Cases of rickets in Scotland have surged by 25 percent, from 354 in 2018 to 442 in 2022, a number nearly equal to the tally of 482 cases in all of England. This rise in prevalence of rickets in Scotland, traditionally associated with Victorian slums and believed to be eradicated from modern society, is a cause for concern. The disease is caused by a lack of vitamin D, which is primarily produced in the body through exposure to sunlight.
Interestingly, Scotland experiences limited sunlight between April and September, making it more challenging for individuals to obtain sufficient vitamin D naturally. Furthermore, vitamin D occurs naturally in only a few foods, such as oily fish, liver, and egg yolks. One in six individuals in Scotland has permanently low levels of vitamin D, particularly those with darker skin who process sunlight less efficiently.
Retired Edinburgh GP, Helga Rhein, from the campaign group Scots Need Vitamin D, criticizes the public health system in Scotland for the increase in rickets cases. Rhein emphasizes the importance of educating people about the vital role of vitamin D in overall health and the reasons for its deficiency in Scotland. She suggests the distribution of supplements, as they are inexpensive and easily accessible. Rhein asserts that rickets is not just a consequence of vitamin D deficiency but also reflects a failure of the state.
Vitamin D is essential for building strong bones, and its connection to rickets was discovered a century ago, leading to a decline in bow-legged children, a common sight in the past. The prevalence of rickets during Victorian times was a result of industrial cities’ smog, which obstructed sunlight. Dr. Chris Williams of the Royal College of General Practitioners Scotland argues that more needs to be done to protect individuals with low incomes from relying on products with low nutritional value, leading to malnutrition. Vulnerable individuals and communities lacking access to fresh, nutritious food are at a higher risk of developing rickets due to an inadequate diet.
Dr. Richard Quinton, a consultant endocrinologist, highlights the lack of an active program in schools, nurseries, GP surgeries, or community centers to promote the use of vitamin D supplements. He mentions that preschool and primary school children in Scotland are often treated with sunscreen during sunnier months, blocking the photosynthesis of vitamin D. While parts of England receive over 1,500 hours of sunshine annually, Scotland generally records less than 1,300 hours. As a solution, children under three and pregnant or breastfeeding women are eligible for free vitamin D supplements.
The Scottish Government recognizes the importance of maintaining adequate vitamin D levels for bone and muscle health and advises everyone to consider taking a daily 10-microgram supplement, especially during the winter months. Rickets is a condition where children’s cartilage fails to mineralize, leading to bones bending out of shape. Osteomalacia, which involves weakened bones in adults, is a related condition caused by the body’s inability to properly process calcium due to vitamin D deficiency. Rickets was prevalent in Britain by the 17th century, affecting individuals from all social standings, including royalty. It was only in 1919, during the search for a cure, that vitamin D was discovered, shedding light on the mechanism behind the efficacy of sunshine and cod liver oil in treating the disease.
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