). Greater sea-
work lighting sonal changes
[30.10.2013–1:24pm]
(p50.001) and poor

illumination indoors
(p ¼ 0.0035) were asso-
ciated with more severe

mental ill-being
(LRT)
Bodis et al.20 Heart attack Daylight hours Not reported Time of sun- Retrospective database 32 329 Variance ana- The number of hours with
and myo- (seasonal rise and study lysis (Pearson daylight showed a weak
cardial variation and sunset and negative correlation
infarction time of from the Spearman with the occurrence of
sunrise) National correlative myocardial infarction
[PREPRINTER stage]
[1–22]
Meteorol- and Kruskal– (r ¼ 0.108, p50.05)

ogy Wallis and and a positive correl-
Service Mann– ation was found
(OMSZ) Whitney non- between the time of
parametric sunrise and sunset and
sampling) the occurrence of myo-
cardial infarction
(p50.01)
Vreeburg Salivary corti- Daylight photo- Not reported Not reported Questionnaire study 491 Linear regres- Socio-demographic vari-
et al.31 sol levels period (dark (health and socio- sion analyses ables (sex, age), sam-
months demographic vari- and coeffi- pling factors
October to ables) and measure- cient analysis (awakening time, work-

February vs. ments (salivary ing day, sampling
light months cortisol samples) month (daylight hours),
March to sleep duration) and
September) health indicators
(smoking, PA, cardio-
vascular disease) were
shown to influence dif-
ferent features of saliv-
ary cortisol levels
Jewell et al.24 Self-reported Season of birth Not reported Not reported Cross-sectional data- 67 079 Logistic regres- No significant relationship
postpartum or length of base analysis sion for com- between the season of
depression daylight at plex survey birth or length of day-
birth design light at birth and PPD

Continued.
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Table 3. Continued.
(hour)
Brown and (Risk for) Self-reported Not reported Not reported Questionnaire study 6017 Bivariate-logistic Participants reporting
Jacobs26 depression inadequate (health and light) regression model inadequate natural light
residential in their dwellings were
natural light 1.4 times as likely to
report depression
Feinglass et al.19 Physical Daylight hours Not reported Monthly day- Field study using uni- 241 Three level random- Daylight hours, mean daily
activity light axial accelerometer effects Regression temperature5208
hours counts and interview and Restricted max- or 758, and light or
[30.10.2013–1:24pm]
peaking: data imum likelihoode heavy rainfall (but not

July stimation snowfall) were all sig-
hours/day nificantly associated
15.1 and with lower PA

January
(LRT)
9.1 hours/
day
Mottram et al.15 General health 17 000 K blue- Natural light General light RAND 36-item ques- 15 Repeated measures There were no differences
enriched (3697 1637 boxes: 10 tionnaire study analysis of variance in health score between
lamps, stand- lx and hours per (health) next to acti- the different conditions,
[PREPRINTER stage]
[1–22]
ard white 4094 2309 day and a graphy and sleep only in sleep scores.
lamps lx) vs. Blue- 3-week diaries, urine sam- Analysing all light con-
(5000 K), nat- enriched control ples and light ditions, control, blue
ural light (1812 652 lx, period measurements and white, again pro-
2068 4852 lx before and vided evidence for
and after greater sleep efficiency
235 1152 lx) of blue-enriched light
and White compared with white
lamps (p50.05), but with the
(2206 746 lx, best sleep timing, dur-
1631 487 lx ation, efficiency and
and quality in control nat-

1840 727 lx) ural light conditions
Baert et al.16 Physical activ- Daylight hours Not reported 10.94 2.68 Questionnaire study 16 Spearman rank Age, gender and hours of
ity one year hours/day and PA measure- correlations daylight were not sig-
post-stroke ment via a nificantly correlated
pedometer with PA measured by
the several assessments
Continued.
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Table 3. Continued.
(hour)
[30.10.2013–1:24pm]
Duncan et al.17 Ambulatory PA Daylight hours Not reported 8.7 hours/day Field study including 536 Repeated meas- Hours of daylight at 8.7
ambulatory PA ures, analysis hours/day revealed no
measurement via a of covariance significant main effects
pedometer on PA
Klenk et al.18 Physical Daylight Not reported Days with Population-based 1324 Linear regres- Between days with a short
(LRT)
activity short day- cohort study includ- sion analyses daylight period (9
light ing questionnaires, hours) and a long day-
period (9 uniaxial accelerom- light period (16 hours)
hours) eter data and wea- the walking duration
and a long ther data increased by 12.6 min-
[PREPRINTER stage]
[1–22]
daylight utes in men and 13.3

period (16 minutes in women.
hours) After adjustment for
other weather param-
eters, daylight was no
longer significant
SRSL: Self-reported sleep latency; PPD: postpartum depression; PA: physical activity; SPAQ: Seasonal Pattern Assessment Questionnaire; GHQ: General
Health Questionnaire; CES-D: Community Epidemiological Survey for Depression; STAI-T: State-Trait Anxiety Inventory-Trait; HRQoL: health-related quality
of life.

