- Email: [email protected]
Here comes the sun
ARTICLE IN PRESS Public Health (2008) 122, 219–220
www.elsevierhealth.com/journals/pubh
Editorial
Here comes the sun Depending on your musical tastes (and dare we say age?), there are those amongst you who will now be reading this opening paragraph with a backing track in your mind. For some it will be the gentle, melodic original. For others, it may be one of the many cover versions by artists such as Joan Jett, Steve Harley, Nina Simone or even the instrumental version by James Last and his Orchestra. Of course some of you will be wholly in the dark about this, so let us enlighten you. The song Here comes the sun was written by George Harrison and was recorded as part of the album Abbey Road. It has a very simple lyric which captures something of the yearning for sunshine and warmth among those who experience the ‘‘long cold lonely winters’’ that happen when you live close to either pole. Perhaps part of the reason the song has become so popular (apart from having the sort of simple tune that stays in one’s head) is the way that it captures something deep within the human experience, the need for the warmth and light which promotes growth and life. For millennia people have placed a ritual significance on the return of the sun. Prehistoric people celebrated festivals of fire and light in the depths of winter to encourage the sun to return and bring new life; ancient civilizations expended great effort to calculate—often with amazing precision—the time and place when the sun would return. Across the ages, the echoes of this desire for the sun and how it is linked to life and regeneration can be heard. It can be argued that, against such a background, it is not too surprising that many public health systems across the globe find it hard to get people to take seriously the fact that over-exposure to sunshine is a major risk factor in developing skin cancer due to the damage that can be caused by ultraviolet (UV) light radiation. But if it is not surprising, it should be a cause for concern. The incidence of melanoma in the UK—as in many other countries—is on the increase,1,2 and
even with preventive intervention strategies operating, it may take between 30 and 50 years and peak at upwards of three times the current incidence, before there is a downturn. All melanoma are more prevalent amongst Caucasians and affect more older people than younger. Malignant melanoma, however, is the third most common form of cancer in those aged between 15 and 34 years, occurs more often amongst young women, and whilst it only accounts for just over 10% of all skin cancer, it is responsible for 80% of the deaths.3 As with so many things, prevention—either primary or secondary—is the approach of choice and the UK has, in common with many other countries, developed a national skin cancer prevention campaign. The SunSmart campaign seeks to assist people to become aware of their risk of skin cancer, how the risk can be reduced simply, and early signs of potentially cancerous lesions acted upon.3 Even the British obsession with the weather has been brought into play with The UK Meteorological Office now routinely providing UV warnings as part of their television forecasts to facilitate avoidance of skin cancer. Yet even with such concerted action it is still common for the return of the sun in springtime to be associated with a mad flurry of sun-seekers stripping off layers of winter clothes and exposing skin to be bathed in the warming—but potentially lethal—rays of the sun. However, it may not be that straightforward. Sunlight is a necessary part of the synthesis of cutaneous vitamin D and there is evidence that vitamin D supplementation in association with calcium has an impact on reducing fracture in post-menopausal osteoporosis.4 There is also the evidence that calcium and vitamin D supplementation is associated with reducing allcause cancer risk5 and that there is a role for vitamin D in the aetiology of multiple sclerosis.6 All of which could support an argument that sunshine is a simple way of reducing vitamin D deficiency and its potential consequences.
