I am considering to go and live in Australia for a couple of years. My
concern is with the ozone hole and consequent higher UV radiation in
Australia. Please inform me about the health risks related to UV rays
of residents of Australia as compared to people in other countries (or
compared to Australians before there was an ozone hole 50 years ago)
and whether and how this situation affects daily lives (skin
protection, medical exams, insurance premiums, whatever). I don't know
if that matters, but I would live in a city (Sydney or Merlbourne) and
have a normal office job. I have light skin, do not tan, and my
grandfather had skin cancer. I like to be outside but no extreme
hiking/sailing/whatever activities. It'd be best to get a balanced
view from someone who lived both in Australia and elsewhere and who is
actually concerned about long-term health.

Thanks for your question.  I do a lot of environmental work, and
appreciate the chance to field a query like this.

I haven't been to Australia myself, but I hear from friends that it's
a wonderfully delightful country/continent/state of mind.  Like any
journey, you need to be mindful of changed conditions, and your
safety.  So too with Australia, especially regarding UV radiation.

Bottom line is this:  Australia gets a lot of UV radiation, and
Aussies get a lot of skin cancer, and may be endangered in other
health areas as well.  How much of this is due to the ozone hole, and
how much to the fact that they're a fun loving, out-doorsy, devil may
care sort of culture is an open question.


The Public Health Association of Australia at

 http://www.phaa.net.au/policy/stratos.htm 

put it like this:

"Stratospheric ozone depletion resulting in increased exposure to UVR
is likely to have deleterious health and environmental consequences
for Australia.
Ultraviolet radiation, particularly UVB, has important consequences
for human health, being etiologically linked with

--both melanoma and non-melanoma skin cancer (which are estimated to
increase in incidence at 1 or 2 times the rate of increase in UVB,
which itself increases at twice the rate of ozone depletion);
--non-malignant skin damage; 
--ocular effects, including cataracts (especially of the cortical
type), pterygia, climatic droplet keratopathy and acute
photokeratitis;
--and depression of immune function, especially the T-effector limb of
the immune response, with unknown but potentially important
consequences for human malignant and infectious diseases."

Quite a list, eh? 


The Atmosphere Theme Report of the Australia State of the Environment
Report 2001 at:

http://pandora.nla.gov.au/pan/24565/20020416/www.ea.gov.au/soe/2001/atmosphere/atmosphere03-9.html#healtheffects

is even more explicit about the cancer effects:

"Skin cancer is the major type of cancer in Australia. Malignant
melanoma has been increasing in incidence in white populations
worldwide at 3 to 7% per year since the early 1960s. Australia has the
highest incidence of melanoma in the world, 28 per 100 000
person-years in 1990. Melanoma incidence has been recorded since the
late 1970s in most states and has doubled in both men and women from
1980 to 2000. There are only limited data on trends from three
national surveys for the incidence of non-melanocytic skin cancer. In
1990, the Australian incidence rate for this form of cancer was 980
per 100 000 person-years, and the incidence rate in 1995 was more than
25% higher than in 1985. These surveys underestimate the true
incidence rate because they do not include people with undiagnosed or
untreated non-melanocytic skin cancer."

But they also say it's hard to know how much of these high numbers is
a direct reslut of the ozone hole:

"Because of the very long lead time between exposure to UV radiation
and the related occurrence of skin cancer, the increasing incidences
of skin cancers in Australia (Figure 82) from 1980 to 1996 are thought
to be associated primarily with behaviour in relation to exposure to
UV radiation that presumably took effect before there was any
significant depletion of the ozone layer. However, it is reasonable to
assume that any increase in UV radiation as a result of ozone
depletion has contributed, and will contribute, to increases in the
incidence of skin cancer."


The main conclusion about health effects, though, is this:

""The Australian climate, with high levels of UV radiation, is
conducive to elevated incidences of sunburn and other UV-related
medical problems, such as melanoma. Human behaviour, much more than
ozone depletion, determines the overall effect of UV on people in
Australia. "


In other words, if you stay out of the sun when you can, and wear sun
block when you can't (and a wide brim Panama hat wouldn't hurt,
either), then you greatly minimize any risks from the high UV levels. 
More and more native Australians are swearing off their devotion to
tanning, and in doing so, are taking charge of their exposure levels. 
No reason you couldn't do the same.

I hope this answers your question to your satisfaction.  No, I haven't
lived in (or even visited) Australia, but I have been working on
environmental and public health issues for the last twenty years, and
I like to think I have a pretty good sense of balance on these things.

Let me know if you need any additional information.  

Dave


Search strategy:  [UV radiation "ozone hole" australia "health
effects"]

Hey this came out much better than I thought! Also, I don't know what
makes people write all these comments for free. Are you all aspiring
researchers? I love you all.

Info on the potential effects of the ozone hole in Australia:
http://www.fbe.unsw.edu.au/exhibits/scientia/wwwjul96/brennan/ozone2.htm

Given your family history of skin cancer, and the fact you have fair
non-tanning skin, if you lived in Australia, you would have to be
meticulous about protecting yourself from the sun.  There is some
controversy about whether sunscreens offer sufficient protection. 
Some researchers in Philadelphia argue that while sunscreens may offer
protection from erythema (i.e. going lobster-red), they might not
necessarily protect from the effects of UVA light at the level of the
skin cells http://ehpnet1.niehs.nih.gov/docs/2000/suppl-1/71-78gasparro/abstract.html
 Therefore, to be really safe, you would have to wear protective
clothing and avoid being out when the sun is at its highest.

