Public Health (Sunbeds) Bill 2013: Report and Final Stages

I move amendment No. 1:

In page 5, between lines 25 and 26, to insert the following:

“Prohibition on permitting the use of sunbeds by certain persons

5. (1) The owner, manager or employee of a sunbed business shall not sell the use of a sunbed on a sunbed premises to a person unless—

(a) the owner, manager or employee has assessed the person’s skin type in accordance with the Fitzpatrick skin photo type classification system, or

(b) the person has provided the owner, manager or employee with a certificate from a medical practitioner that certifies that the medical practitioner has assessed the person’s skin type in accordance with the Fitzpatrick skin photo type classification system and states the results of that assessment.

(2) A person whose skin type is assessed as Type I or Type II under subsection (1)(a) or (b) shall not be permitted to use a sunbed on the sunbed premises.

(3) A person who contravenes subsection (1) or (2) commits an offence.".

This arises from Committee Stage, when I gave notice of my intention to table both of these amendments, which I understand are grouped.

Yes. Amendments Nos. 1 and 2 are related and may be discussed together.

I have tabled these amendments, relating to a ban on the use of sunbeds for people with skin types I and II, based on the Fitzpatrick skin photo type classification. As I indicated on Committee Stage, I thank the Irish Cancer Society for framing these proposed amendments, and I hope the Minister of State has had the opportunity in the intervening period to give the good sense behind the amendments her due consideration and, I hope, her support. The amendments take the form of new sections as set out in the amendments, which are also tabled in the name of Deputy Kelleher.

I hope the Minister of State has carefully examined the proposals and that she will be in a position to advise of their acceptance. These amendments would prohibit those with the fairest skin types, types I and II, from using sunbeds in "designated sunbed business settings". The Bill can only directly refer to such settings, and one would hope that in any other setting, people would use their good sense and not use sunbeds at all. The majority of Irish people are of skin type I or II, and that is just a fact of who we are and where we live.

There are international comparisons. In Australia, people with skin type I are prohibited from using sunbeds and I expect that also applies in related settings. In proposing the inclusion of both these amendments, we want to ensure that the people most at risk are protected. The Bill as drafted addresses the issue of young people but we also want to ensure the greatest protection for people of the fairest skin types. Sadly, this requires small terms, including prohibition, if we are to achieve the necessary result.

I have no doubt that the Minister of State knows that cancer incidence is projected to double by 2040. That makes for disturbing reading, and the fastest-growing number of cancers are expected to be skin cancers. As the Irish Cancer Society has indicated, sunbed use is as carcinogenic as smoking and plutonium. Skin cancer is the most common form of cancer in Ireland and in 2010, some 9,450 people were diagnosed with skin cancer in Ireland. Of those, 896 people were diagnosed with melanoma, the most serious form of skin cancer. There were 158 deaths from skin cancer in 2011, and as the Irish Cancer Society has stated, there is a very clear link between this rise in skin cancer and sunbeds. The international agency for research on cancer in July 2009 placed sunbeds in the highest cancer risk category, indicating they are as carcinogenic as the use of tobacco and plutonium.

Every year, up to 28,000 young people in Ireland put their lives at risk by using sunbeds. Although I cannot extrapolate numbers for the broader use of sunbeds, if a majority of the population are of skin types I and II, more than 50% of adult use would be putting their lives at risk.

This is a huge issue which requires as stoic and determined an address as that shown by the Minister and Ministers of State regarding tobacco use. I commend amendments Nos. 1 and 2 in my name and that of Deputy Kelleher. I hope when the Minister responds she will indicate that she accepts them for the very good, sane and sensible reasons I have given.

I raised this issue on Committee Stage. The purpose of the amendment is straightforward. I understand the complexities and difficulties it poses in respect of over-18s, who have freedom of choice. It is, however, important to table the amendments to highlight the need to address this issue. If it cannot be addressed in legislation, it should be addressed by some form of regulation that would impose obligations on sunbed operators emphatically to inform people with skin types I and II that they are more likely to contract melanomas by the use of sunbeds.

