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OPINION

CANCER

‘Avoiding the sun is as dangerous as smoking’

Staying out of the sun to avoid skin cancer? Don't, argue Swedish doctors Pelle Lindqvist and Håkan Olsson.

'Avoiding the sun is as dangerous as smoking'
How many sun hours do we get in Sweden anyway? Photo: Janerik Henriksson/TT

For 40 years we have been taught to avoid the sun in order to reduce the risk of malignant melanoma skin cancer. But new findings show that avoiding exposure to the sun, on the contrary poses a major health risk.

We believe that those who campaign for “the less sun, the better” take large responsible for our health. Those who follow this advice seem to shorten their life expectancy by half-a-year to two years.

There have been three great lifestyle factors that are strongly related to illness and death: smoking, inactivity and obesity.

Our research indicates that people who are both non-smokers and non-sunbathers have the same risk of death as those that are both smokers and sunbathers. Avoiding the sun thus puts you at as great a risk of dying as smoking does.

We also find that women who avoid the sun double their risk of cardiovascular diseases such as heart attacks, strokes and blood clots. Twice as many who don't sunbathe also contract “other” illnesses, such as diabetes, multiple sclerosis and lung disease.

In all likelihood, people who live in the Nordic countries have become pale because it gives them an advantage. In terms of nature, it is the “survival of the fittest”.

If you listen to the debate, you are led to believe that it is dangerous to be pale or sensitive to the sun. Redheads are, however, probably the ones best suited to a sun-starved life in Scandinavia.

Sun-sensitive and fairskinned people likely need less sun for their health, and should be outside in the sun a shorter amount of time before they cover themselves up. Sunscreen “protection” is not a good idea.

It is likely that sunscreen eliminates the skin's reaction to too much sun, but does not significantly protect against melanoma. The price for sun-sensitive people's adaption to a sun-starved environment is that the risk of melanoma increases at over-exposure to the sun.

There is no scientific study that shows that you can be outside in the sun longer with sunscreen, in terms of the risk of melanoma. In Sweden, we see that sunscreen users double their risk of melanoma, most likely because they have spent too much time in the sun.

We share the same concern as the Swedish Radiation Safety Authority (Strålskyddsmyndigheten) that 80 percent of Swedes feel safe in the sun after applying sun lotion. Changing this way of thinking is key when it comes to decreasing the rate of malignant melanoma.

One thing many guidelines for sunbathing have had in common is that they have been poorly founded in science. Some campaigns have, on the contrary, helped create wrong and unhealthy sunbathing habits.

In 1992 a campaign was run in Sweden called “how to sunbathe safely”. It advised that you should “use sunscreen with a high sun protection factor (SPF) at first (…) then slowly increase the number of hours in the sun from one hour a day to five, six”.

This sort of advice likely contributes to both the wrong way of thinking and a large increase of melanoma in Sweden. You should/cannot stay out in the sun for longer time with sunscreen. After you have received a “lagom” dose of sunshine (preferably without sunscreen) you should seek the shade or get dressed.

So what can we do to get the sun we need without increasing the risk of melanoma?

The melanoma risk increases when you over-tan (for example spend too much time in the sun with sunscreen), get burned (get blisters and so on) and during exaggerated use of sunbeds. At the same time we know that those who work outside do not increase their risk of melanoma. Daily exposure to the sun thus does not increase the risk of melanoma.

Our advice is that famous Swedish word 'lagom' [meaning average or just right]. Sunbathe 'lagom' every day.

A 'lagom' start is having your lunch coffee in the sun. Then it will be every day, in the middle of the day when you enjoy the best rays – and not too long.

This article was written by doctors Pelle Lindqvist, who works at the women's hospital in Huddinge, and Håkan Olsson, from the oncology department in Lund. It was first published in Swedish by SVT.

FOOD AND DRINK

OPINION: Are tips in Sweden becoming the norm?

Should you tip in Sweden? Habits are changing fast thanks to new technology and a hard-pressed restaurant trade, writes James Savage.

OPINION: Are tips in Sweden becoming the norm?

The Local’s guide to tipping in Sweden is clear: tip for good service if you want to, but don’t feel the pressure: where servers in the US, for instance, rely on tips to live, waiters in Sweden have collectively bargained salaries with long vacations and generous benefits. 

But there are signs that this is changing, and the change is being accelerated by card machines. Now, many machines offer three preset gratuity percentages, usually starting with five percent and going up to fifteen or twenty. Previously they just asked the customer to fill in the total amount they wanted to pay.

This subtle change to a user interface sends a not-so-subtle message to customers: that tipping is expected and that most people are probably doing it. The button for not tipping is either a large-lettered ‘No Tip’ or a more subtle ‘Fortsätt’ or ‘Continue’ (it turns out you can continue without selecting a tip amount, but it’s not immediately clear to the user). 

I’ll confess, when I was first presented with this I was mildly irked: I usually tip if I’ve had table service, but waiting staff are treated as professionals and paid properly, guaranteed by deals with unions; menu prices are correspondingly high. The tip was a genuine token of appreciation.

But when I tweeted something to this effect (a tweet that went strangely viral), the responses I got made me think. Many people pointed out that the restaurant trade in Sweden is under enormous pressure, with rising costs, the after-effects of Covid and difficulties recruiting. And as Sweden has become more cosmopolitain, adding ten percent to the bill comes naturally to many.

Boulebar, a restaurant and bar chain with branches around Sweden and Denmark, had a longstanding policy of not accepting tips at all, reasoning that they were outdated and put diners in an uncomfortable position. But in 2021 CEO Henrik Kruse decided to change tack:

“It was a purely financial decision. We were under pressure due to Covid, and we had to keep wages down, so bringing back tips was the solution,” he said, adding that he has a collective agreement and staff also get a union bargained salary, before tips.

Yet for Kruse the new machines, with their pre-set tipping percentages, take things too far:

“We don’t use it, because it makes it even clearer that you’re asking for money. The guest should feel free not to tip. It’s more important for us that the guest feels free to tell people they’re satisfied.”

But for those restaurants that have adopted the new interfaces, the effect has been dramatic. Card processing company Kassacentralen, which was one of the first to launch this feature in Sweden, told Svenska Dagbladet this week that the feature had led to tips for the average establishment doubling, with some places seeing them rise six-fold.

Even unions are relaxed about tipping these days, perhaps understanding that they’re a significant extra income for their members. Union representatives have often in the past spoken out against tipping, arguing that the practice is demeaning to staff and that tips were spread unevenly, with staff in cafés or fast food joints getting nothing at all. But when I called the Swedish Hotel and Restaurant Union (HRF), a spokesman said that the union had no view on the practice, and it was a matter for staff, business owners and customers to decide.

So is tipping now expected in Sweden? The old advice probably still stands; waiters are still not as reliant on tips as staff in many other countries, so a lavish tip is not necessary. But as Swedes start to tip more generously, you might stick out if you leave nothing at all.

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