Closing speech by Minister for Health, Dr James Reilly, T.D. on the second stage of the Public Health (Sunbeds) Bill in Dáil
Skin cancer is the most common type of cancer in Ireland and represents a major public health challenge in both the short and long-term. For most people the main source of exposure to ultra-violet radiation is the sun. However, there is clear evidence that some people are exposed to high doses of ultra-violet radiation through artificial sources. Sunbeds and sunlamps used for tanning purposes are the main source of deliberate exposure to artificial ultra-violet radiation and, as we know,all forms of such radiation contribute to skin cancer.
We cannot ignore then, the frightening figures and projections provided by the National Cancer Registry.Lest anyone is thinking that this proposed legislation is frivolous or indicative of a “nanny state” approach, let me repeat those figures.
We know that
there are over 850 new cases of melanoma in Ireland each year;
over 150 Irish people die each year from melanoma;
there were over 7000 people alive with this type of cancer in 2011;
data from the HSE indicates that the cost of treating skin cancer ranges from €6,000 to €10,000 per patient depending on the complexity of the disease. However, recently new high oncology drugs have become available, such as Ipilimumab (ipil-imu-mab). Ipilimumab became available for patients with progressive melanoma in May 2012. The cost of this treatment is in the region of €50,000 to €80,000 per patient. There are around 60-80 patients per year with such advanced melanomas.
the incidence of cancer in Ireland is expected to double by 2040 and the fastest growing number of cancers are expected to be skin cancers.
These are not mere statistics. Behind each one of these numbers are people fighting painful and debilitating cancers. Many are winning that fight but far too many are losing it. The impact of these cancers on individuals and their families cannot be underestimated. The long term treatment and its cost on individuals, families and the health system are significant. The sad reality is that we know that this disease is totally avoidable. As I have already said, this is a true case of prevention being better than cure……. and a very painful cure at that.
That is why we must legislate now to put the measures in place that will protect our children and which will allow adults to make better informed choices. We must do all we can to discourage the use of sunbeds and to encourage a healthier attitude to protecting ourselves and our children from ultra-violet radiation.
Research and recommendations from the World Health Organisation, International Agency for Research on Cancer, National Cancer Control Program and the Chief Medical Officer have pointed to the abundant evidence to support public health measures to regulate the use of sunbeds.
Legislative action is required and justified
to protect the public, in particular children and young persons, from the risk of skin damage, and the increased risk of developing skin cancer,
to promote a greater public awareness across all age groups of the dangers of developing skin cancer, premature ageing and eye damage from exposure to ultraviolet radiation.
I am convinced that, in the long term, this Bill will contribute to a reduction in the incidence of skin cancers. This Bill is a comprehensive response to a serious public health issue.
The Government’s key objective in the Bill is to protect young people. Therefore, we propose to make it an offence to sell or hire a sunbed to a person aged under 18, or to allow them to use a sunbed on a sunbed premises. In this regard, I would like to state that I have taken note of the interventions in this House, and I will ensure that the measures aimed at the protection of children, set out within this Bill, will be commenced and implemented as a priority.
I would also like to take this opportunity to call on parents to act responsibly when it comes to the issue of permitting or encouraging their children to use a sunbed. Parents may think that they are doing something positive in allowing their children to use a sunbed but they are in fact risking their children’s health. Parents must act responsibly to protect their children. There is absolutely no justifiable reason to allow the use of sunbeds by children under 18 years of age.
Many Deputies have referred to the need to raise awareness about the health risks associated with sunbed use. This is an issue we have taken seriously within the Bill. In order to ensure that adults who are considering using sunbeds fully understand the implications and risks associated with sunbed use, we will require sunbed businesses to display warning signs on both the sunbed premises and on any social media used for advertising sunbeds.
In addition, the operator of a sunbed business will be required to provide information to potential sunbed users on the dangers of sunbed use, including the risk of skin and eye cancer. This information will be set out in a specified form. The operator will be required to ensure that the client has the opportunity to read and consider the information, and has signed the form confirming that they have done so before they are allowed to use a sunbed.
Concerns have been raised during this debate regarding claims that sunbeds can in some way be good for you or can help with certain conditions such as acne. We know from all the scientific evidence that any claimed benefit for sunbed use is far outweighed by the risks. Where a patient is in need of phototherapy, this Bill provides a clear exemption for such therapy under the supervision of a relevant medical practitioner. Therefore, to avoid industry presenting confusing messages and making health claims for sunbed use, we will prohibit the use of health claims unless such claims are prescribed in Regulations.
