Health effects of sun exposure

Protecting children from ultraviolet radiation

Children
are in a dynamic state of growth, and are therefore more susceptible to environmental
threats than adults. Many vital functions such as the immune system are not fully
developed at birth, and unsafe environments may interfere with their normal development.
But most environmental hazards are preventable: reducing exposure is the most
effective way of protecting children's health.

Ultraviolet
radiation and ozone depletion

Ultraviolet (UV) radiation is one component
of solar radiation. It is progressively filtered as sunlight passes through the
atmosphere, in particular by the ozone layer.

As the ozone layer is depleted,
the protective filter activity of the atmosphere is reduced and more UV radiation,
in particular the more harmful UVB, reaches the Earth's surface. In the year 2000,
the ozone hole over the Antarctic reached its biggest size ever covering 11.4
million square miles - an area more than three times the size of the United States.
For the first time it also stretched over populated areas exposing local residents
to extreme levels of solar UV radiation. Local authorities warned residents in
Southern Chile that they could sunburn in less than seven minutes and should avoid
spending time outdoors in the middle of the day.

Sustained ozone depletion
and enhanced levels of UV radiation on Earth will aggravate UV effects on the
human skin, eyes and immune system. Children are at especially high risk of suffering
damage from exposure to UV radiation.

Health effects
of sun exposure: a global concern

UV radiation causes sunburn and skin
cancer and accelerates skin ageing. Overexposure to UV radiation can lead to inflammations
of the cornea and the conjunctiva in the eye, and causes or accelerates cataract
development. A health issue of growing concern is that UV radiation can reduce
the effectiveness of the human immune system. Consequently, sun exposure may enhance
the risk of infection and could limit the efficacy of immunization against disease.
Both of these act against the health of poor and vulnerable groups, especially
children of the developing world, as many developing countries are located close
to the equator and hence exposed to very high levels of UV radiation.

Skin
cancer has become the focus of intervention campaigns in Australia, Europe and
North America. Many believe that only fair-skinned people need to be concerned
about overexposure to the sun. Although it is true that darker skin has more protective
pigment, the skin is still susceptible to the damaging effects of UV radiation.
The incidence of skin cancers is lower in dark-skinned people, nevertheless skin
cancers occur and are often detected at a later, more dangerous stage. The risk
of other UV-related health effects, such as eye damage, premature ageing of the
skin, and immunosuppression is independent of skin type. For example, a 10% decrease
in total stratospheric ozone is predicted to result in between 1.6 and 1.75 million
additional cases of cataract per year worldwide.

Skin
cancer incidence on the rise

Between 2 and 3 million non-melanoma skin
cancers and approximately 132,000 malignant melanomas occur globally each year.
With a sustained 10% decrease in stratospheric ozone, an additional 300,000 non-melanoma
and 4,500 melanoma skin cancers could be expected world-wide, according to UNEP
estimates. Currently, one in five North Americans and one in two Australians will
develop some form of skin cancer in their lifetime.

People's behaviour in
the sun is the main cause for the rise in skin cancer rates in recent decades.
An increase in popular outdoor activities and changed sunbathing habits often
result in excessive UV exposure. Many people consider intensive sunbathing to
be normal and unfortunately, even many children and their parents perceive a suntan
as a symbol of attractiveness and good health. However, a suntan is merely a sign
of UV damage and represents the skin's defence to prevent further harm.

Children
require special protection

The United Nations Convention on the Rights
of the Child states that children, including all developmental stages from conception
to age 18, have the right to enjoyment of the highest attainable standard of health
and to a safe environment. Children require special protection as they are at
a higher risk of suffering damage from exposure to UV radiation than adults, in
particular:

• A child's skin is thinner and more sensitive
  and even a short time outdoors in the midday sun can result in serious burns.
  
• Epidemiological studies demonstrate that frequent sun exposure and sunburn
  in childhood set the stage for high rates of melanoma later in life.
• Children
  have more time to develop diseases with long latency, more years of life to be
  lost and more suffering to be endured as a result of impaired health. Increased
  life expectancy further adds to people's risk of developing skin cancers and cataracts.
  
• Children are more exposed to the sun. Estimates suggest that up to 80 per
  cent of a person's lifetime exposure to UV is received before the age of 18 .
  
• Children love playing outdoors but usually are not aware of the harmful effects
  of UV radiation.

