Interior design: an overlooked health promotion strategy

by Lindsay Miller on October 5, 2012

The retail world has figured out what store layout makes us spend the most money.
Corporate America has discovered what lighting tint optimizes worker productivity.
Healthcare systems have learned that noise reduction improves patient comfort and care.

Adapted from Microsoft Image Gallery

But the truth is that we don’t need to be sick or shopping or slaving away at work to be influenced by our environment. We can thoughtfully design our own surroundings in such a way as to promote health and harmony. And since we spend about 90% of our lives indoors, it might not be a bad idea to pay more attention to how our interior environment affects our well-being!

Let us start with lighting. Lighting is key for mood and energy regulation. Just think about Walmart. Have you ever felt as though those cold, pulsating fluorescent lights were literally draining all of the energy from your soul? Well, the research has something to say about this. The “gold standard” of light is–you guessed it–sunlight! In a prospective study that followed patients recovering from spinal surgery, Walch et al. (1) found that those exposed to higher-intensity sunlight reported less pain and stress and required significantly less pain medicine. Though the exact mechanisms are still unclear, most scientists believe sunlight affects levels of serotonin, often considered the “feel good” neurotransmitter.  Additionally, research (2) has shown that overexposure to artificial light, especially at night, can throw off your natural sleep-wake cycle, the disruption of which affects your energy levels throughout the day and may be linked to long-term metabolic conditions. Sunlight also has a direct and beneficial effect on physical health, since exposure to sunlight triggers the production of Vitamin D (3), which is thought to be a key player in bone health and potentially in protecting against high blood pressure, some cancers, and certain immune diseases.

Feeling more relaxed? Image courtesy of dan/

When it comes to decor, like light, natural is better. Natural decor elements, such as plants, images of nature, and the like, have been consistently associated with reduced stress levels in patient care settings. A while back, Ulrich et al. (4) found that blood donors who were shown a video of a natural setting had lower pulse rates (that is, they were calmer) than those shown a video of an urban setting. Another study (5) found that the presence of greenery in a health care setting had a stress-reducing effect for patients and that this effect may be explained by the “perceived attractiveness” of the plants. So we may be biophiliacs, after all. But the “green is good” trend may go beyond psychological effects: researchers (6) have demonstrated that indoor plants can actually reduce air contaminants, like carbon monoxide and carbon dioxide, and improve air humidity. And air quality certainly impacts health, particularly cardiovascular and respiratory health. We are what we breath, right?


Health never looked so chic! Pillows, rugs, and linens can help to absorb ambient noise.
Source: Microsoft Office Image Gallery

Finally, as an ambulance siren wails through my window, it’s hard to forget about noise. There is a whole body of research that links noise exposure (7) with a variety of negative outcomes, such as stress, increased annoyance, lowered work performance, hearing problems, as well as some more chronic conditions like hypertension, or high blood pressure. Think about it from an evolutionary standpoint: it is advantageous for us to react to noise, as that noise might signal a predator or dangerous situation. In other words, noise evokes our “fight or flight” response–triggering the production of stress hormones like adrenaline and noradrenaline, which in turn raise our heart rate and blood pressure. Although the effects for women were greater than for men, Chang et al. (8) confirmed that increased environmental noise exposure contributed to both temporary and sustained increases in blood pressure among young adults. If you are still reading (and haven’t disregarded interior design as a valid health promotion strategy), you might be wondering: what does noise have to do with interior design? Well, a lot of the decor items that we fill our homes with–heavy curtains, plush pillows, thick rugs, anything “fluffy”– can help to absorb noise. So, if you are like me and have an unnecessary number of throw pillows in your home, now you have a legitimate “health” reason for it!



(1) Walch, J. M., Rabin, B. S., Day, R., Williams, J. N., Choi, K., & Kang, J. D. (2005). The effect of sunlight on postoperative analgesic medication use: A prospective study of patients undergoing spinal surgery. Psychosomatic Medicine, 67(1), 156-163.

(2) Navara, K. J., & Nelson, R. J. (2007). The dark side of light at night: physiological, epidemiological, and ecological consequences. Journal of Pineal Research, 43(3), 215-224.

(3) Holick, M.F. (2006). High prevalence of vitamin D inadequacy and implications for health.
Mayo Clinic Proceedings, 81(3), 353-373.

(4) Ulrich, R.S., Simons, R.F., Losito, B.D., Fiorito, E., Miles, M.A., & Zelson, M. (1991). Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology,11(3), 201-230.

(5) Dijsktra, K., Pieterse, M.E., & Pruyn, A. (2008). Stress-reducing effects of indoor plants in the built healthcare environment: The mediating role of perceived attractiveness. Preventive Medicine, 47(3),  Issue 3, 279-283.

