Public Health (Sunbeds) Bill 2013: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

Deputy Jerry Buttimer

I concluded my contribution yesterday by saying it is important that the risk of exposure to UV rays be reduced as well as the incidence of skin cancer. There is a clear link between sunbeds and skin cancer. In 2009 the international agency for research on cancer placed sunbeds in the highest category for cancer risk and rated sunbeds to be as carcinogenic as tobacco and plutonium.

Today's meeting of the Joint Committee on Health is dealing with the legislation to provide for plain packaging for tobacco products. The tobacco companies are attending the meeting to discuss this legislation. We need to tackle the issue of sunbed use in tandem with that of cigarette smoking. The World Health Organisation reclassified sunbed use from what was termed a group 2A carcinogen which is probably carcinogenic to humans, to group 1 carcinogen which means it is carcinogenic to humans. This is an extraordinary reclassification because it firmly links sunbed use with cancer.

Deputy Alex White is the Minister of State with responsibility for primary care and it is appropriate that he is here. We need to send a message to parents that it is not acceptable for young children to be exposed to UV rays through the use of sunbeds in preparation for first holy communion or confirmation, debs or grads. That message must go out from this House.

The British Association of Dermatologists has advised that certain groups should never use sunbeds. These include those under the age of 18; those with fair, freckled skin that does not tan with exposure to the sun; those with a large number of moles; those with a history of skin cancer; those with abnormal sensitivity to the sun due to photo-sensitive diseases such as sun allergy; those on certain medications. These groups comprise a significant swathe of people.

I wish we could ban sunbeds altogether. I stand corrected but as of now, anyone can set up a tanning salon because there are no regulatory restrictions on the type of equipment. In 2012, the Irish Cancer Society conducted a secret shopper survey which showed that seven out of ten tanning shops would allow a fair-skinned child use a sunbed without any advice or warning. Deputy Billy Kelleher referred to the use of goggles and other types of protection used. I ask if there are regulations in place to ensure eye protection is used. There is no regulation of the use of sunbeds. All that is required for these devices to be used is to have a strategic location for a tanning salon.

We must aim to reduce the risk of cancer and implement customer safety standards which will allow the National Consumer Agency to take measures against products posing a serious risk to the health and safety of consumers. This Bill will provide for those standards and it will provide for robust measures to deal with the risk and threats from sunbed use.

Some will argue that sunbeds are beneficial in that they give access to UV rays which are converted into vitamin D. However, unless one never ventures out of house, one will get sufficient vitamin D to avoid any deficiency. Even those who attempt to argue for the benefits of sunbeds cannot argue the case that they should be unregulated. At the very minimum their use needs to be regulated.

The Bill prohibits the use of sunbeds by people under the age of 18 either in a tanning shop or in a similar premises. This is in keeping with the World Health Organisation recommendations. It also prohibits the use of sunbeds in unsupervised premises; it makes it mandatory that sunbed operators make users fully aware of the risks involved; and it requires warning signs to be put in place in all sunbed locations.

What regulation will govern the training for those who provide these services? This aspect could be examined on Committee Stage. Thankfully, the trend for sunbed use is decreasing, down from 9% of the population to 4% in 2010. A source of concern is that 88% of sunbed users are women. The age categories of users of sunbeds are those between the ages of 15 and 24 and 35 to 49. I think those categories puts all of us in this Chamber in those risk categories. I hope all of us would avoid the use of sunbeds.

I refer to a study on sunbed use by adolescent girls carried out in Cork by Mairead McDonnell. The girls, aged 17 and 18 spoke about their experience of and attitude to the use of sunbeds. Among the main findings were that 28% of the respondents had used sunbeds. Of these, 71% had first used a sunbed between the ages of 14 and 16 and 8% had used a sunbed before the age of 14. The youngest age for reported use was ten years and there was an association between sunbed usage in respondents and family sunbed usage.

Home was the most common place where sunbeds were used. The percentages were 35% in the home and 28% a combination of beauty salon and the home. The author of the report said this is worrying as sunbeds in the home are unsupervised with no control on the length of time they are being used in terms frequency of use and on wearing eye protection. Only 37% of sunbeds users received advice from a member of staff when using the equipment in the salon and one third occasionally did not use eye protection, which is a worrying trend on top of what we have heard already.

The key findings around attitudes in this group were that 62% felt a tan made them look healthy, 68% said a tan made them look and feel more confident, 85% said they considered sunbeds to be harmful and 87% said they agreed that sunbeds can cause skin cancer. The relationship between sunbed use and beliefs shows that the issue should be tackled by Government. Sunbed users seem to be more tolerant of sunbeds and they see them in a more positive light than those of us who do not use them. A point which should be made is that non-users seem to be more aware and better informed of the negative effects and consequences of repeated sunbed use.

To go back to the survey, when asked if sunbeds should be used to get freckles, 43% said that they were unsure. People who get freckles are recommended never to use sunbeds. The author of the report recommended that legislation should be backed up by education on sunbed usage - that is, in schools, whether through social, political and health education, and in a media campaign for children and adults along with a public health campaign in this area.

It is appropriate that the Oireachtas Joint Committee on Health and Children dealt with plan packaging for cigarettes and the use of tobacco today. We heard the tobacco industry say it never targeted young people and that it was not interested in doing so. Those involved in operating sunbeds would probably make the same claim. However, we cannot dispute or ignore the fact there is a clear link between using sunbeds and melanoma and skin cancer. That is why I am particularly pleased this legislation has come before the House ahead of the summer season - a time when many are getting ready to go on holiday. This legislation is about protecting young people, in particular, by regulating the use of sunbeds. One would think it would be a given that people would not use sunbeds but unfortunately that is not the case.

In its briefing document, the Irish Cancer Society gave a very striking statistic that people who start to use sunbeds before the age of 30 have a 75% increased risk of malignant melanoma, the most serious form of skin cancer. That figure cannot be ignored or downplayed. Buy-in is required from sunbed operators who need to be brought along on this journey. The Irish Cancer Society said seven out of ten tanning shops would allow a fair skinned child to use a sunbed without any warning or advice. How can that be justified?

I welcome this important legislation which will perhaps not get much prominence in the national media and may go unnoticed but it will send a very strong message that this Government is concerned about public health. The Bill will afford protection to all citizens. We need to have an efficient and effective enforcement regime. That is why clarity is required in regard to enforcement. The Minister said the HSE will establish a list of sunbed businesses and the Bill will include a notification system where those operating sunbeds, whether the seller or the hirer, will have to notify the HSE and that there will be a notification fee involved. That is welcome but follow up is required in terms of enforcement of the legislation and training for staff in salons. Is the fine of €4,000 for a first offence - a class B fine - sufficient? We are talking about the lives of people and about public health in respect of a group of people who use sunbeds. The Minister spoke about a sunbed non-compliance list which would be a bit like the Revenue Commissioner's list of those who have not paid their taxes.

This is a first step which is about protecting children from the harmful effects of sunbeds and ensuring adults make informed choices. I welcome the Bill and hope it will pass and that we will see further public health measures around the area of cancer.

Deputy John Browne

I welcome the Public Health (Sunbeds) Bill 2013, which probably should have been implemented many moons ago. I certainly hope the Minister accepts amendments on Committee Stage to strengthen the Bill and takes on board some proposals from the Irish Cancer Society and other people who deal with cancer on a daily basis.

This Bill stems from the growing evidence that the use of sunbeds, especially by children, should be restricted because of the associated increased risk of skin cancer and other health problems. As has been outlined, the Bill will prohibit operators of sunbed premises from allowing anyone under 18 years of age to use sunbeds. It provides for controls on the remote sale or hire of sunbeds by way of Internet transactions and it imposes a requirement that sunbed operators provide training for staff which is very important because in my county - I am sure it is the same in other counties - there are coin-operated and unmanned sunbeds and the need for staff who are trained to advise people on the use of sunbeds is irrelevant. This aspect must be included in the Bill.

The Bill proposes an enforcement regime to enable inspections to be carried out by the HSE and to impose penalties for non-compliance, including fixed payment notice. Perhaps the Minister might explain how the HSE will carry out these inspections. Would it not have been better to have had HIQA carry out the inspections rather than the HSE which does not seem to have the manpower or ability to do so?

All sunbed operators will be obliged to provide protective eye wear and ensure sunbeds are maintained in a clean and hygienic condition. Many operators run their premises to a high standard but there are people involved in this business who leave a lot to be desired. There will be a requirement for warning signs to be displayed in all sunbed premises, which is very important in terms of advising and warning people on the implications of using sunbeds.

The Irish Cancer Society sent us a briefing document which spells out starkly the implications for people who have been diagnosed with cancer. It is also traumatic for the families, where an individual is suffering from cancer. The society points out that skin cancer is the most common cancer in Ireland. In 2010, some 9,500 people were diagnosed with skin cancer and almost 10% were diagnosed with melanoma, the most serious form of skin cancer.

There were 158 deaths from skin cancer in 2011. The incidence of melanoma in Ireland is increasing dramatically. For example, it increased by 137% between 1994 and 2010. Up to nine out of ten cases of skin cancer are caused by ultraviolet rays from the sun or from sunbeds and can therefore be prevented. If one reduces one's exposure to ultraviolet rays, one significantly reduces one's risk of developing skin cancer.

There is clear evidence of a link between sunbeds and skin cancer. In July 2009, the International Agency for Research on Cancer placed sunbeds in the highest cancer risk category and rated sunbeds to be equivalent to tobacco and plutonium in terms of causing cancer. Sunbeds have been linked to a variety of adverse health conditions and problems, including eye damage, premature skin ageing and skin cancer. The incidence of skin cancer is increasing worldwide. As I have said, the number of melanoma cases in Ireland has increased alarmingly over the past ten years.

Research commissioned by the Irish Cancer Society and published in June 2010 shows that 140,000 people in Ireland use sunbeds. That number has probably increased substantially since 2010. Some 88% of those who use sunbeds are women and 20% of them are between the ages of 15 and 24. We are all concerned about this age group. The legislation introduced by the Minister deals specifically with this cohort.

The problem, as I see it, is that any individual can set up a tanning salon. There are no regulatory restrictions on the type of equipment that can be purchased. There has certainly been a dramatic increase in the variety of types of equipment. This has been accompanied by the dramatic increase in adverse effects of sunbed use to which I have alluded. People are advertising that one can get a suntan on a sunbed in ten or 15 minutes, or even less. Regulations are needed to deal with such practices. The Minister needs to provide in legislation for a strict regulatory regime.

Young people are particularly at risk when they use sunbeds. People who start using sunbeds before the age of 30 have a 75% increased risk of malignant melanoma, which is the most serious form of skin cancer. The Irish Cancer Society and the World Health Organization have advised that people under the age of 18 should not use sunbeds because of the increased risk of developing skin cancer. I do not think that message has been understood, however, as the facts and statistics demonstrate that a huge number of young people use sunbeds. The Irish Cancer Society suggested in 2010 that 28,000 people under the age of 25 were using sunbeds. That number is likely to have increased dramatically in more recent years.

As previous speakers have said, when the Irish Cancer Society carried out a secret shopper survey, it found that seven out of ten tanning shops would allow a fair-skinned child to use a sunbed without any warning or advice. The society is very concerned about the lack of regulation in this area. It is asking for regulations comparable to those in Australia, where fair-skinned people are prohibited from using sunbeds, to be implemented here. I think the Minister should give serious consideration to that proposal on Committee Stage.

In parts of Australia, tanning shops must carry out a skin type assessment before allowing a person to use a sunbed. As we all know, the Fitzpatrick scale outlines clearly the implications, in terms of skin cancer, of sunbed use for people with various skin types. It would be easy for all shops to use the scale, which is a universal assessment with six points. The legislation should deal with this issue. Perhaps that can be facilitated on Committee Stage.

The Bill before the House is certainly welcome. The authorities across the water in England and Wales have introduced similar regulations and legislation. I understand it started off as a Private Members' Bill before ending up in legislation. The main purpose of the UK Act is to prevent the use of sunbeds on commercial business premises by children and young people under the age of 18. Our legislation is somewhat similar. The UK legislation also prohibits the use of coin-operated sunbeds and unmanned sunbeds. I ask the Minister to examine this particular area.

