Constructing Better Health (CBH), the organisation promoting better occupational health in the building industry, has launched a year-long awareness-raising campaign on skin cancer as new research suggests that the incidence rate in the sector is six times that for the general population.
Bare-chested construction workers are commonplace on building sites around the UK at this time of year, yet new research finds that exposure to ultraviolet (UV) radiation from the sun is damaging to the skin and putting outdoor employees at risk of developing skin disease, including malignant melanoma. CBH has linked up with skin cancer charity Skcin to run a 12-month campaign to raise awareness of the risk of skin cancer as a work-related issue.
All construction workers have an increased incidence rate of skin neoplasia compared with the general population, according to new research published in Occupational Medicine. The research uses data from the THOR surveillance network of occupational health physicians to analyse notifications of different occupational diseases within trades and sub-occupations within construction. The raised risk of skin cancer facing construction workers is particularly significant for certain sub-groups within the sector, such as roofers (who have a standardised incidence risk ratio (SRR) of 6.3), painters and decorators (SRR of 2.1) and labourers in building and woodworking trades (SRR of 6.6).
The increased incidence rates for non-melanoma skin cancers (NMSC) reported under the THOR surveillance scheme agree with the number of work-related NMSC registrations in UK construction workers. International data suggests that the UK incidence rates for skin cancer generally are comparable with those of southern European states, rather than countries with similar climates to the UK, such as those in Scandinavia. This prompts the authors of the research to suggest that factors other than pure latitude are important influences on work-related skin cancer risks.
CBH: extract from new standard on UV radiation from the sun
Ultraviolet radiation (for example, from the sun) can damage the skin and lead to skin cancer, particularly relevant in summer when hot work warrants the removal of clothing. Too much sunlight is harmful to the skin. A tan is a sign that the skin has been damaged by UV rays in sunlight. Some medicines can also make skin more sensitive to sunlight.
Longer-term problems from sun exposure can increase the chance of developing skin cancer. Skin cancer is the most common kind of cancer in the UK, with more than 40,000 new cases diagnosed each year. Workers should be encouraged to check their skin regularly for unusual spots or moles that change size, shape or colour and to seek medical advice if there are concerns.
Construction workers should be encouraged to wear a hat, use a sunscreen with a sun protection factor of 15 or more and to keep shirts on in sunny weather.
Cancer Research UK provides further information.
The latest research by a team at Manchester University builds on an earlier study, which revealed that exposures within the construction industry account for more than half of occupational cancer deaths in Britain and, in particular, a high number of NMSC registrations.
Construction workers had a significantly raised incidence risk ratio for all types of skin neoplasia between 2002 and 2008, according to the THOR data analysed, and exposure to UV light was specified as the suspected causal exposure in 100% of reports of skin neoplasia. The SRR for melanoma in construction workers was 6.6, compared with an incidence risk ratio of five for squamous cell carcinoma and 3.7 for basal cell carcinoma.
It is against this background that CBH has teamed up with Skcin to launch a year-long campaign on the issue across the UK's building sites. The campaign was launched on 1 June 2011 through CBH corporate members, which cover around 90% of large UK construction contractors.
Michelle Aldous, CBH chief executive, argues that employer awareness and action on skin cancer is very low, despite research showing that it is a growing work-related health risk. "Employers do not see skin cancer as a work-related issue, and even though protection products are available, they are not generally provided," she said.
Jane Coombs, OH director at CBH, is not aware of many UK construction companies with comprehensive UV-protection policies, and adds that most have been reluctant to see skin health as a work-related issue. Indeed, this is one of the barriers to getting the message across, as employers are generally wary of treading over the line between work and home life, and tend to see sun protection as something that employees should take sole responsibility for as it arises from recreational behaviour.
CBH is seeking to overcome this and other barriers by chipping away at a variety of OH issues, starting with the more obvious work-related ones, such as lung function testing. "In this way, we hope to build trust among employers so that we can move on to other issues," says Coombs.
As part of the skin cancer campaign, construction employers are being offered free posters and booklets to load onto their websites. The awareness-raising material is accompanied by a roadshow of site visits, during which mole checking of construction workers will take place. CBH is committing 12 days of its OH director's time to visit sites and carry out skin checks over the coming year. Sites will be selected according to whether or not they have the facilities and where checking can take place without disrupting building work.
Professional opinion suggests that individual workers and their partners are best placed to carry out skin checks, as they are most likely to spot any changes in the skin. The main message in the campaign material, therefore, is that workers should check their own skin regularly, and that it only takes five minutes to have a suspicious mole or freckle investigated by a medical professional.
Dr Geoff Davies, occupational medicine consultant to CBH, says that few employers carry out routine skin inspections for UV exposure, and that conducting effective skin checks is difficult: "Even doctors find it hard to spot malignant melanoma," he adds. He also agrees that self-checking is the best approach, but says that employers should be educating, explaining and showing workers what to look for.
All construction workers have an increased incidence rate of skin neoplasia compared with the general population."
The campaign will also include two major charity events to raise funds for the partner charity and the production of a toolbox talk podcast for employers and others to download. CBH is working with two partners, Polypipe and Deb Products, which are sponsoring the distribution of UV sunglasses and sunscreen samples.
CBH is also incorporating information on non-ionising radiation in a redraft of its occupational health standards, which were first produced in 2007 and are currently out for consultation (see box). Coombs adds that it may in the future develop guidelines for employers on skin cancer, although this is "some way off".
