Public support for government-led skin cancer prevention in Aotearoa New Zealand: findings from a national survey

Skin cancer represents a substantial and ongoing public health challenge in Aotearoa New Zealand, which has among the highest incidence rates for melanoma globally.¹ This reflects a combination of relatively high ambient ultraviolet radiation (UVR), predominantly fair‑skinned populations and extensive outdoor exposure through work, recreation and daily life.² Despite the fact that skin cancer is largely preventable, it continues to impose a significant burden on individuals, the health system and the wider economy.

Primary prevention of skin cancer requires a sustained reduction of population‑level UVR exposure across multiple settings, including schools, workplaces and public outdoor environments.³ Scientific evidence demonstrates that structural and regulatory interventions are more likely to achieve equitable and durable reductions in exposure than approaches relying solely on individual behaviour change,⁴ with this pattern also evident in the context of UVR protection.³ However, in Aotearoa New Zealand, investment in skin cancer prevention has remained relatively limited, with prevention efforts described as fragmented and inconsistently implemented despite long‑standing evidence of effectiveness.³

In line with Te Tiriti o Waitangi obligations to achieve equitable health outcomes, equity considerations are central to understanding melanoma outcomes in Aotearoa New Zealand.⁵ Although invasive melanoma incidence is substantially lower among Māori than non‑Māori, Māori are more likely to be diagnosed with thicker and more advanced melanomas and experience markedly poorer survival following diagnosis.^6,7 National surveillance data indicate that melanoma mortality rates have declined since 2015, coinciding with the introduction of more effective treatments for advanced disease; however, substantial survival inequities for Māori persist.^6,8,9 Melanoma mortality increases sharply with age and is higher among males than females, while population‑level melanoma mortality rates are relatively similar across socio-economic deprivation quintiles.⁸ When considered together, these patterns point to persistent inequities across the melanoma pathway, particularly at earlier stages of disease where prevention and early detection efforts are most effective. Reducing these inequities will therefore require population‑level prevention and early detection policies, which depend on both demonstrable effectiveness and sustained public support.

Despite the substantial skin cancer burden, there is limited contemporary, nationally representative evidence on public support for population‑wide and regulatory approaches to reducing UVR exposure. Understanding public preferences is critical for informing policy development, prioritising prevention investment and challenging assumptions that may impede action on preventable risks such as UVR.¹⁰ In addition, examining how responsibility for skin cancer prevention is perceived across government, institutional and community actors provides insight into whether the public views prevention as an individual responsibility or as a shared societal obligation. Such insights are particularly relevant in the context of UVR exposure, which is shaped by environmental, occupational and institutional conditions beyond individuals’ control.

This paper aims to assess public support in Aotearoa New Zealand for a range of skin cancer prevention policies, including society‑wide regulatory measures, school‑based interventions and increased public investment in prevention. It also examines public perceptions of where responsibility for skin cancer prevention lies across key actors, and whether levels of support vary by voting intention and demographic characteristics. By documenting public preferences and perceptions, this study seeks to inform policy discussions and identify areas of alignment or tension between public expectations and current approaches to skin cancer prevention in Aotearoa New Zealand.

Methods

This study presents results from a national cross‑sectional online survey examining public support for evidence‑informed cancer‑related policies in Aotearoa New Zealand. Detailed methods are reported elsewhere in the published study methods paper.¹¹ In brief, adults aged 18 years and older were recruited through a large commercial online research panel using quota‑based sampling to achieve national representation by age, gender and ethnicity, with additional oversampling of Māori and Pacific peoples. After weighting was applied, the effective sample size was 1,161 (from an unweighted sample of 1,635). One further respondent was excluded from analyses because information on voting intention was missing. The approximate worst-case 95% margin of error for a population estimate was ±2.9%. Analyses were descriptive and focussed on summarising public support and perceptions by demographic characteristics.