This legislation includes provisions restricting the use, sale or hire of sunbeds, requiring information to be provided to sunbed users and requiring protective eyewear to be supplied. When the Minister has brought this legislation through, will he have the power to introduce further regulations at a later stage if he feels they are required? Bills are often introduced in this House that allow the relevant Minister to introduce further regulations over a period if he feels additional penalties are needed. This happens in the case of road traffic regulations, for example. I do not always agree with Ministers giving themselves too many powers, but in this case I think the Minister should be allowed to attach additional regulations to the legislation we are discussing if he feels they are necessary.

It is important to ensure young people get the message that sunbeds are not the be-all and end-all. They need to appreciate that sunbeds can be dangerous, particularly for fair-skinned people. While I welcome the Minister's decision to ban the use of sunbeds by people under the age of 18, I think he could tighten the legislation further. My party's health spokesperson, Deputy Kelleher, will table amendments on Committee Stage to strengthen the Bill and help the Minister to introduce further controls. Perhaps the Minister will consider what has been done in Australia with regard to people with fairer or lighter skin who seem to be more likely to contract skin cancer.

Overall, I welcome that the Bill is before the House. It has been a long time coming, but it is here now and it is welcome. In addition to banning the use of sunbeds by young people, it is important we ensure sunbed salons and health salons that operate sunbeds have to adhere to a strict regulatory framework. People should not be allowed to open sunbed salons without having to meet the proper regulations and criteria the Minister plans to introduce.

I am not sure the HSE will have the manpower to investigate this activity by carrying out sporadic visits to ensure sunbed salons are operating properly. Perhaps it would be more appropriate to give this responsibility to HIQA, which seems to be able to bring people to heel. It is able to change the views of those who are operating outside the legislation and bring them on board. I suggest that HIQA be asked to carry out these investigations.

I welcome this Bill. I hope it will pass all Stages as soon as possible because the summer period is approaching and, as we all know, people like to prepare for that by visiting sunbed salons I have never had the pleasure of lying on a sunbed, but many of my friends and constituents use them frequently. Some of these establishments are very well run and some of them not so. We are taking a step in the right direction by ensuring people under the age of 18 are not allowed to use sunbeds, just as we have banned young people from buying cigarettes and other tobacco products.

Deputy Mary Mitchell O'Connor

I would like to share time with Deputies Regina Doherty and Peter Fitzpatrick.

Acting Chairman (Deputy Joe O'Reilly)

Is that agreed? Agreed.

Deputy Mary Mitchell O'Connor

Last Tuesday was World Cancer Day, a sad day. Like so many others I have lost many relatives and friends to cancer, including skin cancer and melanoma. Yet only a few years ago a well-known song, entitled "A Sunbed Song" was played on radio stations, encouraging our young children to go out and top up their summer tan through the use of sunbeds.

I am therefore extremely pleased to welcome the Public Health (Sunbeds) Bill, which firmly prohibits anyone under the age of 18 from using these extremely harmful machines. I have just come from attending a meeting of the Oireachtas Joint Committee on Health and Children, at which I shed crocodile tears because the tobacco industry is so concerned about children's use of tobacco that it wants schools to undo the damage of the tobacco industry and to educate children about the dangers of tobacco while it walks away with a massive profit and a clear conscience.

We must protect our young people. I was horrified when I heard that young children were being sent for a few quick sunbed sessions so that they could have a nice tan on the day of their First Holy Communion. I was also disgusted to hear that some operators offer harmful promotion, such as receiving an extra half hour when they buy one hour of tanning.

For too long the use of sunbeds has been commonplace and used as the quick and easy option to give our naturally fair skin a brown glow. According to the Irish Cancer Society almost 28,000 young people use sunbeds in Ireland each year. These people are deliberately exposing themselves to high doses of ultraviolet radiation. The dangerous effects of sunbed use takes years to be fully known, as there is often a long time delay between sunbed use and the onset of medical problems.

The Bill will protect the public and in particular young persons from the risk of skin damage and the increased risk of developing skin cancer. The World Health Organization recently reclassified sunbed use from a group 2A carcinogen to a group 1 carcinogen. With this classification, how can anyone even proclaim that sunbeds have any benefits? In 2011, some 158 people died from melanoma cancer in Ireland. This number could and must be greatly reduced. The Bill will take a step towards doing so. It will help promote a greater public awareness across all age groups of the dangers of developing skin cancer, premature ageing and eye damage from exposure to ultraviolet radiation.

While the Bill does not prohibit everyone from using sunbeds, I welcome its stricter controls and requirements on sunbed operators, such as requiring that sufficient staff training, accurate health information and warning signs are provided. Adults planning to use sunbeds must be correctly informed and instructed on how to use them safely. A young man contacted my office after he went to a sunbed-tanning salon and received no instructions. The unfortunate man, because he knew no better, sprayed himself with what he thought was a product for use with a suntan bed. However, instead it was a detergent cleaning product and consequently he was very badly burnt.

The Bill prohibits dangerous promotional marketing practices and certain claims that attribute ludicrous health benefits to sunbed use. Overall the Bill will strongly encourage a reasonable code of conduct among sunbed operators.

Thankfully the Government is making unprecedented moves towards ensuring a healthier and safer Ireland, not just through this Bill, but also through our moves towards making Ireland a tobacco-free country by 2025 and I am proud to be part of that campaign.

As the Minister stated yesterday, prevention is better than cure. The Bill will help ensure such prevention and contribute to a reduction in the incidence of unnecessary skin cancers over the coming years.

Deputy Regina Doherty

The pioneering designer and fashion icon, Coco Chanel, has a lot to answer for because in the 1920s she popularised the idea of tanning. At that stage the sun was promoted to represent pleasure, relaxation and, obviously, good health. We all want to look our best and people will often go to any lengths to do so. Self-image is particularly important for young women and the cult of tanning has led to an obsession with being brown, not just during the summer, but all of the time. This is at the expense of health and encourages increased incidence of skin cancer and other related issues.

It is estimated that a staggering 140,000 people in Ireland use sunbeds, of whom 20% are aged between 15 and 24. There is anecdotal evidence that parents send children as young as seven for sun-tanning sessions, particularly in advance of their First Holy Communion. What is that about? The world has gone mad if mothers are sending their seven-year old children to sun-tanning salons to make them look good on the day of their First Holy Communion. Are we so concerned about how we look on the outside that we completely ignore the health risks and effects this treatment has on our bodies?

We need to focus on the statistics and get the information out there. I cannot believe that any mother would knowingly do something like that to her child if she knew the risks. Every year 8,000 people are diagnosed with skin cancer, of whom 896 are diagnosed with melanoma, which is the most serious form of skin cancer. Some 156 people died of skin cancer last year and 148 in the previous year; the problem is growing. How many more statistics do we need to see in stark detail the extreme damage caused beneath the surface when people lie underneath these machines? We need to stave off the temptation to hit the sunbeds by showing people the ugly truth beneath the tan. As long as sunbeds are available to the public, we clearly need legislation to reduce the risks associated with their use and therefore I am very pleased to support the Bill.

The research has already shown that people, who use sunbeds for the first time before the age of 35, increase the risk of contracting malignant melanoma by 87%. They are not going to do someone any good. In the very best-case scenario they will age and damage a person's skin and in the worst-case scenario will cause death. The Bill will ensure that any sunbed operator will be banned from allowing anyone under the age of 18 from using them. The operator's premises will need to be licensed and staff trained. The sale or hire of sunbeds online will be controlled. The HSE will be mandated to carry out inspections. Penalties and fines will be levied on operators for non-compliance. I agree with some of the previous speakers who have said that the penalties are not large enough. They need to be sufficiently large for people to take them seriously.

Sunbed operators will be required to provide goggles and sunbeds must be maintained in a clean and hygienic condition with appropriate warnings and sidelines for those people who want to continue to use them. In addition there will be a ban on claims that attribute health benefits to sunbed use and a ban on promotional marketing practices.

The number of cases of skin cancer in this country is rising every year. Regulations such as this are very welcome and will in time reduce the rate of skin cancer. The Bill is literally a lifesaver and I congratulate the Minister on bringing it to the House.

Deputy Peter Fitzpatrick

The Public Health (Sunbeds) Bill 2013 aims to restrict and regulate the use of sunbeds in order to protect the public from the risk of skin cancer posed by UV radiation exposure. The Bill would ban sunbed operators from allowing the use of sunbeds by people aged under 18 on their premises or through sale or hire to this age group. It also introduces a mandatory notification system for those operators and a range of regulations relating to staff training and health warnings among other things.

The HSE will be the enforcement body and the Bill provides for a range of penalties. People who use sunbeds generally do so for cosmetic and psychological benefits. However, medical evidence accepted by authoritative bodies such as the World Health Organization show that exposure to UV radiation during sunbed use may cause skin cancer, eye damage and premature skin ageing.

Skin cancer is the most common form of cancer in Ireland.

In 2010, 9,450 people were diagnosed with skin cancer in Ireland and, of those, 896 were diagnosed with melanoma, the most serious form of skin cancer. A 2010 survey for the Irish Cancer Society estimated that just fewer than 140,000 people in Ireland use sunbeds on a regular basis. Some 88% of those who use sunbeds are women and 20% are between the ages of 15 and 24. The incidence of skin cancer is increasing worldwide and the number of melanoma cases in Ireland has increased more than 66% in the past ten years.

Sunbed use in increasing and tanning devices are more powerful than even a decade ago. Consequences of regular sunbed use could include pain and suffering, early death, disfigurement and substantial cost for the national health systems in screening and monitoring skin cancer patients.

Most skin cancer is caused by ultraviolet radiation through sun exposure and sunbed use and is therefore preventable. Other causes of skin cancer include genetic factors and a history of sunburn. Young people are particularly at risk when they use sunbeds as people who start using sunbeds before the age of 30 have a 75% increased risk of developing malignant melanoma, the most serious form of skin cancer. As a result of this additional risk, there has been longstanding professional advice against children using sunbeds. However, this message does not appear to be getting through and a large number of children are using sunbeds.

Research conducted by the Irish Cancer Society in April 2010 found that 28,000 young people under the age of 25 use sunbeds in Ireland. The majority of these children use sunbeds once a week. The British Association of Dermatologists has identified a number of groups who should never use sunbeds. They include those under the age of 18, those with fair, freckly skin that does not normally tan with sun exposure, those with a large number of moles, those with a history of skin cancer, and those with abnormal sensitivity to the sun due to photosensitive diseases, sun allergies or the taking of medication. They also argued that advertising material claiming health benefits of sunbed use should be prohibited.

The Bill provides for the control of the remote sale or hire of sunbeds; Internet transactions; a requirement that sunbed operators provide training for staff; an enforcement regime to enable inspections to be carried out by the HSE and the imposition of penalties for non-compliance including fixed payment notices; an obligation on sunbed operators to provide protective eyewear and that the sunbeds are maintained in a clean and hygienic condition; a requirement that warning signs be displayed in sunbed premises; a prohibition on certain claims attributing health benefits to sunbed use; a prohibition on promotional marketing practices; a requirement on operators to ensure that sunbed users are made fully aware of the potential dangers of sunbed use and that they are given an opportunity to read the health information form and sign it; and an exemption to enable medically supervised phototherapy treatment within the health system.

It has also been suggested that the broader public health information campaigns about the dangers of sun and sunbed exposure are important in achieving an overall policy goal of reducing illness related to ultraviolet radiation exposure. Many people use sunbeds before holidays in sunny countries in the belief that a sunbed-acquired tan will afford them protection from the sun as well as improving their appearance. The level of protection afforded by a sunbed tan is, however, small and is associated with morbidity.

The HSE is under an obligation to compile and maintain a list of persons who own sunbed businesses under section 13. At present there is no such list or registration process. Owners of sunbed businesses are under a duty to notify the HSE in writing that they provide sunbeds for use, sale or hire. This notification must be made within six months of this section being commenced. A person who intends to carry on a sunbed business must notify the HSE of this intention no later than 30 days before commencing business.

