Reducing the impact of skin cancer in NSW Strategic Plan

Transcription

1 Reducing the impact of skin cancer in NSW Strategic Plan Reducing the impact of skin cancer in NSW

2 Acknowledgments This Plan was developed by the NSW Skin Cancer Prevention Working Group, comprising representatives from The Cancer Council NSW (Anita Tang and Kay Coppa); the Cancer Institute NSW (Trish Cotter and Anita Dessaix) and NSW Health (Jenny Hughes and Nidia Raya Martinez). We would also like to thank the many key informants working in skin cancer prevention who generously gave us their time for interviews and comments in reviewing the Skin Cancer Prevention Strategic Plan. ARTD Project Team Chris Milne, Greg Davies, Margaret Thomas, Marita Merlene January 2007 For more information Cancer Institute NSW The Cancer Council NSW Level 1, Biomedical Building 153 Dowling Street Australian Technology Park Woolloomooloo NSW 2011 Eveleigh NSW 2015 PO Box 41 PO Box 572 Alexandria NSW 1435 Kings Cross NSW 1340 Telephone: Telephone: Facsimile: Facsimile: ARTD Pty Ltd ABN Tel Fax Level 4, 352 Kent St Sydney PO Box 1167 Queen Victoria Building NSW 1230 Australia Reducing the impact of skin cancer in NSW

3 Reducing the impact of skin cancer in NSW Strategic Plan Foreword Reducing the Impact of Skin Cancer in NSW Strategic Plan sets out the commitment of three partner agencies toward skin cancer prevention. The Cancer Council NSW, the Cancer Institute NSW and NSW Department of Health have collaborated to develop a plan that will guide and coordinate skin cancer prevention initiatives of the three agencies. The plan builds on the efforts and learning s of the previous strategic plan and considers current priorities in skin cancer prevention. The need for continued investment in the area of skin cancer prevention is evident with figures showing melanoma cases rising. Between 1995 and 2004 NSW incidence rates of melanoma rose by 18% in males and 21% in females. While survival for melanoma is high, so are the costs of treatment with skin cancer (melanoma and non-melanoma) being the most costly cancer to the Australian health system. The plan has been developed and informed through consultation with stakeholders from the Alliance of NSW Divisions, Northern Sydney Central Coast Area Health Service and Mid North Coast Area Health Service. The plan recognises the challenges and opportunities in this area, as well as the resources that each partner agency can contribute. The plan outlines a coordinated approach to activities, identifying specific priority groups and settings to maximise impact. The overarching goal is to reduce the incidence of skin cancer in NSW. However, as with many public health issues, the benefits of interventions may not be evident for a number of decades. Therefore the plan specifically sets out an objective of reducing people s exposure to UV radiation, as the key contributor to skin cancer risk. Key result areas include improved sun protection behaviour, early detection and treatment of skin cancer, increased community awareness of the importance of sun protection, implementation of sun protection policies by industry groups, coordinated action by core partners and research to inform current and future decision making. These are concrete and intermediate areas where progress now will reduce the impact of skin cancer later. Reducing the Impact of Skin Cancer in NSW Strategic Plan provides an overview of actions by partner agencies to deliver key result areas. Together this coordinated action will continue the already good work in skin cancer prevention to benefit the people of NSW now and for the future. JAMES F BISHOP DR DENISE ROBINSON DR ANDREW PENMAN MD MMed MBBS Chief Health Officer and CEO, Cancer Council NSW FRACP FRCPA Deputy Director-General Chief Cancer Officer and Population Health CEO, Cancer Institute NSW NSW Department of Health Professor of Cancer Medicine, University of Sydney Reducing the impact of skin cancer in NSW

4 Table of Contents 1 The Plan Targets Long term aims & results Priority groups The wider community Roles of the partner organisations NSW Cancer Council Cancer Institute NSW NSW Health National and interstate agencies Implementing the Plan Core partners Other sectors Priority actions Results logic for the strategic plan Reduced harmful UVR exposure (KRA 1) Cancers detected and treated early (KRA 2) Increased community awareness (KRA 3) Partner organisations implement sun protection policies and practices (KRA 4) Coordinated action by core partners (KRA 5) Research informs decision-making (KRA 6) Monitoring and evaluation Monitoring Evaluation activities Reducing the impact of skin cancer in NSW