0033-3506/$ - see front matter & 2008 Published by Elsevier Ltd on behalf of The Royal Institute of Public Health. doi:10.1016/j.puhe.2008.01.001
ARTICLE IN PRESS 220 All of which leaves the jobbing public health practitioner with something of a conundrum. How to get a health message across to a population that does not seem to want to hear the message? Or for whom the message may not be a simple one? The analogy that may be drawn with the problem of promoting ‘‘safe’’ or ‘‘sensible’’ alcohol use should not be missed. In this issue of Public Health we have two contributions that can help answer these questions. The first contribution is a study exploring new ways of calculating skin cancer risk in a high-risk population.7 Clearly, trying to get the message of skin cancer prevention amongst those who are potentially at greatest risk is a sensible way forward. Whilst for the wider population—where a more sophisticated message may be needed— there is our second contribution. This is a study of how planning models and social marketing for population interventions are understood and how best to improve the application of these methods to support public health action.8 Two studies will not change the world. But they may throw extra light on solving the problem of getting complex messages across to protect the populations from the potentially damaging effects of something that many of us welcome so warmly. And in the meantime: ‘‘Do remember to use the sun wisely’’; or how about: ‘‘Avoid binge sunbathing’’y
Editorial
References 1. Diffey BL. The future incidence of cutaneous melanoma within the UK. Br J Dermatol 2004;151:868–72. 2. Lends MB, Dawes M. Global perspectives of contemporary epidemiological trends of cutaneous malignant melanoma. Br J Dermatol 2004;150:179–85. 3. Cancer UK SunSmart Campaign. Available at: /http:// last info.cancerresearchuk.org/healthyliving/sunsmart/S, accessed 11 December 2007. 4. Avenell A, Gillespie WJ, Gillespie LD, O’Connell DL. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database of Systematic Reviews 2005, Issue 3 [DOI: 10.1002/14651858.CD000227.pub2]. 5. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007;85:1586–91. 6. Van Amerongen BM, Dijkstra CD, Lips P, Polman CH. Multiple sclerosis and vitamin D: an update. Eur J Clin Nutr 2004;58:1095–109. 7. Pritchard C, Dixon PB. Reporting of skin cancer risks in the house-building industry: alternative approaches to the analysis of categorical data. Public Health, this issue, DOI: 10.1016/j.puhe.2007.05.015. 8. Kohr JM, Strack RW, Newton-Ward M, Cooke CH. The use of programme planning and social marketing models by a state public health agency: a case study. Public Health, this issue, DOI: 10.1016/j.puhe.2007.06.009.
P. Mackie F. Sim The Royal Institute of Public Health, 28 Portland Place, London W1B 1DE, UK E-mail address: [email protected]
In this Issue In this issue of Public Health we return to some common themes. The relationship between social inequalities and early mortality is now widely recognised. So in presenting new data on inequalities from South Korea in relation to cancer incidence or from Taiwan regarding low birthweight, few will be surprised. Perhaps more surprising is the relationship between income and being able to undertake everyday activities reported from the US. Another common theme is that of mortality, and with papers from Serbia on premature mortality, from Australia on firearms related deaths and hospital trauma services in preventing mortality, this area is well represented. The obesity epidemic is considered in a paper from Canada that looks at the contribution of excess weight to the prevalence of diabetes and from the UK in relation to monitoring obesity in school children. Given the observations of the evolution of the school health services in England, it provides some pause for thought to reflect on the fact that such monitoring takes place within the school setting. Finally, we present four papers considering differing aspects of study methods and their application in helping to understand public health interventions based on social marketing, screening, enriching food stuffs, and alcohol use.
www.elsevierhealth.com/journals/pubh
Editorial
Here comes the sun Depending on your musical tastes (and dare we say age?), there are those amongst you who will now be reading this opening paragraph with a backing track in your mind. For some it will be the gentle, melodic original. For others, it may be one of the many cover versions by artists such as Joan Jett, Steve Harley, Nina Simone or even the instrumental version by James Last and his Orchestra. Of course some of you will be wholly in the dark about this, so let us enlighten you. The song Here comes the sun was written by George Harrison and was recorded as part of the album Abbey Road. It has a very simple lyric which captures something of the yearning for sunshine and warmth among those who experience the ‘‘long cold lonely winters’’ that happen when you live close to either pole. Perhaps part of the reason the song has become so popular (apart from having the sort of simple tune that stays in one’s head) is the way that it captures something deep within the human experience, the need for the warmth and light which promotes growth and life. For millennia people have placed a ritual significance on the return of the sun. Prehistoric people celebrated festivals of fire and light in the depths of winter to encourage the sun to return and bring new life; ancient civilizations expended great effort to calculate—often with amazing precision—the time and place when the sun would return. Across the ages, the echoes of this desire for the sun and how it is linked to life and regeneration can be heard. It can be argued that, against such a background, it is not too surprising that many public health systems across the globe find it hard to get people to take seriously the fact that over-exposure to sunshine is a major risk factor in developing skin cancer due to the damage that can be caused by ultraviolet (UV) light radiation. But if it is not surprising, it should be a cause for concern. The incidence of melanoma in the UK—as in many other countries—is on the increase,1,2 and
even with preventive intervention strategies operating, it may take between 30 and 50 years and peak at upwards of three times the current incidence, before there is a downturn. All melanoma are more prevalent amongst Caucasians and affect more older people than younger. Malignant melanoma, however, is the third most common form of cancer in those aged between 15 and 34 years, occurs more often amongst young women, and whilst it only accounts for just over 10% of all skin cancer, it is responsible for 80% of the deaths.3 As with so many things, prevention—either primary or secondary—is the approach of choice and the UK has, in common with many other countries, developed a national skin cancer prevention campaign. The SunSmart campaign seeks to assist people to become aware of their risk of skin cancer, how the risk can be reduced simply, and early signs of potentially cancerous lesions acted upon.3 Even the British obsession with the weather has been brought into play with The UK Meteorological Office now routinely providing UV warnings as part of their television forecasts to facilitate avoidance of skin cancer. Yet even with such concerted action it is still common for the return of the sun in springtime to be associated with a mad flurry of sun-seekers stripping off layers of winter clothes and exposing skin to be bathed in the warming—but potentially lethal—rays of the sun. However, it may not be that straightforward. Sunlight is a necessary part of the synthesis of cutaneous vitamin D and there is evidence that vitamin D supplementation in association with calcium has an impact on reducing fracture in post-menopausal osteoporosis.4 There is also the evidence that calcium and vitamin D supplementation is associated with reducing allcause cancer risk5 and that there is a role for vitamin D in the aetiology of multiple sclerosis.6 All of which could support an argument that sunshine is a simple way of reducing vitamin D deficiency and its potential consequences.