(6) Lim, Y., Kim, H., Yang, J., Kim, K., Lee, J., & Shin, D. Improvement of indoor air quality by houseplants in new-built apartment buildings. (2009).Journal of the Japanese Society for Horticultural Science, (78)4, 456-462.

(7) Passchier-Vermeer, W., & Passchier, W.F. (2000). Noise exposure and public health.Environmental Health Persepctives (108)1, 123–131.

(8) Chang, T., Liu, C., Hsieh, H., Bao, B., & Lai, J. (2012). Effects of environmental noise exposure on 24-h ambulatory vascular properties in adults.Environmental Research (118),112-117.



***Updated 10/6/2012***

Margaret October 5, 2012 at 11:48 am

I always thought going outside made me feel better. That idea of fresh air. Now I can tell someone it is true. It is interesting that pictures of nature can actually reduce your pulse rate.


Elizabeth Fryer October 5, 2012 at 2:24 pm

Lindsay, The first two paragraphs read so well, I really looked forward to the rest of the post. Then the next paragraph: “I’ll start with lighting.” You and your fellow students need to consider whether first person adds anything to your blogs. Gillian is talking about *her*children, Ali is talking about *her* workout habits. First person is appropriate. You could say “Let’s start with lighting” or “Starting with lighting.”
The “maybe that’s just me” sentence can say, “Research supports this.”

The next paragraph uses “I’m not talking…” It’s not *your* research you’re reporting on. Keep it third person.

Now to the details. “Alright” is not a word. It’s “All right.”

You say sunlight affects, and we can all infer that’s a positive affect, but be aware that “affect” and “impact” are neutral verbs. So in some instances, when the inference is not so obvious, you’ll need to say positively or negatively affect.

Hope this helps you.

Lindsay October 5, 2012 at 3:05 pm

Thank you for your feedback, it certainly helps!

I will be the first to admit that writing is not my strong suit. I love it when I can hear a writer’s personal voice coming through in their writing, and so I have tried to keep my writing style personal and conversational. But I can definitely see where my efforts to “make it personal” lead to inappropriate uses of the first person. This is something I will work on in future posts, thank you again for your comments.

Maryse de la Giroday October 5, 2012 at 7:58 pm

Hi Lindsay! I enjoyed the piece and I was particularly delighted to find out about the research on interior design and health. I’m glad Elizabeth picked up on the pronoun use, although I was disconcerted by the change from the plural ‘we’, to the singular ‘I’ as it changed my experience as a reader, ‘we’ being more inclusive than ‘I’.

Your title and subhead promise information about health promotion and patient comfort and care which you don’t really deliver. The material about Light and Natural is fine but it’s a presentation of research and doesn’t discuss how the research is changing or affecting patient care in hospitals now. Assuming that you don’t have that kind of information, you might want to consider a head like ‘Research on interior design could be changing patient care’. Not as dramatic a head as yours but it sets the readers’ expectations for the material you’re going to share. As for your information on Noise that didn’t seem to have much to do with patient care and seemed more of a helpful hint for decorating at home if you want to minimize noise. Useful but not on topic. There’s a writer’s phrase I like, ‘learn to kill your darlings’. Editing isn’t just about make sure everything is correct grammatically. Sometimes, it means killing something you love, a perfect sentence, material about Noise that doesn’t really serve your piece, etc. I have a ‘darlings’ file where I put them just in case I should ever need that sentence or bit in the future.

I liked your topic, your approach, and your ‘voice’. Now, you may want to consider making sure your heads promise what you will deliver and learning to ‘kill your darlings’.


As for the all right/alright, I like Grammar Girl’s response to that question:

Lindsay Miller October 5, 2012 at 9:28 pm

Thank you, Maryse, for your comments. I really appreciate the feedback.

I think my title and intro may have been a little misleading. What I intended to do with this piece was show how we can design our own spaces (i.e. our homes, apartments, etc.) to promote health. A lot of the research done in this area, especially with regards to light and natural elements, does come from patient care settings, which is why it may have seemed like I was focusing on that.

But I do appreciate the guidance and especially your advice about “killing your darlings.” I hope you keep reading and keep giving feedback!

PF Anderson October 6, 2012 at 10:28 am

I’m LOLing a tad, as I was also going to share Grammar Girl’s post saying that language is always in flux, and that alright is (almost) as acceptable as “all right.” I agree with the 3rd person comment above.

I like the premise of the post (actually I LOVE the idea of the post!), but find that too much info is crammed into too small of a space. I would really really like to see each of these topics developed as separate posts. *Especially* the part about light and sleep. I’ve heard so many rumors lately, and haven’t had a chance to check them out myself. I was recently told that sleeping with the lights on:
– causes sleep disorders;
– slows growth or causes stunting in children;
– reduces learning and IQ;
– causes a lack of alertness during the day;
and more!