5 The Plan Skin cancer remains a significant health issue in NSW and Australia has the highest rate of skin cancer in the world. Prevention is a key action in managing skin cancer at a population level. Action in NSW is undertaken between three key agencies the NSW Cancer Council, the Cancer Institute and NSW Health, and is also influenced by national activities either through the Australian Government Department of Health and Ageing or The Cancer Council Australia (a national body of state and territory non-government cancer control organisations). There is therefore a need to provide a common basis to coordinate action and decision-making in NSW to optimise the use of the limited resources available for skin cancer prevention. The purpose of the Plan is to: outline key activities for the next three years indicate where there are gaps or opportunities, and articulate principles for how the three core partner agencies in NSW will work together in managing skin cancer prevention and how the implementation of the Plan will be monitored This Plan is supported by a companion document, Skin Cancer in NSW Evidence Update, which summarises our current knowledge of skin cancer, the incidence in NSW and approaches to cancer prevention. Key facts about skin cancer in NSW 1 Melanoma There were 3,402 new cases in There were 388 deaths in 2004 in NSW from melanoma, around 3% of all cancer deaths. There has been a dramatic increase in the incidence of melanoma over the last twenty years. However, death rates have stabilised despite the increase in incidence. Non-melanoma (basal cell carcinoma and squamous cell carcinoma) There has been a steady increase in the incidence of non-melanoma skin cancers from 1985 to % increase for basal cell carcinoma and 122% increase for squamous cell carcinoma. The rate of increase has been significantly greater in females than males. On an age-standardised basis, the incidence in 2002 of basal cell carcinoma was 1015 per 100,000 people, and the incidence of squamous cell carcinoma was 354 per 100,000 people. There are no NSW specific data on death rates from non-melanoma skin cancer. Health costs Skin cancers were estimated to account for a total of $294m in health expenditure for the year of $30m of this was for treating melanoma and $264m for treating non-melanoma skin cancers. Current behaviours People in NSW report spending more time in the shade than previously. Around half the population report wearing hats, sun glasses and protective clothing. Slightly more than half of all women, and less than half of all men, report using sunscreen. Interventions The most effective preventative action at a population level is to reduce the cumulative lifetime exposure to UV radiation for each person and avoiding incidents of extreme exposure which lead to sunburn. These will reduce the incidence of melanoma and non-melanoma skin cancers. There is a need to increase all protective behaviours. There are overall benefits from early detection and treatment of skin cancers 1 Skin Cancer in NSW Evidence Update, NSW Skin Cancer Prevention Working Group, 2007 Reducing the impact of skin cancer in NSW 1

6 1 Targets 1.1 Long term aims & results The long term aim of skin cancer prevention is to reduce the incidence of skin cancer (both melanoma and non-melanoma) in NSW on an age-standardised basis, and also to reduce the cost to individuals, the community and to the health system. However, skin cancer generally has a very long development time, occurring mostly in the older proportion of the population (aged 55+). As a consequence, much of the benefit of prevention action now may not become manifest for up to 50 years. A realistic result for this Plan is a reduction in the exposure of the general population to UV radiation through demonstrating changes in behaviours and changing the environment increasing the use of protective clothing and sunscreen; decreasing risk behaviours (spending time outdoors in peak UV periods and incidence of sunburn) and increasing the amount of shade available in public places. This Plan is consistent with the NSW Cancer Plan, which includes the same goal for skin cancer prevention. There are two levels of target audiences for actions under the Plan priority groups the wider community to ensure that all community segments maintain a basic level of awareness of the hazards of UV exposure 1.2 Priority groups Priority groups have been selected based on: degree of risk some community segments are at higher risk, or demonstrate higher risk behaviours incidence of skin cancer some community segments, or populations in some locations, have a higher incidence of skin cancer, indicating behaviours or factors which may need attention potential benefit actions with some groups are more likely to lead to sustained benefits at a population level The Priority Groups for this Strategic Plan are: Children aged 0 to 11 These were identified in the Strategic Plan as the highest priority target group for action and this position is unchanged, given that: - high exposure in childhood is more likely to lead to an individual developing skin cancer, and lifetime cumulative exposure to UV radiation has a strong bearing on the likelihood of an individual developing skin cancer limiting exposure in childhood therefore confers a lifetime benefit; - Children in this age group are typically in more controlled environments there is greater parental influence on daily activities; children may attend pre-schools where it is possible to implement effective sun protection policies; the majority of children attend primary schools where the duty of care in overseeing children s health is generally understood to include sun protection. Adolescents Raising awareness and changing behaviour of adolescents is very difficult. However, this group also demonstrate the highest risk behaviours in terms of long periods of exposure to UV radiation, incidence of sunburn and holding positive views about sun tanning. These attitudes and behaviours are likely to contribute to a higher incidence of skin cancer in later life. Reducing the impact of skin cancer in NSW 2