Up to nine out of ten cases of skin cancer are caused by ultraviolet rays from the sun or from sunbeds and, as such, can be prevented. Reducing exposure to ultraviolet rays significantly reduces the risk of developing skin cancer.

Deputy Tom Fleming

Medical evidence accepted by authoritative bodies such as the World Health Organization shows that exposure to ultraviolet radiation occurring during sunbed use may cause skin cancer, eye damage and premature skin ageing. Skin cancer is the most common form of cancer in Ireland. It is estimated that 794 deaths per year in the EU-18 countries are attributable to sunbed use.

A 2010 survey for the Irish Cancer Society estimated that nearly 140,000 people in Ireland use sunbeds and most of these are women and one in five are aged between 15 and 24. In a report in 2012 it was ascertained that about one in 20 cases of the most dangerous form of skin cancer can be attributed to sunbed use. Researchers from the International Prevention Research Institute in France and the European Institute of Oncology in Italy analysed the results of 27 studies on skin cancer and sunbed use carried out in European between 1981 and 2012. The number of skin cancer cases included in the analysis was 11,428. A study published by the British Medical Journal enabled doctors to calculate that out of 643,942 new cases of malignant melanoma diagnosed each year in Europe, an estimated 3,438, or 5.4%, are related to sunbed use. The authors estimate that from 69,942 new cases of melanoma diagnosed every year in the EU countries 498 female and 296 male deaths would be caused by sunbed use. Some 721 cases of melanoma are diagnosed in Ireland each year.

Modern indoor tanning equipment mainly emits rays in the ultraviolet A range, a fraction of the spectrum is in the ultraviolet B range. Powerful ultraviolet tanning units may be ten to 15 times stronger than the midday sunlight on the Mediterranean Sea and repeated exposure to large amounts of rays in the ultraviolet A range delivered to the skin in a relatively short period, typically ten to 20 minutes, poses a huge risk to humans.

The International Agency for Research on Cancer has classified the whole ultraviolet spectrum and indoor tanning devices as carcinogenic. A study from 2005 found a 75% risk of developing melanoma if sunbed sessions were started during adolescence or early adulthood. Adolescence is the most dangerous period in the lifecycle. However, no studies since then have estimated the impact of melanomas due to sunbeds in western Europe. This latest research estimates the risk of skin cancer doubles if the sunbed use starts before the age of 35. The author of the report believes that earlier studies tended to underestimate the risks of indoor tanning because the use of these devices is relatively new. Furthermore, from 2005 to 2011 most risks have increased.

Further studies could therefore demonstrate an even higher risk, particularly for high risk Irish skin, which is more prone to cancer. Irish people are at a higher risk because three out of every four have skin types 1 or 2 which burn very easily and almost never tan. Sunbeds and sunlamps artificially recreate the sun's ultraviolet rays resulting in the development of a suntan but they also contribute to skin damage and increase the risk of cancer.

A report by the World Health Organization in 2009 showed that the chance of developing skin cancer increases by 75% if a person regularly uses sunlamps under the age of 35.

In July 2009, it reclassified sunbed use from a group 2A carcinogen, which is probably carcinogenic to humans, to a group 1 carcinogen, which is definitely carcinogenic to humans.

Sunbeds also raise the risk of non-melanoma skin cancers, particularly when people start using them before the age of 25. Research found that up to 28,000 people under the age of 25 use sunbeds in Ireland each year. Although indoor tanning devices are linked to the most deadly form of skin cancer, melanoma, a new study states they also trigger other damaging forms of the disease. Non-melanoma skin cancer is triggered by sun damage and, although not usually fatal, may be disfiguring without treatment. These non-melanoma skin cancers are slow-growth cancers that can look like a skin bump on the face, the scalp or the hands. The latest study shows that sunbed users have a 67% greater risk of developing squamous cell skin cancer and a 29% higher risk of basal cell carcinoma compared with people who have never used indoor tanning. It found that exposure to sunbeds before the age of 25 was significantly linked with a higher risk of basal cell carcinoma.

The European Commission has highlighted that the impact of sunbed use takes years to be fully known as there is often a long time delay between sunbed use and the onset of medical problems. Wide use of indoor tanning is also of relatively recent date, which means the detection of these long-term effects is still difficult. The British Association of Dermatologists has identified a number of groups who should never use sunbeds. These include people under 18 years of age, those with fair skin that does not normally tan with sun exposure, those with a large number of moles, those with a history of skin cancer and those with abnormal sensitivity to the sun due to sun allergies or medication. I believe there are very strong reasons to make amendments to this Bill to include some of the above categories and I hope some of these measures will be introduced on Committee Stage.

There is also a need for greater awareness of general health hazards of sunbeds and outdoor sun conditions. Legislation should be backed up by education and a public health campaign both for young people, through the schools, and for adults, through a public relations exercise. This campaign would provide the relevant information and outline the need for protective screening lotions in outdoor sun situations. We have a great opportunity to link in with the sunbed legislation to get the message across to a wider audience that, due to several factors, the sensitivity of Irish skin is an issue we need to address. I ask the Minister either to incorporate this into the Bill or have the HSE take strong action, with the Department of Health, to create a widespread sense of awareness of the sun and the elements we encounter every day.

Some 48% of respondents to a recent survey use sunscreen regularly in this country, which means more than half of the population do not avail of any type of screening. In addition, the majority of those who use protection use only a factor 15 screen. I believe cost is a disincentive to sunscreen use. Like the majority of drugs, the cost of sunscreen in Ireland is very high compared with the cost in most other countries. Irish people who go abroad to enjoy the Mediterranean sun in Spain, Portugal, Greece and so on are astounded by the high cost of general medication here, and the same applies to sunscreen. None the less, they must purchase it, for good reason, given the high level of sunshine when they go abroad. When we get the odd occasion of high sun exposure in this country, however, I believe we neglect to use sufficient sunscreen, and this is particularly the case among the younger generation.

Climate change and global warming are also a factor. We have seen extremities in the past month and also last summer, when we had unusual weather conditions for this country. We must be more careful in future to get the message across that people must use sunscreen regularly.

Melanoma is the most serious form of skin cancer and its incidence has increased in Ireland by 138% between 1994 and 2010. This is a very serious statistic. I know the Minister introduced the melanoma drug 12 months ago, which was a very welcome addition to the medication for the treatment of skin cancer. However, we must introduce more preventative methods and get the message out there. We should talk to and renegotiate with the drug companies. If there was additional demand and additional sales, perhaps the drug companies would reduce the cost of these products, which would make it more favourable to the consumer.

Traditionally, we are not very careful with sunshine when outdoors, for example, with regard to protective clothing. When we get the first splash of sun in May, people rush to the seaside and perhaps are not properly protected. In the past, when people in rural Ireland were in the meadow or the bog, they always wore straw hats but this is no longer the case. The older generation had a lot of common sense and those hats were a great protective measure, without having any other form of screening. Perhaps we need to get back to the old traditions given that generation were wise enough to use this form of protection.

Avoiding the most dangerous time of the day, from noon to 2 p.m., is important and there should be more awareness that people should stay indoors at this time.

We are very fortunate that there are a large number of recreational areas, playgrounds and facilities available outdoors for our younger generation and all age groups. The appearance, one hopes, of longer summers and days of sunshine is all the more reason we need to get the message across to people. We will save ourselves millions and avoid much suffering on the part of our citizens in future.

There is a high level of support for the regulation of sunbeds. According to a briefing paper from the Irish Cancer Society, 90% of people support a ban on sunbeds, be it a complete ban, of which 47% are in favour, or a ban for under 16 year olds, of which 43% are in favour. It is very interesting to see that 38% of sunbed users did not see guidelines posted or receive any verbal information on sunbed use from the sunbed operator. The briefing paper states that:

Self-regulation of the industry is clearly not working. In August 2012, the Irish Cancer Society found that a fair-skinned, seventeen year old child was encouraged to use sunbeds by all seven of the tanning shops she visited as part of an undercover survey. The advice from the tanning salons, which included well-known chains, told the girl that she should be tanning at least three times a week in order to be tanned for a wedding in October. One salon claimed that she would need to use a sunbed more frequently than someone with dark skin because she would find it harder to get a tan. None of the salons asked the child her age or advised her against using a sunbed because of her very fair skin. All salons pressured her to start using a sunbed as soon as possible. The survey revealed that without any regulation, children and people with fair skin are being actively encouraged to use sunbeds by sunbed operators. We are extremely concerned that without regulation that would prevent under 18s and those with Type 1 and Type 2 skin (very fair skin) from using sunbeds, those people most at risk from skin cancer are not being protected.

The paper also lists the jurisdictions that have introduced legislation prohibiting those under 18 from using sunbeds. The array of jurisdictions that have introduced the necessary legislation include Austria, Belgium, Finland, France, Germany, Italy, Norway, Portugal, Spain, Sweden, England, Northern Ireland, Scotland, Wales, British Columbia, Newfoundland and Labrador, Nova Scotia, Quebec, California, New York, Vermont and Iceland. Brazil has banned all tanning beds for commercial purposes and Tasmania, Victoria and Western Australia have introduced legislation that will ban tanning beds from 2014. We are lagging behind in respect of introducing the necessary legislation. It is long overdue for us to proceed with this and introduce the necessary safety measures. I hope we can over the next few weeks improve on what is contained in the draft Bill. I am sure we will have a better and safer country as a result of this.

Acting Chairman (Deputy Joe O'Reilly)

I understand Deputy Breen wishes to share time with Deputies McLoughlin and Kyne.

Deputy Pat Breen

I welcome the opportunity to speak about the Public Health (Sunbeds) Bill 2013. So many people have spoken about this Bill over the past day or so. It is one area where everybody agrees. The purpose of this Bill is to reduce the cancer risk specifically for children by prohibiting anyone under the age of 18 years from using a sunbed. It is very welcome legislation and all parties support it. I compliment the Minister for Health and the Minister of State with responsibility for primary care, who is in the House this afternoon, on taking this action and for introducing regulation in this area, particularly given the conclusive evidence linking sunbed use to skin cancer.

Next month is very important for the Irish Cancer Society when it operates Daffodil Day. According to the Irish Cancer Society, skin cancer is the commonest cancer in Ireland and in 2010, 9,450 people were diagnosed with the disease and, of these, 986 were diagnosed with melanoma, which is the deadliest of all skin cancers, with 158 people dying from skin cancer in 2011. Other countries have similar figures and there is compelling international evidence that there is a link between the increased incidence of skin cancer and the use of sunbeds and that the risks are even greater for younger people. The International Agency for Research on Cancer has classified the use of sunbeds as a class 1 carcinogen because when one uses a sunbed, one is exposed to both UVA and UVB rays which damage one's skin and lead to cancer. The World Health Organization agrees with these conclusions and has described the use of sunbeds as one of the most dangerous cancer-causing habits, describing sunbeds as being as lethal as cigarettes. The fact they are as lethal as cigarettes speaks for itself.

In spite of all this research and warnings, the use of sunbeds in this country has grown, which is a bit like cigarette smoking as well. The Irish Cancer Society report stated that around 140,000 people regularly use sunbeds. The most worrying statistic I read recently is that 20% of these are aged between 15 and 34 years of age, so that in 2010, 28,000 young people under the age of 25 used sunbeds here.

Given our weather patterns, it is not surprising that Irish people have been attracted to using sunbeds, and their popularity may be another effect of the Celtic tiger. That so many young people have been using sunbeds is very alarming and if action is not taken to address this, we will see our skin cancer rates spiral out of control in a few years' time. In a survey of six single-sex Cork city schools carried out in November 2011, 71% of respondents reported that they first used a sunbed before the age of 14 while the youngest reported age was ten years. Children as young as seven and eight are being exposed to sunbeds because it has become common practice for children to have a number of sunbed sessions ahead of their first holy communion. Their parents have a huge responsibility because they do not realise the dangers to which they are exposing their children. It is obvious the message is not getting out about exposure to these sunbeds and is not getting through to people, especially when one sees parents letting their children use sunbeds. This is why I welcome the legislation that will ban those under 18 years of age from using them. The UK, Germany, France and several Australian and Canadian states have introduced similar bans because the evidence is clear in terms of the link between sunbed use and skin cancer.