0033-3506/$ - see front matter & 2008 Published by Elsevier Ltd on behalf of The Royal Institute of Public Health. doi:10.1016/j.puhe.2008.01.001
ARTICLE IN PRESS 220 All of which leaves the jobbing public health practitioner with something of a conundrum. How to get a health message across to a population that does not seem to want to hear the message? Or for whom the message may not be a simple one? The analogy that may be drawn with the problem of promoting ‘‘safe’’ or ‘‘sensible’’ alcohol use should not be missed. In this issue of Public Health we have two contributions that can help answer these questions. The first contribution is a study exploring new ways of calculating skin cancer risk in a high-risk population.7 Clearly, trying to get the message of skin cancer prevention amongst those who are potentially at greatest risk is a sensible way forward. Whilst for the wider population—where a more sophisticated message may be needed— there is our second contribution. This is a study of how planning models and social marketing for population interventions are understood and how best to improve the application of these methods to support public health action.8 Two studies will not change the world. But they may throw extra light on solving the problem of getting complex messages across to protect the populations from the potentially damaging effects of something that many of us welcome so warmly. And in the meantime: ‘‘Do remember to use the sun wisely’’; or how about: ‘‘Avoid binge sunbathing’’y
Editorial
References 1. Diffey BL. The future incidence of cutaneous melanoma within the UK. Br J Dermatol 2004;151:868–72. 2. Lends MB, Dawes M. Global perspectives of contemporary epidemiological trends of cutaneous malignant melanoma. Br J Dermatol 2004;150:179–85. 3. Cancer UK SunSmart Campaign. Available at: /http:// last info.cancerresearchuk.org/healthyliving/sunsmart/S, accessed 11 December 2007. 4. Avenell A, Gillespie WJ, Gillespie LD, O’Connell DL. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database of Systematic Reviews 2005, Issue 3 [DOI: 10.1002/14651858.CD000227.pub2]. 5. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007;85:1586–91. 6. Van Amerongen BM, Dijkstra CD, Lips P, Polman CH. Multiple sclerosis and vitamin D: an update. Eur J Clin Nutr 2004;58:1095–109. 7. Pritchard C, Dixon PB. Reporting of skin cancer risks in the house-building industry: alternative approaches to the analysis of categorical data. Public Health, this issue, DOI: 10.1016/j.puhe.2007.05.015. 8. Kohr JM, Strack RW, Newton-Ward M, Cooke CH. The use of programme planning and social marketing models by a state public health agency: a case study. Public Health, this issue, DOI: 10.1016/j.puhe.2007.06.009.
P. Mackie F. Sim The Royal Institute of Public Health, 28 Portland Place, London W1B 1DE, UK E-mail address: [email protected]
In this Issue In this issue of Public Health we return to some common themes. The relationship between social inequalities and early mortality is now widely recognised. So in presenting new data on inequalities from South Korea in relation to cancer incidence or from Taiwan regarding low birthweight, few will be surprised. Perhaps more surprising is the relationship between income and being able to undertake everyday activities reported from the US. Another common theme is that of mortality, and with papers from Serbia on premature mortality, from Australia on firearms related deaths and hospital trauma services in preventing mortality, this area is well represented. The obesity epidemic is considered in a paper from Canada that looks at the contribution of excess weight to the prevalence of diabetes and from the UK in relation to monitoring obesity in school children. Given the observations of the evolution of the school health services in England, it provides some pause for thought to reflect on the fact that such monitoring takes place within the school setting. Finally, we present four papers considering differing aspects of study methods and their application in helping to understand public health interventions based on social marketing, screening, enriching food stuffs, and alcohol use.