7 Older people, especially older men (55+) The incidence of skin cancer is highest in older men. Whilst exposure early in life is critical, the incidence of skin cancer in older men is significantly higher than older women, indicating that there are lifestyle factors that trigger skin cancers in later life. The incidence of skin cancer in older men has tripled on an age standardised basis over the last 20 years. Whilst older men are the higher priority group, actions and programs for this group are often directed at both older men and women based on findings from previous programs that older men tend to change behaviour based on advice from their partners or wives. Actions for older people focus mostly on early detection, with a limited emphasis on prevention through reducing exposure. People living in coastal zones, particularly mid to upper North Coast The areas covered by the current North Coast Area Health Service have the highest incidence. Other coastal zones are also above the State average. 1.3 The wider community The partners to the Plan also maintain an ongoing level of activity to support awareness raising across the community overall. This includes the Cancer Helpline managed by the Cancer Council, development and distribution of brochures and other resources and work with sectors that have a broad impact. 2 Roles of the partner organisations This Plan is an agreement between the three core partners the NSW Cancer Council, Cancer Institute NSW and NSW Health. The priority actions identify which agency is the lead for each action. The actions of the NSW agencies are also influenced and informed by actions nationally and interstate. The three core partners bring complementary assets and capacities to deal with skin cancer prevention: Capacity and experience in mass media campaigns (Cancer Institute NSW) Statewide infrastructure and reach into communities for community-based or collaborative activities (The Cancer Council NSW and NSW Health through the Area Health Services) Policy advocacy (The Cancer Council NSW) Policy advice to Government (NSW Health and Cancer Institute NSW) Standing relationship with other key parties, especially local Government (NSW Health and The Cancer Council NSW) and peak bodies Development and co-ordination of State Cancer Plan, including through professional education (Cancer Institute NSW) 2.1 NSW Cancer Council The Cancer Council NSW is an independent cancer charity with a mission to defeat cancer, by building a cancer smart community. The Cancer Council has a broad portfolio of functions, including providing support and information about cancer, conducting behavioural and epidemiological research, funding research, preventing cancer and advocating for improved cancer control. The Cancer Council has played a significant ongoing role in raising the community awareness of the risks of UV exposure and strategies for reducing that exposure. The Cancer Council s key activities in skin cancer prevention include: Raising awareness of individuals to encourage behaviour change Development of resources and information to support increased community awareness Reducing the impact of skin cancer in NSW 3

8 Working with and through key organisations (local councils, schools, child care centres) to improve their capacity to prevent skin cancer, particularly through the adoption of good sun protection policies and practices Working with health professionals to support increased awareness of sun protection and skin cancer issues Liaison with an expert reference group on skin cancer to provide professional advice on key issues Commissioning or undertaking research into sun protection knowledge, attitudes and behaviour; and funding research relevant to skin cancer Increasing the availability of high quality, sun protective clothing and products through Cancer Council retail stores and other outlets. The Cancer Council has a statewide community presence through its network of regional offices that implement Cancer Council programs in their areas. The Cancer Council s local infrastructure provides the community with a key point of contact for cancer issues, including skin cancer prevention. The local staff of The Cancer Council are well-established in regional communities, and deliver a range of skin cancer prevention programs and messages to priority target groups and settings. 2.2 Cancer Institute NSW The Cancer Institute NSW was established in July 2003 through the Cancer Institute (NSW) Act 2003 as a direct response to the need to decrease the burden of cancer. The Cancer Institute NSW has the statutory mandate to substantially improve cancer control in NSW by increasing cancer survival, reducing cancer incidence, improving the quality of life of cancer patients and their carers and providing expert advice to patients, the public health care professionals and the Government. The NSW Cancer Plan notes that the Cancer Institute NSW has a collaborative and key role in cancer prevention, including skin cancer and melanoma. The Cancer Institute NSW has identified that its primary role in skin cancer prevention is through a population approach, using mass media social marketing campaigns to increase awareness of melanoma and the importance of sun protection. The Cancer Institute NSW will explore opportunities to work with health professionals to promote melanoma awareness and promote local activity in skin cancer prevention with the Cancer Council, NSW Health and Area Health Services. The Cancer Institute NSW also contributes to improved understanding of cancer and cancer management through: the cancer registry, including reporting on incidence and mortality research funding, including a melanoma program grant co-ordination of an expert Melanoma NSW Oncology Group. 2.3 NSW Health Within the NSW Department of Health, the primary interest in skin cancer prevention rests with the Centre for Chronic Disease Prevention and Health Advancement which focuses on health promotion. The Centre is represented on the Skin Cancer Prevention Working Group, although it does not currently have programs relating directly to skin cancer. The Centre provides a direct connection to the Health Promotion units in each Area Health Service, some of which are working in skin cancer prevention where there is a high local need or opportunity (e.g. good working relationship with Cancer Council regional staff). The Centre maintains a strong connection to public health programs in Local Government, particularly through a close relationship with the Local Government & Shires Association of NSW, and is therefore well placed to provide a conduit for the promotion of skin cancer prevention messages and programs to local councils. The Department contributes to better knowledge of skin cancer and management through regular Reducing the impact of skin cancer in NSW 4

