sign in sign up
<<
Home , List of zoos by country, Up (airline)

GLOBAL GLOBAL SOLAR UV INDEX SOLAR

A marked increase in the incidence of skin UV INDEX cancers has been observed in fair-skinned populations worldwide since the early 1970s. This is strongly associated with A Practical Guide personal habits in relation to sun exposure and its ultraviolet (UV) component, and the societal view that a tan is desirable and healthy.

The Global Solar UV Index (UVI) described in this document was developed in an international effort by WHO in collaboration with WMO,UNEP and ICNIRP,and is a simple measure of the UV radiation level at the Earth’s surface. It serves as an important vehicle to raise public awareness and to alert people about the need to adopt protective measures when exposed to UV radiation.

Intersun, WHO’s Global UV Project, aims to reduce the burden of disease resulting from exposure to UV radiation by assessing and quantifying health risks, and developing an appropriate response through guide- lines, recommendations and information dissemination.

A joint recommendation of: World Health Organization World Meteorological Organization United Nations Environment Programme International Commission on Non-Ionizing Radiation Protection WHO/SDE/OEH/02.2 GLOBAL SOLAR UV INDEX A Practical Guide

A joint recommendation of:

World Health Organization

World Meteorological Organization

United Nations Environment Programme

International Commission on Non-Ionizing Radiation Protection

i Contents

Preface iv Introduction 1

Copyright © World Health Organization 2002 The Global Solar UV Index – An Educational Tool 4 Reporting the UV Index – The Basic Scheme 6 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization.The document may, however, be freely reviewed, abstracted, reproduced or Sun Protection Messages – Creating Variety 10 translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. Educational Concepts and Their Practical Implementation 12 The views expressed in documents by named authors are solely the responsibility of those authors.

WHO Library Cataloguing-in-Publication Data

Global Solar UV Index: A Practical Guide.

A joint recommendation of the World Health Organization,World Meteorological Organization, United Nations Environment Programme, and the International Commission on Non-Ionizing Radiation Protection Annex

1. Ultraviolet rays – adverse effects 2. Sunlight – adverse effects 3. Radiation monitoring – instrumentation 4. Radiation monitoring – standards 5. Reference values 6. Health education 7. Environmental exposure – prevention and control 8. Manuals A Health Effects of UV Radiation Exposure 15

ISBN 92 4 159007 6 (NLM classification: QT 162.U4) B Internet Links: Organizations Reporting the UV Index 19

Graphic icons designed by Pauls Sloss C The UV Index 21 Printed in Geneva, D Graphic Presentation of the UV Index 22 E Additional Sun Protection Messages 23 F List of Contributors 25

ii iii Preface Introduction

A marked increase in the incidence of skin Ionizing Radiation Protection (ICNIRP) and cancers has been observed in fair-skinned the German Federal Office for Radiation populations worldwide since the early 1970s. Protection (Bundesamt für Strahlenschutz, This is strongly associated with personal BfS) (see Annex F for list of contributors). Everyone is exposed to UV radiation from habits in relation to sun exposure and its Since its initial publication in 1995, several the sun and many artificial sources used in ultraviolet (UV) component, and the societal international meetings of experts (Les industry, commerce and recreation. view that a tan is desirable and healthy. Diablerets, 19941; Baltimore, 19962;Les Emissions from the sun include light, heat Educational programmes are urgently Diablerets, 1997 3; Munich, 20004) have been and UV radiation. needed to raise awareness of the damaging convened with the aim to harmonize the effects of UV radiation, and to encourage reporting of the UVI and to improve its use as The UV region covers the wavelength range changes in lifestyle that will arrest the trend an educational tool to promote sun 100–400 nm and is divided into three towards more and more skin cancers. protection. bands:

The Global Solar UV Index (UVI) described in This practical guide, prepared by Eva UVA (315–400 nm) this document is a simple measure of the UV Rehfuess, is based on the consensus reached radiation level at the Earth’s surface and an at the Munich meeting,and is intended to be UVB (280–315 nm) indicator of the potential for skin used by national and local authorities and damage. It serves as an important vehicle to non-governmental organizations active in UVC (100–280 nm) raise public awareness and to alert people the area of skin cancer prevention, as well as about the need to adopt protective meteorological offices and media outlets As sunlight passes through the measures when exposed to UV radiation.The involved with UVI reporting.This publication atmosphere, all UVC and approximately UVI was developed through an international can serve as an entry point for the 90% of UVB radiation are absorbed by effort by the World Health Organization development and implementation of an ozone, water vapour, oxygen and carbon (WHO) in collaboration with the United integrated public health approach to sun dioxide. UVA radiation is less affected by Nations Environment Programme (UNEP),the protection and skin cancer prevention. the atmosphere. World Meteorological Organization (WMO), the International Commission on Non- Therefore, the UV radiation reaching the Earth’s surface is largely composed of UVA with a small UVB component.

