Over the past few years, the challenge of working in the summer’s heat has been significantly increased with the holy month of Ramadan occurring in the hotter months, particularly between June and August.
Ramadan, a month of prayer, charitable giving and self-accountability for Muslims, requires them to abstain from all food and drink between sunrise and sunset. Accordingly, the risk of exposure to heat illnesses is significantly increased for observant Muslims due to dehydration and fatigue, which can be fatal without sufficient controls.
The summer months bring extremely harsh weather to the Middle East region, particularly in the Gulf, where temperatures soar above 50°C and pose a serious challenge to safely conducting labour-intensive activities outdoors.
A new campaign to raise awareness of work-related cancers and their causes has turned its attention to skin cancer.
The Institution of Occupational Safety and Health’s (IOSH’s) No Time to Lose campaign is focusing on solar radiation and distributing helpful guidance that Middle East employers and safety and health professionals can use to manage the risks.
While countries in the region do not feature high on the chart of incidence rates, organisations like the Dubai Health Authority have raised concerns about the dangers of the sun’s rays, particularly for those with fairer skin types.
Risk of solar radiation
Solar radiation is the radiant energy emitted by the sun. The sun emits different kinds of light, some of which we can see and others that are invisible:
• Visible light you see
• Infrared radiation you feel as heat
• Ultraviolet (UV) radiation that produces tanned skin
It is the UV radiation element of the sun that can lead to premature ageing, wrinkles and skin cancer if precautions are not taken to protect our skin when outside.
UV radiation is classified into three bands: UVA, UVB and UVC.
UVA UVA accounts for around 95% of the UV radiation reaching the Earth’s surface. This type penetrates deeply into the skin and is principally responsible for premature ageing and wrinkling of the skin, as well as skin cancer.
UVB The majority of this type of UV radiation is filtered by the ozone layer before reaching the Earth’s surface. This type of radiation is more damaging than UVA, affecting outer layers of the skin and causing sunburn, as well as premature ageing, wrinkles and ultimately skin cancer.
UVC UVC is the most dangerous type of UV radiation, but mostly prevented from reaching the Earth’s surface by the ozone layer.
Solar radiation is classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), part of the World Health Organization (WHO). It is treated as a definite cause of cancer in humans. Ultraviolet radiation (encompassing UVA, UVB and UVC) and UV-emitting tanning devices are also classified as definite human carcinogens (Group 1) by IARC.
Today, the risk of getting skin cancer from sun exposure is well known and widely understood – we hear about it in the media and we see the marketing associated with sun creams and other products, almost universally aimed at consumers in the holiday, sport and leisure markets.
In contrast, in many industry sectors there is a failure to acknowledge or properly manage the risks from sun exposure, often because of a lack of awareness of the scale of the issue, and because of the myths around how sun damage can actually happen and risk factors associated with different climates – even misunderstandings around potential vitamin D deficiency from lack of UV exposure.
There are cultural challenges in some industries, too; for example, a ‘macho’ culture in the face of certain risks in some parts of the construction sector.
The reality is that the risks to ordinary holiday-makers targeted by sun product advertising campaigns are incomparable to the risks faced by millions of outdoor workers, who for significant periods of the year are typically exposed to solar radiation for hours at a time, day in, day out.
So who is affected at work?
Anyone working outside in the sun can be affected – outdoor work does not have to be full-time to pose a problem.
The groups of people who can be affected are many and varied, from those who work in agriculture and construction to maritime industries and grounds and landscape management.
People who ply their trade in outdoor leisure, entertainment and professional sports, police services, railroad working, refuse collection and recycling can contract skin cancer because of what they do for a living.
Other occupations in which workers can be exposed to this potentially deadly carcinogen include roadworking, telecommunications, traffic and parking control, water and sewage treatment, outdoor play supervision, painting and decorating, postal work, professional outdoor-based sport, refuse and recycling, roofwork, signage and outdoor advertising installation.
Some health facts about skin cancer
Sun exposure is the main cause of skin cancer. The simple fact that skin has changed colour after being exposed to the sun shows that it is being affected.
Sunburn is a reaction to over-exposure of UV radiation – the top layers of skin release chemicals that make blood vessels expand and leak fluid causing swelling, pain and redness. Without protection from the sun, UV radiation starts to penetrate deeply into the layers of the skin and damage skin cells, which can lead to the cell mutations associated with cancer.