9 studies of attitudes and behaviour (e.g. Health Behaviours of Secondary School students survey, NSW Health survey and solarium operators compliance to voluntary standards). 2.4 National and interstate agencies It is important to recognise that the actions taken by NSW agencies are informed by, and in turn inform, the broader context of actions and activity underway nationally and in other States. The Cancer Council Australia This is a national body comprising the Cancer Councils from each State and Territory (eight in total). This body auspices a National Skin Cancer Committee, which has issued position statements on key issues relating to sun protection e.g. sun protection for 0-1 yr olds; solaria; risks and benefits of sun exposure. These are de facto policy statements and are endorsed by medical experts such as the Australian Council of Dermatologists. The National Working Group includes a NSW representative from the Cancer Council to ensure that NSW approaches and concerns are both informed by and inform the national processes. Australian Department of Ageing and Health The Department is currently funding a national mass-marketing campaign focusing on prevention and targeting 13 to 17 year olds. The campaign is anticipated to be launched in November The Cancer Institute NSW is represented on the advisory committee for the campaign. The Department does not significantly contribute to other ongoing skin cancer prevention programs. SunSmart The Cancer Council Victoria has played a significant role in promoting skin cancer prevention over the last twenty years, including the development of the SunSmart program as an umbrella for all sun protection activity in Victoria. This has been a very effective program in many areas, including: recognising settings as SunSmart when they meet the criteria for best practice for sun protection policies and practices; work with sports organisations; social marketing campaigns; work with local government and shade awards for local councils. Peak bodies and community groups There are a range of peak bodies which are active in the public debate around prevention, detection and treatment of skin cancer. These include professional groups (e.g. the Melanoma Group as part of the Clinical Oncology Society of Australia) and foundations (e.g. the Melanoma Foundation). Each of these groups has some links to the core partners, ranging from formal links e.g. through representation on expert panels, to informal links through personal contacts. 3 Implementing the Plan The implementation of the Plan will be coordinated by the Skin Cancer Prevention Working Group, made up of the three core partners. The Working Group will be responsible for monitoring progress and preparing an annual progress report. 3.1 Core partners The core partners have agreed to work together cooperatively by: jointly managing the implementation of the Strategic Plan through annual progress reviews at the end of each calendar year, and outlining forward plans at the beginning of each new calendar year jointly planning projects and campaigns where more than one partner is involved the Cancer Council and the Cancer Institute NSW agreement on the design and implementation of the Tattoo social marketing campaign in Summer 2006/7 which provides a working example providing advance notice (where possible) of projects and campaigns to maximise the opportunities for coordinating programs and notifying staff implementing programs Reducing the impact of skin cancer in NSW 5

10 (particularly staff in Cancer Council Regional offices and Area Health Service Health Promotion Units) recognising that whilst the Plan aims to coordinate action between the three parties, any one of the partners may undertake other skin cancer prevention activities additional to those outlined in this Plan. 3.2 Other sectors In working with other sectors, the core partners recognise that: strategies that integrate sun protection messages and programs into the core business of the other sectors will be more successful, and there is limited capacity (both in available funding and staff expertise) in most sectors and strategies and actions will be developed to suit the available resources 3.3 Priority actions In considering actions, priority has been given to actions or projects which: apply to a priority group apply in a relevant setting to that priority group use an intervention which addresses the factors contributing to the risks for that group, and have a reasonable chance of success with the available resources (this does not preclude exploration of new interventions e.g. trialing a new approach for raising awareness in adolescents). The Plan is a dynamic document and the partners recognise that it may be modified during its lifetime in response to new knowledge or emerging priorities. New actions or projects which may arise in the life of the Plan will also be assessed against these criteria. 4 Results logic for the strategic plan The Strategic Plan aims to achieve results through feasible strategies that reflect priorities and opportunities to make effective reductions in sun exposure for at risk groups. It represents the ways the three core partners will contribute to the ultimate outcomes of reduced incidence of skin cancers for the people of NSW. These strategies and their intended results are outlined in the results logic for the plan (Figure 1). It shows in general terms how the three partners intend to produce a set of intermediate results that in turn contribute to the ultimate outcomes. While terminologies vary (eg program logic, logic models, outcomes hierarchy), results logic is the approach used by NSW Treasury and is appropriate for this plan. It has three broad levels of services/ intermediate results/ ultimate results. The main distinction is that the core partners are directly responsible for the services (the bottom level), have a reasonable degree of control and responsibility for the intermediate results, but have far less control over the ultimate results which occur in the longer term and are increasingly influenced by range of external factors. The foundation of the results logic is the services delivered by the three core partners the creation and implementation of an appropriate and feasible strategic plan, represented as the bottom levels in Figure 1. A key element in achieving the plan is up-to-date research on the scope of the problem, on the effectiveness of interventions, and on the opportunities to take action in the current institutional and policy context. The other key element is agreement by the three partners on priorities, strategies and resources, so that the plan will have a strategic and coordinated approach. Reducing the impact of skin cancer in NSW 6