Data collection took place between November and December 2025 using a structured questionnaire administered via Qualtrics.¹¹ Participants completed a survey assessing support for a range of skin cancer prevention policies and perceptions of responsibility for prevention (Appendix A). Policy support was assessed for both society‑wide and school‑based measures. Society‑wide items included banning the sale of commercial sunbed services, regulating sunscreen as a therapeutic product, increasing funding for skin cancer prevention and making sunscreen more affordable. School‑based items included compulsory sun‑protection policies in schools, Education Review Office (ERO) checks of school sun‑protection practices and government funding for a national SunSmart school programme. For each policy item, respondents indicated their level of support using a six‑point response scale: strongly support, support, slightly support, slightly oppose, oppose or strongly oppose, with an additional option for did not want to answer (which was considered informative in itself). Responses were analysed both by individual response category and as combined measures, with “overall support” defined as the combination of strongly support, support and slightly support (with similar for “overall oppose”). Perceptions of responsibility for skin cancer prevention were assessed by asking respondents to indicate the extent to which different actors should be responsible, including central government, local government, schools and early childhood centres, workplaces, sports organisations and non‑government organisations. Participants rated each actor’s level of responsibility as: a great deal of responsibility, some responsibility, a little responsibility or no responsibility, which was further analysed as any degree of responsibility versus none.

Total weights (design and poststratification) aligned the sample with 2023 New Zealand Census benchmarks for age, gender and Māori ethnicity. Survey‑adjusted analyses summarised results by age group, gender, prioritised ethnicity and voting intention (Appendix B). Although the wider survey covered multiple cancer policy domains, this paper focusses on skin cancer prevention.

Ethical approval

Ethical approval was granted by the University of Otago Human Ethics Committee (25/1184).

Results

Tables present unweighted counts, while weighted percentages are reported in the tables and text. Support for society‑wide skin cancer prevention measures was high (Table 1). Overall support was 90.1% for government funding for a SunSmart programme in Aotearoa New Zealand, 89.1% for making sunscreen more affordable, 80.7% for regulating sunscreen as a therapeutic product and 72.5% for banning commercial sunbed services. Majority support occurred across all age, ethnicity and voting intention groups (see Table 3 for voting intention results, see Appendix B for age and ethnicity results,). Women reported higher overall levels of support than men across all four measures (Appendix B). Stratified analyses by age and voting intention did not materially alter overall patterns.

Support for school‑based skin cancer prevention policies was also high, being 87.3% or higher for all measures examined, including compulsory school sun‑protection policies, ERO checks and a nationally funded SunSmart school programme. Gender differences were modest, although men were consistently more likely than women to oppose each policy (Appendix B). Support was high across all age groups and stratified analyses by ethnicity did not materially alter overall patterns (Appendix B).

Perceived responsibility for skin cancer prevention was widely shared, with over 70% assigning at least some responsibility to all actor groups examined, including schools and early childhood centres (highest at 96.3%), central and local government, workplaces, sports organisations and non-government organisations (lowest at 91.4%, Table 2). Schools/early childhood centres and government were most frequently identified as having a great deal of responsibility. Patterns of perceived responsibility were consistent across age, gender and ethnicity (Appendix B).

Discussion

This study demonstrates strong and broad public support in Aotearoa New Zealand for government involvement in skin cancer prevention, including regulatory, population‑wide and school‑based approaches. Support for measures such as a comprehensive national SunSmart programme and targeted interventions in schools consistently exceeded 80%, with minimal opposition. These findings provide strong evidence of a public mandate for policy action and directly challenge assumptions that preventive health regulation lacks public legitimacy or political feasibility.

Importantly, support for preventive measures was evident across voters of all major political parties and among those undecided about their vote. This cross‑partisan support suggests that government inaction cannot readily be attributed to electoral risk or lack of public mandate. Instead, the findings indicate a disconnect between public preferences and policy priorities, reinforcing the feasibility of decisive, evidence‑based action on skin cancer prevention.

The results reinforce the framing of skin cancer prevention as a shared societal responsibility, rather than an issue of individual behaviour alone. This is consistent with contemporary public health and systems-thinking approaches, which emphasise upstream interventions that modify environments, institutions and policies to reduce exposure to risk across entire populations.⁴ The strong endorsement of structural measures is particularly notable given Aotearoa New Zealand has very high skin cancer incidence and melanoma mortality. In this context, reliance on individual behaviour change is unlikely to be a sufficient or equitable solution to this issue.