Worldwide, sun exposure is the main cause of both malignant melanoma and non-melanoma skin cancer. Malignant melanoma is an aggressive form of cancer, less receptive to treatment than non-melanoma skin cancer, and has a higher death rate, especially if diagnosis is delayed and the cancer has spread.
Non-melanoma skin cancer, which includes basal cell (rodent ulcers) and squamous cell carcinoma, is rarely fatal but requires treatment and sometimes minor surgery.
Cancer Research UK suggests that people who have been diagnosed with a non-melanoma skin cancer are nine times more likely to get it again. Both non-melanoma skin cancer and malignant melanoma have been shown to be associated with chronic exposure, typically experienced by many outdoor workers, although for malignant melanoma intermittent sun exposure and sunburn history are considered particularly important.
New research commissioned by IOSH from Nottingham University into sun exposure in the UK construction sector found that awareness around solar radiation risks is generally poor – two thirds of workers outside for an average of nearly seven hours a day thought they were not at risk, or didn’t know whether they were or not.
In addition, 59% of construction workers reported having sunburn at least once in the last year. Just over 40% thought there was no need to wear sunscreen on a cloudy day. Most failed to use measures to protect themselves against sun exposure.
The Fitzpatrick skin type scale
This scale measures the risks faced and protective steps people need to take according to skin type, which has a bearing on just how dangerous the sun’s rays are for you.
Characteristics - Pale skin, light or red hair, prone to freckles. Burns very easily and rarely tans.
At the greatest risk of developing skin cancer. Need to protect skin, preferably with clothing.
Characteristics - Fair skin, likely to have light hair, blue or brown eyes. Some have dark hair, but still have a fair skin. Usually burns, but may gradually tan.
At the greatest risk of developing skin cancer. Needs to protect skin, preferably with clothing.
Characteristics - Light olive skin with dark hair and brown or green eyes. Burns with long exposure to the sun, but generally tans quite easily.
Workers should protect themselves in strong sunshine.
Characteristics - Brown eyes and dark hair. Burns with very lengthy exposures but always tans easily.
Workers should protect themselves in strong sunshine.
Characteristics - Naturally brown skin, brown eyes and dark hair. Burns only with excessive exposure to the sun. Skin easily darkens further.
Should protect themselves when outdoors in the sun for a long time.
Very dark brown
Characteristics - Black skin with dark brown eyes and black hair. Burns only with extreme exposure to the sun. Skin very easily darkens further.
Should protect themselves when outdoors in the sun for a long time.
The scale of the problem
Worldwide, skin cancer is the most common cancer – non-melanoma skin cancer accounts for about 30% of all newly diagnosed cancers. The WHO estimates that between 2million and 3million non-melanoma skin cancers and 132,000 melanoma skin cancers occur globally each year.
From an occupational perspective, it is difficult to achieve accurate estimates of people diagnosed with skin cancer as a result of solar radiation at work – only one or two countries have estimated exposure levels.
In Germany, it has been estimated that 2.5million to 3million outdoor workers are exposed. In Great Britain, an estimated 5.5million people have been exposed to the sun’s rays through their work in the service industries, construction sector, manufacturing and agriculture.
According to Cancer Research UK, outdoor workers are at higher risk from non-melanoma skin cancer – 43% higher risk of basal cell carcinoma and 77% higher risk of squamous cell carcinoma.
New research commissioned by IOSH into sun exposure at work in Britain has found that malignant melanoma (the more serious form of skin cancer) kills nearly 50 people each year, with 240 new cases being registered. The majority affected are men, and just under half those diagnosed with malignant melanoma linked to occupational exposures are under 65.
These findings, from Imperial College London, are echoed in studies from around the world, including North America, Australia and other European countries.
What you need to do
Skin cancer is often avoidable. Tackling solar radiation exposure is relatively easy to achieve, and doesn’t have to be costly.
Start by assessing the risks of exposure to your employees:
• Do any employees work regularly outside?
• Are workers unprotected from the effects of solar radiation?
• Are workers exposed to high levels of solar radiation for long periods of time?
Remember that even on cloudy days there can be enough radiation to damage the skin – 80% of UV rays can penetrate clouds. The strength of solar UV radiation is not connected to temperature and can bounce off reflective surfaces like metal, water, snow and some concrete finishes.