The fact that up until now, sun tanning salons were unregulated and coin-operated and unsupervised sunbeds were in existence made access easier for young people The question of how this ban will be enforced is very important because there is no doubt that some young people under the age of 18 will try to break the ban. While I understand that salons will have to display signs advertising the fact that those under 18 cannot use sunbeds, I suggest that the regulations should include the requirement for proof of age in cases where the salon owner is not sure of a person's age.

As well as banning the use of sunbeds for children under 18 years of age, a focused educational programme should be introduced in our schools to highlight the devastating effects of using sunbeds. Such a programme would be effective in deterring young people from using sunbeds, particularly as they get older. A media campaign including a blitz on social media could also come on stream at the same time, as it would be a great way of connecting with young people, many of whom are on Twitter, Facebook, etc.

The message needs to get out and people need to be fully informed and aware of the consequences and the risks that they are taking when they use sunbeds. In the course of my research for this debate, I read a number of articles about people who have developed cancer as a result of using sunbeds. Their stories are horrific. I am sure that most Deputies have heard of them. I read one story of a 25 year old girl in the UK who was fighting skin cancer after spending 20 minutes per day for eight years on a sunbed. She started going to tanning salons when she was 17 years of age. She described the day the doctor told her that she had cancer as devastating. She stated: "No tan is worth the pain of an operation, scarred skin and the constant feeling of what if while waiting for my results". In another case in the US, a young 26 year old woman died from a melanoma three years after being diagnosed. She had also been a regular sunbed user.

Making people aware of the risks will have an impact, just as similar campaigns have impacted on smokers and drink drivers. Will the Minister for Health or the Minister of State, Deputy White, who is present, discuss with the Minister for Education and Skills the possibility of introducing an awareness campaign in our schools as soon as possible? A laissez-faire attitude has been adopted towards the use of sunbeds, particularly by users who have continuously ignored the risks in favour of having tans. The onus, therefore, will need to be placed on the salon. It is also important that salons display warning signs advising people of the risks associated with their use and that new protocols be put in place, including training and inspections.

Some sunbed users claim that they are just doing what other sun worshippers are doing while on summer holidays. However, we need to take precautions when sunbathing, given the fact that sunburns have been associated with lasting skin damage. One blistering sunburn in childhood can lead to the development of melanomas later in life. People are always warned about the risks of lying under the midday sun when the chance of sunburn is at its greatest and are encouraged to use sun protection creams. The risk is even greater in the case of sunbeds, with scientists calculating that a ten-minute session on a sunbed is twice as likely to cause skin cancer as spending the same amount of time in the midday sun in the Mediterranean. We cannot ignore this stark statistic.

Having been informed of all the risks, some people will continue using sunbeds. As such, it is important that the equipment they use be fit for purpose. Sunbeds produce ultraviolet radiation, which makes it possible to tan. Therefore, the equipment should be maintained to the highest standards. Operators and their staff should be familiar with the correct operations of UV tanning equipment and ongoing health and safety training should be provided to ensure that employees can operate the equipment correctly and are able to provide customers with information about the risks. Staff should be aware of the risks to themselves from working with UV tanning equipment and how to reduce or avoid those risks.

There is also the issue of UV emission levels. The Minister of State has departed, but I would be interested in the Minister's views on whether the regulations will include a restriction on emission levels. In the UK, regulations introduced in 2009 restrict the emission level to 0.3 W/m2 compliant, which means that a UV emission is guaranteed to be no higher than that of the midday Mediterranean sun. In spite of these regulations, however, a study carried out by Cancer Research UK - indeed, many studies have been carried out - on 402 sunbeds across England in 2010 and 2011 found that nine out of ten sunbeds failed to meet British and European safety standards. It found that the levels of UV radiation emitted by the 400 sunbeds were on average twice as high as the recommended limits. This is an interesting statistic.

It is important that we learn from the experience in other countries so that the regulations being introduced in Ireland provide the best international practice. This legislation is about protecting lives, especially among young people, from the evil that is skin cancer. Benjamin Franklin once stated, "An ounce of prevention is worth a pound of cure". That is true. By avoiding risks such as overexposure to sunbeds and adopting a healthy lifestyle, people can reduce their risk of cancer by up to 50%. For this reason, I support the legislation and trust that it will be enacted as soon as possible.

Deputy Tony McLoughlin

I thank the Leas-Cheann Comhairle for the opportunity to contribute on this Bill, which will undoubtedly have a positive impact on many families. Many consumers have the tendency to believe that if a product is on the market it has been deemed safe. This assumption is wrong and it is our job to have laws in place that protect our citizens. We all know the dangers of tobacco and alcohol. Over the years, new legislation has come into place in order to protect people, especially children, from the harmful effects of those substances.

It is widely known that most forms of ultraviolet radiation contribute to skin cancer. The main contributors of UV radiation are the sun, sunbeds and sun lamps. Over the years, the use of sunbeds has become more common among Irish people, contributing to a variety of medical conditions, with skin cancer being the most serious and dangerous one. Research published in the British Medical Journal reveals that 794 people die each year in Europe from sunbed-induced skin cancer. In Ireland, the situation is even more serious, with 158 deaths from skin cancer in 2011. In up to 90% of cases, the cause of the cancer is mostly the exposure to one or more cancer causing factors. The majority of people are aware of the dangers that prolonged exposure to the sun can cause, yet many still choose to use sunbeds for cosmetic purposes not knowing that the intensity of the UV rays of some sunbeds can be five or more times stronger than what they would get from the midday sun. People need to know that using a sunbed is not a safer way to tan.

Lack of regulation of the industry only makes the situation more dangerous, with information on the number and standard of sun tan studios difficult to come by. Studies have shown a lack of public knowledge about the health risks associated with the use of sunbeds. The main reason people use them is to have an all year round "healthy look" not knowing about or dismissing the dangers and health risks that come with it. I am aware of some people, mostly women, who engage the services of tanning salons for a period of weeks before they go on two-week sun holidays. One can only imagine the damage done if this is a yearly practice for some people.

Sunbeds are more dangerous for some than others. People who have a frequent sunburn history, a large number of moles or a family history of skin cancer are more likely to be diagnosed with cancer. It is also widely known that people with fair skin are more likely to get sunburn and, as a result, have a higher risk of developing skin cancer. The protection of citizens is a priority for the Government. We must spread the knowledge and, where necessary, use the power of law in order to ensure that people's health is being protected. For this reason, the Bill should prohibit people with the fairest skin, referred to as type 1 and type 2, from using sunbeds.

The Irish Cancer Society, the World Health Organization, WHO, and the Environmental Health Officers Association agree that no one should use a sunbed to get a tan. In fact, the WHO has classed sunbeds alongside cigarettes on the list of the most cancer causing substances. The current Fianna Fáil leader and former Minister for Health and Children took a bold step some years ago in prohibiting smoking in public places, including workplaces. That Act will be forever seen as one of the most innovative pieces of legislation on the protection of people's health against the damages caused by passive smoking. This Bill is as important as that one in our quest to tackle bad practices that lead to cancer and will be seen in years to come as vital in reducing the number of cases of skin cancer in particular.

Some of the proposals contained within the Bill include the control on the remote sale or hire of sunbeds, provisions that tanning salons provide training for staff and that inspections can be carried out by the HSE.

Education on the dangers of over exposure to sunbeds is paramount. The decision to have warning signs displayed in all sunbed premises alongside the prohibition on promotional marketing practices is very welcome, as is the requirement on operators to ensure that sunbed users are made fully aware of the potential dangers of sunbed use and who must be given an opportunity to read the health information form and sign up before they use the sunbeds. I also welcome the decision by the Minister to prohibit persons under 18 to use a sunbed in tanning salons, and to prohibit the use of sunbeds in unsupervised premises. It galls most people to see little girls, many under 12, spending hours in tanning salons before their First Holy Communion or Confirmation ceremonies. Apart from anything else, this is a religious occasion and it is sad that some parents is our society would be so reckless as to encourage their children to partake in such a vanity exercise and to ignore all the health implications.

Finally, I congratulate the Minister for introducing and indeed all parties in the House for supporting this Bill, which is very timely.

Deputy Seán Kyne

I welcome the publication of the Public Health (Sunbed) Bill 2013. Earlier this month, the UN's International Agency for Research on Cancer presented research showing that the number of cancer cases will rise by 50% by 2030, which is just 16 years away. Cancer deaths globally are likely to rise from 8.2 million per year to 13 million. These worrying figures have been compiled by teams of more than 250 scientists from over 40 countries. Several reasons are put forward for this surge in cancer cases, including the aging populations of many nation states, as well as growing populations. However, behaviour is also cited as a factor, and included in this category is the use of sunbeds. For over half a century we have known that there is a definite link between certain behaviours and cancers. Smoking is one such behaviour which as we all know now causes cancer, despite the initial denials by manufacturers. Without doubt the use of sunbeds is also a behaviour which substantially increases the risk of skin cancer.

Skin cancer is the most common cancer in Ireland, with the skin type of the majority of people in Ireland particularly susceptible to the disease. The Irish Cancer Society's finding that nine out of every ten cases of skin cancer is caused by ultraviolet rays from the sun, or from sunbeds, demonstrates the higher risks that most Irish people face. The statistics provide further evidence and show the alarming increase in the incidence of melanoma by 137% between 1994 and 2010. Yet much of this risk can be avoided. We need to realise that wearing sunscreen or sun cream is no longer just for travelling to foreign places. We also need to realise that by using sunbeds, we are putting ourselves at ridiculous risk of developing life-threatening cancers. The effects on children are even more pronounced. When parents permit their children to use sunbeds, they are increasing the risk of their children developing skin cancer by 75%. This is a fact that cannot be disputed and should serve as a startling wake-up call to anyone using sunbeds.

Ideally the Government would not have to regulate the use of sunbeds; parents and guardians would know better and would realise the potential harm. In legislating for any issue, there is a balance to be achieved in promoting the common good and in protecting or respecting individual, personal rights. To be very clear, the World Health Organization has classified sunbeds as belonging to the highest cancer risk category, which also contains tobacco and plutonium. Despite this, some people go to great lengths to get that so-called healthy glow. More ludicrous still are the efforts to which some parents go to have their children use sunbeds, even when it is common knowledge that children have sensitive skin and so are at even greater risk of developing skin cancer. Armed with the evidence of what is happening, it is clear the Government has a duty to step in.

The WHO's International Agency for Research on Cancer provides the following advice to governments, policy-makers and health-planners:

Lessons from cancer control measures in high-income countries show that prevention works, but that health promotion alone is insufficient. Adequate legislation plays an important role in reducing exposure and risk behaviours.

This Bill vital to help reduce the risk and exposure to skin cancer. Indeed, the Irish Cancer Society refers to the Bill as "life-saving legislation", which is completely accurate. As a result of medical research and evidence and as a result of concerns from parents, guardians, health professionals and others, the Bill is being enacted to ban outright the use of sunbeds by those under the age of 18. It rightly contains other essential provisions to ensure persons are informed and fore-warned of the potential, and likely, dangers and risks. It also prohibits ridiculous and groundless health benefit claims that some sunbed operators make. Marketing nonsense can be very powerful and we are all susceptible to it, which is why accurate, verified information is essential to help people make informed and wiser choices.

The HSE is to be instrumental in the enforcement of the regulations, and will be responsible for the register and for appointing authorised officers. I have concerns about enforcement and compliance, which has been problematic in other jurisdictions, and about how measures can be put in place to ensure someone who claims to be 18 is in fact 18. A similar situation occurs in nightclubs, where some people may unfortunately not be of legal age, in spite of the measures put in place.

In Victoria, Australia, a person with fair skin of type 1 or type 2 is not allowed to use tanning salons. Every client must have a skin type assessment made prior to using a sun tanning facility. I think that should be examined here, because those with the fairer skin types are most prone to melanoma and to skin cancers.