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10 MBC Aries et al.
Davis et al.25 Exposure levels for either light and higher satisfaction. If this effect is exclu-
source were not mentioned. More hours of sively related to daylight is not proven, since
daylight and subsequently the less hours of for example Newsham et al.30 found also
darkness were associated with lower noctur- positive correlations between the (satisfaction
nal urinary 6-sulphatoxymelatonin (aMT6s) with) lighting (daylight and electric lighting)
levels. 6-sulphatoxymelatonin is the metabolic and job satisfaction.
end product of the hormone melatonin. Vreeburg et al.31 researched a combination
Three other studies26–28 did not mention of factors (both sampling factors and health
the light levels in their methodology section indicators) and found that, amongst all,
either. They investigated health-related qual- sampling month (daylight hours) influenced
ity of life, self-reported sleep latency and (risk salivary cortisol levels. Cortisol is important
for) depression, respectively. Grimaldi et al.27 for the hypothalamic–pituitary–adrenal
found positive results for poor indoor illu- (HPA) axis regulation: ‘The HPA-axis is
mination and an increased mental ill-being in hypothesized to be one of the key biological
their regression analysis. However, it is not mechanisms underlying several stress-related
clear what the exact contribution of daylight disorders, including somatic and psychiatric
was to this indoor illumination. disorders’.31
Alimoglu and Donmez29 based their day-
light exposure on questionnaire results (cate- 3.2. Step 2: Specific health keywords
gories 51 hour, 1–3 hours and 43 hours). Table 4 shows the results from the search
They investigated the link between burn-out, on specific health keywords. The specific
a psychological term for the experience of health issues with an association with daylight
long-term exhaustion and diminished interest. are divided into three categories: ‘positive’,
Since daylight has an impact on human ‘negative’ and ‘both positive and negative’.
alertness and cognitive responses, Alimoglu Scientific literature sources were obtained via
and Donmez29 investigated if daylight expos- PubMed, Scopus/ScienceDirect, Google
ure in a work setting could be placed among Scholar or at an author’s personal website.
the predictors of job burn-out, but found no The most well-known effect of light is on
direct effect. They did find an indirect effect vision. Human day vision (photopic) is
via work-related stress and job satisfaction. regulated by three cone photoreceptors,
More daylight exposure leads to less stress while vision in dim light (mesopic) is
Table 4. Specific health associations linked to (interaction with) daylight
Positive association Negative association Positive/negative association
Improvement of vision (and reduction of Triggering of migraines Influence body height and birth
depression) Triggering of epilepsy weight
Reduction of myopia Increase chance for autism Influence bilirubin levels and
Reduction of eyestrain (and improvement of haem catabolism
relaxation) Influence sleep problems for
Reduction of headaches people with autism
Stimulation of circadian physiology and Induce/modify changes in
cognitive performance human gonadal function
Improving sleep quality Influence breast cancer
Reduction of ADHD prevalence tumours
Reduction of SAD depressions
Prevention of obesity
ADHD: attention-deficit/hyperactivity disorder; SAD: seasonal affective disorder.