Charlotte Fionda, marketing director of charity at Skcin, argues that outdoor workers are clearly an at-risk group worthy of targeting with a specific campaign. She suggests that employers are in a crucial position to put in place policies and procedures to mitigate the demonstrated risk from UV, for example, by incorporating shaded areas in work sites, giving advice and guidance on covering up and providing protective equipment. The main message in all of Skcin's campaigns, including the current joint venture with CBH, is that over-exposure to the sun can be dangerous, but that skin cancer is preventable.
The UK is at a very early stage in persuading employers and workers that UV protection is a workplace health issue: "Employers are only just beginning to approach us for literature and information," Charlotte Fionda points out, "but are beginning to gear up their actions on UV risks."
Kier Group action
The construction division of Kier Group is one such employer to approach Skcin; it incorporates sun awareness messages in two health-focused events held each year.
"Skin cancer resulting from over-exposure to the sun is just one health issue that Kier, as both an employer and management contractor, is keen to raise awareness around," explains Andy Turrell, the company's construction health manager. Sun awareness is rising and attitudes to UV protection are changing: "For example, we no longer allow people to work without wearing appropriate tops on our sites," he adds.
Employers are only just beginning to approach us for literature and information, but are beginning to gear up their actions on UV risks."
The UV-protection message is included in a 40-minute workplace health presentation that has been delivered at sites during the past year and will continue. UV protection at the construction division of Kier also extends to the provision of protective equipment and other skin health facilities. "All Kier sites have a skin-care station in the toilet blocks, including barrier creams, cleansers and moisturisers, and site managers are also encouraged to provide sun cream," Turrell adds.
Some of the company's operations have site-level eye-protection policies, generally because they are working for a client with its own rules on the issue. The group also has a relationship with a supplier of safety eyewear with UV protection and has a process in place for managers and supervisors to procure prescription safety eyewear with UV tints if a risk assessment demonstrates a need.
Network Rail campaign
The construction industry is not the only sector to tackle the issue. Network Rail has partnered with charity Cancer Research UK to launch a campaign that includes the distribution of 2,000 posters and 20,000 skin-health leaflets to depots and site offices, encouraging employees to use skin protection.
Steve Featherstone, director of maintenance at Network Rail, hopes that the campaign will form part of the organisation's overall efforts to keep the workforce fit and healthy: "With so many of our people working outdoors for many hours, it's important they make sure they protect themselves during the summer months by using an SPF spray or cream, lightweight protective clothing and regularly checking their skin."
Changing the health behaviours of construction workers around UV protection presents particular challenges. Men are reluctant generally to present to primary healthcare professionals, and construction workers in particular tend to be itinerant, often working away from home, partners and access to their general practitioner. Outdoor workers, including those in construction, often adopt a fatalistic attitude to UV exposure, arguing that it is impossible for them to stay out of the sun at work, and see sunburn as an acceptable occupational risk.
Labour turnover is high in the sector, and some workers may not stay in the job long enough to receive any health messages or education on UV protection, while others perceive messages to cover up at work and use sunscreen as patronising or impractical. As a result, only 40% of construction workers wear adequate protection against UV exposure - measured by the extent to which various body areas are covered - and only 30% wear sunscreen.
Avoiding the sun by working in a shaded area or keeping out of the sun at peak times are simply not practical preventative strategies for many in construction, and individual employees are often powerless to control their own exposure by altering their outdoor working hours or location, reinforcing the role of employers.
The same risk-management principles that apply to other occupational-health-related hazards should be used in the case of UV exposure, according to Davies - organisations need to undertake a risk assessment to identify the degree of hazard and risk, and then introduce control measures to reduce it.
There needs to be a culture of compliance generally and a willingness on the sites to challenge non-complying behaviours."
Dr Geoff Davies,
occupational medicine consultant
In the case of UV exposure, employers should initially seek to isolate people from the source of UV, for example, by putting cabs on construction vehicles. If this is not possible, employers should provide equipment to protect workers from the sun's rays, for example, hats that have a "skirt" covering the neck, or providing UV protection and sun-barrier creams.
Davies argues that employers should also look at operational issues to minimise exposure, for example, scheduling work early in the morning or later in the afternoon during the summer.
How do you persuade construction workers to wear or use personal protective equipment that is designed to reduce the risk from UV exposure? Health and safety managers in construction firms need to advise line managers and workers on the control measures that the employer requires and, crucially, should check that these are being followed.
"There needs to be a culture of compliance generally and a willingness on the sites to challenge non-complying behaviours," says Davies.
He accepts that "sub-contractors are a problem" on larger sites, but adds that the main contractor still has a degree of control over self-employed workers, and should set standards in a range of health and safety areas, including UV protection.
"There is no doubt that skin cancer has significantly increased over the past few years," Davies concludes, adding that despite continued uncertainty surrounding the link between patterns of exposure and skin cancer, the basic message is strong: avoid prolonged exposure to UV light.
Stocks SJ et al (2010). "The incidence of medically reported work-related ill health in the UK construction industry". Occupational & Environmental Medicine; 67: 574-576.
Glanz K et al (2007). "Reducing ultraviolet radiation exposure among outdoor workers: state of the evidence and recommendations". Environmental Health; 6:22.