The Bill also provides for the control of the remote sale or hire of some beds, and I welcome that. There is also a requirement that sunbed operators provide training for staff, with which I fully agree. There is an obligation on all sunbed operators to provide protective eye wear and to maintain all sunbeds in a clean and hygienic condition. Warning signs are very important for these premises, and there is a prohibition on certain claims being made about alleged benefits of sunbeds, as well as a prohibition on promotional marketing practices.

This is a very welcome Bill. We see it is getting cross-party support, which is also welcome. The protection of children is very important, but I reiterate my concerns about how this will be enforced. Rules and regulations are fine, but when someone rushes into a salon who may not be 18, what measures will be in place so if the child is under the age of 18 she will not be able to use these facilities? I am not sure how the HSE will enforce that. There are issues with enforcement of other legislation, and the HSE has many different pressures to deal with, so I wonder where that body can ensure that this is enforced. I reiterate the concerns about skin type restrictions in Victoria, Australia. The Irish Cancer Society has stated that it would prefer if nobody used sunbeds. The evidence shows that sunbeds are a risk for every skin type. People with skin type 1 and skin type 2 have double the risk of developing skin cancer than people with skin type 4. We have heard it said that rules are being put in place to force people to do something, but when we look at something which has the potential to save lives, it is more important that we provide that level of protection. I commend the Government on introducing this very important Bill.

Deputy Patrick O'Donovan

I welcome the opportunity to speak on this Bill. I am glad it is not being opposed and is being welcomed on both sides of the House.

Sunbeds are cancer-causing agents and, as with the case of tobacco, the State has a duty to act in respect of all such agents. Previous speakers noted Government action on the control of tobacco in the workplace. This legislation is another positive development which brings Ireland into line with other states both in the European Union and further afield. It also adopts the recommendations made by the World Health Organization on sunbed use, especially by children. Children are being exposed to ultraviolet radiation in an unregulated manner. When a conflict arises between individual rights and the public good, the Government must err on the side of the public good by introducing regulation.

Children of seven and eight years preparing to make their first holy communion are being exposed to ultraviolet radiation in an unregulated manner. This has the potential to cause serious short-term and long-term problems. I find it difficult to understand how a parent could expose his or her child to the possibility of developing skin cancer for the sake of appearing tanned or standing out from his or her peers in a photograph at a religious ceremony. This practice, which Deputies will be familiar with from their constituencies, is wrong and must be stopped. It is a sad reflection on society that legislation of this nature must be introduced to protect children.

In 2012, some 156 people died from melanomas and 7,000 others contracted melanomas and survived. Clearly, not all of these cancers can be ascribed to the use of sunbeds and some will have been caused by exposure to other forms of ultraviolet radiation. It is not pleasant to watch someone die from skin cancer. I speak from personal experience as my uncle died of skin cancer and secondary cancers. It is not a nice experience. Children are essentially being placed in what could be described as a microwave oven and cooked from the outside in to look good on a photograph. Government action to address this practice is long overdue. The Bill is, therefore, appropriate.

I welcome the proposal to regulate sunbed use for people aged over 18 years. If adults wish to continue to use sunbeds, so be it, but the Bill provides that they will do so in a regulated environment. As previous speakers noted, there is little point introducing legislation if it is not enforced by health authorities at local level or the Health Service Executive. The legislation must be enforced in a manner that is mindful that people make a living from sunbeds, which are a legitimate business. The position here is similar to the position in respect of cigarettes. One cannot have shops selling cigarettes to ten and 11 year old children or treat children of that age the same as 18 year olds. This is the kernel of the Bill.

We must consider the broader of issue of respecting the sun. The weather of recent days makes discussion of the sun appear irrelevant. We should contrast the programmes introduced in Australia to protect children from ultraviolet radiation from the sun with what is being done here. One of the advertisements running on television illustrates the Irish mentality in matters relating to sun. As soon as a ray of sunlight appears, everybody togs off and tries to get a good burn to ensure they have a tan. This mentality must be changed through education programmes that show people that exposure to ultraviolet radiation increases the risk of dying from a painful condition, namely, skin cancer. As was the case with the tobacco industry, we must appreciate the effects of ultraviolet radiation and exposure to the sun. We must cop on and accept that sunbeds have the potential to cause serious damage.

This is welcome if overdue legislation as it is probably being introduced too late for many people who may have been exposed to radiation from sunbeds in an unregulated environment. It is a start and I hope the Minister and his officials will make arrangements to ensure it is properly enforced.

An Leas-Cheann Comhairle

I note some Deputies did not appear at the correct time. We will sort everything out in due course.

Deputy Terence Flanagan

I welcome the Bill, which introduces measures to restrict access to sunbeds for those aged under 18 years. Sunbeds will also be prohibited in unsupervised premises. I am pleased the Government is acting on the advice of the World Health Organization that no person under the age of 18 years should be allowed to use a sunbed. Legislation prohibiting those aged under 18 years from using sunbeds is already in place in the United Kingdom and a number of other European countries.

It is a matter of concern that the sunbed industry in Ireland has been unregulated until now. This legislation will ensure greater safety for sunbed users and is, therefore, welcome. Important measures included in the Bill will control the sale of sunbeds over the Internet and require all sunbed operators to employ fully trained staff. Fines will be imposed on any premises that are found not to be in compliance with the new rules set out in the legislation. The Bill provides that the Health Service Executive will carry out site inspections. As Deputy O'Donovan stated, while it is fine to introduce regulation, the inspection regime will be crucial. Legislation is pointless unless adequate resources are provided to ensure the law is respected.

Everyone will have a family member or friend who has been affected by cancer. This is a silent killer and one of the leading causes of death. For this reason, any measure that reduces the number of people who die from cancer is welcome. Skin cancer has become the commonest cancer in Ireland and the increased use of sunbeds has without doubt contributed to the increasing number of skin cancer diagnoses. People who use sunbeds for personal and fashion reasons are placing themselves at risk.

One in ten women in Ireland will develop skin cancer and the incidence of the disease has been increasing each year. Ireland has the fourth highest skin cancer rate in Europe, with 148 people dying from the condition in 2012. This figure needs to be reduced in the same way as we reduced fatalities in road traffic accidents. People are unnecessarily putting their lives at risk and regulation is required to address the problem.

The dangers of sunbed use are being increasingly recognised. The World Health Organization reclassified sunbed use in 2009 and upgraded it from a group 2A carcinogen to a group 1 carcinogen. The amount of ultraviolet radiation to which a person is exposed on a sunbed can be up to 15 times higher than the midday sun in Spain. People are doing serious damage to their skin and bodies through exposure to deadly ultraviolet A and ultraviolet B rays on sunbeds. These rays damage skin cells and can eventually lead to skin cancer.

Statistics from the Irish Cancer Society show that people who use a sunbed only once increase their chance of contracting a melanoma by 15%. Melanoma is the most dangerous type of skin cancer and can prove fatal if not detected early. Cases of melanoma increased by 138% in Ireland between 1994 and 2010.

People who use sunbeds before they reach 30 years of age increase their chances of getting melanoma by 75%. Two thirds of sunbed users have reported to the Irish Cancer Society that they first used a sunbed when under the age of 24. Alarmingly, 7% of those interviewed first used a sunbed under the age of 15. Those who use sunbeds on a monthly basis increase their risk of getting skin cancer by more than 50% With these statistics in mind, it is shocking that up until now people under the age of 18 have been allowed to use sunbeds frequently without any element of regulation. This cohort of people are not permitted to drive until they are 17 years of age or to vote until they are 18 years of age yet they are able to use sunbeds regularly, thus greatly increasing their risk of getting skin cancer. Younger sunbed users are not fully aware of the consequences of using a sunbed and of their increased risk of getting skin cancer. It is often too late for them when they become aware of this risk.

The Bill also imposes an obligation on sunbed operators to display warning signs in their premises, and on sunbeds, regarding the risks of sunbed usage. It is important this provision is included in the legislation to ensure users are fully aware of the risks of using sunbeds. While people are more aware these days of the consequences of exposure to ultraviolet rays, there is a need for greater public awareness of the dangers of exposure to the sun and the use of sunbeds, perhaps through schools, universities and national media campaigns. Research commissioned by the Irish Cancer Society in 2010 highlights that approximately 28,000 young people under the age of 25 use sunbeds each year. It is important that this age group is properly targeted with the full facts about the danger of sunbed usage. It is important that this happens at a younger age to prevent young people from using sunbeds in the first instance. The Minister might when responding indicate if he has any plans to launch a public health information campaign in this regard.

It is vitally important that premises that operate sunbeds are regularly checked to ensure that their staff are fully trained. If used incorrectly, sunbeds can cause substantial burns on the body. Last year, the media reported on a case involving a woman in her 30s, a first-time user of sunbeds, who as a result of not being given proper advice by the salon owner in regard to sunbed usage, had used the sunbed at an unsafe power setting for an unsafe length of time and had suffered first degree burns to the majority of her body, leaving her unable to walk or sleep comfortably and having to take time off work. She was awarded damages as a result of the owner's negligence.

I am aware of the concerns of the Irish Cancer Society that people with type 1 or type 2 skin, which are the two fairest skin types, should be banned outright from using sunbeds. I believe the Minister should consider inclusion of such a provision in the Bill. As people with fair skin are more likely to develop skin cancer, this may require further consideration in the future. An estimated 794 deaths each year in the EU are as a result of skin cancer through sunbed use. The European standard in respect of sunbed usage was amended in 2009. Worryingly, a 2013 study by the University of Dundee revealed that nine out of ten sunbeds in the UK do not meet these safety standards. It is important that the tanning equipment being used in Irish tanning salons is monitored to ensure it is of a safe standard.

Another important aspect of this Bill is that it will ban sunbed operators engaging in promotional marketing practices. Sunbeds are often marketed in an appealing way, usually using photographs of male and female models posing on sunny beaches, which is misleading from a consumer perspective in that it suggests that the user will look the same as the model following usage of the sunbed. Sunbed salons often provide buy one get one free offers and other deals to entice customers to sign up for a number of sessions. Prohibition of this type of promotional marketing would help to reduce the number of users, which I would welcome.

I welcome the significant fines that will be imposed on salons found to be in breach of the regulations. I am confident that they will act as a deterrent to sunbed operators allowing under age users to avail of their services. Fines of up to €4,000 or a period of six months imprisonment will be imposed in respect of committal of a first offence. Further offences may be subject to a fine of up to €5,000 or 12 months imprisonment. These penalties, coupled with site visits by the HSE, should help to sufficiently address the issue. If not, tougher action may need to be considered, including a ban on people with fair skin using sunbeds or an outright ban on the use of sunbeds in Ireland.

Enforcement of this legislation is crucial. We all know what happened when we fell down in terms of regulation in other areas, in particular in the banking sector. I ask that the Minister confirm that this issue will be taken seriously and that following enactment of this legislation the necessary inspections will take place.

An Leas-Cheann Comhairle

As some members did not turn up at the appointed time, I will be calling Deputies in the following order: Deputy Brian Walsh, Deputy Joe O'Reilly, Deputy Kevin Humphreys and Deputy James Bannon, all of whom have five minutes each, followed by Deputy Eamon Maloney.

Deputy Brian Walsh

I welcome the opportunity to contribute briefly to the debate on this Bill. I thank the Government Whip for sharing time to facilitate my participation in this debate. This is extremely important legislation. I have no doubt it will result in lives being saved. The Minister and his officials are to be commended on the introduction of this legislation. While like Deputy Terence Flanagan I had a difference of opinion with the Minister in relation to other significant legislation, there is no such difference of opinion between us in respect of this Bill. I commend the Minister on his work not alone in this area, but in tackling the tobacco industry. I also commend the Minister of State, Deputy White, on his work in tackling the drinks industry. The legislation that will ensue from that body of work is equally as important as the legislation being discussed today.

Unfortunately, cancer is all too common in Irish society today. It is a scourge that has claimed many lives and affected so many others. In many respects, we are powerless to hinder its march. If there is anything we can do to lessen its toll, it is incumbent upon us as legislators to do so. This Bill is a step in that direction. Most skin cancer is caused by UV radiation through sun exposure and sunbed use and is, therefore, preventable. People have a choice in regard to whether to use sunbeds.