1 Report of the WMO meeting of experts on UVB measurements, data quality and standardization of UV indices, Les Diablerets, Switzerland, 22–25 July 1994. Geneva,World Meteorological Organization, 1995 (Global Atmosphere Watch, No. 95). 2 Educating the public about the hazards of ultraviolet radiation. Summary report. International workshop, Baltimore, 26–28 August 1996. Aberdeen Proving Ground MD, U.S. Army Center for Health Promotion and Preventive Medicine, 2001. 3 Report of the WMO–WHO meeting of experts on standardization of UV indices and their dissemination to the public, Les Diablerets, Switzerland, 21–24 July 1997. Geneva,World Meteorological Organization, 1997 (Global Atmosphere Watch, No. 127). 4 UV index in practical use. Proceedings of an international workshop. Munich, Federal Office for Radiation Protection, Institute of Radiation Hygiene, in press. iv 1 UV RADIATION LEVELS ARE INFLUENCED BY: Small amounts of UV radiation are beneficial Furthermore, a growing body of evidence for people and essential in the production of suggests that environmental levels of UV vitamin D. UV radiation is also used to treat radiation may enhance the risk of infectious SUN ELEVATION several diseases, including rickets, psoriasis diseases and limit the efficacy of vaccina- The higher the sun in the sky, the higher and eczema. This takes place under medical tions. Please see Annex A for a detailed the UV radiation level.Thus UV radiation supervision and the benefits of treatment description of the health effects of exposure levels vary with time of day and time of versus the risks of UV radiation exposure are to UV radiation. year. Outside the tropics, the highest a matter of clinical judgement. levels occur when the sun is at its People’s behaviour in the sun is considered maximum elevation, at around midday Prolonged human exposure to solar UV to be a major cause for the rise in skin cancer (solar noon) during the summer months. radiation may result in acute and chronic rates in recent decades. An increase in health effects on the skin, eye and immune popular outdoor activities and changed Over 90% of UV can LATITUDE penetrate light cloud system. Sunburn and tanning are the best sunbathing habits often result in excessive The closer to equatorial regions, the known acute effects of excessive UV exposure to UV radiation. Many people higher the UV radiation levels. radiation exposure; in the long term, UV consider intensive sunbathing to be normal; radiation-induced degenerative changes in unfortunately, even children, adolescents CLOUD COVER cells, fibrous tissue and blood vessels lead to and their parents perceive a suntan as a UV radiation levels are highest under premature skin ageing. UV radiation can also symbol of attractiveness and good health. cloudless skies but even with cloud cover, cause inflammatory reactions of the eye, UV radiation levels can be high. Clean snow reflects such as photokeratitis. Sun protection programmes are urgently up to 80% of Scattering can have the same effect as sunburning UV needed to raise awareness of the health 60% of UV is the reflectance by different surfaces and received Chronic effects include two major public hazards of UV radiation, and to achieve thus increase total UV radiation levels. between 10 am health problems: skin cancers and cataracts. changes in lifestyle that will arrest the trend and 2pm daily Between two and three million non- towards more and more skin cancers.Beyond ALTITUDE melanoma skin cancers and approximately the health benefits, effective education At higher altitudes, a thinner UV increases by 4% 132000 melanoma skin cancers occur programmes can strengthen national atmosphere absorbs less UV radiation. for each 300 metre globally each year.While non-melanoma skin economies by reducing the financial burden increase in altitude With every 1000 metres increase in cancers can be surgically removed and are to health care systems caused by skin cancer altitude, UV radiation levels increase by rarely lethal, malignant melanoma substan- and cataract treatments. Billions are spent 10% to 12%. tially contributes to mortality rates in worldwide to treat these diseases, many of fair-skinned populations. Some 12 to 15 which could have been prevented or OZONE million people are blind from cataracts. delayed.The Global Solar UV Index should be Ozone absorbs some of the UV radiation According to WHO estimates, up to 20% of an important element of an integrated and that would otherwise reach the Earth’s these cases of blindness may be caused or long-term public health approach to sun Indoor workers enhanced by sun exposure, especially in protection. surface. Ozone levels vary over the year receive 10% to Shade can and even across the day. 20% of outdoor reduce UV by , and other countries of the workers' yearly 50% or more “cataract belt” close to the equator. UV exposure GROUND REFLECTION

UV radiation is reflected or scattered to Sand reflects up to varying extents by different surfaces,e.g. At half a metre 25% of UV fresh snow can reflect as much as 80% of depth UV is still 40% as UV radiation,dry beach sand about 15% intense as at and sea foam about 25%. the surface 2 3 WHAT IS THE IMPORTANCE OF A clearly defined as an educational tool,and its The Global Solar UV Index HARMONIZED UVI? use must be based on effective communica- AN EDUCATIONAL TOOL Many countries use the UVI to promote sun tion with the public and the media. protection. Surveys suggest that a large Uniformity of UVI presentation, and percentage of the public is aware of the uniformity of sun protection messages existence of the UVI but does not understand associated with different UVI values, will its meaning or usefulness. These problems facilitate the delivery of a simple and relevant WHAT IS THE GLOBAL SOLAR UV are related to the lack of standardized message, and will help to familiarize people INDEX? radiation exposure. The UVI should especially aim at vulnerable and highly-exposed groups messages associated with the UVI. The UVI is with this important concept. The Global Solar UV Index (UVI) describes the within the population,e.g.children and tourists, level of solar UV radiation at the Earth’s and should inform people about the range of surface. The values of the index range from UV radiation-induced health effects including zero upward – the higher the index value,the sunburn, skin cancer and skin ageing, and greater the potential for damage to the skin effects on the eye and immune system. and eye,and the less time it takes for harm to Educational messages should emphasize that occur. the risk of adverse health effects from UV radiation exposure is cumulative, and that WHY DO WE NEED THE UVI? exposure in everyday life may be as important A marked increase in the incidence of skin as exposure during vacations in sunny climates. cancer in fair-skinned populations worldwide is strongly associated with excessive UV HOW IS THE UVI PRESENTED? radiation exposure from the sun; it may also UV radiation levels and therefore the values be associated with the use of artificial UV of the index vary throughout the day. In radiation sources such as sunbeds. Current reporting the UVI, most emphasis is placed evidence indicates that personal habits in on the maximum UV radiation level on a relation to sun exposure constitute the most given day. This occurs during the four-hour important individual risk factor for UV period around solar noon. Depending on radiation damage. The UVI is an important geographical location and whether daylight vehicle to raise public awareness of the risks saving time is applied, solar noon takes place of excessive exposure to UV radiation, and to between local noon and 2 p.m. The media alert people about the need to adopt usually present a forecast of the maximum protective measures. Encouraging people to UV radiation level for the following day. reduce their sun exposure can decrease harmful health effects and significantly reduce health care costs. WHERE IS THE UVI REPORTED? In many countries the UVI is reported along with the weather forecast in newspapers, on HOW SHOULD THE UVI BE USED? TV and on the radio; however, this is usually This educational tool should be used as an done only during the summer months. integral component of a programme to inform Annex B lists a series of Internet links that the public about UV radiation health risks and provide the UVI for a range of countries and sun protection, and to change people’s in many different languages. attitudes and behaviour with respect to UV