Respondents identified schools as a priority setting, including 96.3% attributing responsibility to schools/early childhood centres. This reflects evidence that UVR damage accumulated in childhood and adolescence increases lifetime skin cancer risk.¹² Research shows that schools with comprehensive sun-protection policies demonstrate more consistent sun‑protective policies and practices, including hat use, sunscreen encouragement and shade provision.¹³ Public support for shade provision demonstrated in other research, particularly in schools, shows the appeal of passive, low‑burden interventions that do not rely on sustained individual compliance and are likely to reduce inequities in protection.¹⁴

Outdoor workers experience high levels of UVR exposure; however, occupational sun protection is inconsistently addressed in policy and practice across Aotearoa New Zealand, including within current occupational health and safety policy and practice overseen by WorkSafe New Zealand.¹⁵ The findings, including 93.3% attributing responsibility to workplaces/employers, suggest strong public alignment with treating UVR radiation as an occupational health and safety hazard, rather than a personal lifestyle risk. This has important implications for regulatory frameworks, employer obligations and enforcement mechanisms.

The results also indicate robust support for regulation of sunbeds and sun-protection products, aligning closely with the scientific consensus on UVR-related cancer risk. Indoor tanning devices are classified as a type I carcinogen, with clear evidence of increased melanoma risk, particularly with exposure under the age of 35 years.¹⁶ Public endorsement of regulation suggests that such measures would be socially acceptable in Aotearoa New Zealand, consistent with experience in jurisdictions such as Australia that have implemented comprehensive sunbed bans.¹⁷ Similarly, support for stronger regulation of sunscreens reflects public concern about product effectiveness, safety and consumer protection, rather than resistance to regulation per se.

View Table 1–3.

Gender differences observed in this study, with women expressing stronger support for preventive policies, are consistent with international research showing higher female support for public health regulation and preventive interventions.¹⁸ While not the primary focus of this study, these findings highlight the potential role of women as key advocates for cancer prevention.

Taken together, these findings reveal a striking disconnect between public preferences, scientific evidence and current levels of government investment in skin cancer prevention. Despite skin cancer being the most common and preventable cancer in Aotearoa New Zealand, prevention remains chronically underfunded relative to the scale of the burden. Until recently, public investment in skin cancer prevention is less than NZ$500,000 per year, compared with an estimated NZ$450 million per year in treatment costs.³ This is despite global evidence that investment in skin cancer prevention is highly cost effective and, in many cases, cost saving, from a government funding perspective.¹⁹ These results suggest that political inaction cannot be justified on the basis of public opposition and instead point to a missed opportunity for decisive, evidence‑based and cost-effective policy reform. On 30 April 2026, the Cancer Society of New Zealand and the Government announced joint funding of NZ$2 million for the 2026/2027 financial year to support a SunSmart programme.²⁰

From a policy perspective, the findings support renewed investment in a nationally co-ordinated SunSmart programme; mandatory sun-protection standards in schools; strengthened regulation of sunbeds and sun-protection products; addressing the affordability of sunscreen; and a shift towards treating UVR exposure as an environmental and occupational risk. A co-ordinated, multi-setting approach has the greatest potential to achieve population health gains, consistent with systems-based models of prevention.⁴

The study as a whole has several key strengths and limitations that are discussed in the methodology article.¹¹ Recruitment via an online panel may introduce selection bias, as it includes only individuals with internet access and willingness to participate, and the risk of participation bias is introduced through who chose to respond to this survey. The English-only format may have limited participation among some migrant groups, and although weighting achieved alignment with broad population benchmarks, residual differences remain and broader representativeness cannot be guaranteed. The use of a market research company prevented calculation of response rates and assessment of non-response bias. Finally, all measures were self-reported and therefore subject to recall and reporting bias, particularly for sensitive questions.

Conclusion

This study provides strong evidence that the public is ready for, and supportive of, comprehensive government action on skin cancer prevention. Aligning policy with this mandate offers a timely opportunity to reduce avoidable disease burden, improve equity and achieve long-term health and economic benefits.

View Appendix.