In many cases cancer is visited upon individuals without any warning or tell-tale signs. We have all had conversations on numerous occasions with friends or acquaintances in which we have heard of someone known to us who is being treated for cancer. We talk about that individual and say he was the last person we would ever expect to be treated for cancer because he lived a healthy lifestyle, did not smoke or drink, took exercise and led an active lifestyle. Such people do not have a choice and this disease is visited upon them without any warning. However, that is not the case with skin cancer. The choices we make can greatly reduce our vulnerability to this form of cancer.

All Deputies and Senators get a good deal of documentation from various bodies. I have before me one document which I received last year from the Irish Cancer Society. The statistics contained in the documentation are frightening and I will highlight some of them. The average risk of skin cancer from sunbed use is more than double that of spending the same length of time in the midday Mediterranean sun. Young people are particularly at risk when they use sunbeds. People who start using sunbeds before the age of 30 have a 75% increased risk of malignant melanoma, the most serious form of skin cancer. In 2012, the Irish Cancer Society carried out a secret shopper survey. It found that seven out of seven tanning shops surveyed would let a fair-skinned child use a sunbed without any warning or advice. Sunbeds are ranked in the highest cancer risk category and are rated as being as carcinogenic as tobacco and plutonium. Skin cancer is the commonest cancer in Ireland. In 2010, almost 9,500 people were diagnosed with skin cancer. Of these, 896 were diagnosed with melanoma, the most serious form of skin cancer. There were 148 deaths from skin cancer in Ireland in 2012. The incidence of melanoma rose dramatically by 130% between 1994 and 2010. These are some of the statistics the Irish Cancer Society has brought to our attention in recent months and they highlight the need for this legislation, which I welcome and enthusiastically support. I am pleased to see it is not being opposed by the Opposition.

Deputy Kevin Humphreys

I thank the Leas-Cheann Comhairle for facilitating my participation in the debate. It struck me when Deputy Flanagan was making his contribution that the area of buy one, get one free was a problem. At the time the Visitors Gallery was full of young ladies. Often, this is the very market that is exploited on the basis that sunbeds will enhance their good looks. Sunbed operators sell a product, wrongly, to convince, for the most part, young women to go under sunbed treatment. It is a treatment. This involves burning their skin to change its colour. In theory it makes them better looking and feel better about themselves, etc. It is all part of a marketing ploy.

I was pleased to see various school classes in the Visitors Gallery as the debate got under way. They were for the most part made up of young women. They were listening to the debate and they heard the seriousness of it. Certainly, when I was their age I never thought about cancer or its serious effects. Every family has been touched by the horrible C word. I am referring to when the investigation has been carried out, the medical personnel arrive, the curtain is pulled back and the person is told he has cancer. Unfortunately, I was one of those people many years ago. I was told at short notice I had cancer and had to undergo surgery. It is somewhat ironic in many ways that Professor Crown entered the Seanad at the same time I entered the Dáil. He was my doctor and treated me throughout eight months of chemotherapy, successfully, as everyone can see at the moment.

Deputy Eamonn Maloney

He saved Deputy Humphreys.

Deputy Kevin Humphreys

However, not all families come through that. Often, when a person is going through treatment he does not necessarily think of the effects on a wider circle. The process immediately affects a man's wife, children, mother, brothers and sisters. This is what is being sold, mainly to young ladies in their early 20s. They come in and get under the sunbeds. They put their skin into an oven, a little like a chicken, and get it burned. Ten or 15 years later they get diagnosed with cancer. Is it really worth it? Is it really worth having a little brown skin or looking well at their debutante ball or wedding day but possibly not live to see their children grow up?

Melanoma cancer, as the Irish Cancer Society continuously points out, is a killer. Using sunbeds amounts to playing Russian roulette. The odds are stacked against Irish people because we have fairer skin and we are more prone to skin cancer. Other Deputies have read the statistics. They are the cold figures. Irish people are more likely to get skin cancer than people from many other European countries. That is a fact and that is why I welcome the Bill.

I have no wish for other families to go through what my family went through. I have no wish to see any woman become ill because she wanted to have a lovely colour on her debs day or wedding day. Is fashion that important? The more we speak about it, the better. The purpose of the Bill is to control and regulate sunbeds, but more important is the discussion to highlight the impact the problem has on our families and friends. We could go to the hospital in Elm Park and talk to anyone there about it. When I was going through my treatment, there was a woman from Carlow with three young children. The effects are felt ten or 15 years after the people being treated used sunbeds. If they had been warned or if the regulation we are proposing now had been in place at the time, many lives could have been saved. We have a responsibility not only to bring through regulation and legislation but to discuss the dangers openly and ensure safeguards are put in place such that in the middle of a young man's or young woman's life, when their families are young, they need not go through the traumatic experience of chemotherapy and surgery. I thank the Leas-Cheann Comhairle for the time and opportunity to debate the matter today.

Deputy Joe O'Reilly

I welcome the move to professionalise further the sale and hire of sunbeds. I commend the Government, specifically the Minister for Health, Deputy Reilly, and the Minister of State, Deputy White, on their efforts to ensure the members of the public who avail of these services not only use them in a safe environment under professional supervision but understand the dangers associated with their use as well.

Most people in Ireland are exposed to ultraviolet radiation from daily exposure to the sun. However, some people expose themselves to high doses artificially through the use of sunbeds and sunlamps. For many, this type of exposure is a deliberate lifestyle choice, often made without prior knowledge of the serious risks it carries. In 2006, a review by the European Commission Scientific Committee on Consumer Products concluded that there is strong evidence to suggest exposure to sunbeds increases the risk of cancer of the eye, also known as ocular melanoma. In 2009, the International Agency for Research on Cancer classified sunbed use as a known carcinogenic closely linked to the development of skin cancer.

In the same year, the Office of the Chief Medical Officer conducted a review which highlighted that sunbed users aged under 30 were at a 75% higher risk of developing skin cancer. It is even more concerning that using a sunbed without ever burning appears to be no safer. That can increase the risk of malignant melanoma and early onset BCC diagnosed in people aged under 40 by more than 60%, according to the Yale School of Public Health.

The operators of these services are not obliged to provide adequate eye care to their customers nor are they obliged to inform the customer of the potential dangers that may arise due to the use of these services. This is a cause of concern and it is one of the main reasons I am relieved that this legislation is finally going through the House. Sections 6, 7 and 15 address these concerns by ensuring not only will customers be provided with approved eye protection but there will also be an obligation on the owner or employee to ensure the customer receives the correct information and is fully informed. Section 6 ensures people can only use beds under supervision while section 8 ensures proper hygiene. The legislation also ensures there will be no offer of free use as an attractive carrot and no promise of health benefits, which would be bizarre.

Section 14 provides that the Minister shall prescribe training leading to a qualification in the safe use of sunbeds to be recognised under the National Framework of Qualifications. This will ensure qualified persons are available to operate and maintain these services safely and to also act as a point of information regarding concerns customers may have. In light of the fact that in my own constituency Cavan Institute of Further Studies runs a wide range of excellent beauty therapy courses, will the Minister indicate the timeframe for the introduction of these training courses? My local college, along with other PLCs, would be excellent venues for the provision of such courses.

Section 13 provides for the introduction of fees to cover investigation costs and costs associated with the enforcement of the Act. A list of non-compliant businesses will be maintained. All the evidence suggests something needs to be done in this regard. It is bizarre that youngsters aged under 18 can use these facilities and I am delighted the legislation bans them from doing so and ensures they will have to furnish identification if there is a doubt about their age. Under 18s will also be prevented from hiring or buying sunbeds. Nothing exemplified more the tragic way our society evolved during the Celtic tiger years than youngsters using sunbeds prior to making their first communion or confirmation. It was a travesty and it is great that the legislation will prevent this happening in future.

I welcome this Bill as part of a suite of legislation that will create a healthier Ireland. Legislation to ban tobacco and introduce plain packaging for tobacco products and to ensure the moderate use of alcohol are on the way. We need to adopt a new attitude culturally to the use of alcohol. It is important that we not only order society from an economic perspective and get our people working but that we also create the proper health conditions to ensure a better quality of life for people and a healthier society. This is a significant step in that direction.

Deputy James Bannon

I am pleased to have an opportunity to contribute to the debate. I commend the Minister on bringing this important, life-saving legislation before the House. No one in this country has not in some way or another been affected by cancer, whether in his or her own home as he or she witnessed the downward spiral of a family member or through the death of a loved one.

Cancer treatment is a significant challenge to our health services. It is a major cause of death in Ireland with 28,000 people diagnosed with the illness each year. That number has increased annually over the past ten years. Improving cancer care support services for patients is a priority for the Government. It has been accused of tiptoeing around the problem, which is not the case, as we have appointed additional consultants specialising in cancer care since coming into office. More people are treated for cancer in our hospitals now compared to ten years ago. We are all aware of links between some forms of skin cancer and the use of sunbeds, especially among younger people with fair skin, and that is the major reason this important Bill to control the use of sunbeds is before us.

Doctors and consultants throughout the country are concerned that sunbeds are overused by children. Previous speakers referred to this and it was a particular phenomenon during the Celtic tiger era. This legislation brings into focus the Government position on an effective approach to sunbed misuse. A total of 9,450 people were diagnosed with skin cancer in Ireland in 2010, of whom 896 people were diagnosed with melanoma, the most serious form of this cancer. There is a 75% increase in the risk of developing melanoma when sunbed use begins before the age of 25. Alarming research by the Irish Cancer Society found that up to 28,000 young people under the age of 25 use sunbeds each year. Without adequate legislation to regulate the use of sunbeds, they could be putting their health at risk in search of a golden tan.

In our programme for Government we are committed to regulating the use of sunbeds. Last year I called on the Minister to bring forward the necessary legislation in order that people, young and old, would be aware of the dangers of over use or over exposure from this type of tanning method. I very much welcome this Bill. Proper regulation of this sector will at least help prevent further cases of skin cancer developing in the future. There is a need for the development of appropriate health education strategies at community, family and individual levels, which require the use of appropriate education methods. The legislation recognises that there are many approaches to the education surrounding sunbed misuse. Research has proved that sunbeds are as dangerous as tobacco or plutonium in causing cancer.

Aside from blocking parlours from admitting anyone under age, the Bill will seek to control the sale and hire of sunbeds, introduce enforcement and ensure staff members receive training. I welcome these restrictions but I believe the legislation should have prohibited people with certain skin types from using sunbeds. There were three children in my family and all of us were red heads while my mother was fair skinned. She always ensured we were not exposed to the sun and she always covered our heads when we attended sports events and so on. Thankfully, we are all still healthy as a result. The Bill should prohibit people with type I and type II skin from using sunbeds, as most people in Ireland have these skin types. Given the evidence that the use of sunbeds poses a major cancer risk, the Bill provides for many controls and I very much welcome that.

I compliment the Minister, his officials and all of those who were involved in drafting this legislation, which is important in the context of the health and safety of the public.

An Leas-Cheann Comhairle

I call Deputy Maloney. Does the Deputy wish to avail of five or ten minutes for his contribution?

Deputy Eamonn Maloney

I will need fewer than five minutes. The Leas-Cheann Comhairle can distribute my additional time. I am sure someone will avail of it.

Deputy Bernard J. Durkan

We will encourage the Deputy to use all of his time.

Deputy Eamonn Maloney

There is no need for that.

I thank the Department of Health and the relevant Ministers for bringing forward this legislation. The health issue with which it deals is extremely important. The evidence for the relationship between sunbeds and skin cancer is indisputable. Previous speakers went into great detail in describing that relationship. There is no argument which can be used in defence of the use of sunbeds. The legislation focuses on people under a particular age. Sunbeds are bad for young people but they are also bad for those who are not so young. The only distinction which can be made between the two is on the basis of age. Some very good research has been carried out internationally and here in Ireland in respect of the relationship between cancer and sunbeds and all of it shows that using sunbeds is bad for people, both young and old.