I know the Minister of State envisages this but the Irish Cancer Society has strongly urged us to highlight the issue because there may be a lack of awareness in the broad population of the dangers sunbeds pose to people, particularly those with skin types I and II. I, Deputy Ó Caoláin, the Irish Cancer Society and others who advocate awareness in the battle against various forms of skin cancer have made the point that there is still a lack of awareness among some cohorts of people of the dangers of excessive, or indeed any, use of sunbeds and from exposure to the sun. People do not take precautions, as we see time and again in summertime, even in Ireland where people are surprised to find that ultraviolet rays are present when it is cloudy. When we go abroad, we are obsessed with tanning to the point of endangering our health. For all those reasons there is merit in the thrust of these amendments to highlight our concern, and that of the Minister of State and the makers of public health policy, to develop some system that imposes a clear obligation - not one in small print but one that is well-defined and publicised - on sunbed operators to inform those more prone to contract skin cancers of the danger of exposure to ultraviolet radiation, particularly through using sunbeds. There should be an advertising campaign around this issue. We are all at one in advocating and supporting policies that cut down on the threat of developing cancers. We support the efforts made in public health policy on smoking, alcohol, where maybe more should be done, and sexually transmitted disease, and many other areas. This issue, however, seems to need a higher awareness level.

As we speak we are coming into a time when kids will be herded into tanning shops all over the country in preparation for first holy communion and confirmation. The Minister of State is as aware of this as I am. This Bill hopefully addresses the concern for those under age, putting inspection regimes in place with prosecutions for those who breach the legislation. I accept that people over 18 are entitled, and have a right, to use sunbeds. I tabled this amendment to hear the Minister of State’s response, given that the Minister said on Committee Stage he was very conscious of this and would take it on board in some way. I am anxious to hear the Minister of State’s response.

Who could disagree with these arguments? We know and see the obsession not just in tanning shops, but on our beaches every year and when we go abroad, with coming back a different colour. Unfortunately, in my case that will never happen. I am probably skin type I or II, as are the majority in this country. We have to realise that we should not be out in the sun.

There is a clear need for an awareness campaign. We all accept now that smoking is bad for us although it still happens, but hopefully at a reduced rate. People still drink too much although there is a recognition that they should not. We are only beginning to become aware of skin cancer, in respect of exposure to the sun, ultraviolet rays, tanning parlours and sunbeds. There is value in these amendments on that issue. Both Deputies, however, will understand that we cannot put them into legislation because we have to accept that people have a right to behave in a way that has consequences down the line.

We accept the argument of the Irish Cancer Society. Under EU legislation and our equality legislation, we cannot discriminate on the basis of skin type. It seems self-evident that people of my skin type should not use sunbeds or go out in the sun but people feel they have a right to do so. All we can do is protect those whom we are legally obliged to protect, those under 18. There will be an obligation on the owners of tanning parlours to display notices outlining exactly the type of person who should not use sunbeds. The customer will be asked does he or she understand the rules and to sign confirmation of this. The operators must retain these documents for two years. They will also have to display a notice of the effects and dangers of using sunbeds, and a health warning. On top of this, they must comply with the regulations as written. There will be inspections and significant on-the-spot fines and court appearances if they do not comply.

The Deputy is quite right to point out that as we speak we are coming up to a time when children are being prepared for first holy communion and confirmation. In the past few years, thankfully, they have moved to using artificial tan rather than sunbeds but it happens. Deputy Ó Caoláin knows this too. This Bill will prohibit that use.

These two amendments which, unfortunately, I cannot accept, for the reasons I have outlined, will draw to the attention of people who are over 18 the need to know their skin type and that they should not be out in the sun. We have to accept that we must allow that type of freedom to people who are over 18.

The Minister apologises for his absence. He is in Greece on official business; otherwise he would be here. I am sure he dealt with all of this on Committee Stage. We cannot accept the amendments for all the reasons I have outlined but they are well worthwhile because they draw attention to the type of public awareness that people should have.