I’m also not exactly happy that there is no bibliography at the end. The internal links in the post are just that – links. If the link breaks, there is no way to find out what the title was or who the author was. You’ve addressed that in part through use of DOI links and Pubmed links, however I have seen Pubmed links change when a record was reported to have errors in it, usually as an accidental duplicate record. DOI links *are* supposed to be stable (see: Citing or linking with a DOI link|StartTopic=Content%2Fdoi.htm|SkinName=svs_SD and DOI ), but there are other reasons as well to include more info than just the link.

Not including the identifying information makes it impossible for the reader to get a gut sense of whether they agree with your selection of the evidence. It forces them to click through to assess your selection. Many won’t do that. For a critical reader, this is not a kindness. Including the identifying information is one way to tell people “these people are the experts, the names on this topic.” For a less critical reader, you are missing an educational opportunity.

The two places where I thought you came close to embedding enough of the article information in the text to be able to get by without a citation were these:

“In a prospective study that followed patients recovering from spinal surgery, Walsh et al. found that those exposed to higher-intensity sunlight reported less pain and stress and required significantly less pain medicine.”

“A while back, Ulrich et al. found that blood donors who were shown a video of a natural setting had lower pulse rates (that is, they were calmer) than those shown a video of an urban setting.”

For (1), The problems with this sentence are (a) you might want to explain “prospective study” and some of the other jargon; and (b) (this is BIG) you have the senior author’s name wrong. OOPS! I clicked through, and had a doubletake.

Walch JM, Rabin BS, Day R, Williams JN, Choi K, Kang JD. The Effect of Sunlight on Postoperative Analgesic Medication Use: A Prospective Study of Patients Undergoing Spinal Surgery. Psychosomatic Medicine (2005) 67(1):156-163.

My first thought with the different author name was that there had been a typo in the URL. That is easy to do, as easy as a typo in the author name. If this had been anything other than a DOI link, and the link broke in the future (and those darned journal sites often do redesign their websites) it would have involved some painful digging to try to find an article on this topic written around this time span (2005??? might not have guessed that) with an author with a similar name. Maybe. Most people probably wouldn’t be able to find it, but if someone asked a librarian for help, maybe.

Thus, this makes an excellent example of why to include citations as endnotes in your blogpost: (1) In case of a typo in the link; (2) In case of later broken URLs; (3) To teach others about the evidence in the field, its jargon and main players; and (4) to allow experts reading your post to quickly assess the evidence you’ve selected to support your arguments. Thank you!

For (2), you do say it was a while ago. 1991 is REALLY a while ago! Is there anything more recent on this topic? Is this the best evidence available at this point in time? Also, it might have been helpful to pepper your sentence with a few more words from the original title, to forge a connection between the two. I wouldn’t have guessed an article from the 90s with “stress recovery” as the lead terms.

Ulrich RS, Simons RF, Losito BD, Fiorito E, Miles MA, Zelson M. Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology (1991) 11(3):201-230.,

I’m not checking all the cites here, but I hope there are some that are more recent. If these were selected as the original and most seminal works on the topic, that are most cited by others, that would be nice to know. I’m not sure what would be best practices on how to do that, but perhaps someone else has ideas?

Lindsay Miller October 6, 2012 at 2:44 pm

Wow, thank you for taking the time to respond so thoroughly! We have had a few ongoing discussions in our class as to whether linking to the articles was sufficient or if further citations are needed. But I will include the citations if readers will appreciate that.

It was a struggle for me to find more recent and credible articles about natural settings and health. In fact, many of the ones I found were reviews or analyses of past literature, including Ulrich’s study. It would have been easier for me to just find a recent study on any topic and then write about it, but with this post, I chose the topic before doing the literature search, so it was a little more challenging to ensure that the research was recent. But definitely something to keep in mind, thank you.

As for the author misspelling–thank you for catching that! Though it is no excuse, Word detected “Walch” as incorrect spelling but not “Walsh,” so I must have just clicked correct. I’ll be more careful next time.

And I am considering revisiting some of these topics in more detail further in the semester, as I think I could definitely go more in-depth.

Lindsay Miller October 6, 2012 at 3:11 pm

I have updated my post to include all of my citations. As you will see, most of them are 2005 or more recent. Again, thank you for your suggestions!

Grainne October 6, 2012 at 11:27 am

Thank you for a great article. Yes I do think you delivered what the title promised. As a mother of a child with autism whose senses are assaulted by noise, light and smells. I wish that you could get this vital message through to shopping centres, cinemas, and most public buildings. Well done and keep spreading the word (whatever way you choose to write it).

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