4 5 A SIMPLE AND RELEVANT MESSAGE the UVI as a guide to healthy, sun-protective Reporting the UV Index Acceptance by the general public of the UVI behaviour. THE BASIC SCHEME as useful daily information is the ultimate goal. In order to achieve this, the messages From a public health point of view, must be simple and easily understood. it is especially important to protect the • However, when cloud cover is variable, the REPORTING UVI VALUES Reporting the UVI with relevance to the most vulnerable population groups.Based on UVI should be presented as a range of The UVI is a measure of the intensity of UV recipient will allow people to put the finding that more than 90% of non- values. UVI forecasts should include effects radiation on the Earth’s surface that is recommendations into practice and accept melanoma skin cancers occur in skin types I relevant to effects on the human skin. of cloud on UV radiation transmission and II(Table 2), the basic protective messages through the atmosphere. Programmes not associated with the UVI should focus on fair- incorporating cloud effects in their • UVI reports should present at least the skinned people who tend to burn. Children, forecasts should refer to them as a “clear daily maximum value.When forecasting or who are particularly sensitive to UV radiation, sky” or “cloud free” UVI. reporting daily maxima, a 30-minute time require special protection. average value should be used. Where UVI values are grouped into exposure continuous observations are available, a Even though the incidence of skin cancer is categories 5–10 minute average is useful to display (Table 1). The national meteorology lower in dark-skinned people,they are never- short-term changes. office or media service may choose to report theless susceptible to the damaging effects the exposure category,the UVI value or range of UV radiation, especially to the effects on • The UVI should be presented as a single of values, or both. the eye and immune system. Additional value rounded to the nearest whole number. messages at the national or local level will allow the particular needs of other population sub-groups to be addressed. EXPOSURE CATEGORY UVI RANGE These should take into account differences in LOW < 2 climate and culture, the perception of UV MODERATE 3 TO 5 radiation risks in the population, and the stage of sun protection education. HIGH 6 TO 7 Figure 1: Enjoy the sun but enjoy it safely VERY HIGH 8 TO 10 EXTREME 11+ SKIN TYPE CLASSIFICATION BURNS IN THE SUN TANS AFTER HAVING BEEN IN THE SUN l. Always Seldom Table 1: UV radiation exposure categories Melano-compromised ll. Usually Sometimes lll. Sometimes Usually Melano-competent REPORTING BURN TIMES IS NOT RECOMMENDED. lV. Seldom Always Burn times have been used in many should not imply that extending exposures V. Naturally brown skin countries as this simple concept can be is acceptable. Although the priority goal of Melano-protected VI. Naturally black skin directly translated into action. However, primary skin cancer prevention is to avoid people tend to interpret burn times to mean sunburn, cumulative UV radiation exposure Table 2: Classification of skin types (adapted from TB Fitzpatrick and JL Bolognia, 19951) that there is a safe level of unprotected sun plays a major role in developing skin cancer exposure. Hence, relating UVI values to “time and promotes damage to the eyes and 1 Fitzpatrick TB, et al, reported in TB Fitzpatrick and JL Bolognia, Human melanin pigmentation: Role in pathogenesis of cutaneous to burn” or “safe tanning time” sends out the immune system. melanoma. In: Zeise L, Chedekel MR, Fitzpatrick TB (eds.) Melanin: Its role in human photoprotection. Overland Park, KS,Valdenmar wrong message to the public. The UVI Publishing Company, 1995:177-82.

6 7 THE BASIC SUN PROTECTION MESSAGES GRAPHIC PRESENTATION OF THE UVI different media to cope with technical A standard graphic presentation of the UVI limitations.The graphics package (see Annex • Limit exposure during midday hours. Two different concepts of sun protection promotes consistency in UVI reporting on D) can be downloaded from the website • Seek shade. have been proposed: a binary response news and weather bulletins, and serves to of WHO’s Global UV Project Intersun • Wear protective clothing. with a defined threshold UVI value beyond improve people’s understanding of the UVI http://www.who.int/uv/ and includes the UVI • Wear a broad-brimmed hat to protect which sun protection is recommended, or a concept. Ready-made materials for UVI logo, icons for UVI reporting, sun the eyes, face and neck. graded response with increasing UVI values reporting facilitate successful media uptake, protection icons,and colour codes • Protect the eyes with wrap-around- that would involve the successive use of and more than one option is given to allow for different values of the UVI. design sunglasses or sunglasses with different sun-protective measures. There side panels. is little scientific basis to support the latter: if • Use and reapply broad-spectrum sun protection is required, this should sunscreen of sun protection factor include all protective means, i.e. clothing, (SPF)15+ liberally sunglasses, shade and sunscreen(Figure 1). UV UV UV UV UV UV UV UV UV UV UV • Avoid tanning beds. Nevertheless, a graded approach is relevant INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX • Protect babies and young children: this in the sense that more sun protection is + is particularly important. needed at higher UV radiation levels. 1 2 3 4 5 6 7 8 9 10 11 Shade, clothing and hats provide the best Even for very sensitive fair-skinned people, protection – apply sunscreen to parts of the the risk of short-term and long-term UV body that remain exposed, like the face and radiation damage below a UVI of 3 is limited, hands. Sunscreen should never be used to and under normal circumstances no prolong the duration of sun exposure. protective measures are needed. Above the threshold value of 3, protection is necessary, and this message should be reinforced at UVI values of 8 and above.

UV UV UV UV UV UV UV UV UV UV UV INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX 1 2 3 4 5 6 7 8 9 10 11+

NO PROTECTION PROTECTION EXTRA REQUIRED REQUIRED PROTECTION

You can Seek shade during midday hours! Avoid being outside during safely stay Slip on a shirt, slop on sunscreen and midday hours! Figure 3: Examples of UVI graphics outside! slap on a hat! Make sure you seek shade! Shirt, sunscreen and hat are a must!