11 The next level in the logic of the plan is that implementation by the core partner organisations will lead to the intermediate results. The intermediate results are produced by two broad strategies that occur in parallel : Communications campaigns targeting priority population groups to improve their awareness of the risks of skin cancer and lead to increased protective behaviours (Cancer Institute NSW) Actions to support and influence peak or representative bodies in priority sectors (e.g. childcare, schools, local councils, sports) to develop and adopt appropriate sun protection policies and practices. In turn the work of the key partners is intended to influence organisations in their sectors to implement appropriate sun protection policies and practices (The Cancer Council NSW). These two strategies are interrelated in a number of ways. In particular the level of awareness in the community can influence and assist organisations to implement sun protection practices. The successful implementation of these strategies should lead to the intermediate result of reduced sun exposure by priority groups. This represents the Strategic Plan's contribution to the ultimate outcome of reduced incidence of skin cancers for the people of NSW, and so to improved community health and reduced health costs. Obviously these ultimate results rely on external factors beyond the scope of this Strategic Plan. These include changes in the policy context, such as different priorities in the NSW Cancer plan or from the Commonwealth government; the emergence of new evidence about the causes of skin cancer and the effectiveness of interventions; economic and social changes that impact on sun exposure for different population groups; and significant changes to the NSW population. The results logic is an important tool in framing the strategies, and in setting a framework for monitoring and evaluating the effectiveness of the overall plan. There are six key result areas that arise from the results logic: 1. Reduced harmful UVR exposure through increased sun protection behaviours, reduced risk behaviours and increased availability of shade in public places 2. Cancers are detected and treated early 3. Increased community knowledge, skills and attitudes 4. Partner organisations and industry groups implement sun protection policies 5. Coordinated action by core partners 6. Research studies inform decision-making Reducing the impact of skin cancer in NSW 7

12 Figure 1 Plan logic Ultimate result Improved community health and reduced health costs Reduced incidence of melanoma and non-melanoma skin cancers Cancers detected and treated early (KRA2) Intermediate results Reduced harmful UVR exposure (KRA1) Increased sun protection behaviours Reduced risk behaviours Increase in shaded environments Factors New policy context New evidence New economic & social drivers Popn. changes Increased community awareness of risks of skin cancer and options for protection (KRA3) Organisations in priority sectors (schools, local councils, sports, industry groups) implement appropriate sun protection policies and practices (KRA4) Services and activities: design and implement the plan Partners in priority sectors undertake activities in line with the Strategic Plan Core partner organisations undertake strategic and coordinated actions in line with the Strategic Plan (KRA 5) Core partner organisations (CCNSW, CI, NSWH) agree on priorities, strategies and resources (the Strategic Plan) Research better identifies scope of the problem and effectiveness of interventions for prevention of skin cancer (KRA 6) Reducing the impact of skin cancer in NSW 8

13 5 Reduced harmful UVR exposure (KRA 1) Longer-term result Reduced harmful UV exposure Measures Increasing % of the population reporting protective behaviours (using sunscreen; wearing protective clothing) Decreasing % of the population reporting risk behaviours (being outside in peak UV periods; getting sunburnt; using solaria) Increasing area of shade available in public places Data sources National Sun Survey (behaviours and access to shade) Health Behaviours of Secondary School Students Survey NSW Health Survey 5.1 Context The primary focus of activity in this Strategic Plan is in raising awareness (Section 8) and promoting early detection (Section 7). At this level of changing behaviour, the work in the Plan will mostly be around monitoring reported changes in behaviour. The surveys and analysis are vital to monitoring the effectiveness of the other strategies, and these are included throughout the plan. Activities around shade are of a different type. Where most of the activities in the Plan focus on raising individual awareness and changing individual behaviour, the shade actions aim to change the environment by increasing shade in public places or in locations where people are commonly exposed to UV radiation (e.g. schools). Actions to increase shade are related to other outcomes e.g. a sun protection policy for an organisation may include a commitment to a shade audit and the installation of adequate shade. Many of these activities will also be captured in increased awareness (KRA 3) or in the actions of the partner organisations in other sectors (e.g. partner organisations implement sun protection policies and practices, KRA 4). Solaria are currently subject to a voluntary Code of Practice which particularly promotes the adoption of safer practices for populations at higher risk adolescents and people with fair skin. The degree of compliance with the Code of Practice in NSW is the subject of a research study currently underway by NSW Health. The question of whether further action is required on solaria will depend on the results of that study. 5.2 Priority actions Action 1 Review the impacts on behaviour of the overall population Priority Group Lead Partners This Plan is focused on raising awareness in the community with the aim of changing behaviour. The premise is that increased awareness will lead to changed behaviour. Further evaluation is required to assess whether the changes in behaviour occur across the population. Revised projects and approaches will be required if impacts are not being identified. All Skin Cancer Prevention Working Group Various depending on the target sector and action Milestones Annual progress report first report December 2007 Related actions Monitoring and evaluation activities (Section 12) Reducing the impact of skin cancer in NSW 9

14 5.3 Opportunities in the next three years Actions under the other key result areas may generate new priorities under this KRA, particularly: Developments in shade planning, particularly opportunities to promote shade audits Research on the effectiveness of social marketing to adolescents in generating behaviour change (joint research project between The Cancer Council NSW and the University of Wollongong) Reducing the impact of skin cancer in NSW 10

