Blindspot: how sun exposure guidelines have ignored the health of individuals with skin of color.

This review examines the history of sun exposure guidelines and their implications for the health of people with skin of color. Medical authorities first encouraged limiting sun exposure in the 1930s. This guidance followed a decade of findings indicating that rickets and hypertensive heart disease were far more likely to afflict Black than White Americans and that ultraviolet radiation cured rickets and lowered blood pressure. In the late 1950s it emerged that South Asians suffered from high rates of coronary artery disease. Australia introduced the first national sun exposure guidelines in the 1980s, recommending that all residents drastically limit their sun exposure to address the epidemic of skin cancer among its White majority. In succeeding decades other White-majority countries introduced restrictive sun exposure policies. These directives assumed that sun exposure confers no benefits beyond catalyzing the production of vitamin D and that the amount of vitamin D readily available through diet is sufficient for good health. Evidence available at the time indicated that both assumptions were likely flawed. Differences in risk-benefit profiles of sun exposure by skin color were discussed within the public health community but were not communicated to the public. In the 2010s large studies reported that sun exposure is associated with reduced risk of cardiometabolic disease in Northern Europe and among Black Americans. The UK and Australia have recently revised their guidelines to recognize that people of different skin colors have distinctive needs. Still, guidelines in the US and many other countries continue to take a 'one-size-fits-all' approach to sun exposure. By extending policies originally tailored to White needs to populations for whom sun/UV exposure has very different risks and benefits, this approach may have significant negative consequences for the health of people with skin of color.