Figure 2: Recommended sun protection scheme with simple “sound bite” messages

8 9 Sun Protection Messages USING COLOUR TO INCREASE VARIABILITY Specific colours should be used for presenting The colour coding facilitates variation CREATING VARIETY the solar UVI. These do not have a scientific between geographic areas of high and low UV basis but are a means of making the radiation levels, and a basic colour is defined presentation of the UVI more appealing. for each category(Table 4; see also Annex D). ADDITIONAL SUNSMART MESSAGES The basic scheme for UVI reporting and sun protection can be varied and expanded UV UV UV UV UV UV UV UV UV UV UV INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX INDEX through the use of additional messages at + the national or local level. Messages on suntanning, sun protection and people’s 1 2 3 4 5 6 7 8 9 10 11 inability to perceive UV radiation underlie Low Moderate High Very high Extreme the basic message and can be used in all Figure 4: Children require special protection (1,2) (3,4,5) (6,7) (8,9,10) (11+) settings. Targeted groups must include children and Green Yellow Orange Red Purple Environment-based, activity-based or risk young people(Figure 3), since frequent UV PMS 375 PMS 102 PMS 151 PMS 032 PMS 265 group-based messages can be geared radiation exposure and a history of sunburn Table 4: Presenting the UVI: International colour codes1 specifically to local weather conditions, or during childhood and adolescence is an the particular environmental or societal important risk factor for skin cancer, especially The colour within categories can be graded situation of a given country. Annex E lists for potentially lethal malignant melanoma. The approach focuses on the hours of the day to allow for variation at the national level examples of such additional sun protection Additional messages can also be used to correct during which the UVI is above a given where values often remain within one (Figure 5).While on one day the messages adapted from , common misconceptions about UV radiation threshold value category throughout the summer months UVI may reach a value of above 3 for no more and . and its effects on human health (Table 3). (see Annex D). than 30 minutes, on another day it may remain above 3 for several hours. The advice FALSE TRUE Not all media will be able to integrate the to the public emphasizes the need to adopt A suntan is healthy. A tan results from your body defending itself against further damage variation in colour into their presentation. sun-protective practices during these hours. from UV radiation. Television media generally use standardized A tan protects you from the sun. A dark tan on white skin offers only limited protection equivalent to maps and changing the colours may not be Darwin Wed 27 3 2002 an SPF of about 4. 20 feasible due to technical limitations.Similarly, CLEAR SKY MAX: 13 You can’t get sunburnt on a Up to 80% of solar UV radiation can penetrate light cloud cover. Haze black and white print media will not be able cloudy day. 15 in the atmosphere can even increase UV radiation exposure. to use the recommended colour scheme. You can’t get sunburnt while in Water offers only minimal protection from UV radiation, and EXTREME the water. reflections from water can enhance your UV radiation exposure. 10 EMPHASIZING DANGEROUS HOURS UV radiation during the winter UV radiation is generally lower during the winter months, but snow VERY HIGH is not dangerous. reflection can double your overall exposure, especially at high In countries where UV radiation levels are UV INDEX 6 altitude. Pay particular attention in early spring when temperatures high and where knowledge about UV HIGH are low but the sun’s rays are unexpectedly strong. 3 radiation and sun protection in the MOD 0 Sunscreens protect me so I can Sunscreens should not be used to increase sun exposure time but to population is widespread, a further concept sunbathe much longer. increase protection during unavoidable exposure.The protection they 5 AM 9 11AM 3PM 5 8PM afford depends critically on their correct application. may be applied to increase variability. This LOCAL TIME was introduced in Australia in 2000. Figure 5:A graphic representing dangerous hours If you take regular breaks during (Bureau of Meteorology,Australia)2 sunbathing you won’t get sunburnt. UV radiation exposure is cumulative during the day.

