Children spend a good deal of time in the care of other people other than their parents. As a parent I would go to great lengths to ensure my kids caregiver reapplied sunblock every two hours, tipping the counselor at camp and drilling the message into my childcare provider. But time has come for more intervention in protecting our children while at school. Other countries do it and America needs to step up.
The Federal Government needs to enact legislation that requires elementary schools to provide sunblock and sunblock applications for children while at school. Given the rise in skin cancer and the vulnerability of children to protect themselves against sun exposure much is at stake. Worldwide policies that have failed, emphasize the US government’s need to assess its current policies and to draw from other countries’ experiences, and enact new legislation which reflects the current knowledge of the risks involved. The Skin Cancer Foundation recently reported that skin cancer rates are increasing at an alarming rate. (“Skin Cancer Facts”). The potential harm that sun exposure poses on children requires the government to address this as an urgent health concern and implement laws that take effect immediately.
Skin cancer in certain groups will be the leading cause of death in America, surpassing all other cancers combined and according to Perry Robins, M.D, President of the Skin Cancer Foundation “Americans are developing skin cancer at an alarming rate” (Perry Robins). In order to prevent melanoma skin cancer, it is imperative that children do not develop a sunburn caused by overexposure to the sun. The World Health Organization guidelines state children are particularly at risk, as sun exposure during childhood and adolescence appears to set the stage for the development of both melanoma and non-melanoma skin cancers later in life. As children spend the majority of the day at school, and during a time when the sun is worst ,sunblock needs to be made readily available for children. An adult should be designated to apply sunblock to children before they go out into a yard, particularly if that playground does not provide shade, either natural or manmade.
The sun rays are at their highest during the hours of 10 AM to 4 PM and this is the time of the day the rays are more likely to cause damage to the skin, this peak exposure falls at a time when a child may no longer be under the supervision of a parent, and in the supervision of school. Unless a school provides adequate shade or trees, over playing areas, most children will be receiving some sun exposure while at school. One government agency recommends that you should “Generously apply about one ounce of sunscreen to cover all exposed skin 15 minutes before going outside and reapply every 2 hours, even on cloudy days and after swimming and sweating” (United States, Environmental Protection Agency). If sunblock was applied to a child in the morning by a parent, assuming most schools have a break for lunch, sun block would need to be reapplied prior to leaving the classroom for afternoon break.
This analysis further assumes that responsible parents have applied sunblock to their children in the morning, whereas in most cases this may not be the situation, further emphasizing the need for intervention whilst the children are at school. It only takes one blistering sunburn in childhood or adolescence more than doubles a person’s chance of developing melanoma later in life… and there little evidence that school districts are taking the appropriate steps to protect children from UV radiation” (Skin Cancer Facts) and citing a recent study conducted by the Center for Disease and Prevention which found “that 60 percent of schools do not avoid the sun at peak times and fewer than 47 % encouraged students to apply sunblock before going outside” . . . (Foundation). An obvious solution in protecting children while playing outside during school hours would be to ensure there is adequate shade, but this is not always practical. The Surgeon General’s recent initiative “A Call To Action” recommended schools to “identify opportunities to increase shade through relocating activities or providing sun structures in key locations” (Surgeon). However this did not address the issues faced at this time and for countries that have had similar recommendations in place, studies have recently shown that this shade policy is difficult to implement. This is evident in New Zealand “who after five years after policies were issued recommending schools provide shade showed only 52% of schools did so citing cost as the main obstacle” (Reeder I Anthony).
As skin cancer rates continue to increase The United States is in a position to enact laws that have a direct immediate impact on the problem as evidence has shown that local intervention and policies are ineffective. Currently, California is the only State to make an effort to improve sun safety legislation for children while at school. According to Perry Robins, M.D, President of the Skin Cancer Foundation, he notes that “alarmingly California is the only State with legislation that gives children the right to take sun protection measures to school”. The California Law that was recently passed, was only affected because a child with a rare genetic disease was not allowed to wear a hat. Jeffery Ashley M.D explained “imagine having a child stricken with xeroderma pigmentosum a genetic disease causing extreme susceptibility to sun- induced cancer. Now imagine being told by the child’s school that wearing a sun protection hat is forbidden”…. (Ashley).
The Center for Disease and the World Health Organization both provide extensive guidelines for schools on how to protect children from sun exposure, mainly relying on parents to rally school parent boards to educate teachers and other staff members on sun safety policies. Their position on children being adequately protected at school from sun exposure is a personal decision is evident from its report ‘’Sun Protection and Schools’’ which states, “The school environment and the manner in which a school operates can have a significant impact on children’s UV radiation, … “While it is a personal decision to adopt sensible sun behavior, positive choices can be supported through adequate structural and policy measures” (Organization, Sun Protection and Schools, How to Make a Difference). Even if sun protection is a “personal choice” schools have a responsibility to ensure children are adequately protected while they are in their care. Some parents may prefer that their child does not have sunscreen applied. This may be because of recent studies which suggests we are not getting sufficient vitamin D because of sunscreen application. Several studies have shown the application of sunscreen does not affect our vitamin D levels and thereby cause a deficiency in vitamin D (Farrerons J et al). And evidence continues to remind us there is a clear link between sun exposure and skin cancer and vitamin D can be supplemented with food and a supplement if required.
Children need protection now, we cannot wait for trees to grow to offer shade and wait for the funding shade structures to be built, and these efforts could take years to have an effect. It’s time for Federal intervention to allow sun protection to be made available on school property, this law could be similar to the use of seat belt requirements and children and have an immediate effect on the health and wellbeing of children.
