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Summary box
The effects of climate change are increasing human exposure to ultraviolet radiation and persons with albinism are among those at increased risk from the consequent negative health impacts, such as skin cancer.
Amidst a warming world, healthcare systems and providers must act urgently to address current health inequalities and protect the health of vulnerable populations, such as persons with albinism, from being eroded further by climate-related impacts.
Persons with albinism must be included in initiatives to protect and educate populations of the risks of sun exposure. In particular, the affordability and availability of appropriate sunscreen products should be increased. Initiatives exist in some countries already, but there are inconsistencies in supply, affordability and product quality, so many persons with albinism remain unprotected.
Introduction
Healthcare systems are failing to protect persons with albinism from the health impacts of climate change. Albinism occurs worldwide regardless of ethnicity or gender and its prevalence is estimated to be between 1:12 000 and 1:15 000 in European countries and between 1:4000 and 1:7000 in Africa, reaching as high as 1:1755 in Namibia, for instance.1 The treatment of persons with albinism and the significant health inequalities and discrimination they experience relative to the general population has long been recognised as a significant public health concern.2 Climate change is exacerbating these health inequalities and contributing to the exclusion of persons with albinism from education, employment and many other aspects of social participation. Yet, the impact of climate change on the health of persons with albinism has received little attention. This commentary summarises the key health concerns in relation to sun exposure and identifies measures that healthcare systems and healthcare providers can take to protect the health of persons with albinism amidst a rapidly warming world.
Climate change, sun exposure and the health consequences for persons with albinism
As persons with albinism lack melanin in their hair, skin and eyes, they are more vulnerable to the negative health impacts of ultraviolet radiation (UV) contained in sunlight. Climate change contributes to an increase in UV exposure through various factors, including ozone depletion, reduced cloud cover, and interrelated human behaviour factors, like spending more time outdoors due to temperature rises.3 Individuals with albinism globally face a significantly higher risk of developing skin cancer from UV exposure compared with the general population, with regional estimates suggesting that Africans with albinism are up to 1000 times more likely to develop skin cancer compared with the overall African population.4 Estimates also suggest 98% of African persons with albinism do not live beyond the age of 40 because of sun exposure, with skin cancer responsible for at least four-fifths of these deaths.5 Persons with albinism mainly develop non-melanoma skin cancer, which are known to be mostly UV-induced types of cancer.6 Incidences of skin cancer have been rising globally as a result of climate change and in north-west Europe are expected to reach an additional 90 million cases by 2050.7 Adequate sun protection is therefore also a concern for persons with albinism living in more temperate climates at higher latitudes. For example, the UV Index, which measures the intensity of UV radiation, ranges between 7 and 9 in summertime in Germany, as high as 8 in the UK, and 7 in Finland.8 Conversely, sunscreen for the general population is recommended by the WHO when UV exposure reaches 3 or above.9
As persons with albinism are already likely to live in poverty, they are among the population groups least able to cope with the consequences of climate change.10 For instance, persons with albinism commonly cannot afford the costs of commercially available sunscreen, including costs associated with travelling to get it.10 Often, existing barriers to accessing education and employment, like stigma, lead to increased sun exposure, as the only sources of income left to them are outdoor occupations, such as field labour or street vending.10 As a consequence, many persons with albinism develop skin cancer as the result of outdoor work. This highlights the fact that skin cancer in persons with albinism should be considered an occupational disease. The health risks of sun exposure, such as skin cancer, and associated consequences, such as scarring from cancer surgery, in turn worsen the barriers that persons with albinism face.10 This keeps them and their families in poverty.
Ways forward and recommendations
As the world warms and human exposure to ultraviolet radiation increases due to climate change, access to mitigation measures is vital to ensure populations enjoy the highest attainable standard of health. There is urgent need to include persons with albinism in all current and future initiatives designed to protect individuals from extreme sun exposure. Use of broad-spectrum high sun protection factor (SPF) sunscreen and protective clothing (eg, UV resistant hats and long-sleeved tops) are key among protective interventions. Measures should be taken to increase the availability of these products and reduce costs to consumers in all countries across the world. In particular, sunscreen should be classed as an Essential Medicine by the WHO and by national healthcare systems worldwide. More broadly, countries should also ensure that relevant healthcare information and guidance to foster good sun protection practices, such as forecasts about UV levels, are made publicly available, in a format accessible to persons with albinism (who frequently have visual impairments) and contain additional guidance that is specific to their condition.
Furthermore, healthcare systems should prioritise persons with albinism in initiatives to distribute broad spectrum high SPF sunscreen free of charge or at as low cost as possible to their citizens. Government schemes to provide free or discounted sunscreen to persons with albinism already exist in many places such as Brazil, Kenya, Nigeria and South Africa, although there are inconsistencies in product supply and availability. A recent expert panel recommended that sunscreens including SPF50+ and possessing good UVA protection be used for skin cancer prevention in fair-skinned individuals.11 However, we have noted examples of sunscreen products being provided to persons with albinism through government schemes that do not meet this standard. This includes in countries within latitudes that currently have among the highest current global average levels of UV exposure. For example, while the South African government provides free sunscreen to persons with albinism, this is reported to be a generic product of only SPF 15.12 13 Healthcare systems must ensure not only that broad spectrum sunscreen is available and affordable to persons with albinism, but that the product they are given offers the highest level of SPF available on the market (at minimum SPF 50).
Conclusion
As climate change continues to increase exposure to ultraviolet radiation, the health inequalities that persons with albinism experience will lead to increasingly dire consequences for their health and social participation. Healthcare systems and healthcare providers must act urgently to address these disparities and protect the health of persons with albinism.
Data availability statement
No data are available.
Ethics statements
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Footnotes
Twitter @DrMarkCarew
Contributors MC conceptualised the commentary, drafted the original version and implemented revisions. MK, AG, SM-R and M-AM-D provided feedback and edits on drafts.
Funding MC is funded by the Programme for Evidence to Inform Disability Action [PENDA] grant from the UK Foreign, Commonwealth and Development Office.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.