15 6 Cancers detected and treated early (KRA 2) Longer-term results Increasing % of early stage cancers and decreasing % of late stage cancers Measures Increasing awareness of priority groups of risks of skin cancer and to identify changes in their skin General Practitioners report increasing confidence in ability to diagnose and treat skin cancers Data Sources NSW cancer registry (early stage/late stage cancers) Campaign tracking results from mass media campaigns Health surveys National Sun Survey (annual) 6.1 Context As for reducing exposure, much of the activity in early detection relates to increasing awareness in the target populations of their risks and of the importance of seeking professional advice. Actions to promote awareness are outlined in Section 8 (KRA3). There are conflicting views about the merits of a population-wide program for early detection, and more evidence would be required before embarking on a screening program for the whole population. However, there is benefit in targeting higher risk people, particularly those who are over 55, have grown up in Australia and are therefore more likely to have higher cumulative UV exposure and particularly are fair skinned. General Practitioners are well placed to target this segment of the community, both with information about early detection to raise awareness, and to accurately diagnose skin cancers and provide treatment or referrals. Other health workers, such as practice nurses in GP clinics, potentially also have a role in raising awareness. Reducing the impact of skin cancer in NSW 11

16 6.2 Priority actions Action 2 Early detection campaigns Save your own skin 2006/7 Strip Search and Save, 2006/7 Priority Group People 55+ Rationale Lead Partners Save your own skin targets people aged 55 and over to be aware of their risk and to check their own skin for signs of cancers. The campaign has been running for two years and is delivered centrally from the Cancer Council as well as through the regional offices of the Cancer Council. The campaign is due to end after summer Strip Search and Save targets the same general audience using a web-based viral campaign, a new approach to social marketing. People aged 55+ are the most likely to have skin cancer, and there are demonstrable benefits from (a) early detection of skin cancers once they occur, leading to early treatment continuing (b) protecting skin from further UV exposure. The early detection program so far has demonstrated an increase in awareness in the individuals who attend presentations, but there is no evidence that it has had a wider impact or that it has generated behaviour change in the attendees. NSW Cancer Council Community groups Milestones Campaigns continues to March 2007 Related actions The Cancer Council is developing a new project targeting people in this age group by working with General Practitioners and other health workers (See Action 5). Tracking of campaign impacts Reducing the impact of skin cancer in NSW 12

17 Action 3 Campaign with General Practitioners and other health workers There is a need to continue to work with people aged 55 and over to raise awareness, encourage protective behaviour and promote the value of early detection. The program may include training for GPs in coordination with the Australasian College of Dermatologists and the Alliance of NSW Divisions of General Practice. Priority Group People 55+ Rationale Lead Partners There are a number of factors which indicate that working with GPs and other health workers may lead to better results for this target group: Health workers will be able to target higher risk people (higher risk skin types or medical histories) Studies have demonstrated that individuals are more likely to act on advice from a health worker than a mass media campaign GPs report an increase in the number of patients seeking advice on skin cancers. As a result, GPs have been requesting training in skin cancer identification and treatment. NSW Cancer Council NSW Alliance of Divisions of GPs, Australasian College of Dermatologists, Cancer Institute NSW Milestones Program design June 2007 GP Training package complete August 2007 Roll out of training in priority areas starting September 2007 Related actions Potential emerging role for practice nurses and other allied health workers Reducing the impact of skin cancer in NSW 13

18 7 Increased community awareness (KRA 3) Longer-term results Increasing awareness in the community of the risks of UV exposure and appropriate actions Measures Increasing awareness of the risks of UV exposure by priority group Increasing awareness of types of skin cancer and sources of professional advice Data Sources Campaign tracking results from mass media campaigns (campaign specific) NSW Health surveys (triennial) National Sun Survey (annual) 7.1 Context Mass media campaigns are a common tool in health promotion strategies. The Australian Government has funded a campaign for early summer 2006 although there is no current commitment to funding beyond this period. NSW actions in awareness raising are consistent with the approach of the national campaign. 7.2 Priority actions Action 4 Tattoo mass media campaign, Summer 2006/7 Priority Group Rationale Campaign to commence in December/January 2007 and will use advertising only. The project will include tracking of consumer awareness before, during and after the campaign. Adolescents/young adults Mass media campaigns have been demonstrated to be highly effective in raising community awareness there is widespread and enduring recall of previous skin cancer prevention campaigns (e.g. Me no fry ; Slip, Slop, Slap ); recent quit smoking campaigns have shown a high impact on community awareness of health issues. Lead Partners Whilst the campaign will have adolescents and young adults as its primary focus, there will be a secondary benefit in raising awareness generally in the community. Cancer Institute NSW NSW Cancer Council Milestones Campaign commences December/January 2007 Monitoring pre, during and post campaign Related actions The Cancer Institute NSW anticipates investing in similar social marketing campaigns for the next two years. Reducing the impact of skin cancer in NSW 14

