Council on Environmental Health
Article Review

Prepared by: Sophie J. Balk, MD
June 2008

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

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

Pediatrics, May 2008; 121: e1074 - e1084. 

Standard cost/benefit and cost-effectiveness analysis methods.

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.

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.

The study showed that:

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.

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

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