I'm afraid I do not know anything about the Australian health
insurance system so cannot say whether your skin type and family
history would result in you having to pay higher premiums.  One thing
you might need to bear in mind is that, if you ever undergo genetic
screening to see whether you have an inherited susceptibility to skin
cancer, insurance companies might have the right to see the results of
your tests before deciding your premiums.  It is rather a strange
situation at present.  An insurance company cannot coerce you into
being tested, but they do have the right to see your results if you do
take that decision.

I'm a fair-skinned Briton who lived in Australia for nine years, so I
have some personal experience to add to Dave's excellent research.

Australia has the highest rate of skin cancer in the world, and this
was the case even before the ozone hole became a matter of concern.
There has been a massive public health education effort over the last
two decades - I can testify to this, as I can still sing the "Slip,
Slop, Slap" jingle 16 years after leaving the country. "Slip on a
shirt, slop on sunscreen and slap on a hat" sums up the necessary
precautions, although sunglasses are a good idea as well. Sensible use
of personal protection greatly reduces UV exposure and hence the risk
of skin cancer, and other medical problems where UV is a risk factor,
such as cataracts. It's no great imposition to do the things that
reduce the risk, and if you don't tan anyway you're not going to be
tempted to ignore the guidelines for the sake of getting a tan. The
public health campaign is having an effect, and the rates are starting
to drop.

One advantage of the high rate is that the medical profession is well
aware of the possibility of skin cancer, and detection and cure rates
are very high. There is also a thriving research programme.

You don't specify where you live at the moment, but you may find the
following chart from the World Health Organization website useful for
comparing UV levels in Melbourne and Sydney with your current
location:
http://www.who.int/peh-uv/UVIpublic.htm#travelling

The Cancer Council of Victoria has an excellent website on UV and skin
cancer at
http://www.sunsmart.com.au/
You might want to browse this site to get a feel for what the cancer
prevention organisations recommend.

Search strategy: "UV Australia", then picking out the Bureau of
Metereology website and following links from there.

A further comment now that I've refreshed my memory on the medical
care system:

Australia has a tax-funded medical insurance system called Medicare,
which can be supplemented by private health insurance. If you are a
visitor or temporary resident, you are not normally eligible for
Medicare cover. The normal private policies are not suitable for such
people, because they are designed to supplement the Medicare system
and wouldn't fully cover someone who isn't eligible for Medicare. If
you have a permanent resident's visa, you normally would be eligible
for Medicare. Medicare is a universal system, paid for by a tax
surcharge, and does not have any restrictions based on your existing
health or genetic profile.

There are eight countries with a reciprocal health care agreement with
Australia which gives some basic medical cover for visitors and
temporary residents from those countries (New Zealand, the United
Kingdom, the Netherlands, Sweden, Finland, Italy, Malta and Ireland),
but you would still require a top-up private policy suitable for
non-residents.

If you will need insurance cover as a temporary resident, the relevant
government website has this to say:

http://www.health.gov.au/haf/docs/visthlth/2001hlth.htm#hifov
"Private health insurance for overseas visitors in Australia is
available from Australian registered health organisations, insurance
brokers and general insurers. To obtain contact details for insurers
offering private health insurance for overseas visitors, you can phone
the Department of Health and Aged Care on (02) 6289 7531."

Which is not entirely helpful, because it doesn't give the number in
the format for dialling from overseas. You need to dial your
international access code, then 61 2 6289 7531.

Note that even if the Australian insurers aren't concerned about your
risk level for skin cancer (which I think is likely to be the case),
you may find that your local insurers are concerned about it when you
return to your home country.

Search strategy: "Medicare Australia"

This is a comment from an Australian who lives in Melbourne...

Yes the ozone layer hole does extend over Tasmania and also Melbourne
at times during the year.
At present not all the year in Melbourne (I cant speak for Tasmania on
that)
Preventive measures: sunglasses and large dollop of common sense!
(even on a cloudy day I may wear sunglasses, depending on how the
light intensity feels)
I'm not aware of the ozone hole extending much north of Melbourne,
certainly not yet to Sydney, let alone Brisbane.

The high rates of skin cancer in Australia are due to the dumb Aussie
habit of frying their skin on the beach. Those playing outdoor sports
use zinc cream on the faces and other exposed parts of the body.

Its a great country, dont be put off (I came here in 1986 from
Britain...)

the ozone risk terms are all fake !!!

Good question!  I am also a non-tanner and have dreams of being a
long-term Aussie visitor some day...

Let me suggest that you might want to research the idea that having
abundant antioxidant intake (like Vitamin E and C, whether from food
and / or supplements) will reduce the skin damage that sun
over-exposure can do.  I've seen it suggested that a rub-down with
olive oil after sun exposure would be helpful this way.  Another idea
floated in the alternative health world suggests that keeping your
refined sugar intake very low will help improve your body's ability to
respond to the radiation damage (so avoid sugary sodas while you're
out playing at the beach, for example).  Keep in mind that there are
informed folks out there who point to LACK of sun exposure, and the
consequent low Vitamin D levels, as a potential cause of health
problems, so in theory, it is possible to be TOO rabid about avoiding
sun exposure.  Try www.mercola.com for info on this subject.