If you don’t feel the hot rays of Sunburn is caused by UV radiation which cannot be felt.The heating 1 The eps graphic files, which are downloadable from the website of WHO’s Global UV Project Intersun http://www.who.int/uv/, will the sun you won’t get sunburnt. effect is caused by the sun’s infrared radiation and not by UV radiation. reproduce satisfactorily in most cases, allowing the worldwide reproduction of a standardized colour scheme. Pantone Matching System (PMS) colour references may be used for minor colour correction. Table 3: UV radiation danger: Facts and fiction 2 The colour scheme currently used by the Bureau of Meteorology, Australia does not comply with the international colour codes promoted in this publication. 10 11 national weather bureaux and companies Educational Concepts and producing sun protection items such as Their Practical Implementation sunscreen and sunglasses. THE ROLE OF NATIONAL GOVERNMENTS Increased sun exposure has been identified Schools are essential for getting the message as the main reason for the increase in skin EDUCATION EVALUATION across to young people. Teachers and their cancer rates since the early 1970s, and only • Encourage the use of the UVI as part of • Establish national statistics on UV associations should be encouraged to take changes in lifestyle can stop this ongoing public awareness programmes. radiation-induced skin and eye diseases. up the cause and include UV radiation trend. Public education aims to improve • Supply health care professionals, • Encourage research on UV radiation awareness and protection projects in the people’s knowledge about the health risks of teachers and carers of children with related health effects and protective educational system.Furthermore,all outdoor excessive sun exposure, and to achieve a educational material for distribution to measures. recreational sites – beaches, sports centres change in attitudes and behaviour. Reducing the public. • Support national programmes and and swimming pools, and parks – the occurrence of sunburn and cumulative • Organize workshops for medical doctors international collaboration efforts on UV provide a good setting for information about UV radiation exposure over a lifetime will and other health professionals. radiation monitoring and health UV radiation levels and sun protection. eventually cause skin cancer rates to decline. • Establish education programmes for education. teachers. • Conduct research that monitors As a large percentage of many people’s It is important that information be presented • Establish education programmes for behavioural, knowledge and attitudinal lifetime exposure to UV radiation is received in a positive manner that enables people to outdoor workers. trends related to sun protection. during vacations, tourists represent an enjoy the sun safely but at the same time • Encourage and support the provision of important audience for UVI reporting and STANDARDS makes them aware of the need to avoid shaded areas in schools, playgrounds and sun protection advice. • Facilitate the development of standards overexposure. The UVI should form an parks, and in public places such as bus related to sun protection products such as integral element of programmes to educate stops and swimming pools. sunscreens, clothing, sunbeds and the public about the health hazards of BUILDING NETWORKS AND • Recommend against the use of sunlamps sunglasses to ensure clear and safe excessive UV radiation exposure.The sections ALLIANCES and sunbeds for cosmetic purposes. guidelines for manufacturers and below address key elements of effective In order to change people's sun exposure • Inform the community of drugs and consumers. education campaigns. habits and the current societal view that cosmetics that sensitize the skin to the • Encourage the provision of information associates a tan with good health, long-term effects of UV radiation. on the degree of UV radiation protection strategies are required. The cooperation of • Enlist weather broadcasters, health provided by sunscreens, eyewear, clothing different sectors is necessary to implement reporters and the media to provide the MAIN TARGET AUDIENCES AND SUN and other protective measures. PROTECTION SETTINGS far-reaching educational strategies and UVI service to the public. A majority of a person’s lifetime exposure create a supportive environment for the occurs before age 18, and sun avoidance integration of sun protection into the culture during childhood has a greater impact on of a country. For this reason, campaigns in ENSURING MEDIA SUPPORT health risk reduction than sun protection many countries are organized as a collabora- The media should be encouraged to report and national programmes by highlighting during adulthood. Therefore, children and tive effort between different medical and the UVI with their daily weather information, health concerns, and can even promote adolescents should be the primary target for scientific associations, government and so that people begin to accept this as an research by making the results of new health education about the sun and how to avoid specialized private institutions, and important piece of information in addition to effects or protective devices known to the damage to health.An effective campaign can charitable societies. the news and weather report. The TV, radio public. To ensure continuing interest in the have an enormous impact on public health:a and print media provide an essential medium awareness campaign, it will be necessary to change in people’s behaviour towards Further partners in disseminating the for informing the public about the hazards of progressively develop short, clear messages effective sun protection could eliminate message may include the tourism industry UV radiation and the need to adopt that are tailored to the particular medium. more than 70% of skin cancers in Australia. such as ,hotel chains and cruise liners, protective measures. They can support local 12 13 THE ROLE OF LOCAL AUTHORITIES AND HEALTH AGENCIES Health Effects of UV Radiation • Encourage behaviour change through • Promote creative activities on sun sign prompts and educational activities in protection, e.g. fashion shows using UV Exposure community and recreation facilities and radiation-protective designs and fabrics, ANNEX A services.These could include programmes science projects, and competitions. in schools and kindergartens, the distri- Human exposure to solar radiation may bution of brochures in public buildings, • Modify the physical environment and the skin that attenuates UV radiation result in acute and chronic health effects on banks, shopping centres and health care promote the consideration of shade in penetration to the deeper layers of the skin. the skin, eye and immune system. It is a centres, and sun protection fairs where urban planning and in the modification Both changes are a sign of damage to the popular misconception that only fair- health professionals participate in presen- of public places. skin. Depending on their skin type, skinned people need to be concerned about tations and skin cancer screening. individuals vary greatly in their skin’s initial overexposure to the sun. Darker skin has threshold for erythema and their ability to more protective melanin pigment, and the adapt to UV exposure. Chronic exposure to incidence of skin cancer is lower in dark- USEFUL STRATEGIES INCLUDE: UV radiation also causes a number of degen- EVALUATING THE EFFECTIVENESS skinned people. Nevertheless, skin cancers erative changes in the cells, fibrous tissue • Holding a press conference at the OF A UVI CAMPAIGN do occur with this group and unfortunately and blood vessels of the skin. These include launch of a campaign, e.g. in late-spring, A sun awareness programme that uses the they are often detected at a later, more freckles, nevi and lentigines, which are where appropriate health professionals UVI as an educational tool aims to improve dangerous stage. The risk of UV radiation- pigmented areas on the skin, and diffuse are available for interviews. people’s knowledge, and change attitudes related health effects on the eye and brown pigmentation. UV radiation and behaviour with respect to sun exposure immune system is independent of skin type. accelerates skin ageing, and the gradual loss • Organizing short seminars for journalists and sun protection. A well-designed A comprehensive summary and review of UV of the skin’s elasticity results in wrinkles and to educate them about the problems of evaluation survey should assess: radiation-related health effects can be found dry, coarse skin. excessive UV radiation exposure and to in the WHO Environmental Health Criteria disseminate the key sun protection • whether members of the general public Monograph Ultraviolet Radiation1 and in the messages. understand the meaning of the UVI and NON-MELANOMA SKIN CANCERS Proceedings of an International Workshop on the message it carries; Non-melanoma skin cancers (NMSC) Ultraviolet Radiation 2. • Using the announcements for press comprise basal cell carcinoma and conferences to highlight key issues, • whether the campaign has changed squamous cell carcinoma. These are rarely followed by press releases that provide people’s knowledge, attitudes and SKIN lethal but surgical treatment is painful and clear and simple messages. behaviour with respect to sun exposure. often disfiguring. The temporal trends of SUNBURN, SUNTAN AND SKIN NMSC incidence are difficult to determine, • Using human interest stories to get the AGEING because reliable registration of these cancers message across. The best known acute effect of excessive UV has not been achieved. However, specific radiation exposure is erythema, the familiar studies carried out in Australia, Canada and The promotion of the UVI needs to be skin reddening termed sunburn. In addition, the , indicate that between conducted in a positive and attractive way. most people will tan from the UV radiation the 1960s and the 1980s the prevalence of The key words are “save”,“protect”and “help”. stimulation of melanin production, which NMSC increased by a factor of more than occurs within a few days of exposure. A two. The risk of NMSC has been examined further, less obvious adaptive effect is the with respect to personal exposure, and the THE UVI CAN: thickening of the outermost layers of save lives protect good health 1 Ultraviolet radiation. An authoritative scientific review of environmental and health effects of UV, with reference to global ozone help preserve youthful complexion layer depletion. Geneva,World Health Organization, 1994 (Environmental Health Criteria Monograph, No. 160). 2 Proceedings of an international workshop on ultraviolet radiation exposure, measurement and protection, St Catherine’s College, Oxford, 1999. Radiation Protection Dosimetry, 2000, 91:1-3. 14 15 • NMSC is most frequent on parts of the EYE • A large number of atypical nevi (moles) is body that are commonly exposed to the The eye is recessed within its orbit and the data remain preliminary, there is the strongest risk factor for MM in fair- sun such as ears, face, neck and forearms. shielded by the brow ridge, the eyebrows increasing evidence for a systematic skinned populations. This implies that long-term, repeated UV and the eyelashes. Bright light activates the immunosuppressive effect of both acute and radiation exposure is a major causal factor. constriction of the pupil and the squinting low-dose UV radiation exposure. • MM is more common among people with a reflex to minimize the penetration of the pale complexion, blue eyes, and red or fair • Within some countries there is a clear rela- sun’s rays into the eye. However, the effec- Animal experiments have demonstrated that hair. Experimental studies have demon- tionship between increasing incidence of tiveness of these natural defences in UV radiation can modify the course and strated a lower threshold erythema and NMSC with decreasing latitude, i.e. higher protecting against the dangers of UV severity of skin tumours. Also, people treated more prolonged skin reddening in UV radiation levels. radiation is limited under extreme conditions with immunosuppressive drugs have a melanoma patients than in controls. such as sunbed use or strong ground greater incidence of squamous cell reflection from sand, water and snow. carcinoma than the normal population. • High, intermittent exposure to solar UV Consequently,beyond its role in the initiation radiation appears to be a significant risk Acute effects of UV radiation exposure of skin cancer, sun exposure may reduce the factor for the development of MM. include photokeratitis and photoconjunctivi- body’s defences that normally limit the tis. These inflammatory reactions are progressive development of skin tumours. • The incidence of MM in white populations comparable to a sunburn of the very Figure 6: Basal cell generally increases with decreasing sensitive skin-like tissues of the eyeball and Several studies have demonstrated that carcinoma latitude, with the highest recorded eyelids, and usually appear within a few exposure to environmental levels of UV incidence occurring in Australia,where the hours of exposure. Both can be very painful, radiation alters the activity and distribution annual rates are 10 and over 20 times the but are reversible and do not result in any of some of the cells responsible for triggering rates in Europe for women and men long-term damage to the eye or vision. immune responses in humans.Consequently, respectively. Extreme forms of photokeratitis are “arc-eye” sun exposure may enhance the risk of and “snow blindness”. infection with viral, bacterial, parasitic or • Several epidemiological studies support a fungal infections, which has been demon- positive association with history of sunburn, strated in a variety of animal models. Figure 7: Squamous Cataracts are the leading cause of blindness particularly sunburn at an early age. cell carcinoma in the world. Proteins in the eye’s lens Furthermore, especially in countries of the unravel, tangle and accumulate pigments developing world, high UV radiation levels • The role of cumulative sun exposure in the MALIGNANT MELANOMA that cloud the lens and eventually lead to may reduce the effectiveness of vaccines. development of MM is equivocal.However, Malignant melanoma (MM), although far less blindness. Even though cataracts appear to Since many vaccine-preventable diseases are MM risk is higher in people with a history prevalent than NMSC, is the major cause of different degrees in most individuals as they extremely infectious,any factor that results in of NMSC and of solar keratoses, both of death from skin cancer and is more likely to age, sun exposure, in particular exposure to even a small decrease in vaccine efficacy can which are indicators of cumulative UV be reported and accurately diagnosed than UVB, appears to be a major risk factor for have a major impact on public health. radiation exposure. NMSC. Since the early 1970s, MM incidence cataract development. has increased significantly, e.g.by an average OZONE DEPLETION AND UV- 4% every year in the United States. A large RELATED HEALTH EFFECTS number of studies indicate that the risk of IMMUNE SYSTEM Depletion of the ozone layer is likely to malignant melanoma correlates with genetic The immune system is the body’s defence aggravate existing health effects caused by and personal characteristics, and a person’s mechanism against infections and cancers, exposure to UV radiation, as stratospheric UV radiation exposure behaviour. The and is normally very effective at recognizing ozone is a particularly effective UV radiation following is a summary of the main human and responding to an invading micro- absorber. As the ozone layer gets thinner, the risk factors: organism or the onset of a tumour. Although protective filter provided by the atmosphere