If you answer ‘yes’ to these basic questions there could be a risk of people being harmed by solar radiation and you will need to either prevent or control the potential exposure.
Actions to control exposure as part of sun safety strategy:
1. Checking the UV index from the weather forecast and communicating information to relevant workers, alongside prompts to use protective measures to minimise exposure. You can get monitoring devices that trigger action at certain levels.
2. Avoiding or minimising exposure to direct sunlight in the middle of the day – 60% of daily UV radiation occurs between 10am and 2pm. Many advise minimising exposure until at least 3pm.
3. Regularly swapping job tasks between workers to make sure everyone on the team can spend some time in the shade.
4. Using heavy-duty cover or shade when working outdoors in the sun – shade can cut UV exposure by 50% or more. Check protection levels with your supplier.
5. Making sure rest breaks are taken in shaded areas or indoors – siting water points in shaded areas or indoors can help encourage breaks to be taken out of the sun.
6. If employees are regularly driving during high UV months, adding UV protective films or tints to plain glass vehicle windows if they are not laminated (lamination can filter most UVA). Of course, on side windows, lamination, films or tints are only effective when the windows are closed, so this measure is less likely to be successful in vehicles without air-conditioning.
7. Raising awareness of solar radiation issues with workers using toolbox talks or training sessions – using a resource like IOSH’s free ‘Sun safety in construction’ film will help get the message understood and encourage outdoor workers in any sector to take responsibility for their own health.
8. Wearing long-sleeved, loose-fitting tops and trousers when working outdoors during months with high UV levels – you will need to check the ultraviolet protection factor (UPF) rating and make sure the design of the clothing fits the job and does not introduce other hazards. ‘High wicking’ fabrics are designed to draw moisture away from the skin.
9. Using high factor sunscreen where the skin can’t be protected by other measures, for example, on the hands, face and lips. Sunscreen should be water-resistant and have ‘broad spectrum’ protection, with an SPF of at least 30 and a UVA rating of four or five stars. Sunscreen should only be used alongside other protective measures – it is best not to rely on sunscreen alone.
10. Wearing wide-brimmed hats that shade the face, head, ears and neck or if safety helmets are worn, using those fitted with flaps to protect the neck.
11. Wearing sunglasses with 100% UV protection or using UV-filtering safety goggles with the same level of protection if the work means physical eye protection is needed. Look for the ‘UV 400’ marking.
12. Encouraging workers to check their skin for changes to moles or other changes. Detecting the early signs of skin cancer and undergoing early treatment can save lives.
If your employees have to wear protective clothing and equipment to help cut down solar radiation exposure, make sure it fits properly and comfortably, especially when the temperature is rising – discomfort is a common reason not to use PPE.
Research commissioned by IOSH from Nottingham University suggests that to shield the body, arms and legs from the sun’s rays, it is more effective to issue workers with clothing rather than issuing sunscreen and encouraging workers to use it – it is difficult to reapply in dusty or dirty conditions and tougher to make sure that work teams are using it effectively.
Sunscreen is less effective than covering up with clothing in any case. Sunscreen is obviously still needed to protect the face, assuming that headgear shields the neck and ears, and of course the hands if gloves aren’t worn. The study also found that nine out of 10 workers would follow site rules about sun safety measures if they were introduced.
Although protective equipment should usually only be used as a last resort, in the case of solar radiation it will typically form a significant part of your control programme. Relying heavily on controls like protective clothing means that you may need to concentrate on changing the way people do things.
You should explain to your employees why these actions are necessary to protect their health – if people understand why you’re making changes they are more likely to comply. It is worth carrying out observational assessments to see if the controls are working, and that people are doing what they have been asked to do.
After you have put new control measures in place you should assess the risk again to see if the actions you have taken have made a difference; for example, are task rotations working in practice, are workers following site rules on taking rest breaks under cover?
Encourage basic self-checks for moles or skin changes. Given how reluctant many men are to visit their doctor, you may also want to consider annual skin checks by a trained health professional as an additional way of trying to catch possible skin cancers in the early stages. This could form part of a more general health check-up, or fit into a health and wellbeing campaign. Solar radiation exposure could form part of your health surveillance programme, although remember that health surveillance alone is not an effective health management strategy.
You should also give people who could be at risk from sun exposure information and training about the possible dangers and how exposure can be cut down.
Published: 07th May 2015 in Health and Safety Middle East