Intended for healthcare professionals

Rapid response to:

Analysis Christmas 2009: Christmas Fayre

Santa Claus: a public health pariah?

BMJ 2009; 339 doi: (Published 17 December 2009) Cite this as: BMJ 2009;339:b5261

Rapid Response:

Re: Santa Claus: a public health pariah?

Santa Claus has received criticism for promoting an unhealthy lifestyle, with his rotund body habitus, penchant for alcohol and mince pies, and predilection for airborne travel.

Yet little consideration is given to the possibility that all is not always as it may seem. Santa is a famously private individual. Without the opportunity to undertake a full history and examination, we are limited in what conclusions we may draw regarding his health.

What we do know is that he spends a great deal of time in soot lined chimneys, seemingly without adequate personal protective equipment (PPE). It seems feasible that cumulative exposure to these conditions might result in some form of chronic interstitial lung disease while alighting in tobacco smoke-filled living rooms might contribute an obstructive component. His centripetal obesity and round face could therefore derive from a cushingoid effect of regular systemic corticosteroids, with his dependence on airborne transportation and multiple helpers indicative of a limited exercise tolerance. Indeed his functional residual capacity may be such that wheezy monosyllabic utterances, such as "ho ho ho", are all that he can routinely muster, with the break neck speeds of his open sleigh necessary to deliver continuous positive airway pressure support.

As good clinicians we ought to be wary of misdiagnosis based on lazy assumptions.
Santa Claus may suffer from disabling medical comorbidities which in conjunction with his advanced age, might easily justify State support. Shamefully, despite the huge progress made in access for the disabled, we still insist on him making home visits via unregulated chimneys. Nevertheless, his dogged determination to continue working, and deliver results in a reliable and timely manner, suggests why in common with many other skilled migrant workers, he remains in such high demand.

Far from being a public health pariah, Santa’s public health relevance extends beyond the mental wellbeing of the paediatric population and their grateful parents. By managing chronic illness without allowing it to dominate his life, he may be a powerfully enabling and destigmatising force.

Competing interests: No competing interests

07 November 2013
Roshan Vijayan
Junior Clinical Fellow
Gregory Scott
Queen Victoria Hospital
East Grinstead, RH19 3DZ