Figure 8: Maligant melanoma 16 17 is progressively reduced. Consequently, Computational models predict that a 10% human beings and the environment are decrease in stratospheric ozone could cause Internet Links: Organizations exposed to higher UV radiation levels, and an additional 300 000 non-melanoma and especially higher UVB levels that have the 4500 melanoma skin cancers and between Reporting the UV Index greatest impact on human health, animals, 1.6 and 1.75 million more cases of cataracts ANNEX B marine organisms and plant life. worldwide every year.

WORLD World Ozone and Ultraviolet Radiation Data Centre (Czech/English) http://www.msc-smc.ec.gc.ca/woudc/ Czech Hydrometeorological Institute http://www.chmi.cz/meteo/ozon/o3uvb.html WORLD Institute of Medical Physics and Biostatistics, University of Veterinary Medicine (Finnish) http://i115srv.vu-wien.ac.at/uv/uv_online_alt.htm#uvimaps Finnish Meteorological Institute http://www.ozone.fmi.fi/ EUROPE Scientific UV Data Management (SUVDAMA) FRANCE http://www.ozone.fmi.fi/SUVDAMA/ (French) Securité Solaire MEDITERRANEAN BASIN www.securite-solaire.org (French/English/Spanish/Italian) Environmental Forecast and Information Service http://www.enviport.com/index_en.html (German) Federal Office for Radiation Protection http://www.bfs.de/uvi/index.htm (Spanish) Regional Centre of Satellite Data German Weather Services http://www.conae.gov.ar/iuv/iuv.html http://www.uv-index.de/

National Meteorological Service http://www.meteofa.mil.ar/ (Greek) Laboratory of Atmospheric Physics AUSTRALIA http://lap.physics.auth.gr/uvindex/ Bureau of Meteorology http://www.bom.gov.au/info/about_uvb.shtml HONG KONG SPECIAL ADMINISTRATIVE REGION OF Hong Kong Observatory Institute for Medical Physics, University of http://www.info.gov.hk/hko/wxinfo/uvindex/english/ http://www.uibk.ac.at/projects/uv- uvindex_e.htm index/aktuell/mon_kart_eng.html

CANADA (English/French) Meteorological Service of Canada http://www.msc-smc.ec.gc.ca/uvindex/

18 19 (Hebrew/English) (Slovenian) The UV Index Israel Weather Forecast Environmental Agency of Slovenia http://www2.iol.co.il/weather/Edefault.asp http://www.rzs-hm.si/zanimivosti/UV.html ANNEX C