Caring for children in the sun

According
to an Australian study, four out of five cases of skin cancer are preventable
by sensible behaviour. Encouraging children to take simple precautions will prevent
both short-term and long-term damage while still allowing them to enjoy the time
they spend outdoors. Parents should serve as role models, and it is their responsibility
to ensure that their children are protected adequately. Always keep infants of
less than 12 months in the shade and make sure your children:

• Cover up with protective clothing, a hat and sunglasses.
• Apply broad-spectrum
  sunscreen of SPF 15+.
• Limit their time in the midday sun.
• Seek shade.
  
• Avoid sunlamps and tanning parlours.

Shade, clothing and hats
provide the best protection for children -- applying sunscreen becomes necessary
on those parts of the body that remain exposed like the face and hands. Sunscreen
should never be used to prolong the duration of sun exposure.

Sun
protection is relevant in all settings

Sun protection is not only necessary
on the beach or at the swimming pool but applies to all outdoor settings. In many
situations sunburn arises because people do not realize the need for protection.
Children can be exposed to intense sunlight on the balcony at home, on weekend
trips or a visit to the zoo, during breaks at kindergarten or school, and during
outdoor sporting activities.

Particular attention should be paid in the
mountains, as UV levels increase by approximately 8 per cent with every 1000 meters
altitude. Although UV radiation is most intense under cloudless skies it may be
high even on an overcast day. Many surfaces such as snow, sand and water reflect
the sun's rays and add to the overall UV exposure.

Sun
protection programmes can make a difference

Sun protection programmes to
raise awareness and achieve changes in life-style is urgently needed to slow down
and eventually reverse the trend towards more and more skin cancers. An effective
campaign can have an enormous impact on public health: the regular use of sunscreen
with sun protection factor 15 or higher up to the age of 18 could decrease the
frequency of skin cancer in Australia by more than 70 per cent. Beyond the health
benefits, effective education programmes can significantly decrease costs in the
health system and strengthen the economy. Current prevention campaigns in Australia
invest approximately US$ 0.08 per person per year, while the direct costs of skin
cancer treatment have been estimated at US$ 5.70 per head of the population during
the same period of time.

WHO's Activities to promote
children's sun protection

INTERSUN Project

INTERSUN, WHO's
Global UV Project aims to reduce the burden of disease resulting from exposure
to UV radiation. The programme encourages and evaluates research to fill gaps
in scientific knowledge, assesses and quantifies health risks, and develops an
appropriate response through guidelines, recommendations and information dissemination.
Beyond its scientific objectives, INTERSUN provides guidance to national authorities
and other agencies about effective sun awareness programmes. These address different
target audiences such as occupationally exposed people, tourists, school children
and the general public. The programme is working towards the development of a
framework for children's sun protection education that comprises an educational
package as well as recommendations on best practices.

Global Solar UV
Index

The UV Index (UVI) was developed by WHO, the United Nations Environment
Programme, and the World Meteorological Organization as part of an international
effort to raise public awareness of the risks of sun exposure. It is a simple
measure of the intensity of the sun's ultraviolet rays at the earth's surface,
and in many countries is presented as part of the weather forecast. INTERSUN promotes
the harmonized use of the UVI, and advises governments to employ this educational
tool in their health promotion programmes. WHO encourages dissemination channels
such as the media and tourism industry to publish the UVI forecast and promote
sun protection messages.

Global School Health Initiative

WHO's
Global School Health Initiative seeks to mobilize and strengthen health promotion
and education activities to improve the health of students, school personnel,
families and other members of the community. Schools are vitally important settings
to promote sun protection, and play a significant role in increasing awareness
and changing behaviour among children and the people taking care of them. As part
of the WHO Information Series on School Health, INTERSUN is preparing a document
that will describe the essential steps in setting up a school initiative on sun
protection.

Task Force for the Protection of Children's Environmental
Health

In response to new knowledge about the special vulnerability
of children and to growing concerns about the health impact of unsafe environments,
WHO set up a Task Force for the Protection of Children's Environmental Health
in July 1999. Its objectives are to raise the awareness of member states and the
general public, to assist countries in mitigating the effects of environmental
threats and to develop methodologies for risk assessment and the dissemination
of information. Protecting children from harmful ultraviolet radiation is one
of the topics covered by the Task Force's activities.