Sunny Australia's Efforts Are Putting Skin Cancer in the Shade

Issue 20, 2012

Slip! Slop! Slap! Campaign Started Big Turnaround in Tanning Attitudes

Slip! Slop! Slap!

Blessed with beautiful surroundings and an enviable climate, Australians have long revelled in the outdoors and time spent in the sun.

But with two to three times the rates of Canada, the US and the UK, Australia has one of the highest rates of skin cancer in the world. In fact, two out of every three Australians will be diagnosed with skin cancer by the time they are 70, and skin cancers still comprise 80 percent of all newly diagnosed cancers in the country.

Something had to change. The challenge has always been to balance Australians' love of the great outdoors with the sometimes unpopular message that too much sun raises your risk of skin cancer.

Campaigns that began in the 1980s sought to do just that, and three decades later the battle for hearts and minds is clearly being won.

"In recent years, we have seen a shift away from the desire for a tan, with fewer people believing that a tanned person is actually healthier," said Cancer Council Australia CEO, Professor Ian Olver. Data from the Australian state of Victoria, for example, shows that the number of residents who say they like getting a tan fell from 61 percent in 1988 to just 35 percent a decade later. Those trends appear to be continuing nationwide: recent data from the National Sun Protection Survey shows that Australians were 43 percent less likely to prefer getting a tan in 2011 than they were in 2004.

According to Olver, there's also been "increased awareness of the signs and symptoms of skin cancer and the importance of getting anything unusual checked out as soon as possible."

Two campaigns - the famous Slip! Slop! Slap! initiative which ran from 1980 to 1988, and the SunSmart Program that picked up the message thereafter - may get much of the credit. Both were built on two strong foundations: the vital integration of research and evaluation and a strong basis of consistency and continuity.

It's paying off. Although overall skin cancer rates remain high today, in part thanks to a legacy of UV exposure, Australia has seen positive changes in sun-related behavior and attitudes in the last two decades. For the first time, the country's skin cancer rates are starting to trend down, especially in the under-40 age group who have grown up with Cancer Council’s multifaceted and community-wide approach to skin cancer prevention.

Three Simple Words

Couple wearing hats with protective sun visors outdoors.

Mass media campaigns have been key to tackling people's beliefs, informing them of the risks of sun exposure, and giving them strategies to protect themselves. In 1980, Sid the seagull – wearing board shorts, t-shirt and a hat – first tap-danced his way across television screens reminding everyone of three easy ways to protect against skin cancer while outdoors - slip on a shirt, slop on some sunscreen and slap on a hat.

The Slip! Slop! Slap! slogan became the core message of the Cancer Council's SunSmart program and has become part of the Australian lexicon. Australian research has directly linked SunSmart mass media campaigns to the shifts in sun protection attitudes and behaviors over the past two decades, from Sid all the way through to today's more hardhitting campaigns.

In 2007, the slogan was updated to Slip! Slop! Slap! Seek! Slide! to reflect the importance of seeking shade and sliding on wraparound sunglasses to prevent sun damage.

But SunSmart's approach doesn't stop there. There's also been a push for public education and legislative change around tanning bed use.

In 2007, a 26-year-old terminal skincancer patient, Clare Oliver, bravely shared her story as a warning to others of the dangers of tanning salons. The media attention and subsequent community service announcement released in early 2008 had an enormous impact. In one month, the story generated more than 100 press articles and nearly 400 broadcast items nationwide.

"Clare's story and the resulting media attention gave huge impetus to Cancer Council's ongoing awareness and advocacy campaign against tanning bed use, with states and territories toughening legislation and large numbers of tanning bed operators closing their doors around the country," SunSmart Research and Evaluation Manager Jen Makin said.

And a legislative milestone was reached in 2011 when the New South Wales State Government announced its decision to ban tanning salons from Dec. 31, 2014 - a major public health win.

Starting Young

Young women wearing sunscreen on their noses.

Another highly successful SunSmart program component has been policy development and action in schools. Following earlier work in Victoria, Cancer Council launched the national SunSmart Schools program in 1998. The program has grown rapidly and there are now more than 2,500 SunSmart schools and 3,500 SunSmart childcare centers across the country. This program, which provides schools with sun protection guidelines, policy and curriculum resources, has one of the highest participation rates of any health-related program in Australian schools.

"The SunSmart program has contributed to sun protective behaviors becoming the norm rather than the exception, particularly among younger children,” Makin said. “As UV exposure in childhood plays an important role in lifetime risk of skin cancer, we expect to continue to see the value of the SunSmart Schools program reflected in incidence rates when those children who have grown up with SunSmart as a way of life, become adults."

Other initiatives are also reaping benefits. National Skin Cancer Action Week - held annually at the start of summer – focuses on a different theme each year. The spotlight in 2011 was teenagers and their ‘cooling attitudes’ towards tanning, with celebrities like Australian cricket captain Michael Clarke taking part.

A SunSmart app has also been produced that uses cellphone technologies to let Australians know when they do and don't need sun protection. SunSmart also works with sporting groups to boost Australians’ sun protection while at play, and offers workplace seminars to help people stay sun-safe while on the job.

All of this may be reaping real health benefits at last. There's now clear evidence that skin cancer rates are starting to plateau after many years of increase, rates of skin cancer are falling among younger Australians, and early detection and treatment is helping bring about better outcomes.

Through its SunSmart program, Cancer Council is continuing to build on past successes by influencing behaviors and tanning attitudes through education campaigns, and by partnering with public health organizations. There’s still a long way to go, but the battle against skin cancer is one Australians now know they can win.