19 Action 5 Support for mass media campaign, Summer 2006/7 To support the mass media campaign, the NSW Cancer Council will promote teaching resources linked to the campaign for Science, English and Media Studies courses to all NSW secondary schools. Priority Group Rationale The NSW Cancer Council will also promote the campaign through regional media. Adolescents The Cancer Council has existing resources that build on the messages and images in the proposed mass media campaign. Previous evaluations of these resources have shown good rates of uptake and positive responses. The formats have been modified so that the kits include DVDs rather than videos. Lead Partners These resources make effective use of the mass media campaigns. The Cancer Council is able to use its existing network of regional contacts to promote and support the distribution of the resources. NSW Cancer Council Cancer Institute NSW Milestones Contact with schools early in Term 1, 2007 Related actions The Cancer Institute NSW anticipates investing in similar social marketing campaigns for the next two years, and the Cancer Council may play a similar role in coordinating a community level activity to build on the mass media campaign. Action 6 UV Index As part of a national program, NSW media outlets are provided with forecasts and daily measures of UV radiation. These are badged with a common brand to promote recognition. The system has been in place nationally for 12 months. There will be continued public education to encourage the use of the UV index to guide sun protection behaviour. The Cancer Council Victoria is piloting training programs for weather presenters which may be rolled out to NSW. Priority Group Rationale The next National Sun Survey, which includes a NSW component, will include questions about the recognition of the UV Index to test the impact of the index. General community The UV Index is a useful component of the overall package of issues to promote community awareness and to attempt to change behaviours so that there is less exposure to UV radiation in peak periods and high UV days. Lead Partners The UV Index has also been useful in supporting the need for organisations (Child Care centres, Primary Schools) to adopt comprehensive sun protection policies, and so forms an effective complement to other priority actions. NSW Cancer Council Cancer Council Victoria Milestones Review of results of the pilot training program 2007 Related actions Further development of programs using the UV Index will be informed by the results of the National Sun Survey and the pilot training program for weather presenters. Reducing the impact of skin cancer in NSW 15

20 7.3 Opportunities in the next three years Raising community awareness is a major focus of this strategic plan which may generate an increased public interest in skin cancer prevention, leading to increased demand for programs or resources. Reducing the impact of skin cancer in NSW 16

21 8 Partner organisations and industry groups implement sun protection policies and practices (KRA 4) Longer-term results Increasing capacity in organisations dealing with priority groups to promote awareness of the risks of UV exposure and to take action to reduce the exposure of those priority groups Measures Increasing % of target organisations implementing appropriate sun protection policies Data Sources Early childhood centre survey Primary school survey Local Council questionnaire NSW Health survey 8.1 Context Much of the work of skin cancer prevention relies on effective partnerships with other organisations. Previous work in sun protection has been framed in this way in targeting key settings. This Plan identifies the actions of the three core partners. Success will depend on the uptake of actions by the target organisations. The premise behind the interventions at this level is that: Organisations will adopt sun protection policies and practices, which Increase the awareness of the clients or members of the organisation, which Changes the behaviour of the clients or members. For example, if a child care centre has a sun protection policy that requires all children to wear hats and sun screen, and has adequate shade protection, then the children at the centre are likely to be more aware of the risks of UV exposure and adopt protective behaviours. Organisational groups have been selected based on their contact with a priority group, and the degree to which skin cancer prevention aligns with the core functions and interests of the organisation. Reducing the impact of skin cancer in NSW 17

22 8.2 Priority actions Action 7 Priority Group Rationale Lead SunSmart Early Childhood Program This program is targeting the 3,000 early childhood services in NSW. Services apply to be recognised as SunSmart, based on their policies and practices. The program started in March 2006 and 150 centres have been recognised as SunSmart to date. Applications have been received from a further 550 centres and the applications are currently being reviewed. The program is aiming to have 10% of all centres (300) recognised as SunSmart by the end of the 06/07 financial year. The program raises awareness and supports services to better understand sun protection. Services receive four newsletters per year, as well as a Parents page with each newsletter to distribute. The Cancer Council reports that the program has had a very positive impact. Children 0-5 yrs Children are a priority group, and can spend long periods of time in early childhood services. The services can be an important vehicle for promoting prevention. Sun protection also fits with the core responsibility and interests of the services in their responsibility for taking care of small children. The majority of children in NSW attend early childhood services for at least part of a week. NSW Cancer Council Partners National Childcare Accreditation Council (accreditation of centres for funding) Department of Community Services (licensing of centres) - DoCS has placed information about the program on its website and provided training for staff involved in licensing centres Milestones 300 centres recognised by 30 June centres recognised by 30 June 2008 Related actions Consistent with SunSmart programs in other States Action 8 Priority Group Rationale SunSmart Primary Schools The Cancer Council is developing a program for supporting Primary Schools towards improved sun protection practices including investigation of interstate and best practice approaches, analysis of NSW data from the National Primary School Survey and consultations with the Department of Education & Training and the Parents and Citizens Federation. The intent is to start approaching schools in late 2007 with a voluntary opt-in program. The Cancer Council will generally work directly with individual schools. Children 6-12 yrs The program is intended to work at two levels it will promote awareness, and it will aim to work with schools to provide better protection from UV radiation and modify behaviours during school hours. Lead Partners Schools are an effective theatre for promotion of health messages and this is consistent with the general duty of care that schools have whilst pupils are in their care. NSW Cancer Council NSW Department of Education & Training; Parents & Citizens Federation Milestones Roll-out to schools commences 2007/2008 Related actions Consistent with SunSmart programs in other States Reducing the impact of skin cancer in NSW 18