ITALY (Italian/English) (Spanish) Labratory for Meteorology and Environmental National Meteorological Institute Modelling http://www.inm.es/wwz/fijo/estaciones.html The Global Solar UVI is formulated using the International Commission on Illumination (CIE) http://www.lamma.rete.toscana.it/previ/ita/stazlam.htm reference action spectrum for UV-induced erythema on the human skin (ISO 17166:1999/CIE S 007/E-1998).It is a measure of the UV radiation that is relevant to and defined for a horizontal (Swedish/English) surface.The UVI is a unitless quantity defined by the formula: (English) Swedish Radiation Protection Institute Shiseido UV Ray Information http://www.smhi.se/weather/uvindex/sv/uvprog.htm http://www.shiseido.co.jp/e/e9708uvi/html/index.htm SWITZERLAND LUXEMBOURG (German/French) 400 nm (French) Federal Office of Public Health Meteorological Station of the Lycée Classique http://www.uv-index.ch de Diekirch . . λ λ IUV = ker ∫ Esλ er ()d http://meteo.lcd.lu/ (Turkish) 250 nm Scientific and Technical Research Council of Turkey (Spanish/English) http://www.tubitak.gov.tr/ Air Quality Report where E http://sima.com.mx/sima/df/_zseeng.html λ is the solar spectral irradiance The second is to use a broadband detector The Meteorological Office expressed in W·/(m2·nm1) at wavelengthλ and that has been calibrated and programmed to http://www.met-office.gov.uk/sec3/gsuvi.html d λ is the wavelength interval used in the give the UVI directly. Prediction of the solar Lauder National Institute of Water and summation. serλ is the erythema reference UVI is achieved with a radiative transfer Atmospheric Research (NIWA) UNITED STATES OF AMERICA action spectrum, and k is a constant equal model that requires the input of total ozone http://katipo.niwa.cri.nz/lauder/homepg07.htm er The Weather Channel to 40 m 2/W. and the aerosol optical properties. A http://www.weather.com/activities/health/skin regression model is used to predict the total The determination of the UVI can be through ozone using the input from ground-based (Norwegian/English) National Oceanic and Atmospheric Administration Norwegian Radiation Protection Authority (NOAA) and Environmental Protection Agency (EPA) measurements or model calculations. Two ozone spectroradiometers or from satellites. http://uvnett.nrpa.no/ Climate Prediction Center measurement approaches can be taken: the A good cloud parameterisation is also http://www.cpc.ncep.noaa.gov/products/stratosphere/ first is to use a spectroradiometer and to required unless only clear sky values are uv_index/index.html calculate the UVI using the above formula. reported. (Polish) Institute of Meteorology and Water Management http://www.imgw.pl/

PORTUGAL (Portuguese/English) Meteorological Institute http://www.meteo.pt/uv/uvindex.htm

20 21 Graphic Presentation of the UV Index Additional Sun Protection Messages ANNEX D ANNEX E

UVI Web Colour Table (HEX) 1 #4eb400 2 #a0ce00 SUNTANNING MESSAGES PERCEPTION OF UV RADIATION Riga 3 #f7e400 • Tanning does not stop much UV radiation! • Cloudy weather doesn’t mean you can’t get London Kiev 4 #f8b600 Paris Even when your skin is tanned, limit your burnt. It’s the UV radiation in the sun's rays Vienna 5 #f88700 Geneva 6 #f85900 exposure during midday hours, and that burns you and causes skin cancer, and #e82c0e continue to protect yourself. UV radiation can penetrate through cloud. Tblisi 7 8 #d8001d Algier Rabat #ff0099 9 • Don’t UV OD. Sunburn is literally an • Remember the sun does not need to feel Canary 10 #b54cff Islands Cairo indication that your skin has overdosed on hot to damage your skin and eyes. The 11 + #998cff UV radiation so Slip! Slop! Slap! and Save damage is done by UV radiation, which is Your Skin. not seen or felt – so don’t be fooled by mild temperatures.

SUN PROTECTION MESSAGES • Wear sunglasses, a wide-brimmed hat and ACTIVITY-BASED MESSAGES protective clothing, and frequently apply • If you’re out to watch or participate in sunscreen of SPF 15+ to protect yourself. (name of event), don’t forget your sunscreen, hat and long-sleeved shirt.That • Applying sunscreen is not a means to should be all you need to make sure all you prolong your stay in the sun but to reduce go home with are great memories of the health risk of your exposure. today’s events – and not a nasty dose of sunburn. • Taking certain medications as well as using perfumes and deodorants can sensitize • This is a great time to head to the ski slopes. your skin, causing serious burns in the sun. High altitudes and fresh snow can double Ask your pharmacist for advice. your UV radiation exposure, so wear sunglasses and sunscreen! • Sun exposure increases skin cancer risk, accelerates skin ageing and causes • Going on a sunny vacation? Make sure to damage to the eyes. Protect yourself! pack your wide-brimmed hat, sunglasses and sunscreen. • Shade is one of the best defences against the sun’s radiation. Try to find some shade • School break means fun in the sun for the during midday hours when the sun’s UV lucky ones. If you’re one of them, rays are at their peak. remember to pack a hat, sunscreen and sunglasses.

22 23 • Springtime, gardening time. While tending MESSAGES FOR CHILDREN AS A your flower beds, don’t forget to protect SPECIAL RISK GROUP List of Contributors your skin. • Extended sun exposure during childhood ANNEX F increases the risk of skin cancer later in life and can cause serious damage to the eye. ENVIRONMENT-BASED MESSAGES • Identify risky situations. If your shadow is • All children below age 15 have sensitive short or if you are exposed for a long time skin and eyes – protect them and set a L.R. Acosta, SIMA Ministry of the J. Brix, Bundesamt für Strahlenschutz – protect yourself! good example for them! Environment (Mexico) (Germany) • Watch out! A lot of UV radiation can pass • Children below one year of age must never C.B. Archer, South African Weather Bureau V.L. Buchanan, U.S. Army Center for Health through clouds. stay in direct sun. () Promotion and Preventive Medicine (United States) • In the mountains, UV radiation levels • The sun is getting stronger and children are B. Armstrong, New South Cancer increase by approximately 10% with every exposed to its damaging rays during lunch Council (Australia) W.R. Burrows, Meteorological Service of 1000 metres in altitude. Snow reflection and recess. Encourage your children to use Canada, Environment Canada (Canada) can double the quantity of UV radiation sun protection and to take a break in the A. Bais, Laboratory of Atmospheric Physics, you are exposed to. shade. Aristotle University of (Greece) F.Carvalho, Institute for Meteorology () • Fresh snow can double your UV radiation • Most of our lifetime UV radiation exposure J.H. Bernhardt, International Commission for exposure, so wear sunglasses and occurs before age 18.Protect your children Non-Ionizing Radiation Protection J.-P.Césarini, Institut National de la Santé et sunscreen! … their skin will be healthier and look (Germany) de la Recherche Médical (France) younger throughout their lives. M. Blumthaler, Institut für Medizinische P.Césarini, Sécurité Solaire (France) • Parents – protect your children from the Physik, Universität Innsbruck (Austria) sun. Teach them about avoiding sun J. Damski, Finnish Meteorological Institute exposure and the proper steps for sun C. Boldemann, Karolinska Hospital (Sweden) (Finland) protection. W. Bonta, National Conference of Radiation M. Davis, U.S. Army Center for Health Control (United States) Promotion and Preventive Medicine (United States) J. Borkowski, Institute of Geophysics, Polish Academy of Sciences (Poland) K. Dehne, Deutscher Wetterdienst (Germany) D. Broadhurst, Meteorological Service of Canada, Environment Canada (Canada) Y.Deslauriers, Health Canada (Canada)