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controlled by cone and rod photoreceptors, in different animal species36. Norton and
and (almost complete) darkness (scotopic) is Siegwart36 concluded in their review that
regulated by rod photoreceptors. This light ‘retinal dopaminergic activation seems very
input then triggers a response through the likely to play a role in the protective effects of
optic nerve to the visual cortex in the brain. outdoor activities in children and the effects
The primary transition between scotopic, of elevated light levels in the animal studies’.
mesopic and photopic vision – the switch The most common health effect operating
from employing solely rod to solely cone through the visual system is eyestrain.
photoreceptors – is a direct response to Eyestrain is pain and fatigue of the eyes,
environmental irradiance.32 Human vision due to tightening of the ciliary muscle.37
under daylight conditions is normally better Cowling et al.38 found that there were signifi-
than under electric lighting due to the higher cantly less incidents of eyestrain reported by
quantity (and often a better colour rendering people whose workstations received large
index), enabling better visual performance. proportions of natural light. A total of 310
Recently, Zhang33 concluded that self- questionnaires were distributed in nine differ-
reported visual function loss, rather than ent buildings and 254 were returned (response
loss of visual acuity, is significantly associated rate 82%). Both chi-squared tests and mul-
with depression. This study was based on a tiple regression analysis were employed.
cross-sectional, nationally representative Headaches, severe fatigue and eyestrain were
sample of adults 20 years of age or older the three conditions canvassed as having
(N ¼ 10 480). It was not possible from this some work environment precursor. The
analysis to determine whether depression is a majority of respondents reported suffering
cause or an effect of visual function loss. from all three symptoms, at least occasion-
Even though myopia (short-sightedness or ally. The triggering source for eyestrain can
near-sightedness) can be corrected with be electric equipment, lighting or daylight,
glasses, contact lenses and refractive surgery, although the view that comes with a daylight
according to Morgan et al.34 it has emerged as opening can provide a point of relaxation for
a public health concern since its prevalence is the eyes (focus in the distance) and higher
increasing in Asia, North America and incident light can reduce the pain.37 Eyestrain
Europe. Surveys have shown that increased is often accompanied by headache, resulting
amounts of time outdoors protect against the from prolonged use of the eyes, uncorrected
development of myopia35,36. In a cross-sec- defects of vision or an imbalance of the eye
tional study of two age samples from 51 muscles.2,37,38 The decrease in headache inci-
Sydney schools, children and their parents dence with daylight illuminance increase was
completed detailed questionnaires on activity assessed in the study of Wilkins et al.37 using
and the children had a comprehensive eye a Jonckheere non-parametric trend test based
examination. The researchers concluded that on the data of N ¼ 20 people and corrected
higher levels of total time spent outdoors were for age and seniority (superiority). The illu-
associated with less myopia (p ¼ 0.04) and mination from daylight increased with the
suggested that light intensity may be an height of the office above the ground by an
important factor. Due to the higher light average of 80 lx per storey (measured at the
levels pupils will be more constricted out- work surface on a sunny day). Headaches
doors, resulting in a greater depth of field and tended to decrease with increasing storey level
less image blur.35 Periods of 5–7.5 hours of (z ¼ 2.13, p50.02, one-tailed, before lighting
elevated light levels (15 000–28 000 lx) have change). Robertson et al.39 compared two
been found to reduce the amount of myopia buildings and 106 out of 109 (97%) workers

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completed a health questionnaire. The daylight’s seasonal variation has positive

researchers found a significantly higher preva- influences on people with autism. Hayashi44
lence of work-related headache in the building reported in a case report on seasonal changes
with less daylight and lower mean luminances in sleep problems and behavioural problems
and illuminances of the work positions (even in an adolescent with autism over the year.
with electric lighting on) compared with the Sleep problems decreased from January to
other building (p50.001). The building with June, and disappeared in July and August.
less daylight was air conditioned and the Most of the behavioural problems (i.e. crying)
headache could therefore be related to either decreased gradually from January to June.
an interaction between daylight and ventila- The subject was one 15-year-old autistic male.
tion or related to the ventilation type only. Recently, Mazumdar et al.45 showed evidence
Migraine is a recurrent moderate to severe of seasonality in the risk of conceiving a child
headache. The triggering of migraine is later diagnosed with autism. They authors
hypothesized to start in the visual cortex. applied a one-dimensional scan statistic (with
Amongst other things, people who suffer adaptive temporal windows) on case and
from migraine are more sensitive to light control population data from California,
than other people (which is also described as USA for the years 1992 through 2000
photophobia).37,40 The high level of daylight (with4400 000 births per year).
and often occurring large contrast causing Foster and Roenneberg46 state that ‘despite
glare makes this light source a potential human isolation from seasonal changes in
trigger for migraine.2 Results of a reviewed temperature, food and photoperiod in the
study in Mulleners et al.41 indicated that industrialized nations, the seasons still appear
patients with migraine, both with and without to have a small, but significant, impact upon
an aura, have lower thresholds for visual when individuals are born and many aspects
stress than control subjects. Daylight, espe- of health’. Using a large US human male
cially in the window zone, usually provides population of 507 125 people, Weber et al.47
much higher light levels than electric lighting. found clear evidence for a dependence of
Photosensitive epilepsy (PSE) is a form of body height at age 18 on birth month. Over a
epilepsy in which seizures are triggered by period of 10 years there is a sinusoidal
visual stimuli that form patterns in time or variation with a period of 1.0 year with
space. PSE can start due to lamp flicker (with maxima in spring and minima in autumn
a frequency of 15 Hz), but this frequency is differing by 0.6 cm, a difference of 0.3%
not dominantly present in daylight. If day- associated with a changing photoperiod
light enters a space through a moving filter, (height M SD ¼ 177.2 0.33 cm with
PSE can occur.2 For example, daylight shin- 0.057 cm/year secular trend; sunshine dur-
ing off water or through the leaves of trees ation M SD ¼ 144 65 hours with a trend
can trigger seizures. In their book, Harding of 10.69 hours/year). They linearly interpo-
and Jeavons42 show multiple cases and studies lated both datasets, generated a Fourier
where seizures had been precipitated by spectrum and produced a Lomb–Scargle
flickering sunlight. periodogram. The authors cannot offer
People with autism have a chronically high definitive explanations but hypothesize that
level of arousal and high levels of daylight are the underlying physiological mechanism
arousing.2,43 The variability of daylight can might involve the light-dependent activity of
create a stimulating environment, which for the pineal gland. Also Wohlfahrt et al.48
most people would be preferable, but not for found a circannual variation in length at birth
people with autism. However, exposure to in a population-based cohort of 1 166 206

