lighting and health symposium notes

Y:\0702 CEC PIER LRP2\0702e Market Connections\Lighting and Health Symposium\LightingHealth_SymposiumNotes_Day12_HMGFormat LH.doc, David Douglass

Lighting and Health Symposium Notes

Heschong Mahone Group, Inc.

March 13 -14, 2008

HESCHONG MAHONE GROUP, INC.

11626 Fair Oaks Blvd. #302 Fair Oaks, CA 95628

Phone:(916) 962-7001 Fax: (916) 962-0101

e-mail: [email protected] website: www. h-m-g.com


TABLE OF CONTENTS

1. INTRODUCTION .........................................................................................................5

2. DAY ONE ......................................................................................................................7

2.1 George ‗Bud‘ Brainard, PhD: Photoreception for Non-optical Systems ...........7

2.2 David Sliney, Ph.D., Photo-biology and Eye Structures ...................................8

2.3 Joan Roberts, Ph.D, Circadian Biochemistry .....................................................9

2.4 Chuck Fuller, Ph.D., Circadian Rhythms in Health and Disease ...................10

2.5 Dr. Jamie Zeitzer, Ph.D., The Biological Functions of Sleep ..........................11

2.6 Dan Kripke, M.D., Lighting Effects on Mood and Sleep ................................11

2.7 Glenna Dowling, Ph.D., circadian Implications for Gerontology ...................11

2.8 Scott Davis, Lighting Effects on Wildlife and Ecosystems .............................12

3. DAY TWO ...................................................................................................................14

3.1 George ‗Bud‘ Brainard, Ph.D., Lessons from Day One ..................................14

3.2 Day Two, Panel 1: Design Issues ....................................................................16

3.2.1 Lisa Heschong, Architect, Implications for Building Design .................. 16

3.2.2 Sam Berman, Ph.D., Implications for Lighting Practice ......................... 16

3.2.3 Naomi Miller, FIES, Balancing Visula Needs and Circadian Health ..... 17

3.2.4 Panel One Discussion: ............................................................................. 18

3.3 Panel 2: Behavioral Issues ...............................................................................19

3.3.1 Scott Slotterback, AIA, Evidence Based Design in Hospitals .................. 19

3.3.2 Eve Edelstein, Ph.D., Understanding Human Needs in Buildings........... 19

3.3.3 Carrie Armel, Ph.D., Energy Impacts of Behavioral Choices ................. 20

3.3.4 Panel Two Discussion: ............................................................................ 20

3.4 Panel 3: Lighting Research Issues ...................................................................20

3.4.1 Francis Rubinstein, FIES, The IESNA Research Agenda ........................ 20

3.4.2 Luis Lomelino Fernandez, Ph.D., Implications for Lighting Industry ..... 21

3.4.3 Naomi Miller, FIES, Lighting for Human Needs .................................... 21

3.5 Panel 4: State Policy Issues..............................................................................22

3.5.1 Tim Tutt, California Energy Commission, California Policy Issues ....... 22

3.5.2 Dan Burgoyne, AIA: California Department of General Services .......... 22

3.5.3 Steve Blanc, PE, PG&E, Implications for Energy Codes ........................ 23

3.5.4 Diane McLean, AIA, SCE, Implications for Utility Programs ................. 23

3.6 Planning Next Steps, Discussion .....................................................................23


1. INTRODUCTION

The Lighting and Health Symposium brought together daylighting design and energy

policy experts with circadian health, doctors and researchers for two days of

presentations and panel discussions at PG&E‘s Pacific Energy Center in San Francisco,

on March 13 and 14, 2008.

In addition to support from PIER for this project, the Lighting and Health Symposium

was also co-funded by the Illuminating Engineering Society of North America (IES),

Pacific Gas and Electric (who also hosted the event), and Southern California Edison,

with support in-kind from CLTC. Presentations and discussion topics covered the

implications of newly discovered photoreceptors, including their circadian effects,

disease and mood impacts, building design implications, behavioral impacts and

ecologically sensitive lighting. The symposium provided opportunities for synergies

between the fields of lighting design, engineering, policy and medical research.

The consensus among the 50 invited participants was that such an event was all too rare,

and that there was great need for continued collaboration and research to better

understand the connections between light and health. Participants identified

opportunities for future cooperation, and venues and publications for continued outreach.

Figure 1: A discussion of photoreceptors in the human eye during the Lighting and

Health Symposium

The 4-page brochure, including agenda and biographies of participants, is included in the

Appendix, briefly summarizing the presentations and discussion. The individual

presentations were not archived.

The ten speakers on the first day focused on recent findings in the science of how light

interacts with the circadian systems and its implications for human and animal health.

The fifteen speakers on the second day brought in engineers, designers and policy experts

to discuss the implications for building design and the policies that effect building codes,

standards and energy efficiency programs.


The following summary of the event was compiled from notes taken by a number of

participants. It is NOT a definitive record of what was presented or discussed, nor has it

been reviewed or approved by the presenters, thus this report should NOT used reference

material or quoted.

Rather, it is meant to provide an overview of the range of topics covers and perhaps serve

as a foundation for future events. Bullet points were compiled to make complete

statements, but left out much contextual information and detail. Much discussion was

missed in the notes. We apologize if any information is incorrectly transmitted. We

strongly urge readers of this document to follow up by finding and reading the original

papers and journal articles by the various presenters.


