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The Ontario Sun Safety Working Group Background Solar ultraviolet radiation is classified by the International Agency for Research on Cancer (IARC) as a carcinogen, causing skin cancer.1 It also causes a number of other health-related conditions, such as sunburn, photoaging and cataracts.2 In Canada, the incidence of melanoma, the least common but most life-threatening form of skin cancer, increased by 5-6% per year between 1970 and 19863 and more slowly thereafter.4 In 2002, it is estimated that there will be 3,900 new cases of melanoma and 72,000 new cases of non-melanoma skin cancer.4 Health Canada has recognized exposure to sunlight as an important health issue, and in the 1990s sponsored two symposia to review the scientific evidence concerning health effects of ultraviolet radiation (UVR), and to identify research and surveillance gaps.2,5 “Sun safety”, the practice of sun protective behaviours, is increasingly considered an important public health strategy by Canadian health professionals, especially those concerned with cancer prevention. For example, sun safety is included in the Mandatory Health Programs and Services Guidelines under which Ontario's public health units operate, and a set of recommended sun safety messages were developed at a Health Canada workshop.6 The National Survey on Sun Exposure and Protective Behaviours found that most Canadians practise insufficient sun protection and that awareness of the need to practise sun protection is not high.7-9 Sun safety programs and policies in Canada are largely developed and communicated by health professionals, including dermatologists, public health workers, researchers and sunscreen manufacturers, and promoted through organizations like the Canadian Cancer Society, the Canadian Dermatology Association, Health Canada and local health units.10 In other countries, such as Australia and England, sun safety programs may be disseminated by marketing and health promotion specialists.10 The Ontario Sun Safety Working Group (OSSWG) was formed to provide an opportunity for professionals involved in sun safety to work together to enhance sun-related activities. The purpose of this report is to describe the OSSWG as a model that may assist professionals in other parts of the country to more effectively mobilize expertise on sun safety or other public health issues in their regions. History of sun safety in Ontario Sun safety activities in Ontario, and across most of Canada, date back to the late 1980s. At that time, several organizations initiated campaigns in response to concerns about both rapidly rising skin cancer rates and depletion of the ozone layer.10 In 1989, the Canadian Dermatology Association began its national Sun Awareness Week. Several other national organizations also initiated UVR protection programs with Ontario components, often including Sun Awareness Week as part of their outreach strategies. The Canadian Cancer Society began producing sun safety materials in the late 1980s and elevated “SunSense” to one of its four health promotion priorities in 1993. One year later, its Ontario Division designed and packaged a full suite of sun protection activities to be delivered by its volunteers. Health Canada produced a number of sun protection resources in the early 1990s, including one of the first to emphasize the importance of sun protection for children. Environment Canada launched the daily UV index forecast program, with accompanying support materials, in the spring of 1992. In 1995, the Ontario Ministry of Labour published a “Sun Safety Alert” for outdoor workers and then developed a UVR health and safety guideline governing both solar and non-solar UVR exposures in the workplace. At the local level, individual public health units (e.g., London-Middlesex, Scarborough and others) created innovative sun protection campaigns in their respective communities. These organizations cooperated on specific projects and loosely coordinated their core sun awareness messages. Individuals representing some of these groups began meeting once a year in 1992 to discuss topical issues such as Sun Awareness Week activities, the status of the ozone layer and recent research and policy developments in the field. The Ontario Sun Safety Working Group Membership and purpose By the mid-1990s, several federal, provincial and municipal government departments and ministries, as well as health organizations, had resources dedicated to UVR protection in Ontario. Several of these groups identified the need for a more coordinated and dedicated approach to the provision of sun safety information to the public and policy makers, and the need for an enhanced profile for sun protection issues, especially in high-risk populations such as children and outdoor workers. In response to these needs, the Ontario Sun Safety Working Group was formed in 1997 