The Fitzpatrick chart exists but we cannot discriminate on the basis of skin type.

We will be advising the operators of sunbed parlours about the skin types of which they should be aware. We will also pursue a public awareness campaign along with the other agents involved in this area, including the Irish Cancer Society, the National Cancer Control Programme and the HSE. Individual agencies and organisations have developed their own awareness campaigns but we will also make a co-ordinated effort to raise awareness. However, we can only administer legally on behalf of those we are obliged to protect, namely, people under the age of 18 years.

Our interest is in preventing cancer and, while I understand the Minister of State's argument, I am none the less perplexed by the assertion that we cannot act under the heading of equality. We would achieve equality by banning them outright.

We cannot legislate for private use but, given our population profile and the predominance of skin types I and II, further protections are necessary. Discouragement and disseminating information are useful but, sadly, further measures are required in the context of public health. If a measure has been successfully employed in another jurisdiction, it is not beyond our gift to undertake a similar approach. A number of states in Australia require tanning shops to carry out skin type assessments prior to allowing a person to use a sunbed. Interestingly, the scale employed is called the Fitzpatrick scale. There must be an Irish connection. Apparently the Fitzpatrick scale is universally recognised and can be easily employed in such settings, whether in Australia or in Ireland.

The evidence shows that Ireland already has a significant problem with skin cancer and the projections and statistics suggest that the challenge will double by 2040. I cannot contest that claim but those who make it are well informed of developing trends in public health and the Irish Cancer Society fully supports it. Those at greater risk need higher levels of protection. Cautions will not be sufficient. We should be prepared to go the extra mile and people will appreciate that we are doing so in their collective interest. Every person who avoids the process of treatment represents a significant saving in terms of public outlay on health costs. Prevention is the way to proceed.

The Minister of State referred to regulations and the obligation on proprietors of tanning shops to inform customers of the risks. I assume the customer is also obliged to read and sign a disclaimer to show he or she understands not only the terms and conditions, but also the risks. Sometimes it is said we have a lot of laws. It is a question of enforcing them and, more important, educating people so that they understand and comply with the law.

Although the climate in Australia is very different, the skin types are very similar due to our shared genetic background. Australia operates strict regulations for children playing in school grounds which require them to wear hats and protect their shoulders and arms. We do not need to be as extreme but we must be conscious that the vast majority of Irish people are unaware of the dangers of the Irish sun. In Inchydoney during the first week of June, irrespective of whether it is fine or overcast, one can see people who are sunburnt because they do not understand the dangers of ultraviolet rays even on a cloudy day. We need to develop a public health policy for awareness raising and an aggressive campaign to highlight the dangers. I hope the Minister of State will take that on board by rolling out a campaign in a targeted way to children as well as adults. It is often the case that children impart knowledge to their parents about these issues.

In regard to public awareness, I am often astonished not so much so see that adults are burning, but that they have removed protective clothing from their own children. In regard to the lack of knowledge about preventative measures to which Deputy Ó Caoláin referred, it is more likely that damage will be done to children under the age of 12 years because of the way in which their skin develops. That is the age group we are considering seriously.

Deputy Ó Caoláin referred to Australia. The obvious solution would be an outright ban but the difficulty is that we are close to other jurisdictions. For example, there is nothing to stop someone in the Deputy's county from ordering a sunbed across the Border and having it delivered to his or her door. That happens on a regular basis. This Bill would require such an individual to operate the sunbed according to the laws of this country, even though the equipment came from a different jurisdictions. We must also abide by the Constitution and EU legislation.

Given my skin type, I am well aware of the dangers arising. It is a question of public awareness and this legislation will begin that process. Many people are aware of the dangers of ultraviolet rays but others are not. The risks do not arise solely in this country. There is a notion that people can go to Spain to throw themselves under the sun for two weeks. Those two weeks do more damage than anything we can do in this country. However, even though we do not have great summers or intense sunshine, we should none the less protect ourselves between April and September. It is not as if we are immune just because we avoid sunbeds or do not travel abroad. There is a process of education involved but the only people we can protect are those under the age of 18 years, and that is the purpose of this Bill. I am not saying that we will never go further but for now this is as far as we are prepared to go. I believe this is a significant Bill in the context of protecting children.