23 Action 9 Local Government Community Partnerships The Cancer Council has a program of establishing community partnerships with local councils to work jointly on cancer prevention and support. The Cancer Council provides each local government partner with advice and support on what can be done in their local area. Priority Group Rationale Lead Partners Skin cancer prevention is a key component of the partnership. The Cancer Council has developed a questionnaire for Councils to report on current activities and policies in a range of areas (land use planning; facilities management, including child care centres and pools; management practices for outdoor workers). The Cancer Council then prepares detailed reports outlining opportunities for the local government authority to take action and where the Cancer Council can provide support. 50 Councils in NSW have signed up to the overall program so far. 16 have completed the detailed questionnaires relating to sun protection practices. The Local Government & Shires Association has also signed up as a partner to promote sector-wide involvement. General community Priority groups as relevant (e.g. some Councils operate early childhood services) Councils have a direct connection to the local community and are committed to improving the health of their communities. The Cancer Council has resources and skills which can assist local government to promote awareness and improve sun protection practices. NSW Cancer Council NSW Local Government & Shires Association Milestones Monitoring and evaluation June 2007 Related actions NSW Health partnerships with local councils in promoting public health Action 10 Review of compliance with the solarium Code of Practice Priority Group Lead Partners Solaria are currently self-regulated by an industry Code of Practice. The degree of compliance with the Code is currently the subject of a research study by NSW Health. Further consideration of the solarium industry will be informed by the results of that study. Adolescents/ young adults (young women are the highest users of solaria) NSW Health The Cancer Council NSW Milestones Solarium study report April 2007 Annual progress report first report December 2007 Related actions Awareness raising (KRA 3) 8.3 Opportunities in the next three years The Cancer Council has identified workplaces as a setting where it is possible to effectively promote sun protection messages. The Cancer Council regional staff frequently present to workplaces about the risks of skin cancer and protective actions. The Cancer Council includes in these presentations messages about protective behaviours outside of the work place. These presentations are a potential avenue to reinforce awareness in men. The program of presentations is currently demand driven, in that the Cancer Council responds to requests from workplaces. There may be some scope to expand this program over the next three years depending on the nature of the requests. The Cancer Council Reducing the impact of skin cancer in NSW 19

24 could also evaluate the coverage of its program (total number of presentations by region, by work type) to determine if there were priority areas for targeting (e.g. employers of outdoor workers in coastal zones). There are also opportunities in working with organisations that coordinate outdoor recreation to promote sun protection messages. The Cancer Council has relationships with some sports organisations (NSW Cricket Association, the Surf Life Saving Association) and stakeholders indicated that peak sports bodies would be positive allies in promoting sunsafe behaviours. The NSW Department of Sport & Recreation provides grants to sporting organisations, and may have the capacity to require sun protection programs as part of grant funding. The Skin Cancer Prevention Working Group may consider developing targeted programs in partnership with key organisations over the next three years. Reducing the impact of skin cancer in NSW 20

25 9 Coordinated action by core partners (KRA 5) Longer-term results NSW agencies work together effectively on a coordinated strategy for skin cancer prevention Measures This Plan is implemented Core partners and stakeholders report that the Plan is useful Strength of the partnership is improved Data Sources Annual progress reports against this Plan Annual partnership survey of the Working Group 9.1 Context This Strategic Plan is an expression of the partners working jointly on skin cancer prevention. Implementation of the Plan itself is therefore a measure of how effectively the partners are working together. Actions and priorities in NSW will both inform and be informed by work nationally as well as new developments in other States. The Skin Cancer Prevention Working Group is an effective mechanism for coordinating action and sharing information between the NSW partners and the various national activities. 9.2 Priority actions Action 11 Priority Group Lead Partners Joint implementation of this Strategic Plan In line with the Monitoring and Evaluation Framework (see Section 12), the Working Group will: informally report progress against the Plan quarterly formally report progress against the Plan annually survey the Working Group periodically to assess the strength of the working partnership using an agreed tool (e.g. the Nuffield Partnership Assessment tool). Not relevant to this Action Skin Cancer Prevention Working Group Various relates to each Priority Action Milestones Plan finalised and endorsed January 2007 Quarterly update on progress March, June, September each year Annual progress report December each year Related actions Monitoring and evaluation of the Plan NSW Cancer Plan (Cancer Institute NSW) Memorandum of Understanding between the Cancer Institute NSW and The Cancer Council NSW Reducing the impact of skin cancer in NSW 21