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children born in Denmark. The circannual alerting effects during the daytime (when
variation of 2.2 mm in length at birth is melatonin is not present) occur through dif-
compatible with the 6 mm variation of Weber ferent pathways. According to Cajochen,56 it is
et al.47 Additionally, they showed that dis- more likely to be the ventromedial preoptic
crepancies in measurements over the seasons area. Not only blue light (max ¼ 460 nm) but
are not likely, since they also found seasonal also green light (max ¼ 555 nm) elicits non-
variations in birth weight, which is often more visual responses to light, such as resetting
accurately measured. Details related to pro- circadian rhythms, suppressing melatonin pro-
cedures and statistical outcomes are not duction and alerting the brain.57 The sensitiv-
mentioned. Seasonal variations were also ity of the human alerting and cognitive
found related to bilirubin levels in newborns. response to polychromatic light at levels as
Bilirubin is the yellow breakdown product of low as 40 lx is blue-shifted relative to the three-
normal haem catabolism occurring naturally cone visual photopic system.58 Daylight inten-
when red blood cells die. Anttolainen et al.49 sity is most of the day much higher than 40 lx
found a significantly lower bilirubin value and will certainly have a significant impact on
from the fifth day of life onwards in a group circadian physiology and cognitive perform-
of Finnish infants born during the light half ance (alertness). It also contains the full
of the year (maximum of 22 hours of spectrum, with changing composition over
daylight), compared with infants born the day. Daylight not only has its impact
during the dark half of the year (maximum during the day but also at night daytime light
of 3 hours of daylight). In total, 86 preterm exposure can play a role. Recently, Cheung
infants born consecutively during one calen- et al.59 reported their results of workplace
dar year were studied. daylight exposure on sleep quality (Pittsburgh
Many aspects of human physiology and Sleep Quality Index), physical activity and
behaviour are adapted to the 24-hour light/ quality of life. Employees (N ¼ 49) with a
dark cycle generated by the Earth’s rotation. window in their workplace got significantly
This 24-hour rhythm has a major impact on more natural light exposure (p50.05) and
human health and well-being,50 and all per- their actiwatches registered on average 47
ipheral organs have autonomous, light- minutes more sleep (p50.05).
responsive oscillators. The 24-hour, or circa- Arns et al.60 studied the relationship
dian, clocks use daylight to synchronize between the prevalence of attention-deficit/
(entrain) to the organism’s environment.51 hyperactivity disorder (ADHD) and solar
Studies from Roenneberg et al.52 strongly intensity (SI) on the basis a cross-state
suggested that the human circadian clock is (study 1) and multinational study (study 2).
predominantly entrained by sun time rather In the datasets, a significant relationship
than by social time. In 2001, two research between SI and the prevalence of ADHD
groups53,54 used the effect of light to suppress was found (Study 1: 2003: p50.000;
nocturnal human melatonin secretion as a r2 ¼ 0.637, 34% variance explained; 2007:
marker of an effect on the circadian system. p50.000; r2 ¼ 0.580; 41% variance explained;
The observed action spectrum for melatonin Study 2: p ¼ 0.018; r2 ¼ 0.758, 57% variance
suppression showed short-wavelength sensi- explained). Approximately, 80% of adult
tivity very different from the known spectral ADHD patients and one-third of children
sensitivity of the scotopic and photopic with ADHD suffer from sleep onset insom-
response curves. The non-visual alerting nia, characterized by a delayed circadian
effects of light during night time appear to be phase and delayed melatonin peak, which
related to melatonin suppression.55 The could be the result of increased use of modern