We will also prohibit certain marketing practices aimed at incentivising people to use sunbeds more than they may have originally intended. There will also be a requirement that sunbed use on a sunbed premises should be supervised.
Through this Bill and the wider Healthy Ireland agenda, we will create an awareness of the dangers of using sunbeds. We will promote healthy lifestyle choices among the public by building on this legislation and by supporting and monitoring collaboration between areas such as primary care, hospitals, cancer screening and clinical programmes.
I note the concerns raised by Deputies with regard to the quality of protective eyewear. The Bill requires that such eyewear should comply with the relevant harmonised EU standards.
A question was raised as to why we would require recognised training for those supervising sunbed use. We know that despite all the warnings and information campaigns around cancer risks, some people will continue to insist on using sunbeds. We need to ensure that these people are fully aware of the risks, are properly supervised in the use of sunbeds, and that their use of sunbeds takes place in as hygienic an environment as possible. To this end we have, in line with many other jurisdictions, made provision for the training of those who will supervise sunbed use.
I have been asked why we should not provide for a prohibition on sunbed use based on skin type. People with skin types I and II are melano-compromised and the World Health Organisation recommends that they do not use sunbeds. I would strongly agree with this advice.
The Chief Medical Officer has suggested that those sections of the adult population at increased risk from ultra-violet radiation could be dealt with by way of regulation rather than prohibition. The HSE National Cancer Control Programme has confirmed a similar viewpoint. The Department of Justice and Equality have advised that a prohibition based on skin type may be incompatible with equality legislation.
Recognising the risks and legal complexities, we have taken the decision to deal with this issue by ensuring that any adult wishing to use a sunbed is fully informed of the risks and is given appropriate advice to enable them to make informed choices.
I was also asked as to whether consideration was given to the provision of a complete ban on sunbeds in commercial premises. A number of options were looked at and, having reviewed the options, it was considered that such a ban would be ineffective for the following reasons:
it would simply move sunbed use from commercial premises, which will be regulated, “underground” to domestic premises where sunbed use would be much more difficult to supervise. We could not, for example, be assured that warning signs would be in place or that the relevant information on health risks would be available to potential users of sunbeds as well as making it more difficult to protect children;
such an approach would be markedly different to the approach to similarly harmful items, for example, tobacco;
it is possible that such a ban would be challenged on EU internal market and anti-competitive grounds;
industry might seek compensation through the courts for loss of livelihood.
For these reasons it was decided that an outright ban on the use of sunbeds on commercial premises was not appropriate at this time.
I concur with the Deputies who highlighted the need for effective enforcement of this important legislation. I have no intention of passing this Bill for it merely to sit on a shelf. I can confirm that the Environmental Health Service will be responsible for compliance building and enforcement.
Environmental Health Officers (EHOs) have a proven track record in the enforcement of a broad range of environmental health legislation. They play a lead role in the enforcement of food safety and tobacco control legislation. As Deputies will be aware, over the past 10 years since the introduction of the smoke free legislation, the EHOs have actively engaged in building compliance. When such efforts have been exhausted, the EHOs have been instrumental in initiating legal proceedings and defending the legislation in the courts. The significance of enforcement is reflected in the consistently high compliance rates of above 90% for smoke free legislation.
Last November, in preparation for the introduction of this legislation, my Department established a National Implementation Group with the HSE and the Environmental Health Association of Ireland. This Group will work with us, in the development of comprehensive information and guidance to facilitate compliance by industry and to inform consumers of the new legislative requirements to protect their health and wellbeing.
I have listened to the concerns raised regarding the proposed level of penalties. I fully understand and agree with the sentiments expressed. This is why the proposed penalty rates are so significant whilst still being proportionate. The maximum rate for a first offence will be €4,000 rising to €5,000 for a second offence and subsequent offences. It will also be possible to commit offenders to prison. These penalties are, as has been noted elsewhere, far higher than the penalties imposed for the sale of alcohol and or tobacco to minors.
Given the medical evidence available to us and the worrying trends facing us, it is essential that we act now.
I would like to thank all Members of the House for their contributions and I look forward to the Bill being further considered at Committee Stage.