segunda-feira, 13 de dezembro de 2010

Article - The bad side of Santa Claus

Sent by my student Daniel

Santa Claus: a public health pariah?

BMJ 2009; 339:b5261 doi: 10.1136/bmj.b5261 (Published 16 December 2009)
Nathan J. Grills, public health fellow
Picture 1 - Unhealthy Santa Claus/ Picture 2 - Healthy Santa Claus

Santa Claus is a well known and loved character, but Nathan Grills and Brendan Halyday question whether he is a healthy role model Santa Claus long ago displaced the Virgin Mary and baby as the most unmistakable Christmas iconography. A recent study among hospital inpatients concluded that awareness of Santa was near universal.1 Given Santa’s fame, he has considerable potential to influence individual and societal behaviour—and not necessarily for
good. Santa is a late adopter of evidence based behaviour change and continues to sport a rotund sedentary image. But this is not the only example where Santa’s behaviour and public image are at odds with contemporary accepted public health messages.

Advertising to children
Eric Schlosser and Morgan Spurlock have both described how McDonald’s used Ronald McDonald to target their products at children by creating an association between McDonald’s food and happy times. Spurlock showed how Ronald McDonald was more highly recognised than the American president or the Pope. Interestingly, Schlosser documents that among American
schoolchildren Santa Claus was the only fictional character more highly recognised than Ronald McDonald. If Ronald McDonald can be so effective at selling burgers to children, we might expect Santa to be equally effective at selling other goods. After all, it was Santa’s advertising potential that reincarnated simple Saint Nicholas into the glory of a universally recognised icon. Santa’s contemporary image was cemented by the Coca-Cola advertisements that began in the 1930s.4 By the mid-1950s Santa had become the leading sales consultant for numerous other companies and products. Today, he is one of the biggest sellers at Christmas and appears in adverts on television, the internet, billboards, and shop fronts. Public health needs to be aware of what giant multinational capitalists realised long ago: that Santa sells, and sometimes he sells harmful products. Several countries, like the UK, limit what can be advertised to children. Since Santa is a childhood icon should we prevent him from selling products such as alcohol and unhealthy
Furthermore, Santa has a growing impact on international public health. Like Coca-Cola, Santa has become a major export item to the developing world. Countries such as India are increasing
celebrating the Christmas festival. The potential for Santa’s growing acclaim to be misused may even be greater in countries where there is less regulation of advertising.

Epidemiologically there is a correlation between countries that venerate Santa Claus and those that have high levels of childhood obesity. Although given the various confounders it is premature to conclude causality, there is a temporal pathway whereby Santa promotes a message that obesity is synonymous with cheerfulness and joviality. Rear Admiral Galson, acting US surgeon general in 2007, commented, “It is really important that the people who kids
look up to as role models are in good shape, eating well and getting exercise. It is absolutely critical.”7 He went on to explain that Santa should slim down.
To create a supportive environment for Santa’s dieting we should cease the tradition of leaving Santa cookies, mince pies, and milk, brandy, or sherry. This is bad not only for Santa’s waistline but for parental obesity. When Santa is full, Dad is a willing helper. Maybe we should encourage Santa (and his helpers) to share the carrots and celery sticks commonly left for Rudolf. Santa might also be encouraged to adopt a more active method to deliver toys— swapping his reindeer for a bike or simply walking or jogging.

Endorsing smoking
Santa was a former lead salesman for cigarettes; however, thankfully, Santa has been banned from overtly advertising cigarettes in many countries. Referring to a letter in which Santa
claims he quit, John Banzhaf, an antismoking advocate, said: “Christmas is about children, and it is wonderful that Santa Claus is setting such a powerful example in protecting them from tobacco smoke pollution. Perhaps the most important and lasting gift any smoker can give a child is to give up smoking, or at least to stop smoking around the child.” Although Santa is banned from smoking in public, the image of the jolly, pipe smoking, bringer of good tidings remains firmly engrained in many people’s imagination. Furthermore, images of Santa enjoying a cigar are still available on Christmas cards and drawings. One blogger recounts how a 4 year old child spotted one such picture and said, “Look, Mommy, Santa Claus is smoking.” You can just imagine a cheeky 12 year old arguing, “Oh Mum, how bad can smoking be? Santa smokes, and he must be at least 99 and hasn’t died of lung cancer yet.”