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14 MBC Aries et al.
(social) media (iPads, mobile phones), espe- Season of the year is known to affect the
cially shortly before bedtime. According to nocturnal rise in melatonin67. Melatonin is
the researchers ‘the apparent preventative involved in a variety of diseases, including
effect of high SI [solar intensity] on ADHD cancer, insomnia, depression, dementia,
[attention-deficit/hyperactivity disorder] pre- hypertension and diabetes. The daylight
valence might thus result from the ability of photoperiod was specifically linked to breast
intense natural light during the morning to cancer. Women with malignant tumours
counteract the phase delaying effects of appeared to have significantly lower 24-hour
modern media in the evening, thus preventing concentrations of aMT6s (6-sulphatoxymela-
the delayed sleep onset and reduced sleep tonin) compared with women with benign
duration’.60 tumours. A study by Obayashi et al.68 showed
Seasonal changes in day length (photo- that daylight exposure (at least 1000 lx
period) and linked night length (scotoperiod) between 37 and 124 minutes, mean 72 min-
induce changes in the duration of melatonin utes) in an uncontrolled daily life setting is
secretion at night. The duration of nocturnal positively associated with urinary 6-sulpha-
melatonin secretion is longer in winter than toxymelatonin excretion in the elderly.
summer and triggers seasonal changes in Environmental lighting can induce or modify
behaviour.61–63 In general, alterations in changes in human gonadal function. A study
monoaminergic neurotransmission in the with blind versus non-blind girls showed that
brain are thought to underlie seasonal vari- puberty developed earlier than normal in blind
ations in mood, behaviour and affective dis- girls. In a study with rats, nocturnal animals,
orders.64 SAD is a syndrome characterized by puberty developed later than expected in blind
recurrent depressions that recur every autumn/ laboratory rats. The difference was explained by
winter. The lack of sufficient natural daylight the fact that humans are active diurnally.69 A
in winter is often thought to be the reason more recent statistical analysis by Flynn-Evans
behind SAD.63,65 The reduction of depression et al.70 was conducted to determine whether
due to exposure to daylight is not fully differences exist in reproductive measures
understood yet. Several researchers have among blind women (N ¼ 1392) with at least
shown that the prevalence of self-reported light perception (LP) compared with women
depression was surprisingly low in winter with no perception of light (NPL) in a cohort
(SAD-season) considering the lack of day- study. Student’s two-sample t-tests and multi-
light.21,22,66 The study of Lambert et al.64 variate logistic or linear regression were con-
showed that the turnover of the monoamine ducted to get statistical results. The findings
neurotransmitter serotonin by the brain was suggested as well that lack of LP affects
lowest in the Australian winter (non-SAD- reproductive development in women (odd’s
season). Serotonin has a role in the develop- ratio NLP vs. LP from birth was 0.88; 95%).
ment of seasonal depression. The rate of A parallel study based on the same group of
production of serotonin by the brain was women by Flynn-Evans et al.71 used multi-
directly related to the prevailing duration of variate-logistic regression models. These
bright sunlight (r ¼ 0.294, p ¼ 0.010), but it was showed that blind women with NPL appear to
not related to the hours of sunlight on the day have a lower risk of breast cancer, compared
before the study. The authors also found that, with blind women with LP (odds ratio, 0.43;
irrespective of the month of the year, turnover 95%), the indirect effect of light may go far
of serotonin in the brain was affected by acute beyond the influence on glandular functions
changes in light intensity, with values being only, potentially with a role for urinary
higher on bright days than on dull days.64 6-sulphatoxymelatonin and melatonin.