2. DAY ONE

The speakers and audience were welcomed by Lisa Heschong, who introduced of all

speakers and attendees present, and thanked the sponsors The first day concentrated on

recent findings in medical fields relating to light exposure and circadian health. The

second day concentrated on implications for building design and energy policy. There

was ample time for questions, discussion and informal conversations. The goal was to

increase contextual awareness and networking on these topics and to lay the ground work

for future collaborations and cross-fertilization.

2.1 George ‘Bud’ Brainard, PhD: Photoreception for Non-optical Systems

Introduction

The rising and setting of sun is a geophysical stimulus. For generations we were hunter

and gatherer society – where the stimulus was light and dark. Humans like other species

have a physiology internal to our biological system that allows us to adapt to time of day

and year. Lighting comes into the eye (allows us to see the world), goes through the

lgn/igl and into the visual cortex. What is less obvious is that light also travels through a

non visual part of the brain (SCN) an internal clock mechanism, communicating with

other parts of the brain and the spinal cord. This is a more complex, indirect pathway

bringing light to a deeper part of the brain that would not otherwise be able to see light.

Melatonin

The pineal gland creates melatonin. There is low production of melatonin during the

daytime hours, much higher during night. Same for birds, fish, insects, even single cell

creatures (where there is no brain, no eye, no pineal gland, but yet creates the same

signal, thus nature has conserved this signal throughout species). It doesn‘t matter what

kind of temporal environments they inhabit, what their sleep cycle is like, and despite this

behavioral activity, there is roughly the same melatonin production throughout species.

A turning point study,

1980 Al Lewy and Tom Wehr: This study exposed healthy men to bright white light and

showed that the acute exposure caused a rapid reduction of hormone secretion and

production. Normal levels of home and office light did not have this effect. This changed

the past experience and thoughts that such things did not effect humans, but only other

species and launched many people into looking into the issue of light effecting the

humans.

Action spectrum

If white light can evoke responses what is the different potencies of different types of

light, are there different response to different wavelengths?

We conducted an experiment where we used a very strong lamp, filtered it for specific

wavelengths, and put it into a dome, exposed these subjects during 2-3:30 am. Test


ranged from short violet indigo 420 to orange-red long wave 600 nm. We found high

correlation .91 to melatonin suppression at a peak sensitivity of 464nm, +- 1 standard

deviation. This did not match existing known opsins. Thus, there must be something else

doing photo detection beyond the visual.

We now know there are two sensory systems in the eye (photoreceptors = rods and cones;

ganglion cells). This was found in 2000. Melanopsin in the ganglion cell can detect light

without the typical rods and cones. There is intercommunication between the two

systems. Not all ganglion cells contain melanopsin. If you destroy photoreceptors you

cannot see, but you still may experience circadian regulation. If you destroy melanopsin

you can see and you experience limited circadian regulation (i.e. there is cross talk

between the systems)

Light Therapy

Other effects of light on body function include: Body temperature; Heart rate; Alertness;

Cognitive performance; Brain blood flow; EEG responses; Clock gene expression;

Psychomotor performance.

Clinical treatments have included seasonal depression, non-seasonal depression, selective

sleep disorder (biological clock where it interferes with sleep), menstrual disturbances,

eating disorders, senile dementia (addressing some of the symptoms).

NASA has become especially concerned about sleep quality for astronauts. (Ed note:

Both Bud Brainard and Chuck Fuller do research for NASA) In space, sleep is

compressed. Astronauts are supposed to sleep 8 hrs, but actually only sleep 4.5-6hrs.

We learned that most astronauts take an astronomical amounts of sleep aids (45% of all

medications consumed). Since space exploration is getting longer and longer in duration,

lack of sleep could have disastrous effects over the long term.

We have been testing the efficacy of various spectrums, for both artificial and natural

sources. Moonlight is rich in red spectrum, deficient in the blue balance. Need to factor

in filtering of windows in space capsules.

How does this affect Californians? 40% of people work on swing shifts, night, early

morning etc. This distorts their biological rhythms, which can increase health problems,

accidents.

New Opportunities

There is an open door in front of us, to explore the workings of a new sensory system.

But from the application side, this will affect the technologies used in the built

environment, such as both active and passive lighting. The thousands of new technologies

which may arise are not planned to address circadian rhythms directly, but could have

unintended consequences.

2.2 David Sliney, Ph.D., Photo-biology and Eye Structures

This talk will discuss the visual spectrum and its relation to the photobiological action

spectra. What are the action spectra effects? Some are hazardous, some are not.

Ultraviolet light is a well-known hazard. Blue light is not as well known, but its effects

are understood. Both involved relatively limited spectral bands.


We need to distinguish between a thermal or a photochemical effect. Blue light hazard

can create thermal retinopathy. We do know that blue light can be relatively toxic,

especially in large does and bright light.

It takes time to adapt to bright light, 90 seconds for example when the sun is above you.

Adaption time is always an issue of eye safety with any use of blue light, or high

saturation of light.

Spectrum and intensity changes with the path length through the atmosphere, though

great change in short wavelengths. There is a tremendous change in terms of effects of

exposure at different times of day 7-10 am vs. 12-3pm. Ultraviolet hazards to skin and

eye become more serious.