Reckless role model
Injuries are the leading cause of death in childhood.11 Santa’s public health image in relation to injury prevention has been questioned. The tradition of leaving Santa a cup of brandy led one mother to worry “that my kids are going to think I am encouraging drink driving.” With a few billion houses to visit, Santa would quickly be over the limit. Reassuringly however, another blogger responded to the concerned mother, arguing that “technically it is not Santa
driving as Rudolph and the Reindeers are trained to pull Santa.” Other dangerous activities that Santa could be accused of promoting include speeding, disregard for road rules, and extreme
sports such as roof surfing and chimney jumping. Despite the risks of high speed air travel Santa is never depicted wearing a seatbelt or a helmet.

Infectious disease vector
A quick perusal through the Victorian infectious diseases surveillance records shows no notifications of infectious disease outbreaks associated with kissing Santa. Although there were no cases of infectious mononucleosis (“kissing disease”) associated with Santa, there have been numerous foodborne viral and salmonella outbreaks associated with Christmas parties. Santa was not named as a suspected point source. Surveillance programmes do not routinely collect data on Santa exposure but, temporally at least, Santa is potentially a point source for infectious diseases outbreaks. The grey literature documents clear basic hygiene issues arising from interactions with Santa. One survey found that “Santa is sneezed or coughed on up to 10 times a
day.”13 The potential for Santa in his asymptomatic phase to propagate an infectious disease is clear. Unsuspecting little Johnny gets to sit on Santa’s lap, but as well as his present he gets H1N1 influenza. Santa continues on his merry way and gives the present to a few more 100 kids before coming down with influenza himself. This then becomes a contact tracer’s nightmare.
Additionally, in Australia there is no health check required for most Santas. I have played Santa for two school concerts and one staff function. I was not required to have a health check. It basically relies on the impersonator’s judgment. Indeed, in my first appearance I was filling in for my father who had a viral respiratory illness. He had the insight, or at least a good excuse, to delegate the Santa responsibility and so avoided infecting children. There were no tests for meticillin resistant Staphylococcus aureus, no screening for current viral illnesses, and no immunisation checks. I was kissed and hugged by snotty nosed kids at each performance and was never offered alcohol swabs to wipe my rosy cheeks between clients. The reality is that Santa impersonators are in short supply in December, and organisers of such events are so desperate for Santa impersonators that they skimp on public health safeguards.
In America, some Santas are subject to criminal background checks and pre-employment drug screens.3 However, there is no standardised requirement for Santa to have a medical check-up or even prove his immunisation status. Regulations to mitigate this public health risk should be considered. Clearly, basic Santa education and Santa screening are warranted.
Even more concerning is how Santa’s travels might contravene the international health regulations in the context of an outbreak of new infectious diseases such as avian influenza.14 In the case of a public health emergency, WHO may institute measures to prevent the
international spread of disease. However, Santa flouts the requirements for surveillance at “designated airports, ports and certain ground crossings,” and the international regulations do not mention how to control this transnational unconventional public health threat.

Santa studies is a developing field in public health, and currently there is a disappointing lack of rigorous research on the effect of Santa on public health. More targeted research is required before authorities might take action to regulate Santa’s activities. This research should particularly focus on the ability of Santa to encourage unhealthy behaviour; the use of Santa in advertising to kids; and the infectious disease risk of Santa impersonators.
We need to be aware that Santa has an ability to influence people, and especially children, towards unhealthy behaviour. Given Santa’s universal appeal, and reasoning from a population health perspective, Santa needs to affect health by only 0.1% to damage millions of lives.