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Regular physical activity is crucial for serotonin levels, human gonadal functioning,
human health and it stimulates the level and breast cancer and obesity) or psychological
duration of independence of older people. (alerting effects, burn-out and SAD). The fact
Weather is widely believed to influence that effects of daylight were more frequently
people’s health, mood and their physical found when searching under specific medical
activity level. Particularly among older conditions suggests that much of the current
people, physical activity levels are much literature is aimed at solving medical condi-
higher in summer than in winter. Day tions instead of providing healthy indoor
length, sunshine duration and maximum environments.
temperature have a significant influence on The found studies in the two databases
physical activity levels.72 Brown adipose search were rather limited. It was expected to
tissue (BAT) is present in adult humans and find more studies. Moreover, different scien-
may be important in the prevention of obes- tific proof regarding daylight and health
ity. The study of Au-Yong et al.73 demon- effects was actually found by searching on
strated a very strong seasonal variation in the effects directly, which shows there may be a
presence of BAT relating to ambient tem- missing link in choice of words for titles,
perature and photoperiod. This effect was abstracts, search options or key words.
more closely associated with photoperiod The studies in the two databases were all
(r2 ¼ 0.876) than ambient temperature checked for several information elements,
(r2 ¼ 0.696). The authors studied 3614 con- necessary to assess the initial quality of the
secutive patients and performed a 2 test. study. The results show that all but one of the
selected studies reported on the used methods
4. Discussion and statistical outcomes. It was striking that
illuminances or light exposure were only very
4.1. The influence of daylight on health: The occasionally documented. Only one paper, by
scientific evidence Mottram et al.15, reported actual illuminances
Humans have evolved under the influence with regard to daylight exposure. The lack of
of daylight and its light–dark cycle. This is daylight levels makes it hard to find a
probably why people believe that daylight is consistent conclusion regarding daylight
positively related to human health. Some of influence, especially since the intensity and
the found and investigated studies reported duration of daylight changes over the day and
results on ‘general health’. More specific year. Also the distinction between exclusive
health issues reported are either physiological daylight exposure or a combination of day-
(work-related headache, activity level, heart light and electric lighting is not documented,
attack/myocardial infarction, insomnia and which makes a conclusion relating the effect
breast cancer) or psychological (depression, of daylight impossible.
burn-out, SAD, mental distress and suicide). Multiple studies have found a significant
Objective health measurements that are used influence of the difference in daylight hours
are ‘activity’ (by means of an accelerometer, per day (photoperiod). The focus of all
actiwatch or pedometer), ‘salivary cortisol’ studies was on daylight in general or the
(samples) and database contents regarding photoperiod specifically. No research was
‘heart attack’ and ‘suicide’. The results found found related to the dynamics of daylight,
when searched for more specific relations are other than day length.
also either physiological (visual acuity, eye- Multiple studies used techniques that focus
strain, headache/migraine, epilepsy, autism, on obtaining subjective results (self-reported
body height, birth weight, bilirubin levels, health effects, SAD-questionnaire answers,

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16 MBC Aries et al.
etc.). In some cases, questions were not openings,1 provided thermal or visual dis-
specifically designed for daylight and health comfort are absent. The current design of
research, but were part of a more extensive buildings does not allow this for all users.
questionnaire related to general health. The The reason why people prefer a window seat
questionnaires reported are, therefore, very cannot entirely be explained. It is unknown
different, and in most cases a copy of the whether there is a connection or association
questions was not available via the paper. with health or comfort effects. Potential rea-
Some studies reported results on ‘general sons are the relationship with the view outside
health’. No specific questionnaire focusing with its inextricable supply of information/
on daylight and health was found. view, the quantity of daylight (both high and
Most found studies were executed with low), the presence of the full continuous
daylight as light source; some studies used a spectrum, the (change in) directionality and/
combination of light sources (daylight and or the dynamics from milliseconds to months.
electric lighting). However, conclusions are The maximal seating distance to the window
not always exclusive to daylight only. For for a good daylight experience is not known.
instance, studies that prove that daylight The dynamics in daylight availability vary
makes people more or more efficiently alert from months to milliseconds. Many health
than electric lighting or show the effect on effects are stimulated via ocular light expos-
gonadal functioning and breast cancer exclu- ure, and the origin of the trigger (i.e. photo-
sively related to daylight rather than to period) can be far in the past (i.e. before or at
electric lighting do not exist (yet). birth). The brain structures and functions to
measure changes in day length are still present
4.2. Daylight quality in humans, though mostly not directly appar-
In 1929, the French architect Le Corbusier ent. Much stronger is the existence of a
said that ‘the history of architectural mater- circadian rhythm as manifested by the sleep/
ial . . . has been the endless struggle for wake cycle. The endogenous rhythm of the
light . . . in other words, the history of win- human body clock is usually slightly longer
dows’. Most architects are devoted to daylight than 24 hours and thus needs a daily morning
since they know that no other building com- light signal to reset the clock to entrain with
ponent has such a significant impact on their the Earth’s 24-hour rotation rhythm and the
design of a building than daylight openings. changing photoperiod. Health effects as a
People in the Western world spend result of different levels of daylight variations
approximately 80–90% of their time indoors are largely unknown. Additionally, variations
and therefore buildings play an important in light dynamics are introduced by lighting in
role in providing a healthy daylight environ- computer screens, electric lighting or lighting
ment. Daylight exposure outdoors means full and shading controls. These manmade fre-
exposure to solar radiation with all possible quencies can support, substitute or counteract
positive and negative health effects. Indoors, daylight frequencies, and therefore trigger or
people’s exposure is basically limited to vis- reduce health effects. Certain effects of day-
ible and IR radiation, even though glass light are related to the moment of birth and
innovations attempt to limit the IR contribu- the photoperiod. These effects have no con-
tion significantly due to thermal discomfort. sequences for the design of the built environ-
The design of the building and its floor plans ment, but demonstrate potential unknown
largely dictates how the building can and will influences of the changing photoperiod.
be used. Humans overwhelmingly prefer The daylight spectrum represents all wave-
working, learning and sitting near daylight lengths of the solar visual spectrum. Studies

