Children
and Young People Committee
SSPP04
Inquiry into school sun protection policy
Evidence from Public Health Wales
Public Health Wales are pleased to respond to the request of the Children and Young People Committee of the National Assembly for Wales for comments on sun protection for children and young people at school or in childcare. Comments on the requested paragraphs are:
1 Whether current sun protection policies and guidelines for schools are effective in providing sufficient sun protection for children, and if not, where improvements are required.
- A recent survey by Cancer Research UK, commissioned by the All‐Party Parliamentary Group on Skin of 1000 people has shown that approximately 40% of school‐age children have arrived home with sunburn sustained at school. [1] The survey also showed that more than 40% of parents believe teachers should be responsible for ensuring children are wearing sunscreen at school. 1
- The findings also indicate an urgent need for a well‐funded, national awareness campaign, alongside a focus on sun education and protection in schools, to stem the growth of the fastest rising cancer in the UK. [2]
- National guidelines recommend that schools should have a sun policy but they are not prescriptive or mandatory. Currently, the decision whether or not to deliver sun safety advice is left largely to the discretion of the individual teacher. The National Institute for Health and Clinical Excellence (NICE) recommend the provision of shade in schools but this recommendation appears to be disregarded in many United Kingdom schools. [3]
· Schools should produce a robust policy which guides all members of the school community. Children and young people should be made aware of the importance of following safe sun behaviours, both within the curriculum and through extra-curricular activities. This will allow children and young people to learn about the misconception that a sun tan is healthy and encourage children and young people to change their behaviour and adopt safe sun practice. It will also empower them to share information on safe sun practice with their families. [4] Social marketing interventions may play arole in promoting effective behaviour change.
2. Whether there is sufficient awareness of the current sun protection policies and guidelines, and, if not, how best to raise awareness;
- Evidence from recent surveys suggests that there is a lack of awareness of policies for sun protection. The clinical and public health guidance on skin cancer from NICE has been used to inform a website dedicated to skin cancer prevention and early diagnosis from the South West Public Health Observatory www.swpho.nhs.uk/skincancerhub. There is comprehensive information available on the website on methods to improve awareness of the dangers of overexposure to the sun and the importance of sun protection. Public Health Wales is in the process of developing web pages on skin cancer prevention.
- There are also examples of good practice in the literature that could be adopted in Wales. It is recommended that children and young people are involved in the development of a programme of activities that co-ordinate and raise awareness of a culture of safe sun practice within schools leading to the adoption of safe sun behaviour. This may involve for example designing posters and inventing stories to put across key messages. There are excellent posters and leaflets already freely available from the British Association of Dermatologists, the Teenage Cancer Trust and the Cancer Research UK SunSmart campaign. These leaflets and posters will be available in Welsh and English via the planned Welsh skin cancer web pages.
3. Whether there are any barriers to the use of sun protection in schools, including sunscreen, suitable clothing, hats or shade, by children and young people, for example in terms of cost or the application of sunscreen by teachers or childminders, and if so, how these could be addressed.
- There are sensitivities around whether it is appropriate for school staff to apply sun screen to children and young people and it is vital that primary schools place particular emphasis on encouraging changes in the habits of parents/carers as well as children and young people. Local authorities and school governing bodies should formulate their own policies on this.
· There is no specific guidance from the Department for Education or the Welsh Education Department on this matter, although it is indicated that school staff are not legally obliged to administer sunscreens but schools should discharge their duty of care by ensuring that children are not over exposed to sun.
· The National Union of Teachers has published a health and safety briefing for sun safety. Self administration of sunscreen by pupils is recommended, apart from the very youngest of children and those with special needs. [5]
· Where cost is concerned the systematic review performed to inform the NICE guidance illustrated the poor quality of evidence on outcomes of the provision of free sunscreen and NICE recommend that parents should provide the sunscreen and children could be taught how to apply it themselves. [6] NICE recommend that teachers should supervise the application of sunscreen, possibly with help from the school nurse or interested parents who volunteer on a rota system to help.
· The Cancer Research UK school skin cancer policy guidelines strongly recommend the planting of trees to provide shade.[7] There is however, a lack of cost effective evidence on the provision of facilities to increase shade provision; the inclusion in new build schools is however recommended by NICE. 3 Preliminary research suggests that school children that have playgrounds with trees were found to have higher levels of physical activity and significantly less UV radiation exposure. [8] One survey in the South West found that only 8% of primary schools had performed a formal shade assessment and approximately 66% were not satisfied with the current shade provision within their school. [9]
· One of the potential problems with implementing rigorous sun protection policies is that the evidence suggests that any sun safety measures should not reduce pupil participation in physical activity. An expert paper produced to inform the NICE guidance 3 explores the role of sun protection during outdoor physical activity. [10] The authors indicate that following the recommendations of the Cancer Research UK SunSmart campaign and the World Health Organisation would make outdoor activities off-limits for almost all of the school day (09h to 15.00h). They recommend that where activities cannot be rescheduled, there should be a move towards implementing policies and practices to encourage sun safe behaviour.