I only have one reservation about the Bill. I understand the Minister's comment to the effect that the use of sunbeds must be regulated. There is ample evidence which shows that self-regulation has not worked. Previous speakers referred to deals where people can buy one sunbed session and get another free. Deputy O'Reilly was right to mention the huge expansion in the number of sunbed operators during the Celtic tiger era. To use that awful phrase, "They have not gone away, you know". What sunbed operators have done is reduced their prices and introduced the two-for-one deals to which I refer. If one avails of such offers, one will die more quickly. The more often one uses a sunbed, the more likely one is to develop cancer.

I have already informed the Minister, Deputy Reilly, of my reservation in respect of the Bill. My mind has not changed since I spoke to him so I take this opportunity to formally place that reservation on the record of the House. My reservation relates to the fact that the Bill does not go far enough. There should be an outright ban on the commercial operators of sunbeds. I have yet to hear anyone in this House argue in defence of commercial sunbed operators. On Sunday last the authorities in the Australian state of Queensland very bravely decided to introduce an outright ban on such operators. Those involved will only be compensated to the tune of $1,000 or $2,000. If one visits the state of Queensland after 31 December, one will not be able to find commercial operators offering the use of sunbeds. As already stated, Ireland should follow suit and opt for an outright ban. I hope the Minister of State, Deputy Costello, will restate my view on this matter to the Minister. We have an opportunity to introduce an outright ban in respect of this very important health issue. Let us vote to ban sunbeds altogether.

Deputy Dan Neville

I welcome the opportunity to contribute to the debate on this Bill. The Irish Cancer Society has welcomed the Bill but it also expressed concerns to the effect that it does not go far enough. Under the Bill, the operators of sunbed premises will be prohibited from allowing anyone under 18 years of age to use their facilities. The use of sunbeds on unsupervised premises will also be prohibited. In addition, operators will be required to make users fully aware of the risks involved and all sunbed operators will be obliged to put in place warning signs on their premises. As already stated, however, the Irish Cancer Society is concerned that the Bill does not go far enough and does not prohibit, as is the case in other countries, particularly parts of Australia, people with type 1 and type 2 skin - the fairest types - from using sunbeds.

Skin cancer is the most common cause of cancer in Ireland. Some 9,450 Irish people were diagnosed with skin cancer in 2010 and, of these, 896 cases were melanoma, the most deadly form of skin cancer. A total 158 people died as a result of skin cancer in 2011. The incidence of melanoma in Ireland increased by 137% in Ireland from 1994 to 2010. Nine out of ten cases of skin cancer are caused by exposure to ultraviolet rays, from both the sun and sunbeds. Skin cancers can be prevented. Reducing exposure to ultraviolet rays in turn reduces the risk of developing cancer. There is clear evidence of a link between sunbeds and skin cancer. Sunbeds were placed in the highest cancer risk category by the International Agency for Research on Cancer in 2009, which rates them as being as carcinogenic as tobacco and plutonium. Sunbeds have been linked to a variety of adverse health conditions including eye damage, photodermatosis, photosensitivity, premature skin aging and skin cancer.

The incidence of cancer is increasing worldwide and the number of melanoma cases in Ireland has increased by over 66% in the past ten years. According to the most recent data available, there were 8,145 new cases of skin cases in 2009.women Young people are particularly at risk of melanoma as there is a 75% increased risk of developing melanoma when sunbed use begins before the age of 30. Sunbed use among young people is a big problem in Ireland. Research conducted by the Society found that approximately 28,000 young people under the age of 25 are using sunbeds in Ireland each year. Two thirds of sunbed users began using sunbeds when they were under 25. The incidence of all types of cancer increased dramatically - by almost 75% - between 1997 and 2007. Research commissioned by the Irish Cancer Society and published in June 2010 shows that 140,000 people in Ireland use sunbeds on a regular basis, that 88% of those who use sunbeds are women and that 20% of the latter are between the ages of 15 and 24. Sunbed use is increasing and tanning devices are more powerful than was the case a decade ago. Research published in 2009 by the International Agency for Research on Cancer indicated that there is a 75% increase in the risk of contracting melanoma among people who begin tanning regularly before the age of 30.

Any individual can set up a tanning salon and there are no regulatory restrictions on the type of equipment that can be purchased. Young people are particularly at risk when they use sunbeds because, as already stated, there is a 75% increase in the risk of contracting malignant melanoma - the most serious form of skin cancer - among those who begin tanning regularly before they reach 30. Both the Irish Cancer Society and the World Health Organisation advise that those under 18 years of age should not use sunbeds because of the increased risk they run of developing skin cancer. However, this message does not appear to be getting through and large numbers of children are using sunbeds.

Research conducted by the Irish Cancer Society in April 2010 indicates that 28,000 young people under the age of 25 in Ireland use sunbeds each year. That research also highlights the fact that the majority of children who use sunbeds do so once a week. I welcome the Bill and the debate on it, which has been very positive.

Deputy Bernard J. Durkan

I am pleased to have an opportunity to speak on Second Stage of this important legislation. As can be seen, I am not a regular patron of sunbed salons. However, the danger of over-exposure to ultraviolet radiation either from the sun or from sunbeds has been brought to my attention. I refer to the important points made by earlier speakers. We need to identify the full extent of the danger and this process has been happening over the past years. Sadly, the Bill has been pending for a long time but the matter has come to the fore and we must attempt to deal with this health legislation as quickly as possible.

We must be responsive to concerns about health. Members of the public have concerns and they need to be reassured in particular with regard to carcinogens. It may be necessary to expand this legislation in the future or to include in it other similar threats to the health and well-being of our people. Smoking and excessive alcohol consumption have long been identified as being detrimental to public health and creating a significant burden on the Exchequer not only in this country, but across the globe. The extent to which that can be alleviated by legislation should be considered.

I believe the use from an early age of sunbeds or over-exposure to direct sunlight will have serious consequences for the children at the time but also further down the line as they grow older. It is at that stage in middle age that some of the excesses and over-exposure to such threats become more obvious but by then it is too late, unfortunately. In many cases, young children are unnecessarily exposed to ultraviolet rays either by the use of sunbeds or by over-exposure to direct sunlight in order to get a healthy look and to get a better tan and to stand out in a crowd. I am told sunbed use is not necessary as one can buy a bottle of paint in a chemist's shop to do the same job. Purists will say that this is a fake tan and people in this country are very suspicious of anything fake. However, it is far better to err on the side of safety and take a chance on being ridiculed for using a fake tan. Some cosmetics are also deemed to have been carcinogenic and there have been changes in that area. I would like to know the extent to which carcinogenic substances have been eliminated from our lives, from cosmetics, exposure to sunbeds or from other products.

On a related issue, irradiation of food products is commonly accepted. Food products will not last on a shelf for three weeks without some treatment and this is irradiation. This treatment has been deemed to be safe and sufficient and I presume it is safe. However, to what extent is that tested regularly? Testing is applied to products used by the farming sector on the basis that they may have a negative ecological impact or have carcinogenic concerns.

Many years ago I promoted the establishment of the national cancer register and I have tabled many parliamentary questions to the relevant Ministers in an effort to identify the causes, the incidence and the most prevalent cancers. We still have not succeeded in identifying the many various contributory causes in every region in order to decide that certain behaviours or practices may be to blame. We need to identify the extent to which cancer-causing practices, substances or devices are in use in society. This, in turn, will have a significant impact on the level of expenditure required by the health services.

This legislation is timely although it may be too narrow in its scope in that it only deals with the use of sunbeds. The time has come to examine the menu of substances that are alleged to be carcinogenic in order to determine whether they are carcinogenic. We should be knowledgeable in order to debate such subject matter. We should dispense with myth and clarify the issues.

Deputy Bannon referred to people with fairer skin. My skin was not always the same colour as it is now. A large number of people are very sensitive to ultraviolet rays which can be very damaging to their lifelong health. Many substances, cosmetic procedures and applications can be detrimental to health. The cost to the Exchequer of dealing with the effects of these products can be measured.

Any discussion of radiation should include electronic pulse radiation and electromagnetic radiation. We should become more conversant with the full extent to which these issues affect our daily lives. For example, experts contribute readily to any argument. We need to examine the issues and the arguments for and against in an effort to determine the precise effect such issues may have on the health of the people both here and globally.

We need to be forewarned. We live in a world that readily accuses institutions, governments and communities of failure to warn people in advance. It is one thing to fail to warn people when the information is available; failure to warn people in advance when the information is not available, but in some cases should be available, is another issue.

That is something which perhaps should be considered in the context of this legislation.

We need to educate our children through the education system. It is of critical importance that children get the message about the negatives of having a nice colour if it is achieved through exposure to ultraviolet rays, whether through prolonged exposure to direct sunlight or a sunbed. We must remember that people with different skin colours react to such treatment. Some can withstand it while others cannot and have a very serious reaction. We need to know more about the long-term effects, whether permanent or temporary, of exposure for people with various skin pigmentations. We need to be informed on a regular basis of the wider implications and to point out if there are alternatives. The Leas-Cheann Comhairle will know I would not resort to fake tan but if it has the same result and if it is harmless, why not use it in preference to something which can be very harmful and have a prolonged effect on the life and well-being of the child or even the adult?

The Bill is important and the Minister should look at extending this kind of legislation to a wider number of services and products which may have a detrimental effect on the lives of our children and on adults and at whether it would be possible to draw up a list of areas at which we should look more carefully to try to prevent the problems that might occur in years to come rather than attempting to deal with them when they become a reality.

Deputy Olivia Mitchell

I am very happy to have the opportunity to speak on this legislation, which I support. It has four main planks. The first and second planks are broadly the ban on salon sunbed use for children under 18 years of age and the prohibition on the sale and hire of sunbeds to children under 18 years of age. The third plank is mainly about regulation, registration, supervision, improved standards and inspection, which is very important in terms of ensuring eye protection is provided and so on. The fourth plank is about a health information campaign.

Of these four planks, the fourth is the most important because the key here is to change attitudes. By changing attitudes, we will change behaviour. It is not easy to change the attitudes of a nation and there is no doubt but that it will be a slow process. However, an ongoing campaign of substantiated and accurate information will, ultimately, inform attitudes and alter behaviour. If that did not work, companies would not spend millions of euro on advertising, so it will work.

Over the past number of years, attitudes have already changed as information about the science behind these machines has become more widespread. Usage has dropped by almost a half over the past ten years, although I am not sure to what extent that is due to economic circumstances in Ireland. Nevertheless, there is more information available about sunbeds.

What I find most disturbing is the fact we need this legislation at all. I am amazed there are people who are so uninformed that they would expose their children to sunbeds. It is hard to believe the information about the potential damage caused by sunbeds and crucially the particular vulnerability of children to damage by sunbeds has not filtered down to the general population, in particular to parents.

Ongoing dissemination of accurate information and regular information campaigns are crucial if we are change behaviour and ensure people make informed decisions in their homes because not all sunbeds are in spas, hotels or salons. If there is a problem with the legislation, it is that it does not, or probably cannot, control or ban home usage. Statistics in this whole area are very hard to come by. I know the Irish Cancer Society said 140,000 people in Ireland use sunbeds regularly but I am not sure how it knows that. It may be of that order but accurate information is very difficult to come by.

It is accepted that we do not know how many premises hire out these facilities and how many are providing these facilities in salons, gyms, spas and hotels. We certainly do not have a clue how many of these products are in people's homes. Whatever about sunbeds, the single lamps are relatively cheap and it would be fairly reasonable to assume there are probably quite of lot of them in people's homes, certainly more than in the commercial setting.

At least in the commercial setting, there is the possibility of some professional advice and supervision and there is someone to prevent people from staying on sunbeds long enough to burn themselves. However, in the home there is absolutely no such outside controls and no one to ensure there is not overly long exposure, one uses eye protection and children under 18 years of age or, indeed, under ten years of age do not have access to sunbeds. As long as ultraviolet lamps are available to buy on the Internet or elsewhere and people have them in their homes, the vast majority of sunbed use will remain largely outside the scope of this legislation, a point which others have made. I suppose it has to stay outside the scope of this legislation because even if we thought it desirable to legislate for what happens in private homes, it would be impossible to enforce it.