Hazards involve not just spectrum but also the spatial distribution of light. Different parts

of the retina are not uniformly illuminated. Review structures of eye.

Ocular exposure geometry is complex due to environmental variability, such as cloud

reflections, molecular scattering, direct, haze, clouds, ground reflection (a big factor), tree

blockage, buildings.,etc. Black asphalt has about 10% reflection , grass 1%, thus 10x

more reflection upwards from the paving.

The lid opening determines the area of the inferior retinal hemisphere exposed to

sunlight. We‘ve done lid opening studies, and corresponding vertical visual fields. The

lid closes down linearly with increasing luminance, but with great variation between

subjects. This means that part of the inferior (lower) retina is usually exposed to lower

light levels. This is why the upper macula area has earlier signs of age than the lower part

The spatial distribution of blue light and UV is not uniform. We can combat reflective

glare through polarizing lenses. Eskimos developed ―slit‖ lenses to scan horizon while

blocking much upward reflection and downwards radiation.

There are implications for indoor lighting. We need to think about energy efficiency, but

also of spectrum and health implications. A change in spectrum with the time of day can

be desirable. With the increased use of energy efficiency and solid state LED lighting this

is possible, so don‘t overlook it, such as using fluorescent in day, incandescent at night.

Increased of daylight could provide this change as well

Remember: it is important to think about both the spectrum and the geometry of

exposure. The blue LEDs suggested by some for light SAD treatment crosses into the

blue light hazard spectrum.

2.3 Joan Roberts, Ph.D, Circadian Biochemistry

The eye is exquisitely sensitive to light and can be both helped and harmed by it. To have

an effect, the wavelength of light must reach the biological tissue. The longer the

wavelength, the deeper the penetration. The shorter the wavelength, the more energy

content, and thus the more potential for hazard. The eye can block a small amount of UV

(absorb), but as you get older you lose that capability. As you get older the responsible

chromophore does not diffuse as well, yellowing the lens and cutting off short blue

visible light.

The circadian rhythm doesn‘t just control the sleep wake cycle. The stimulation of the

SCN affects the pituitary gland effecting fertility, the adrenal gland, blood pressure, and


metabolism. Many biochemicals are affected by light. Your body makes serotonin in the

light, and melatonin in the dark. Others include neurotransmitters, such as dopamine and

acetylcholine, and neuropeptides.

If the human circadian clock is out of sync, results can be seasonal depression, jet lag.

Shift work has been shown to increase susceptibility to cancer. It is a circadian

imbalance, - sleep disturbance, confusion, poor coordination, carbohydrate cravings, also

effects your immune response. This is because the immune system is not only a part of

the mood change and seasonal change but also changes the ratio of white versus b- and t-

cells. Every b cell and t cell has receptors for neurotransmitters, or peptide hormones, the

system will either activate or suppress these transmitters and hormones.

Thus, human immune response is circadian: B cells – allergies are worse in the morning,

T cells and n killer cells are activated at night. A new spinoff of this understanding is

chronotherapy: i.e. consider the time of day when treating a particular disease. If you

treat some cancers at night or with the presence of melatonin, the treatment can be 3

times more effective.

Humans are not supposed to have exposure to much light at night. Humans evolved under

spectrum with differences between morning afternoon and evening. At night unless you

have lots of stars or the moon. When you design lighting it may be best to mimic mother

nature.

2.4 Chuck Fuller, Ph.D., Circadian Rhythms in Health and Disease

Circadian timing system and why it is important: It is a physiological system responsible

for temporal coordination of the physiology and behavior of an organism.

There are many oscillating events that cycle daily – both internal and external. The

observation that there is a biological clock is old –Jean Jacques d‘Ortous de Mairan 1729.

He noticed that a plant extended its leaves during the day regardless of whether it saw the

sun. We now know that many rhythms are coordinated by the internal clock: potassium,

growth hormones, reproduction, cognitive performance…much more than just sleep.

Effects of chemotherapeutic agents, radiation, bacterial infections are different at the

different times of day. Those individuals that are the most sick in ICUs or care facilities

often have the least time cues. This could impact their recovery. In one study the

presence of light changed the immune function, diminished by almost 50% after one

week. Light acts via the SCN to maintain temporal synchrony, loss of this can result in

compromised health. It is also involved in regulation of sleep wake behaviors.

The biological clock maximum is occurring later for both girls and boys, but much more

radically in girls than boys: their peaks change as they age, and don‘t necessarily fit into

the school schedules.

Modern lighting and public health: concerns about increased light pollution at night.

Modern street lights also emit more blue light wavelengths. Does this pose danger to

long-term human health?


2.5 Dr. Jamie Zeitzer, Ph.D., The Biological Functions of Sleep

What happens during sleep? How does the brain create sleep? How diodes light impact

the regulation of sleep?

