Council on Environmental Health
Article Review

Prepared by: Sophie J. Balk, MD
June 2008

TITLE
Economic Evaluation of the US Environmental Protection Agency’s SunWise Program: Sun Protection Education for Young Children

AUTHORS
Jessica W. Kyle, James K. Hammitt, Henry W. Lim, MD, Alan C. Geller, Luke H. Hall-Jordan, Edward W. Maibach, Edward C. De Fabo, Mark C. Wagner

REFERENCE
Pediatrics, May 2008; 121: e1074 - e1084. 

STUDY DESIGN
Standard cost/benefit and cost-effectiveness analysis methods.

BACKGROUND
Exposure to ultraviolet radiation (UVR) from the sun and artificial sources is a risk factor for developing skin cancer, including melanoma.  Major skin cancer prevention strategies include recommendations to reduce overexposure to UVR through increasing knowledge and awareness, modifying sun safety practices, and implementing policy measures and environmental initiatives.  The SunWise Program, the first national health and environmental education program for sun safety designed for children in elementary and middle schools, was developed by the US Environmental Protection Agency (EPA) to teach children and their caregivers how to protect themselves from overexposure to the sun.  A number of studies have evaluated the behavioral impacts of school-based and community sun safety education programs; few have evaluated the economics of skin cancer prevention programs.

METHODS
Cost/benefit and cost-effectiveness analyses were used.  Intervention costs were measured as program costs estimated to be incurred by the US government, which funds SunWise, using 3 funding scenarios. Health outcomes were measured as skin cancer cases and premature mortalities averted and quality-adjusted life-years saved. Costs averted were measured as direct medical costs and costs of productivity losses averted as a result of SunWise. Net benefits were measured as the difference between costs averted and program costs.

RESULTS
The study showed that:

  • Every federal dollar invested in SunWise generates $2 to $4 in public health benefits.
  • The larger the investment in SunWise, the more cost-beneficial the program becomes for taxpayers.
  • Over the past 9 years, federal spending per person of less than three cents on EPA’s SunWise Program is helping to prevent 15 deaths and more than 3,000 cases of skin cancer. For pennies more over the next 7 years, the SunWise Program can save 36 to 56 more lives and prevent 8,000 to 12,000 additional cases of skin cancer.
  • Small behavior changes such as wearing a hat or seeking shade can lead to significant health benefits in the future.
  • For very little effort and no cost, teachers can improve students’ health (1-2 hours to use activities in the free educational, standards-based SunWise Tool Kit).

DISCUSSION
The study is unique because few studies to date have analyzed the cost-saving benefits of school-based health programs, and no study has analyzed sun safety programs.

BOTTOM LINE
The primary message of the cost-benefit analysis is that teaching children about sun safety saves lives and money.  Additional information about the SunWise Program can be found at www.epa.gov/SunWise

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