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related to isolated parts of the sunlight due to the higher quantity (and often a better
spectrum are not known, but studies with colour rendering index), enabling better visual
electric lighting are available. For example, performance. Indirectly, vision can influence
Brainard et al.54 and Thapan et al.53 found the occurrence of depression. The sensitivity
effects of the bluish part of the light spectrum of the human alerting and cognitive response
(max ¼ 459–482 nm) on the suppression of to polychromatic light at levels as low as 40 lx
nocturnal melatonin. Gooley et al.75 found is blue-shifted relative to the three-cone visual
that short-duration (590 min) exposure to photopic system.58 Daylight intensity is much
light from the greenish part of the light higher than 40 lx during most of the day.
spectrum ( ¼ 555 nm; 24 lx) was as effect- Alerting affects general human physiology
ive, if not more effective, than an equivalent and behaviour: The human body evolved and
photon dose of 460-nm light (2 lx) in adapted in order to react to external triggers,
causing a circadian phase shift. with the 24-hour day/night cycle as one of the
Sahin and Figueiro76 found that a 48- most important ones. People tend to prefer
minute exposure to short-wavelength (blue) the high light levels of daylight, but do not
light (40 lx, max ¼ 470 nm) and long-wave- (always) follow the natural variation in day-
length (red) light (40 lx, max ¼ 630 nm) light.80 High radiation intensities are not
equally affected human electroencephalogram always desired since this radiation contains a
measures indicating that acute melatonin lot of energy which influences the heat load of
suppression is not needed to elicit an alerting the building. However, high light levels are
effect in humans. Interaction effects between beneficial for groups such as older adults who
different wavelengths and intensities are not require more light to perform well visually,
further studied in the study of Sahin and but the opposite is true for people who suffer
Figueiro.76 However, Brainard et al.54 and from migraine or have autism. There is a
Thapan et al.53 performed a full action potential link between daylight and the inci-
spectra analysis for melatonin suppression dence of migraine. Daylight openings without
and both found a greater sensitivity of mela- or with inadequate luminance screening or
tonin suppression to shorter wavelength light. shading devices can lead to a large contrast
The study of Gooley et al.75 suggested a between the daylight opening and the interior
wavelength-dependent effect on circadian walls surrounding the opening. Cowling
phase shift. This implies that multiple, if not et al.38 concluded that working in a building
all, parts of the light spectrum, at different with highly reflective windows and the pres-
intensities play a role in triggering human ence of blinds/curtains suggested the lowest
visual and non-visual effects. Glazing is able frequency of severe fatigue and eyestrain.
to filter certain parts of the radiation spec- Complaints of eyestrain may be related to
trum, depending on the type. The question those of headache by a common neurological
whether full-spectrum electric lighting can mechanism.37,80 In order to reduce triggers
replace daylight is not proven. According to for neurological attacks due to the high levels
some studies77,78 there is evidence that full- of daylight and often occurring large contrast,
spectrum electric lighting has comparable controllable protection should be provided.
influence on, for example, cortisol and Aries et al.82 found that both view type and
stress-related effects. However, the review of view quality had a significant influence on
McColl and Veitch79 revealed little support physical and psychological discomfort. In
for it. this research, only the view itself was taken
Human vision under daylight conditions is into account, despite possible differences in
normally better than under electric lighting view luminance. Surprisingly, nature views

