Sun Exposure as a Determinant of Health

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Is lack of sun exposure a determinant of your health? According to increasing evidence, the answer is yes.

What exactly is a determinant of health? Determinants of health are the behavioral, social and environmental factors that influence our health status. They include the following factors.

• Living wages

• Access to quality education

• Access to healthy food

• Exposure to crime and violence

• Poverty

• Weather

• Transportation options

• Exposure to toxic substances

• Substandard housing

These are all examples of determinants of health. Recently, more and more people acknowledge that racism and discrimination are also significant determinants of our health.

These combined factors determine individual and population level health. In fact, only 10% - 20% of your individual health is actually determined by health or medical care. The other 80% - 90% is determined by the social, environmental, and behavioral determinants of health.

Increasing evidence confirms that sunshine, specifically sensible sun exposure, is indeed a determinant of health. Sun exposure may actually play a role in reducing health disparities.

Let’s explore why sun exposure is a determinant of health, and how sun exposure prevents or improves health conditions including depression, cancer, and diabetes.

We've all heard the warnings: “Sun exposure causes skin cancer, sunburn, and premature aging.” However, these warnings are mostly for White Americans. According to the American Cancer Society, melanoma is the most serious type of skin cancer and is 20 times more common in White Americans than in Black Americans.

Sun exposure has been used as therapy throughout history and across cultures for the past 50 years. Although, scientists have discouraged sun exposure primarily due to potential skin cancer risks for people with White skin.

These messages have caused widespread paranoia about sun exposure and fear of developing skin cancer in White and Black Americans. Of course we all want to avoid cancer, but as one scientist put it, “Just as vegetation is dependent on the sun's rays for sustenance, sunlight is also a major determinant of human health.” Let’s discuss what makes sunshine a behavioral, environmental, and social determinant of health.

Sunshine as a Behavioral Determinant of Health

Sun exposure is a known behavioral determinant of health. Behavioral determinants encompass the choices people make in their lives that impact their health status. These include: smoking, sexual activity, exercise, eating practices, and sun exposure. Our behavioral choices are impacted by a wide variety of factors: social environment, friends, families, and public health guidance.

Back in 2011, famous chef Nigella Lawson went to an Australian beach in a black swimsuit covering her from head to toe. The media called it a “burkini swimsuit” and asked why she wore it. She stated that she made the choice to avoid the sun. This is an example of a behavioral determinant of health in action.

Public health guidance for the past few decades has encouraged Americans to avoid the sun in order to avoid skin cancer. This guidance has been universally applied to Black Americans, as well as White Americans. That’s why it's not surprising to see people of all races slathered in sunscreen and fully covered when out in the sun.

Every action has a reaction. Due to sun avoidance guidance, we've also seen an increase in vitamin D insufficiency. 70% of Americans are vitamin D deficient, including 62% of the White population and 95% of the Black population.

Vitamin D insufficiency has been called the “hidden epidemic” among Black Americans. Scientific discoveries over the last 20 years find that low vitamin D levels are in some part to blame for racial health disparities, including higher rates of hypertension and heart disease.

Study after study proves that daily sun exposure is a critical determinant of health. It's been shown that insufficient sun exposure may be responsible for up to 340,000 premature deaths in the United States. Insufficient sun exposure can be linked to increased incidents of the following health conditions.

• Breast cancer

• Colorectal cancer

• Hypertension

• Cardiovascular disease

• Metabolic syndrome

• Alzheimer's disease

• Asthma

• Autism

Choosing to enjoy the sun in a safe way can profoundly impact our health, and our environment. Sunshine is an environmental determinant of health, too. Environmental determinants include factors like air quality, exposure to extreme weather conditions, access to clean water, and other external factors that influence our health and health outcomes.

Sunshine as an Environmental Determinant of Health

Evidence suggests that sensible sun exposure should be added to the list of environmental determinants due to our natural environment, weather conditions, and the impact of sun exposure to our health.

Living in areas below a latitude similar to that of Los Angeles and Atlanta for the first 10 years of life reduces the risk of developing multiple sclerosis by more than 50%. A recent study also found that those who were born and lived near the equator are 15 times less likely to develop type one diabetes, when compared to people living in more Northern or Southern latitudes.

Interestingly, it's been found that sunnier locations are associated with fewer deaths from COVID-19. There's even research showing that optimized vitamin D levels are more effective than a flu shot in preventing viral infections. Absorbing these vitamin D health benefits is best through sun exposure than through vitamin D pills.

Sunshine as a Social Determinant of Health

Sun exposure is also a social determinant of health because our exposure to sun is influenced by the conditions of our social environment. According to the Department of Health and Human Services (HHS), social determinants of health include things like safe housing, transportation, safe neighborhoods, and our social conditions.

One of the key reasons why sun exposure can be considered a social determinant of health is because our social environments of today are primarily indoors. Think about how our social environments have changed since the Industrial Revolution.

• Increasing amount of time spent on computers.

• Working long hours from home or an office building.

• Spending leisure time indoors.

• Scheduling activities rather than free play.

Far too many of our communities have limited, if any, available green space. Neighborhoods are even being developed without any sidewalks. These are just a few of the reasons that we're spending less time outdoors, and missing opportunities to get healthy sun exposure.

Our bodies need the sun to make vitamin D, which plays a crucial role in the body’s processes like building bones, boosting immunity, and improving sleep. However, Vitamin D is not the only health benefit we get from the sun. The strongest evidence for sunshine as a social determinant of health comes from its impact on our mood and our quality of life.

Sun exposure helps our brain release the “feel-good” chemical known as serotonin, which is correlated with a better mood and feelings of satisfaction and relaxation. Meanwhile, lower levels of serotonin are linked with depression and anxiety. Sunshine’s ability to impact the overall wellness and quality of life constitutes it as a social determinant of health.

How Much Sun Exposure Do You Need?

Of course, too much sun exposure can increase our risk of skin cancer. You know you're getting too much sun exposure if your skin gets red or burned. However, all determinants of health come with a wide range of health concerns. Modern science shows us the importance of everyday sensible sun exposure for our health.

A standard vitamin D blood test needs your vitamin D level up to 30 nanograms per milliliter. Currently, 95% of Black Americans have less than this amount.

Everyone’s needs vary based on their skin color. Thanks to the magic of melanin, the darker your skin is the more sun exposure you need. The lighter your skin is, the less sun exposure you need.

This is why it’s important to factor sun exposure as a behavioral, environmental, and social determinant of health. As winter approaches, we'll see fewer hours of sunlight and spend even more time indoors. Beware of the wintertime blues. Be intentional with sensible sun exposure.

We hope this information inspires change in the conversation around sun exposure, its potential impact on racial health disparities, and its role as a behavioral, environmental, and social determinant of health.