National health strategies to reduce sun exposure in Australia and the United States.

Australia has developed a national health care policy that has made prevention of the occurrence of skin cancer a societal responsibility. Its strategies for skin cancer control have included careful documentation of the incidence of skin cancer over the last two decades. After realizing that the magnitude of sun exposure during childhood is a major risk factor in the development of skin cancer, Australia provides successful strategies to monitor and reduce the frequency of skin cancer. Early in the 1970s, education campaigns for the public as well as the healthcare worker were implemented that included booklets, posters, and teaching materials. This educational program allowed the public as well as healthcare workers to diagnose accurately the presence of skin cancer. In addition to identifying tumors at an early stage, Australia managed an exciting educational program on photodamage prevention. Australian standards governing ultraviolet radiation protection were incorporated into numerous comprehensive legislative bills that set standards for a wide variety of sun protective products to include sunscreens, photoprotective apparel, sunglasses, and occupational standards for sun exposure. On the basis of these comprehensive standards, the epidemic of skin cancer has been curbed, as documented. In contrast to Australia, the United States has relatively few comprehensive skin cancer prevention programs. These programs include the National Skin Cancer Prevention Educational Program, National Skin Cancer Prevention and Detection Month, The Skin Cancer Foundation's Self-Examination Program, and the State of California and US Food and Drug Administration Sunscreen legislation. It is difficult to measure the impact of these innovative efforts because there is not an accurate monitoring system for all skin cancers in the United States. However, the National Cancer Institute does determine the incidence of melanoma, which is reported annually by the American Cancer Society in their January/February issue of CA Journal for Clinicians. Statistics on other skin cancers are only projective. In the absence of an accurate, comprehensive statistical monitoring system for the frequency of skin cancer in the United States, as well as the limited legislative initiatives, it is difficult for organizations such as the American Academy of Dermatology, the American Cancer Society, the Centers for Disease Control and Prevention, and The Skin Cancer Foundation to ascertain the results of their efforts to prevent skin cancer. Consequently, the prevention of skin cancer in the United States is a personal rather than a societal responsibility.