Public Health Challenges in Sun Protection: An Overview

Introduction:

Since time immemorial, people and public health services have actively participated in taking measures to protect one another from harmful ultraviolet radiation to prevent skin damage. Many skin cancer cases have been reported due to prolonged exposure to harmful radiation from the sun. Many campaigns have been conducted to reduce the incidence of skin cancer by encouraging people to take necessary steps to avoid over-exposure to the sun. However, recent studies that reveal the insufficient availability of vitamin D due to reduced sun exposure now contra-indicate the sun protection policies devised to protect the skin from sun damage. Hence, public health should implement strategies that balance the benefits and risks of sun exposure and strive to protect public health from the harmful effects of the sun and also ensure the availability of sufficient vitamin D naturally among the public.

How Does Sun Exposure Influence Various Diseases in Humans?

• Many recent studies reveal both the harmful effects of sun exposure in causing skin cancer and the benefits of sun exposure by being the natural source of vitamin D, which is beneficial in the case of osteoporosis and bone fractures.

• Also, there is evidence that sun exposure has beneficial effects on some cancers like breast, prostate, bowel, and non-Hodgkin’s lymphoma and autoimmune diseases like multiple sclerosis.

• However, this concept requires more evidence-based studies to confirm the benefits of sun exposure.

• Countries like Australia present with the highest cases of skin cancer due to exposure to harmful ultraviolet rays of the sun, with an incidence rate of affecting two out of three people around the age of 70.

What Are Ultraviolet Rays?

The sun emits various types of radiation on the earth’s surface. The earth receives visible light radiation (light) and infrared radiation (heat). Along with visible light and infrared radiation, ultraviolet radiation (UVR) is also emitted, which cannot be felt or seen. The majority of the UVR is absorbed by the ozone layer, following which some of it reaches the ground. The UVR reaching the ground has the potential to cause serious skin problems like sunburn and skin cancer.

How Harmful Is the Ultraviolet Exposure?

• Sunburn and skin cancers are caused due to excess UVR exposure.

• Even the eyes are not spared when exposed to UVR, which may cause photokeratitis, photoconjunctivitis, and cataracts.

• Cataract refers to the blurring of the lens due to clouding, which impairs the focus of light and the production of sharp images. If not intervened at the right time, it can eventually turn into blindness.

• Sunburn or erythema, is a short-term consequence of increased UVR exposure.

• Sunburn increases with the intensity of UVR exposure, and the increased incidence of sunburn in childhood is highly linked with developing skin cancer.

• Melanoma is an uncommon skin cancer that occurs due to increased exposure to UVR. It affects young children and is the most dangerous of all skin cancers.

• Malignant melanoma is a type of skin cancer and is of major concern, as it occurs without any warning signs except for the appearance of a black spot or mole on the skin.

• Such unusual skin findings should be identified and immediately reported to the hospital.

How Is the Strength of the Ultraviolet Radiation Measured?

• Ultraviolet radiation is measured by the ultraviolet index or UV Index, which is an international standard for measuring the strength of UVR reaching the ground at a specific time.

• This index serves as an important tool in spreading awareness about the risks of developing skin damage due to increased UV exposure and thus encourages the public to take protective measures against sun exposure.

• The risk increases with an increase in the rise in UV index. As the UV Index increases, the hazard increases.

The increasing risk and the exposure are given below:

• UV index of 0 to 2 is considered as low exposure and hence it is considered safe.

• UV index of 3 to 7 is considered as moderate; however, it is better to seek shade during midday, or apply sunscreen before going out.

• UV index of 8 and above is considered under very high risk category, therefore it is better to avoid going outside or it is a must to wear sun-protective clothing, sunglasses, and a wide hat when outdoors.

What Are the Challenges Encountered in Addressing the Sun Protection Issues?

• The sun protection campaign did not face challenges until some studies revealed the importance of vitamin D in preventing diseases like osteoporosis and its insufficiency due to sun protective measures like applying sunscreen and reducing sun exposure by remaining indoors.

• This topic has become more serious nowadays as some studies reveal very low levels of vitamin D (25 to 50 nmol/l) in people living in southern states of Australia during the winter season.

• Research shows that vitamin D insufficiency is more common in females of child-bearing age in winter with blood vitamin D levels less than 25 nmol/l. Even the dark-skinned women are equally affected.

• Increasing cases of osteoporosis in Australia have raised concerns regarding sun protection practices being the reason for considerably low levels of vitamin D in older adults, making it difficult to tackle the adverse effects and benefits of sun exposure.

• Also, it has become difficult to determine the optimum level of sun exposure in making the availability of vitamin D for maintaining bone health and, at the same time, to avoid sun exposure to prevent skin damage.

What Are the Measures Taken in Addressing the Challenges of Benefits and Adverse Effects of Sun Exposure?

• Public health sectors need to plan and devise strategies that balance the prevention of skin cancer measures and, at the same time, focus on availing essential vitamin D to maintain adequate levels in the body.

• Sun protection messages should not promote staying indoors all the time to prevent sun exposure.

• Skin cancer campaigns should consider both the risks and benefits of sun exposure and should implement strategies accordingly.

• Sun protection awareness programs should encourage the public to take necessary protective measures against sun exposure and should not encourage them to stay indoors all the time.

• People living in regions that are more sensitive to UVR should be given awareness about sun protection in the summer months and encouraged to go out during winter months to avoid the insufficiency of vitamin D.

• Also, sun protection measures should be initiated if the ultraviolet index goes beyond 3.

Conclusion:

Sun protection programs need to consider both the risks and benefits of sun exposure. The standard UV index needs to be considered, and the sun protection campaigns for the places need to be planned accordingly, as places with a UV index below 3 are at low risk of developing skin cancer. The UV index should be used as a guide to conduct sun protection campaigns by guiding the appropriate timing based on the intensity of the rays in different seasons of the year.