as a partnership of individuals and organizations concerned with the impact of solar and artificial UVR on health. The OSSWG's stated purpose is to promote healthful behaviours and policies in relation to UVR exposure. Current member organizations and titles of their current representatives are shown in Table 1. The OSSWG meets monthly between September and June. Meetings involve planning and coordination of activities, examination of scientific developments in the field, updates on initiatives in member organizations and the coordination of sun protection messages among members. Goals and activities The OSSWG has the support of its member organizations in terms of the commitment of the professionals who form its core. In its early days, the major foci were the professional development of OSSWG members and attendance at public events where promotion of sun safety was relevant (e.g., Cottage Life Show, Royal Winter Fair, garden shows, etc.). However, as the group developed, it began to broaden its scope and undertake more challenging work. The goals of the OSSWG and some of its activities are listed in Table 2. A sample of activities is described in more detail below. |
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Gathering and evaluation of information on the health impact of UV radiation exposure and the effectiveness of protective behaviours: OSSWG members routinely bring new communication materials from their organizations to the meetings. This results in continuing education of members and promotes use of uniform materials and messages. The group also evaluates and provides feedback on these materials. The Canadian Health Network is being developed by Health Canada as a reliable Canadian Internet source of health information. The Canadian Cancer Society (CCS) was designated as the coordinator of cancer-related information for the Network, and invited the OSSWG to assist in the development of the section on skin cancer. Several members of the OSSWG, along with other Canadian skin cancer and UVR experts and CCS staff, constituted the Skin Cancer Task Force. Since the skin cancer section was the first to be developed by the CCS, the Task Force piloted the way in which web site material would be identified, evaluated and augmented. The Task Force determined the spectrum of information required, evaluated existing web sites, identified information gaps and assisted with the development of “FAQs” (frequently asked questions with answers) to address these gaps. Identification and development of key information/educational materials: The OSSWG analyzed Ontario data from the National Survey on Sun Exposure and Protective Behaviours7-9 to describe the recent sun exposure, protective behaviours and sunburn experience of Ontario adults and children. The results were published as a report11 that has been disseminated free of charge to Ontario public health units and other interested parties. When the Ontario elementary school curriculum underwent major changes a number of years ago, OSSWG members identified sections of the science and health curricula where sun safety-related information could be incorporated. Sample teaching materials were developed. Sun safety has now been integrated into an injury prevention lesson plan in the grade 6 physical and health education curriculum. A sun safety guide for outdoor workers was developed and produced collaboratively with Toronto Public Health and the Canadian Dermatology Association, and has been sold (at cost) to several unions and management organizations.12 Raising awareness on the effects of solar and artificial UV radiation on human health: Members of the OSSWG have made expert presentations to a variety of professional groups. Topics covered included epidemiology of skin cancer, clinical aspects of skin cancer, health effects and biological properties of UVR and sunscreens, physical aspects of UVR (including the state of the ozone layer), and data about the population's exposure to UVR and use of protective behaviours. Members are also available to speak with the media and have published review articles on sun protection. Promotion of consistent public health approaches (personal and institutional) to sun safety: Over the last five years, the OSSWG has supported the dissemination of consistent sun protection messages in Ontario by coordination of outreach campaigns among members, and by providing input to and support for Sun Awareness Week campaigns. A major project in progress is the development of an Ontario Sun Safety Network. Over the years there have been numerous requests from sun safety professionals in public health units for advice on sun-related issues (e.g., reasonable targets for Ontario public health's Mandatory Health Programs and Services Guidelines, existing day care sun safety policies, etc.) or for closer linkage with the OSSWG and others working in the field. Most public