I was not aware that the Bill had the capacity to address the issue of people buying sunbeds for private use.

It is academic as to whether people in Cavan-Monaghan go north of the Border to secure these services or stay here.

However, we have a difficulty in terms of getting in material.

If one gets them, one gets them; that is it. I will not labour the point. It is clear that this is not something the Minister of State believes she can progress at this time. I am willing to accept this is something we may revisit in the future. I hope that good public sense would increasingly prevail and that this is an issue that would self-regulate by virtue of people staying away. That is one way to bring it to a close.

I have already indicated I support the legislation and will support its passage. I regret the amendments cannot be accepted - they have been argued for sincerely. I again thank the Irish Cancer Society for its efforts in this regard.

Amendment put and declared lost.

I move amendment No. 2:

In page 5, after line 36, to insert the following:

Prohibition on sale or hire of sunbed to certain persons

6. (1) A person shall not sell or hire or offer for sale or hire, or permit to be sold or hired or offered for sale or hire, a sunbed to a person unless—

(a) they have assessed the person’s skin type in accordance with the Fitzpatrick skin photo type classification system, or

(b) the person has provided the owner, manager or employee with a certificate from a medical practitioner that certifies that the medical practitioner has assessed the person’s skin type in accordance with the Fitzpatrick skin photo type classification system and states the results of that assessment.

(2) A person whose skin type is assessed as Type I or Type II under subsection (1)(a) or (b) shall not be permitted to use a sunbed on the sunbed premises.

(3) A person who contravenes subsection (1) or (2) commits an offence.”.

Amendment put and declared lost.

Amendment No. 3 arises out of Committee proceedings while amendment No. 4 is an alternative to amendment No. 3. Amendments Nos. 3 and 5 are cognate. Amendments Nos. 4 and 6 are cognate. Amendment No. 6 is an alternative to amendment No. 5. Therefore, amendments Nos. 3 to 6, inclusive, may be discussed together by agreement.

I move amendment No. 3:

In page 10, line 17, to delete “safe”.

This issue was discussed at length on Committee Stage and the Minister for Health acknowledges the input from Deputy Ó Caoláin in this regard. I have discussed it with the Minister and he clearly outlined the Deputy's concerns in this regard. It is accepted that the use of the word "safe" in the context of sunbeds is problematic. It is therefore proposed to delete the word entirely from the section.

However, as the Minister for Health explained on Committee Stage, to substitute "safe" with "authorised" might suggest that the legislation gives tacit approval or authorisation to the use of sunbeds which is clearly not the intention of the Bill. For this reason, I cannot accept the Deputy's proposed amendment. However, the word "safe" will be deleted, which I am sure was the Deputy's intention in the first place.

As the Minister has been gracious enough to acknowledge, I hope he has his sunblock on when he is in Greece. I acknowledge the input of the officials on the evening we took Committee Stage. I tabled my amendments from Committee Stage again just in case the Minister might backtrack on me and I would need a vehicle by which to raise the matter again. I am happy to acknowledge that the intervention on the day was on the mark and that the concern I had is addressed by the deletion of the word "safe" in lines 17 and 33. I am glad we are concluding address of the Bill by giving out one message: the words "safe" and "sunbeds" do not appear in the same sentence, end of story.

Addressing the finer details such as this shows the value of having things discussed both in here and on Committee Stage. I fully recognise that the word "safe" was not appropriate in this instance. I thank the Deputy.

Amendment agreed to.
Amendment No. 4 not moved.

I move amendment No. 5:

In page 10, line 33, to delete “safe”.

Amendment agreed to.
Amendment No. 6 not moved.
Bill, as amended, received for final consideration and passed.