If we want to achieve a situation where there is a real reduction in the number of people exposing themselves or their families to what the World Health Organization gives the status of a group 1 carcinogen and to do what the Minister said is the purpose of this legislation which is to reduce the incidence of skin cancer which seems to be heading towards high numbers, the only way to do so is by persuasive information about the potentially damaging effects on children and the particularly damaging effects it has on certain skin types. Although it is not covered by this legislation, it should be because the skin type which is most prevalent in Ireland - the real Celtic skin - is particularly vulnerable to damage from ultraviolet rays.

The information campaign is the most important aspect of the legislation because it will have a society-wide impact whereas the legislative ban will only touch the tip of the iceberg. I do not think there is any doubt among the experts and most of us in this House that ultraviolet rays are carcinogenic and that they cause skin cancer. The word "cancer" puts such fear in people's hearts but the timelag between exposure to a lamp and the development of cancer cells could be 20, 30 or 40 years, or even longer and somewhere in between, the message is lost. If such a campaign is to work, we need to have a lot more information about attitudes, what causes the attitudes we have to tanning, what is the motivation behind them and why it is more prevalent among young women. The most common usage is between 15 and 34 years of age.

In our society, we talk about a healthy tan and associate a sense of well-being with having a tan. On the other hand, we talk about people being pale and miserable. It seems that we have a positive image of the whole process of tanning. If we really want to change attitudes to tanning, we need to learn more about the psychology of our attitudes. People in Victorian times had a completely different view. A pale face was regarded as a thing of beauty. Any sign of a freckle or a tan was a sign of something highly undesirable and was associated with poverty. We need to change attitudes so that we return to that point. I know some research has been done on attitudes, but we need to know much more. One cannot change an attitude if one does not know what causes it.

Despite the limited application of the proposed legislative ban, I believe it is worthwhile. This Bill will require the registration of premises which provide the commercial setting for tanning activities. It will also ensure certain standards are met. I am sure that many premises are already meeting these standards and equally that some are not. I have heard of gyms that have coin-operated tanning beds in their changing rooms which can be used entirely without supervision. Nobody would know someone was in there. Information is not necessarily provided in such circumstances. The length of time for which people use such machines is not controlled as there is no way of knowing the machines are being used.

I will give an example of an even less regulated environment. I have heard of women buying tanning machines to run mini-businesses in their own homes. They charge their friends and neighbours for the use of sunbeds. It is hard to see what training these operators might have. Basically, they are just ordinary women who see a business opportunity. They have no training, really. They are not able to provide any proper supervision to protect against misuse. While it will be a challenge for the HSE authorities to inspect sunbed facilities that are provided in private homes, it will be important for them to do so. The inspection process should not concentrate solely on those who run spas and salons. They are an easy target because they advertise their businesses. Many of the publicly available and highly advertised sunbed businesses are already operating to the standards that will be required of them.

I will add some balance to this debate by pointing out that we need some sunlight and sunshine. Those with dark-pigmented skin might need more than the rest of us. We all need vitamin D to ensure calcium absorption. There are reports of children of good, careful and conscientious parents in the developed world showing signs of rickets, which is often regarded as a disease of the past and associated with poverty. These children might lack vitamin D because they have been exclusively breastfed. If they are smothered in factor 50 suncream, they might never get a ray of sun on their skin. This problem is caused by parents who listen to medical advice but bring it to such an extreme that it ultimately damages their children. The lesson is that campaigns should be balanced, moderate and comprehensive. Parents should be given an idea of the dangers of sunbeds and sunburn and the need for minimal exposure to natural sunlight. We have been waiting a long time for this legislation. I am delighted to support it.

Minister for Health (Deputy James Reilly)

I was going to say I am a lonely man as I gaze across this Chamber without seeing another soul in it.

Deputy Olivia Mitchell

We are here.

Deputy Joe Costello

We are behind the Minister.

Deputy James Reilly

I am well covered from behind, but there is nobody in front.

Deputy Olivia Mitchell

We are always here for the Minister.

Deputy James Reilly

Skin cancer is the most common type of cancer in Ireland. It represents a major public health challenge in both the short and long terms. For most people, the main source of exposure to ultraviolet radiation is the sun. However, there is clear evidence that some people are exposed to high doses of ultraviolet radiation through artificial sources. Sunbeds and sunlamps used for tanning purposes are the main sources of deliberate exposure to artificial ultraviolet radiation. As we know, all forms of such radiation contribute to skin cancer. We cannot ignore the frightening figures and projections provided by the National Cancer Registry. I will repeat those figures for anyone who might think this proposed legislation is frivolous or indicative of a nanny state approach. There are over 850 new cases of melanoma in Ireland each year. Over 150 Irish people die each year from melanoma. There were over 7,000 people alive with this type of cancer in 2011.

Data from the HSE indicate that the cost of treating skin cancer ranges from €6,000 to €10,000 per patient, depending on the complexity of the disease. New high oncology drugs, such as ipilimumab, have become available recently. This treatment is effective in a number of cases but is extremely expensive. It costs between €50,000 and €80,000 to treat each patient with this drug. Between 60 and 80 patients present with such advanced melanomas each year. The incidence of cancer in Ireland is expected to double by 2040. The fastest growing number of cancers are expected to be skin cancers. These are not mere statistics. Behind each of these numbers, people are fighting painful and debilitating cancers. Many of them are winning that fight, but far too many of them are losing. The impact of these cancers on individuals and their families cannot be underestimated. The long-term treatment and its cost on individuals, families and the health system are significant. The sad reality is that we know this disease is totally avoidable. As I have already said, this is a true case of prevention being better than a cure that is sometimes very painful.

We must legislate now to put measures in place to protect our children and allow adults to make better informed choices. We must do all we can to discourage the use of sunbeds and encourage a healthier attitude to protecting ourselves and our children from ultraviolet radiation. Research and recommendations from the World Health Organization, the International Agency for Research on Cancer, the national cancer control programme and the chief medical officer have pointed to the abundant evidence in support of public health measures to regulate the use of sunbeds. Legislative action is required and justified to protect the public, particularly children and young people, from the risk of skin damage and the increased risk of developing skin cancer and to promote a greater public awareness across all age groups of the dangers of developing skin cancer, premature ageing and eye damage from exposure to ultraviolet radiation. I am convinced that this Bill will contribute to a reduction in the incidence of skin cancers in the long term. It is a comprehensive response to a serious public health issue. The Government's key objective in the Bill is to protect young people. Therefore, we propose to make it an offence to sell or hire a sunbed to a person under the age of 18, or to allow such a person to use a sunbed on a sunbed premises. I have taken note of the interventions in this House. I will ensure the measures aimed at the protection of children set out in this Bill will be commenced and implemented as a priority.

I wish to take this opportunity to call on parents to act responsibly when it comes to permitting or encouraging their children to use sunbeds. Parents may think that they are doing something positive in allowing their children to use a sunbed, but in fact they are risking their children's health. Parents must act responsibly to protect their children. There is no justifiable reason to allow the use of sunbeds by children under 18 years of age. Many Deputies have referred to the need to raise awareness about the health risks associated with sunbed use. We have taken this issue seriously in the Bill. To ensure adults who are considering the use of sunbeds fully understand the implications and risks associated with sunbed use, we will require sunbed businesses to display warning signs on the sunbed premises and on any social media used for advertising sunbeds. In addition, the operator of a sunbed business will be required to provide information to potential sunbed users on the dangers of sunbed use, including the risk of skin and eye cancer. This information will be set out in a specified form.

The operator will be required to ensure the client has the opportunity to read and consider the information, and has signed the form confirming he or she has done so before being allowed to use a sunbed.

Concerns have been raised during this debate regarding claims that sunbeds can in some way be good for people or can help with certain conditions such as acne. We know from all the scientific evidence that any claimed benefit for sunbed use is far outweighed by the risks. Where a patient is in need of phototherapy, the Bill provides a clear exemption for such therapy under the supervision of a relevant medical practitioner. Therefore, to avoid industry presenting confusing messages and making health claims for sunbed use, we will prohibit the use of health claims unless such claims are prescribed in regulations. We will also prohibit certain marketing practices aimed at incentivising people to use sunbeds more than they may have originally intended. There will also be a requirement that sunbed use on sunbed premises be supervised.

Through the Bill and the wider Healthy Ireland agenda, we will create awareness of the dangers of using sunbeds. We will promote healthy lifestyle choices among the public by building on this legislation and by supporting and monitoring collaboration between areas such as primary care, hospitals, cancer screening and clinical programmes.

I note the concerns raised by Deputies with regard to the quality of protective eyewear. The Bill requires that such eyewear should comply with the relevant harmonised EU standards.

A question was raised as to why we would require recognised training for those supervising sunbed use. We know that despite all the warnings and information campaigns around cancer risks, some people will continue to insist on using sunbeds. We need to ensure these people are fully aware of the risks, are properly supervised in the use of sunbeds, and that their use of sunbeds takes place in as hygienic an environment as possible. To this end we have, in line with many other jurisdictions, provided for the training of those who will supervise sunbed use.

I have been asked why we would not provide for a prohibition on sunbed use based on skin type. People with skin types 1 and 2 are melano-compromised and the World Health Organization recommends they do not use sunbeds. I strongly agree with this advice. The chief medical officer has suggested that those sections of the adult population at increased risk from ultraviolet radiation could be dealt with by way of regulation rather than prohibition. The HSE national cancer control programme has confirmed a similar viewpoint. The Department of Justice and Equality has advised that a prohibition based on skin type may be incompatible with equality legislation. Recognising the risks and legal complexities, we have taken the decision to deal with this issue by ensuring any adult wishing to use a sunbed is fully informed of the risks and is given appropriate advice to enable him or her to make informed choices.

I was also asked whether consideration was given to the provision of a complete ban on sunbeds in commercial premises. Having reviewed a number of options, it was considered that such a ban would be ineffective for the following reasons. It would simply move sunbed use from commercial premises, which will be regulated, underground to domestic premises where sunbed use would be much more difficult to supervise if it could be done at all. We could not, for example, be assured that warning signs would be in place or that the relevant information on health risks would be available to potential users of sunbeds as well as making it more difficult to protect children. Such an approach would be markedly different from the approach to similarly harmful items, for example, tobacco. It is possible that such a ban would be challenged on EU Internal Market and anti-competitive grounds. Industry might seek compensation through the courts for loss of livelihood. For these reasons it was decided that an outright ban on the use of sunbeds in commercial premises was not appropriate at this time.

I concur with the Deputies who highlighted the need for effective enforcement of this important legislation. I have no intention of passing the Bill for it merely to be left on the shelf. The environmental health service will be responsible for compliance building and enforcement. Environmental health officers, EHOs, have a proven track record in the enforcement of a broad range of environmental health legislation. They play a lead role in the enforcement of food safety and tobacco control legislation. As Deputies will be aware, over the past ten years since the introduction of the smoke-free legislation, EHOs have actively engaged in building compliance. When such efforts have been exhausted, the EHOs have been instrumental in initiating legal proceedings and defending the legislation in the courts. The significance of enforcement is reflected in the consistently high compliance rates of above 90% for smoke-free legislation.

Last November, in preparation for the introduction of this legislation, my Department established a national implementation group with the HSE and the Environmental Health Association of Ireland. This group will work with us in the development of comprehensive information and guidance to facilitate compliance by industry and to inform consumers of the new legislative requirements to protect their health and well-being.

I have listened to the concerns raised regarding the proposed level of penalties. I fully understand and agree with the sentiments expressed. This is why the proposed penalty rates are so significant while still being proportionate. The maximum rate for a first offence will be €4,000 rising to €5,000 for subsequent offences. It will also be possible to commit offenders to prison. These penalties are, as has been noted elsewhere, far higher than the penalties imposed for the sale of alcohol to minors. Given the medical evidence available to us and the worrying trends facing us, it is essential that we act now. I thank all Members of the House for their contributions and I look forward to the Bill being further considered on Committee Stage. I again thank the Deputies opposite for their support.

Question put and agreed to.

Dáil Éireann díospóireacht - Thursday, 13 Feb 2014

Public Health (Sunbeds) Bill 2013: Second Stage (Resumed)

Dáil Éireann díospóireacht -
Thursday, 13 Feb 2014