health nurses with the sun safety portfolio in a public health unit work alone, and many have responsibilities in addition to sun safety. The OSSWG therefore secured funding from Cancer Care Ontario for a survey of Ontario sun safety practitioners' activities and needs, and development of a proposal for a network to link those interested in sun safety with each other and with information resources. Advocacy for policies to reduce UV radiation exposure: OSSWG members have actively participated in the UVR Working Group of the Toronto Cancer Prevention Coalition, which was charged with making recommendations to the Toronto Board of Health on ways to reduce UVR-related cancers in Toronto. As part of its background work, the UVR Working Group prepared a report reviewing public sun safety policies and programs, both local to Toronto and more broadly. A lack of sun protection policies and/or enforcement was found in the Toronto region. The UVR Working Group made three recommendations for improved sun safety policy and practice in Toronto, one of which (the development of sun protection policies for city employees when working out of doors) has already been acted upon. Evaluation The work of the OSSWG has not been formally evaluated. It has, however, created or contributed in a meaningful way to a number of tangible products. These include skin cancer material for the Canadian Health Network, the Ontario report on sun exposure and protective behaviours11 and the sun safety manual for outdoor workers.12 These materials have been used as information sources for various purposes, including implementation of sun safety policies in the workplace and the development of sun safety materials and strategies. The OSSWG is increasingly gaining recognition as a source of expertise. The OSSWG has successfully secured small amounts of funding for two of its projects: the production of the Ontario report on sun exposure and protective behaviours11 and the development of a proposal for an Ontario Sun Safety Network. The OSSWG undertook a review and strategic planning exercise in 2000 with assistance from the University of Toronto's Centre for Health Promotion. As a result, the group decided to adopt one primary focus with a small number of objectives each year, in addition to our ongoing professional education, support and advocacy work. This exercise also led to greater awareness of the need for the OSSWG to be realistic about what it can achieve, since it is a coalition of a small number of busy professionals without regular funding. The OSSWG's focus for 2001-2002 was the promotion of shade provision in public places. Discussions were held with other organizations that share this goal (e.g., the Toronto District School Board and Evergreen), to identify synergies that would allow each organization to be more effective with limited resources. The OSSWG reviewed “Under Cover”,13 an Australian publication about the provision of quality shade, to determine the extent and nature of revisions required to make it appropriate for use in Canada. Production of a revised version will not be undertaken until there is greater certainty about the level of demand. Some of the OSSWG's members have been instrumental in the organization of a shade conference to be held in 2003. The main focus for 2002-2003 will be the development of the Ontario Sun Safety Network, while continuing the work on provision of shade. Challenges There are a number of challenges facing the OSSWG. One of these is turnover of membership when people are reassigned to other portfolios or jobs. Another is lack of resources. The amount of time each member can give to the group's activities is limited. Apart from the two funded projects noted above, the OSSWG has had to support its activities solely from the resources represented by the members and their associations/employers. This has limited the scope of work. In the early 1990s, the fear of ozone depletion in northern latitudes and the dramatic rise in skin cancer rates received considerable public attention. A decade later, with comprehensive controls on ozone-depleting substances in place, UVR and skin cancer are now viewed as mature public health and environmental issues. Yet skin cancer rates remain stubbornly high, and it continues to be challenging to maintain momentum and secure media attention. This situation underscores the need for a multi-agency team, such as the OSSWG, that can serve as an effective vehicle for collaboration on sun safety initiatives and media opportunities. The OSSWG acts to support and maintain a critical mass of professionals addressing this health promotion issue. A positive challenge has been the interest on the part of Ontario public health unit staff working in sun safety to join the OSSWG. This interest has stimulated the OSSWG to investigate development of a sun safety network so its outreach can be extended, without