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18 MBC Aries et al.
increased discomfort directly while view qual- health consequences, despite the omnipresent
ity negatively predicted discomfort (better attention this supposed relation is receiving.
quality view was associated with lower dis- This may sound rather counterintuitive.
comfort). In relation to eyestrain, people Nowadays, humans spend the majority of
should have the possibility to focus on distant time indoors, where they are often exposed to
objects, for example, by means of a view poor lighting, both in terms of quality and
outside. At the same time, the minimum quantity. The amount of daylight people are
distance is yet unknown. This may be relevant exposed to indoors via windows is lower than
for the further development of (virtual) win- the exposure outdoors. Further research is
dows and the basic design of buildings and required to establish the nature of why some
the surrounding landscape. people prefer non-visual stimulating lighting
and others do not. Also, dose–response curves
4.3. Practical implementations for alertness, performance and mood to
Even though the majority of relevant daylight need further investigation. In order
information regarding daylight and health to ensure that the effects due to daylight
design is not known or only very limited and exposure are not only applicable to people
much more research is necessary, some first with certain (health) conditions, future work
practical implementations for building design should focus on the effect of daylight on the
are shown in Table 5. Nevertheless, these first health of the general population.
recommendations can be followed by archi- Fortunately, the search on specific health
tects and building physicists during the design keywords produced more results, which were
of buildings and rounds of consultancy. divided into three categories according to their
association with daylight: ‘positive’, ‘negative’
and ‘both positive and negative’. Nevertheless,
5. Conclusions the improvement regarding choice of words in
titles, abstracts, search options or key words
There is only limited statistically significant could help finding scientific evidence or know-
and well-documented scientific proof for ledge gaps. If the relation between daylight
the link between daylight and its potential and health is fully understood and actually
Table 5. First practical implementations for daylight and health building design
Create daylight openings that can be opened to allow occasional exposure to the full radiation spectrum (including
ultraviolet and infrared radiation)
Design buildings with floor plans that stimulate people to go outdoors, either via the ground floor or via (protected)
verandas and balconies; independent of the weather conditions
Aim for rooms with relatively high daylight levels (E42000 lx on average vertically) and provide controllable sunlight
and luminance protection (blinds, screens, etc.) on all daylight openings. The shading/protection gives people the
opportunity to control and dose the entering light for the prevention and reduction of eyestrain, headaches,
migraines, discomfort or disability glare, or photosensitive epilepsy, but maintains the option to have enough
daylight quality and quantity for, for example, older eyes
Provide automated controls over blinds, luminance screens and shading that allow daylight access to the fullest.
Especially in periods with sunrise and sunset during work time (winter time on the northern hemisphere), the
daylight opening should be uncovered to expose people to the change in photoperiod. However, users should be
able to override the automated control at all times in order to meet personal comfort and health criteria (see also
the previous implementation)
Apply glazing that allows the transmittance of full-spectrum light in order to provide indoor lighting with all parts of
the visual spectrum represented so interaction effects between different wavelengths and intensities can naturally
occur and are undisturbed

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scientifically proven, future daylight design in 8 Osterhaus WKE. Discomfort glare assessment
buildings will no longer be a mere recommen- and prevention for daylight applications in
dation, but an obligation. office environments. Solar Energy 2005; 79:
140–158.
9 Velds M. User acceptance studies to evaluate
Funding discomfort glare in daylit rooms. Solar Energy
2002; 73: 95–103.
10 Boyce PR. Human Factors in Lighting.
This research received no specific grant from London: Taylor and Francis, 2003.
any funding agency in the public, commercial 11 van Hoof J, Westerlaken AC, Aarts MPJ,
or not-for-profit sectors. Wouters EJM, Schoutens AMC, Sinoo MM,
Aries MBC. Light therapy: Methodological
issues from an engineering perspective.
Acknowledgements Technology and Health Care 2012; 20: 11–23.
12 Hobday RA. Sunlight therapy and solar archi-
The authors are very grateful to Professor tecture. Medical History 1997; 41: 455–472.
Emeritus Anna Wirz-Justice PhD for her 13 WHO. Definition of health. Preamble to the
valuable comments and helpful remarks on Constitution of the World Health
the initial version of the review. Organization as adopted by the International
Health Conference, New York, 19–22 June,
1946; signed on 22 July 1946 by the represen-
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