Australia has the second highest rates of skin cancer in the world behind those of New Zealand. They have been developing and implementing sun safety policies for over twenty five years with the first program developed in 1988. Many of the policies implemented by The United States governing agencies are drawn from the Australian model named SunSmart. Developed by the ACCV (The Anti-Cancer Council of Victoria) it was first launched under the now famous slogan: Slip, Slap, Slop, which later evolved into the SunSmart Program. The SunSmart initiative went on to be hailed as one of the most successful health campaigns ever launched in Australia history (Australia) . In order to become an accredited SunSmart facility you were required to implement several sun safety measures ensuring the school was awarded SunSmart Status. These policies involved requirements such as the installment of shade barriers over the playing areas of playgrounds, the use of broad brimmed hats, protective clothing and the application of a suitable sunscreen of SPF 30. As Australia looks back on more than two decades since the program was established, recent extensive research has found many schools.
Recent research from Australia and New Zealand who have the highest skin cancer rates in the world have also had similar initiatives in place, referred to the “Call To Action “which are also showing signs of frustration at state by state run incentives. This is apparent in a report from Anthony Reeder from the Health Education Research in New Zealand, which states “Sun Protection is an acknowledged health and safety strategy, arguably little different from other injury prevention measures, or the provision of hygienic measures. Therefore, it seems anomalous that it should remain largely the responsibility of NGO health promoters and a charity to not only develop, implement and evaluate the SSAP, but also to continue to resource it in the absence of appropriate commitment at public service level” (Reeder I Anthony).
are non-compliant with the SunSmart program. The Skin Cancer Research Group shows “The SunSmart status is not consistent with better hat –wearing behavior. The protective nature of hats and the proportion of school students and adult role models wearing them could be improved, possibly by offering incentives to schools that offer sun safety" (Turner).
An important study in 2014 from the Australia Health Education Research recently reviewed schools that followed the SunSmart policies (SSS) in the area of Queenstown. Data was collected from schools across the area to ensure sun safety policies were being implemented, some of these included the wearing of hats, the availability of sun block on the premises and adequate shade. “In conclusion, only 5% of schools received a perfect score and the majority of school policies only scored 2 from a possible 12” . Since 1998 the government of Australia has implemented sun safety policies in its schools almost identical to those recently proposed five strategic goals to prevent skin cancer in America from the Surgeon General “Call To Action” with skin cancer now a major public health issue (Services) and the Surgeon General offering more resources to state governments to implement sun safety policies.
Works Cited
Turner, Denise, et al. "Does Being A "SunSmart School" Influence Hat - Wearing Compliance ? An Ecological Study Of Hat-Wearing Rates At Australian Primary Schools In A Region Of High Sun Exposure" Preventive Medicine 60. (2014): 107-114. ScienceDirect. Web. 26 Nov. 2016
Anthony I Reader, Janet A Jopson and Andrew Gray."Primary School Sun Protection Policies And Practices 4 Years Baseline- A Follow-Up Study" Health Education Research 27.5 (2012): 844-856. CINAHL Complete. Web. 26 Nov. 2016. Health Education Research." July 2012.
Ashley, Jeff, M.D. "The Glaring Need for Sun Safety in Schools." 2001. Skin Cancer Foundation . <http://www.skincancer.org/get-involved/schools/the-glaring-need-for-sun-safety-in-schools>.
Australia, Cancer Council Of. "Slip,Slop, Slap, Seek Shade." March 2016. Cancer.org.au. journal. November 2016.
Foundation, Skin Cancer. "Most U.S Schools Not Sun Safe." 28 April 2011. SkinCancer.org. Document. 12 November 2016.
—. "Skin Cancer Rates Soar in US Hispanics." Winter 2013. SkinCancer.org. Article. 16 November 2016.
Miller. K. A., et al. "SunSmart, Evaluation Of A Pilot School-BAsed Sun Protection Intervention In Hispanic Early Adolescents." Health Education Rea 20 Nov 2015: 371-379. web.
World Health Organization. Evaluating school programmes to promote sun protection.(2003).
Geneva:World Health Organization, 2003
Perry Robins, M.D. "Skin Cancer Rates Soar in US Hispanics." 2013. Skin Cancer.org. Document. 20 November 2016.
Surgeons. US Department of Health and Human. "The Surgeons General Call Of Action To Prevent Skin Cancer." 16th Nov 2016. ww.hss.gov. Executive Summary. Accessed March 24th 2021.
Skin Cancer Facts & Statistics.”What you need to know about skin cancer: What You Need To Know:General Facts. 2021, www.skincancer.org/. Accessed 14 Apr. 2021.
Rouhani P, Pinheiro PS, Sherman R, Arheart K, Fleming LE, Mackinnon J, Kirsner RS. Increasing rates of melanoma among nonwhites in Florida compared with the United States. Arch Dermatol. 2010 Jul;146(7):741-6. doi: 10.1001/archdermatol.2010.133. PMID: 20644034.
United States Environmental Protection Agency. Action Steps for Sun Safety. 2019, www.epa.gov
Farrerons, J et al. “Clinically prescribed sunscreen (sun protection factor 15) does not decrease serum vitamin D concentration sufficiently either to induce changes in parathyroid function or in metabolic markers.” The British journal of dermatology vol. 139,3 (1998): 422-7. doi:10.1046/j.1365-2133.1998.02405.x