making the core group too large. The model adopted by the OSSWG works in part because of the critical mass of interested individuals with varied expertise located within a small geographic area. Although there is currently one “long-distance” member who usually joins the meetings by telephone, experience indicates that it is difficult to maintain involvement when connection is only by telephone and e-mail. Conclusions The OSSWG has been successful in accomplishing its mission because of the commitment, energy and enthusiasm of its members and their organizations. The OSSWG provides valuable support to health professionals who may be rather isolated with respect to their sun safety work. Because of its cross-organization, multi-disciplinary nature, it represents an invaluable source of knowledge, expertise and support for both its members and other individuals and organizations with an interest or mandate in sun safety. Because of its critical mass, the OSSWG is able to take actions and to introduce change much more effectively than individual members working on their own. We recommend that those wanting to start a group such as the OSSWG for sun safety or other public health program areas
Acknowledgements The authors gratefully acknowledge the support of their organizations in allowing and encouraging involvement in the work of the OSSWG. Dr. Maurice Bitran (then Ontario Ministry of Labour), Ms. Bonnie Cunningham-Wires (Scarborough/Toronto Public Health), Ms. Denise Vavaroutsos (then Canadian Cancer Society - Ontario Division) and Ms. Patricia Powell (Ontario Ministry of Health and Long-Term Care) are past members who made substantial contributions to the development and work of the OSSWG. References 1. International Agency for Research on Cancer (IARC). Solar and ultraviolet radiation. IARC monographs on the evaluation of carcinogenic risks to humans, Vol. 55. Lyon: IARC, 1992. 2. Mills CJ, Trouton K, Gibbons L. Second symposium on ultraviolet radiation-related diseases. Chronic Dis Can, 18: 27-38, 1997. 3. National Cancer Institute of Canada. Canadian Cancer Statistics 1991. Toronto, Ontario, 1991. 4. National Cancer Institute of Canada. Canadian Cancer Statistics 2002. Toronto, Ontario, 2002. 5. Gibbons L, Anderson L. (Eds.) Proceedings of the symposium on ultraviolet radiation-related diseases, Ottawa, Ontario, March 24-26, 1992. Chronic Dis Can, Suppl 13: S1-S42, 1992. 6. Mills CJ, Jackson S. Public education messages for reducing health risks from ultraviolet radiation [workshop report]. Chronic Dis Can, 16: 33-36, 1995. 7. Lovato CY, Shoveller JA, Peters L, Rivers JK. Canadian National Survey on Sun Exposure & Protective Behaviours: youth at leisure. Cancer Prevention Control, 2: 117-122, 1998a. 8. Lovato CY, Shoveller JA, Peters L, Rivers JK. Canadian National Survey on Sun Exposure & Protective Behaviours: parents' reports on children. Cancer Prevention Control, 2: 123-128, 1998b. 9. Shoveller JA, Lovato CY, Peters L, Rivers JK. Canadian National Survey on Sun Exposure & Protective Behaviours: adults at leisure. Cancer Prevention Control, 2: 111-116, 1998. 10. Garvin T, Eyles J. Public health responses for skin cancer prevention: the policy framing of sun safety in Australia, Canada and England. Soc Sci Med, 53: 1175-1189, 2001. 11. Ontario Sun Safety Working Group. Sun exposure and protective behaviours: Ontario Report 1998. Toronto, Ontario: Canadian Cancer Society (Ontario Division), 1998. 12. Toronto Public Health. Sun safety when employees work outdoors - A health & safety manual. Canadian Dermatology Association, 1998. 13. Greenwood JS, Soulos GP, Thomas ND. Under cover: Guidelines for shade planning and design. Sydney, Australia: NSW Cancer Council and NSW Health Department, 1998. Author References Loraine D Marrett, Division of Preventive Oncology, Cancer Care Ontario, Toronto, Ontario, Canada Dave Broadhurst, Atmospheric Science Division, Ontario Region, Environment Canada, Toronto, Ontario, Canada Stephanie Charron, Health Products and Food Branch, Ontario/Nunavut Region, Health Canada, Toronto, Ontario, Canada Laurie Fraser, Sudbury and District Health Unit, Sudbury, Ontario, Canada Lynn From, Division of Dermatology, Women's College Campus, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada William Hunter, Public Health Branch, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada Patricia Payne, Canadian Cancer Society - Ontario Division, Toronto, Ontario, Canada Mary Louise Yarema, Toronto Public Health, Toronto, Ontario, Canada Cheryl Rosen, Division of Dermatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Ontario, Canada Correspondence: Loraine D Marrett, Division of Preventive
Oncology, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario,
Canada M5G 2L7; |
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Last Updated: 2003-03-20 |  |
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