Our body is not the same during sleep than during the day. It is not just the absence of

function of wake, there are active things occurring. Thermoregulation – active and

passive heat loss, reduced environmental responsiveness. Homeostasis. Cardiovascular

system – decreased cardiac function, increased variability in heart rate. Kidney – lower

volume and more concentrated urine. Stomach – less digestion. Endochrine changes

some hormones suppressed (thyroid stimulated hormone), some things are enhanced

(growth hormone), some not affected (cortisol). Respiration changes – increased airway

resistance, decreased responsiveness to external stimuli. Musculature – relaxed or

actively suppressed, you do not move during rem sleep. Overall reduction of body

function, saving energy reducing wear and tear. Memory consolidation – integrate daily

experience into the existing network of what is known. Reduced energy use – metabolism

down. Cellular maintenance – cleaning up the junk that has moved around all day and

resting your brain for the next day

What creates sleep? Many parts of the brain work on it. Most functions of sleep are

Circadian – predictive; Homeostatic – reactive. The longer you stay awake the more

pressure you have to go to sleep, so your peak drive for wakefulness happens right before

you are supposed to go to bed (at your sleep threshold). ―Second wind‖, occurs at about

hour 36, between hour 30-36 you have a homeostatic pressure to sleep in addition to

circadian pressure. Once that time has passed, the pressure goes down resulting in the

second wind effect.

2.6 Dan Kripke, M.D., Lighting Effects on Mood and Sleep

The human species is designed for more than 1 hr of daylight, but we don‘t get this in

modern society. We did a study to look at the average light exposure of the San Diego

population, which averaged less than an hour of daylight. People who get less light than

the median tend to be more depressed and have more sleep complaints.

Light therapy: There are a multiple studies that have proven that light can improve

depression, both seasonal and not. There is relatively high confidence that light works

better than antidepressant drugs. Treatment of depression usually requires 30 min to 1 hr

of 10,000 lux or 2-4 hrs of 2,000 lux.

We don‘t yet have a good idea of how much light will produce the best effect. Bright

morning light is needed by adolescent and young adults soon after getting up as possible.

School rooms may be too dark. Evening light may be important for elderly: people tend

to fall asleep to the TV and sit in dark living rooms with just the TVs on.

In conclusion, in workplaces and homes we need to be able to achieve 500 to 1000 lux

for at least some of the day.

2.7 Glenna Dowling, Ph.D., circadian Implications for Gerontology

Both the very old and the very young ―nap‖ more than adults do. Their sleep patterns are

more disrupted, especially adults with dementia. People who are institutionalized or have


dementia are exposed to much less light than most other people. A 60 year-old requires

three times as much light to achieve the same visual acuity as a 20 year-old, due to

yellowing of macula and thickening of lens.

Older people go to bed with lower melatonin levels and wake up with higher levels.

Thus, there is a decrease in the amplitude of the rhythm with older population.

Possible mechanisms include changed clocks, decreased input to the system (decreased

illumination, decreased capacity of lens to transmit light, decreased physical activity,

social activity), decreased sensitivity to input.

Consequences include over 80% of elderly complain of some kind of clock problem.

Disturbances cause respiratory problems, cardiovascular problems, decreased immune

function, depression, decreased cognitive function. At its extreme, the result is people

cannot care from themselves as much, at a high cost to society.

Potential Treatments: Many older people take hypnotics and they don‘t actually work

very effectively. Melatonin use has had mixed results. This is particularly mixed in older

adults. It is unclear whether acute intake rather than over the long term is more effective.

Timing can also have different effects. Remelteon is a new melatonin receptor agonist.

This is good for sleep onset insomnia, but we have no good data on long term effects or

side effects. Regular and strong 24 hour ‗zeitgeber‘ input can have a real effect including

social interaction, light, meals, physical activity. Acupuncture has been tried.

Manipulation of the circadian temperature profile – hot baths for example – have also

been tried.

Conclusions: Aging is associated with decrements in the circadian timing system.

Anything we can do from the external environment to help shore up the symptoms would

be useful.

2.8 Scott Davis, Lighting Effects on Wildlife and Ecosystems

Scott‘s PowerPoint presentation was presented by Lisa Heschong, since Scott had to

leave suddenly.

The basic physiology that we have learned today is also applicable to animal species.

Outdoor lighting has only been around for 100 years and it is a huge growth business.

Humans like to expand their ecosystems by spreading day wherever we go. Humans feel

safer in the light, we cannot prove that they are, but they feel that way. This a huge driver

for street lighting.

Animal species have the same melatonin function as humans. It is disrupted by exposure

to light at night.

80% of the species on the endangered species list in San Diego are nocturnal. Especially

in desert environments, there are no trees to block the lights. Mating cycles are often tied

to lunar cycles and this has been disrupted. Migration patterns of birds, their travel at

night and the impact of the bright areas they are traveling through

Light pollution is affecting evolution. This is especially clear with moths and fireflies.


3. DAY TWO

3.1 George ‘Bud’ Brainard, Ph.D., Lessons from Day One

We learned from Lisa Heschong that ―Health can be a scary word‖, especially when it

invokes crossing regulatory boundaries. Interdisciplinary work is always difficult. It is

often difficult for us to understand each other‘s technical jargon, our professional

constraints, and even get the timing right so we can talk to each other. This event is an

important step in the right direction to cross those barriers

The following are some of the highlights of the previous day, along with a few additional

supporting facts or perspectives.

Brainard

We now understand that the eye has at least two functions: a visual system and biological

regulation. We understand that radiation in the blue portion of the spectrum is particularly

potent for the biological regulation system.

We understand that light has pharmacological effects, and it is being used as a healing

agent. Logically, anything that has the ability to heal may also have the ability to harm.