E. Breitbart, Dermatologisches Zentrum C.J. Diaz Leal (Mexico) Buxtehude (Germany) H. Dixon, The Cancer Council Victoria D. Bressoud, Swiss Federal Office of Public (Australia) Health (Switzerland)

24 25 C. Driscoll, National Radiological Protection D. Kastelec, Hyrdometeorological Institute of A.F.McKinlay, National Radiological R. Philipona,World Radiation Centre Board (United Kingdom) Slovenia (Slovenia) Protection Board (United Kingdom) (Switzerland)

A. Fergusson, Meteorological Service of P.Koepke, Meteorologisches Institut, A. Manes, Israel Meteorological Service H. Plets, Royal Meteorological Institute Canada, Environment Canada (Canada) Universität München (Germany) (Israel) ()

D. Frei, Swiss Federal Office of Public Health A. Kricker, New South Wales Cancer Council C. Mätzler, Institute of Applied Physics, T. Prager, Hungarian Meteorological Service (Switzerland) (Australia) University of (Switzerland) ()

R.P.Gallagher, British Columbia Cancer J. Langford, U.S. Army Center for Health R. Meerkoetter, Deutsche Luft- und E.A. Rehfuess,World Health Organization Agency (Canada) Promotion and Preventive Medicine Raumfahrt, Fernerkundungsdatenzentrum (Switzerland) (United States) (Germany) R. Greinert, Dermatologisches Zentrum M.H. Repacholi,World Health Organization Buxtehude (Germany) B. Lapeta, Institute of Meteorology and R. Meisner, Deutsche Luft- und Raumfahrt, (Switzerland) Water Management (Poland) Fernerkundungsdatenzentrum (Germany) D. Harder, Strahlenschutzkommission L. Rikus, Australian Bureau of Meteorology (Germany) Z. Litynska, Institute of Meteorology and B. Menne, European Centre for Environment Research Centre (Australia) Water Management (Poland) and Health,World Health Organization R. Harrington, Journalist (Germany) () C. Roy, Australian Radiation Protection and C.S. Long, National Weather Service, National Nuclear Safety Agency (Australia) A. Heimo, Institut Suisse de Météorologie Oceanic and Atmospheric Administration M. Miller,World Meteorological Organization (Switzerland) (United States) (Switzerland) R. Rubenstein, U.S. Environmental Protection Agency (United States) D.J. Hufford, U.S. Environmental Protection Y.S.Kim, Hanyang University () N. Miloshev, Geophysical Institute () Agency (United States) I. Ruppe, Bundesanstalt für Arbeitsmedizin A. Kulmala,World Meteorological M. Miyauchi, Japan Meteorological Agency (Germany) S. Human,Technikon Natal (South Africa) Organization (Switzerland) (Japan) M.A. Santinelli, Subsecretaria de Servicios L. Jalkanen,World Meteorological M. Lehnert, Universität Bochum (Germany) A. Mylvaganam, International Agency for Educativos para el D.F.(Mexico) Organization (Switzerland) Research on Cancer (France) G.F.Mariutti, Istituto Superiore de Sanit G. Schauberger, Institute of Medical Physics, M. Janouch, Czech Hydrometeorological á P.Nemeth, Hungarian Meteorological University of Vienna (Austria) Institute (Czech Republic) (Italy) Service (Hungary) R. Schmidt,World Health Organization K. Jokela, Säteilyturvakeskus (Finland) R. Matthes, Bundesamt für Strahlenschutz M. Norval, Department of Medical (Switzerland) (Germany) Microbiology, University of W. Josefsson, Swedish Meteorological and (United Kingdom) O. Schulz, Bundesamt für Strahlenschutz Hydrological Institute (Sweden) A. McCulloch, ICI Chemicals and Polymers (Germany) Ltd. (United Kingdom) J. Oliviéri, Météo-France (France) M. Kabuto, National Institute for G. Seckmeyer, Fraunhofer Institute for Environmental Studies (Japan) R.L. McKenzie, NIWA Lauder (New Zealand) S.P.Perov, Federal Service on Atmospheric Environmental Research Hydrometeorology and Environmental (Germany) Control (Russian Federation)

26 27 E. Simeone, NEC Italia (Italy) G.Vlcek, Bundesamt für Strahlenschutz (Germany) P.Simon, Institut d’Aéronomie Spatiale (Belgium) E.Vogel, Bundesamt für Strahlenschutz (Germany) C. Sinclair,The Cancer Council Victoria (Australia) D.I.Wardle, Meteorological Service of Canada, Environment Canada (Canada) D.H. Sliney, U.S. Army Center for Health Promotion and Preventive Medicine E.Weatherhead, NOAA (United States) (United States) A.Webb, University of Institute H. Staiger, Deutscher Wetterdienst of Science and Technology (United (Germany) Kingdom)

M. Steinmetz, Bundesamt für Strahlenschutz S.Wengraitis, U.S. Army Center for Health (Germany) Promotion and Preventive Medicine (United States) C. Stick, Institut für Medizinische Klimatologie, Kiel (Germany) U.Wester, Swedish Radiation Protection Institute (Sweden) F.Tena, Facultat de Fisica, (Spain) M.Wittwer, Deutsche Krebshilfe (Germany) M.Treiliba, Latvian Hydrometeorological Agency () L.Ylianttila, STUK-Radiation and Nuclear Safety Authority (Finland)

28