Intended for healthcare professionals

Education And Debate

Are we really dying for a tan?

BMJ 1999; 319 doi: (Published 10 July 1999) Cite this as: BMJ 1999;319:114
  1. Andrew R Ness, senior lecturer in epidemiology (,
  2. Stephen J Frankel, professor of epidemiology and public health medicine,
  3. David J Gunnell, senior lecturer in epidemiology,
  4. George Davey Smith, professor of clinical epidemiology
  1. University of Bristol, Department of Social Medicine, Bristol BS6 7DP
  1. Correspondence to: Dr Ness
  • Accepted 19 April 1999

Professionals in health care and health promotion have embraced the notion that sunlight (particularly in doses that lead to sunburn) is bad for health.13 This was not always the case. In the early years of this century sunlight was regarded as an effective treatment for tuberculosis of the skin, and was also thought to be generally beneficial to health (box). Even today there are health resorts around the world offering heliotherapy—particularly for diseases of the skin such as psoriasis. The public have been slow to accept the message that exposure to sunlight is bad for health. Many people still sunbathe. In a survey carried out in England in 1995, 40% of those aged 16-24 reported being sunburnt in the preceding year, and just under 40% regarded a tan as being important to them.4 Furthermore, qualitative research with people in Scotland aged 20-35 who regularly travelled abroad for pleasure, suggested that at least part of the attraction of a tan was the perceived feeling of healthiness.5

Summary points

There is discordance between the health message to reduce exposure to sunlight and the health beliefs and behaviour of the public

The health promotion message aims to reduce skin cancer incidence and mortality

Increased exposure to sunlight may have beneficial effects on other diseases

Health educators should weigh up explicitly the potential risks and benefits of reduced exposure to sunlight to ensure that the health education message is appropriate

Prevention paradox

The prevention paradox, as described by Rose, arises because many interventions that aim to improve health have relatively small influences on the health of most people. Thus, for one person to benefit, many people will have to change their behaviour and receive no benefit from these changes. Perhaps sensing that public awareness of this paradox might act as a disincentive to …

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