Sliney

Dave Sliney provided us with a very good overview of the known hazards of light

exposure, especially from UV and blue light, and explained that exposure changes greatly

depending on the geometrical relationship of the light source to the eye.

Roberts

Joan Roberts showed us that light impacts not just about the pineal gland but also many

other different parts of our bodies. And circadian response involves not just melatonin,

but a whole host of hormones, neurotransmitters, and other biochemical systems.

Brainard points out that the three human systems, the endocrine, the nervous, and the

skeleton-muscular systems are rarely looked at together and are even more rarely are

medical students introduced to the connections between these systems.

The hypothesis is that industrialized societies with increased electric light exposure have

a higher breast cancer risk. It is important to emphasize this has not been proven, but that

an association has been found. For example, we see decreased risk of breast cancer in

blind females, increased risk in shift working females.

Breast cancer is the most common malignancy found in women and the second leading

cancer mortality, it develops in about 1 in 8 women in the United States. At this point,

about 50% of the ―causes‖ of breast cancer are known, i.e. can be explained by risk

factors, which means that 50% are not known. Light melatonin cancer hypothesis was

first enunciated by Richard Stevens in 1987.

More recently, melatonin has been shown to be oncostatic, and that human breast cancer

tumors respond to melatonin levels in blood. Some of this work is brand new.


Roberts provided two simple take-home messages: ―First do no harm‖ and try for ―bright

days and dark nights‖.

Fuller

From Chuck Fuller we learned that the circadian rhythm is a highly complex system, not

just one pathway. Light is the single strongest stimulus to the circadian system, however,

there are also clocks in the periphery; they tend to be synchronized through the master

SCN (i.e. the pacemaker). Other inputs, such as activity/exercise, cycles of food, social

cues, have milder yet important impacts.

Zeitzer

Jamie Zeitzer helps us realize that there are very serious consequences to not getting

enough sleep, and/or at the right time of the day. There are two forces influencing our

sleepiness: the homeostatic and circadian systems. This two interact, making the system

even more complex.

Kripke

Dan Kripke was one of the pioneers in light therapy. He made a key point that even in

sunny San Diego, where a healthy California lifestyle would seem to be prevalent, the

average daily light exposure is remarkably small. 80% of the workforce works inside

buildings, and even when we are not working we spend much of our time inside – this

evidence is very important.

We now understand that increasing light exposure by various means can improve the

health and well-being of many people. The hope is that the light devices that Kripke

pioneered will go away because the design community will give us healthy buildings and

communities that provide for our needs through normal exposure to daylight and

carefully engineering lighting systems.

Dowling

Glenna Dowling showed us that light has impact in normal aging, as well as for diseases

associated with aging. Given the aging population, these impacts could easily have have a

rapidly escalating cost to society.

The interaction of light with aging are complex. While our ability to make melatonin is

decreasing, so is the light reception of the eye. For example, a 60 yr old needs 3 times the

light of a 20 year old for reading

Davis/Heschong

We learned that light is important to humans, but it is also important to many other

species. Our entire ecosystem is impacted by the artificial light that we use.

Day One Panel Discussion

To address these issues, we need better information, such as what are the limits that we

face – what do the systems cost, will there be a payback? We need compelling, rock solid

productivity impact data to bring to our community.

Some existing productivity data that is available:


―The 24 hr Society‖ by Moore-Ede, Addison Wesley, Pub. Documents the costs

associated with mal-adaptation to continuous operations.

Other studies show that when you look at the consequences of continuous work

systems, you see:

o Increases in human mortality and morbidity

o Coronary and cardiac disease

o Other medical illnesses

o Vehicle accidents

o Injuries and death at work

While lighting is the largest piece of the energy pie for offices in California, EPRI

estimates that a single day of lost productivity is equivalent to the cost of paying

for a lighting system in a building for an entire year

3.2 Day Two, Panel 1: Design Issues

3.2.1 Lisa Heschong, Architect, Implications for Building Design

Historically, all buildings were daylit. This began to change during World War II, with

the advent fluorescent lighting, shift work, cooling and mechanical ventilation.

Per Prof. Dan Kripke, the average American now spends 95% of their lifetime inside of

buildings. On average, we spend about 1 hr per day outside, very rarely more than 2

hours.

Review of HMG eight daylighting and human performance field studies for schools,

offices and retail. We have consistently found positive outcomes in these space types

with more daylight. Focusing on the SMUD Desktop study – 3 different buildings, one

with great views but virtually no daylight, one with daylight and pretty good views and

one with a little of both. View came out as a significant predictor of performance, in both

new studies of offices and schools, more consistent than any other indicator that was

studied. Daylight was measured as horizontal task illumination, but it probably should

have been measured as vertical circadian lumens at the eye.

Many other researchers have found similar positive associations with view. Her current

hypothesis: ―View is the flavor, and daylight is the nutrition.‖ In other words, view is

the attraction, and resulting daylight at the eye while looking out the window has positive

circadian effects.

3.2.2 Sam Berman, Ph.D., Implications for Lighting Practice

There could be an accounting error when applying standard light meters to evaluate light

levels in real environments

All light meters are calibrated on the basis of central cone sensitivity (fovial) alone.

Furthermore, in the real world, light comes from all different directions not just from one,

but we have different sensitivities at the center of our vision versus the periphery.

LBNL 1991 study – study the perceptual difference between different lamp types – cool

phosphorus on one extreme and a warm lamp on the other. Bluer light sources were


always selected as brighter, given the same lux readings. We thought it was rod

sensitivity that was influencing the result.

Incorporation of this new discovery (of the ganglion cells sensitivity and distribution)

into measuring light for lighting design practice may lead to lighting that provides better

vision and/or circadian impacts, along with energy savings.

Should electric lighting try to simulate daylight? It may be very difficult to come up with

a single source that meets all of our objectives (visual efficiency, energy efficiency,

circadian health).

3.2.3 Naomi Miller, FIES, Balancing Visula Needs and Circadian Health

As a designer, I find myself torn between two camps:

1. The first camp (risk averse) says: we don‘t know enough yet (i.e. you have to be

very cautious about what you say and do in the industry). Since we don‘t know

enough yet, don‘t change what you are doing now.

2. The second camp (do not harm) says: until we know more, we should avoid any

potential harm. Therefore avoid all light exposure at night.

Given this confusion, it is common to jump to the conclusion ‗let them wear eyeshades.‘

Let‘s consider the ―caveperson model‖, e.g. what is our human ―natural environment‖?

This suggests:

Provide daylight in buildings

Provide high illuminance during the day using blue content lamps

Minimize outdoor lighting at night, an especially reduce the blue content (e.g. use

high pressure sodium or low pressure, neither a pleasant option)

Here are some application principles I try to follow:

People need bright days, and evenings with subdued light

Daylight is the perfect daytime light source, so lets try to get more

Windows provide daylight plus a view for visual entertainment (distraction can be

the important antidote for boredom and tedium in the workplace)

At night people may need to avoid blue wavelengths. Amber, orange or red

nightlights inside buildings are less disruptive.

We should consider the needs of special populations:

Night shift workers - users who go and come home from work in the dark should

be considered for artificial, or electric day time, light doses

Elderly – if their eyes filter out more blue light with yellowing/aging lenses – do

they need more blue light? They tend to stay inside (they especially do not want

to go outside when it is very cold, like in Troy NY where I live)

Institutionalized, imprisoned, retired, homebound, or home office individuals

Daytime applications: Where should we consider bright interior daytime architectural

lighting (locate bright light spaces in common spaces, cafeterias, workout space,


corridors, break rooms). Waverly Place nursing home is a good example of creating

daylit ―outdoor spaces‖ as part of the interior environment for the elderly. Some of the

issues that need to addressed:

How to best provide daylight ? Clearstories one of the best examples, bringing

daylight and sun in high to a space. It is important to recognize that not all

windows are equally good at providing daylight into a space.

The resulting brightness of ceilings and walls need to be emphasized, due to less

sensitivity in the upper retina

Good daylighting is often costly in construction and maintenance

It is important to understand that windows can be glaring. High vertical

illuminance can conflict with the visibility of a computer screen.

Controls that allow dimming for architectural lighting for energy savings are

complex to specify, install, commission, and maintain. This is not a slam dunk

solution.

Nighttime applications: We need to pay attention to special populations, e.g. those with

compromised immune systems – HIV, drug treatment, elderly people—and elderly with

suppressed circadian rhythms. This is especially important in communal facilities, places

where people are resident overnight, and there may be conflicting needs between the

sleepers and the nighttime staff. Should the staff be kept ―biologically asleep‖ with

minimum blue light exposure, or phase shifted with white or blue light for maximum

altertness? Consider:

- Red lights in bathrooms to not disrupt sleep patterns (also dimmed incandescents)

- Minimize exterior lighting, especially blue content. Also consider amber LEDs

for exterior, but not here yet

- Duplicative lighting systems for nighttime use is expensive (ultimately 2 sets of

lights)

- Visual needs for the outdoor driver and the biological needs for the indoor sleeper

may be mutually exclusive

- Retailers may like the glare and high light levels, circadian stimulus and visibility

Conclusions: Right now we only have enough information now to make us dangerous.

What we need are robust, well-designed studies, outside of the lab (and in the field)!

3.2.4 Panel One Discussion:

Practical solutions from Joan Roberts: Hallway with red light (because bright light when

the doors open is very obtrusive for patients). A break room with super bright light is

good. Focused task light at the patients beds that that doesn‘t wash over the entire patient,

but allows the nurses to get work done

Dan Kripke: Recognize the need to distinguish between evening light up to bed time,

versus light at night. For a teenager encourage lighting to get them to bed on time, but for

an older person it might be the opposite.


3.3 Panel 2: Behavioral Issues

3.3.1 Scott Slotterback, AIA, Evidence Based Design in Hospitals

Kaiser develops the standards for the way our building are built and polices those

standards. Why is this topic so urgent to us?

We are in the midst of our largest building campaign in history, and perhaps in

healthcare. Our construction budget is $3 billion a year (30 billion w/in 10 year

period), which equates to 26 hospitals, 1,000 remodeling projects, plus numerous

medical offices as well. .

Healthcare is a heavily regulated industry, to move a wall requires an extensive

permitting process, so it is very hard to test out ideas. Thus research is very important to

our facilities decisions. Current research efforts include:

We have created the Garfield healthcare innovation center, allowing mockups in

Oakland.

We participated in the Latrobe fellowship, with Chong Partners (now Stantect),

UC Berkeley and ANA, on ―evidence based design‖.

We have a Kaiser Permanente National Standards Program, meant to incorporate

best practices, and input form panels of experts.

We are running a number of innovation projects, such as solar panels at a Modest

Hospital, ―Connection to the Community‖ walking paths, and ―healing gardens‖.

We are working on the Green Guide for Health Care, and Global Health and

Safety Initiative

Why are we doing this? Kaiser believes it will save money by keeping members healthy.

We have the ability to do large scale evaluations (large base of 85 million members, 63

million sq ft. of space)

3.3.2 Eve Edelstein, Ph.D., Understanding Human Needs in Buildings

The goal of Academy for Neuroscience in Architecture (ANA) is to bridge the gap

between science and design. ―When we talk about high performance environments‖,

some of that has to be human performance.

Cognitive performance related to seasonal changes and electrical lighting changes – this

is very relevant. Some cognitive skills are life and death – for example prescriptive error.

We were interested in specific effects related to medical conditions – there is no one size

fits all. Even a 2/3 of a day reduced-stay in a hospital has big economic implications.

AIA Latrobe Fellowship

We choose to study heart variability as a proxy for circadian response. It is much easier

to collect in field conditions than melatonin or other organic compounds. We set up a

study at UCSD and Ohio State University (currently under publication review)

We looked at circadian and photopic lighting at the same time with the

illuminance sensor mounted near the ear


Student conducted fatigue tasks under two LED panels, with strong blue and

strong red colors

We found that under blue light, the heart rate volatility dropped, within 5 minutes

there was an activation of the heart.

What about the option of taking a ―light shower‖ when you cannot incorporate daylight

or are working at night?

3.3.3 Carrie Armel, Ph.D., Energy Impacts of Behavioral Choices

The state of California has very aggressive energy efficiency goals. We at the Precourt

Institute are interested in looking for co-benefits, i.e. technologies and strategies that

provide both energy and health benefits. My interest is especially in how behavior

choices impact energy use.

For example, high efficiency lighting should also be attractive to users. What are the

drivers between choices of blue versus red LEDs? One thing that could be done with

LEDS is the ability to alter the wavelengths, the ability to shift the colors at different

times to impact mood (or circadian stimulus). Temperature perception may be partially

tied to lighting color (do people feel warmer in red, cooler in blue?).

3.3.4 Panel Two Discussion:

Behavior is often broadly defined, but there should be multiple populations considered

(age, gender issues, social hierarchies)

The increased use of the 24 hour building and 24/7 cities may have important

implications and tradeoffs. Flexibility may be the greatest need.

Should we primarily be concerned with residential or commercial environment?

We need inexpensive ways to collect data on behavioral impacts.

3.4 Panel 3: Lighting Research Issues

3.4.1 Francis Rubinstein, FIES, The IESNA Research Agenda

The Research committee of IESNA has a contract with EPRI and LRO to do a survey of

all the lighting research going on in the US, to do a gap analysis. Lighting and human

health is the number one topic.

This issue is too big for the state. We need to approach this on a national level. I would

like to bring this topic to the national level and find money on the national level to fund

this research.

New lamp standards will have a huge impact on energy use, do not discount these and

Title 24 standards.

We need to understand direction of gaze (DOG) versus work plane illumination. Action

spectra and field of view requirements: how does this vary diurnally? Is morning more

important than afternoon? How does architectural design influence this? Consider the


perimeter requirements in Scandinavia that all workers must be within a certain distance

of a view….or else workers get a 10 minute break every hour.

3.4.2 Luis Lomelino Fernandez, Ph.D., Implications for Lighting Industry

There is a suspicion that the engineering industry wants to replace all incandescent. But

this is not the whole story: we need to weigh the realities of the technology over the

health impacts and cost impacts. It is not just what we see that affects us.

Perhaps the way in which we have been measuring light is not necessarily the correct

one. Some implications for lighting research:

There are many new light sources coming out, not just LEDs. Our first impulse is

to think: how efficient is it? But it is apparent now that the blue hazard risk needs

to be quantified. And the same goes for how light impacts the circadian rhythms.

We need to consider the implications on controls, in terms of the dose of light that

you need every day, and also implications of timing.

We need to understand the implications for the rest of the field of view, in terms

of light measurement. For example, do we need a different sensitivity curve for

task vs. ambient lighting?

We need to reevaluate the way in which we design buildings, but more

importantly we need to also think about the way we live: for example, reasons to

bring people outside, instead of only bringing daylight in.

3.4.3 Naomi Miller, FIES, Lighting for Human Needs

Thoughts on research that we (the lighting designers) need:

We need to know about light exposure. So if someone could say: ―OK, for

healthy living, you need to have minimum of 2,000 lumen hours of exposure per

day,‖ we could figure out how to provide that exposure. (it may also be lux hours,

or circadian-lux hours, or am and pm hours, or ??)

We may need to throw the standard lumen (normalized to foveal color vision) out

the window, and replace it with a variety of specialty lumens: a full field lumen, a

circadian day and circadian night lumen, color rendering lumens, driving lumens

(off-axis versus on-access visibility), visual acuity lumens, vitamin D lumens, etc.

We need a cheap spectral photometer, that designers can afford and use.

LED‘s have a lot of promise, but although we think they will be very energy

efficient, they are not there yet (the vast majority of LED‘s that she has tested

flicker, or if they don‘t flicker at full power, they flicker when they dim.)

The need for continuous spectrum, over spiky spectrum lights

We need an energy use standard (kWh) rather than a installed power (LPD) or

technology (CLF v LED) standard.

We need to focus on existing building stock, not just new buildings. We need to

figure out clever ways to restore buildings, while improving their energy use. This

can be very difficult.


We need to focus on changing behavior: eg. getting people outside for walking

and eating, providing stairwells with lots of daylight,…in other words, using

architectural solutions, not just electric lighting technology.

3.5 Panel 4: State Policy Issues

3.5.1 Tim Tutt, California Energy Commission, California Policy Issues

The availability of energy alone can be a health issue. It is very crucial to life as we know

it to have electricity. The California Energy Commission also recognizes that there can be

health implications of energy regulations. The clearest example has been indoor air

quality: we have tightened our envelopes so much that there is now a concern about

balancing energy efficiency with ventilation and indoor air quality needs. We also

understand balancing the mercury issues from coal plant electricity generation versus

disposal issues for fluorescent lamps.

We have not, however, paid much attention to the topic of this conference. Elderly

population may be especially important in terms of lighting.

We have many initiatives focused on lighting efficiency, some of the most aggressive in

the nation. There is some attention paid to quality of the light sources, such as standards

about flickering, but generally we focus only on lumens per watt.

Our standards and utility programs must be cost effective. These measures are without

exception based on energy savings and installed cost, not taking into account health

impacts.

Assembly bill AB 1109 requires in California that we achieve 50% residential lighting

use reduction, and 25% of outdoor and indoor commercial lighting energy use by 2017:

this will require a general switch from incandescent to CFLs and a emphasis on controls

in residential settings. This may exacerbate the health effects that have been discussed

today.

Our codes also place a limit on window areas. How might health concerns impact this?

We may need to consider CRI, night lights, skylights, sunrooms, controls to allow

dimming, understanding the impact of paint on how we perceive light….

It is important to look outside the US: Cuba, Venezuela, Australia have all banned CFL‘s.

Intercultural research may be informative: residential lighting in Japan is 95% linear

fluorescent.

3.5.2 Dan Burgoyne, AIA: California Department of General Services

Implications for State Buildings

The California Department of General Services (DGS) is the second largest national

building owner and constructor, behind the federal government (GSA). DGS is highly

motivated to build green and energy efficient buildings. Goals are to reduce energy and

water use, improve satisfaction (comfort, ventilation, daylight and views), and ensure the

buildings are good for the environment (mandated by California law AB 32 and the

required reductions of energy use, to reduce our impact on the environment)


Our California requirements are part of the Governor‘s initiative to reduce statewide

energy use by 20% by 2015. One way to reach this goal has been to mandate that all new

state buildings get to LEED silver or higher, all existing buildings over 50,000 ft need to

reach LEED EB certification. In addition, any building even under 10,000 ft needs to

meet LEED certificate. Many state buildings are currently going for LEED certification.

LEED has credits related to daylight and views, including: 6.1: Controllability of systems

and lighting (this may be important especially for different age groups).

We are also working to have ―green building‖ standards become part of the building code

in California.

3.5.3 Steve Blanc, PE, PG&E, Implications for Energy Codes

It is important to understand how complex codes are. In California they are enforced by

400 odd local jurisdictions (planning, building departments, etc). Codes do not exist in a

vacuum; it can be political process as well as a technical one. Most importantly,

completely different bureaucracies control health issues vs. energy issues. They don‘t

talk to each other much. We have had some dialog on the issue of controlled ventilation,

and its health and energy impacts.

When you do research in this field be ready to deal with multiple bureaucracies and their

multiple stakeholders, and all their motivations. Often this means competing

constituencies.

3.5.4 Diane McLean, AIA, SCE, Implications for Utility Programs

The utilities are very aware that ―integrated design‖ has energy payoffs. We are

promoting a variety of programs and strategies to achieve this goal, including incentives

via ―Savings by Design‖ for commercial new construction and ―Sustainable

Communities‖ for multi-use and neighborhood developments. We provide design

assistance and coordination with LEED. We provide lots of educational resources in

support of this, including energy center classes on lighting and daylighting, Energy

Design Resources (www.energydesignresouces.com), videos, Green by Design.

If you are designing for the people and the occupant needs, then you are designing for

energy efficiency. Daylighting is an important component of our energy efficiency

portfolio.

3.6 Planning Next Steps, Discussion

Reconnect in the future, potentially at Southern California Edison‘s CTAC?

Publish in different industry magazines – including architecture, lighting, and science

journals. Include panel discussion at American Association of Photobiology meeting a

potential forum. Baltimore in June 2010.

Use the CLTC lighting portal as a forum to connect. Use the Precourt Institute and its

coordination of behavior, energy and climate change as a model for cross disciplinary

communication.


Determine what the knowledge gaps are. Assemble a responsible forum for research and

documentation.

Below is a photomontage of some of the discussions and presentations at the symposium:


4. APPENDIX: LIGHTING AND HEALTH SYMPOSIUM BROCHURE