HOUSE OF LORDS Science and Technology Committee 1st Report of Session 2007–08 Air Travel and Health: an Update Report with Evidence Ordered to be printed 14 November 2007 and published 12 December 2007 Published by the Authority of the House of Lords London : The Stationery Office Limited £price HL Paper 7 Science and Technology Committee The Science and Technology Committee is appointed by the House of Lords in each session “to consider science and technology”. Current Membership The Members of the Science and Technology Committee are: Lord Broers (Chairman) Lord Colwyn Baroness Finlay of Llandaff (co-opted) Lord Haskel Lord Howie of Troon Lord May of Oxford Lord O’Neill of Clackmannan Lord Patel Lord Paul Baroness Perry of Southwark Baroness Platt of Writtle Earl of Selborne Baroness Sharp of Guildford Lord Sutherland of Houndwood Lord Taverne For declared interests of the Members of the Committee see Appendix 1. Information about the Committee and Publications Information about the Science and Technology Committee, including details of current inquiries, can be found on the internet at http://www.parliament.uk/hlscience/. Committee publications, including reports, press notices, transcripts of evidence and government responses to reports, can be found at the same address. Committee reports are published by The Stationery Office by Order of the House. General Information General information about the House of Lords and its Committees, including guidance to witnesses, details of current inquiries and forthcoming meetings is on the internet at: http://www.parliament.uk/about_lords/about_lords.cfm. Contacts for the Science and Technology Committee All correspondence should be addressed to: The Clerk of the Science and Technology Committee Committee Office House of Lords London SW1A 0PW The telephone number for general enquiries is 020 7219 6075. The Committee’s email address is [email protected]. CONTENTS Paragraph Page ABSTRACT 6 Chapter 1: Introduction 7 Impact of the original report—overview 1.1 7 Reasons for the present inquiry 1.7 8 Acknowledgements 1.14 9 Chapter 2: Changes in Regulatory Arrangements since 2000 10 The Aviation Health Working Group (AHWG) 2.1 10 Box 1: Remit of the Aviation Health Working Group 10 The Aviation Health Unit (AHU) 2.5 11 The Civil Aviation Act 2006 2.9 11 The European Aviation Safety Agency 2.10 12 Other changes in regulatory arrangements 2.12 12 Chapter 3: Research since 2000 15 The scope of research 3.1 15 Box 2: Summary of prioritised research needs 15 Anthropometric Study to Update Minimum Aircraft Seating Standards 3.3 17 Cabin Air Quality 3.6 17 Study of Air Quality in the Aircraft Cabin 3.9 18 Extent of Aspirin Use for the Prophylaxis of DVT on Long Haul Flights 3.10 18 WRIGHT Project 3.11 18 CabinAir 3.15 19 Health Effects of Aircraft Cabin Environment (HEACE) 3.16 20 Ideal Cabin Environment (ICE) 3.17 20 Friendly Aircraft Cabin Environment (FACE) 3.18 20 Mortality and Cancer Rates 3.19 20 United Kingdom research capacity 3.20 20 Gaps in research 3.23 21 Chapter 4: Areas for Action Raised in the Current Inquiry 24 The Cabin Environment 4.1 24 Deep Vein Thrombosis 4.12 26 Infectious Diseases 4.18 27 Air Crew Occupational Health 4.30 30 Contaminated Air Events 4.38 31 Fitness to Fly 4.53 34 BOX 3: Advice on contraindications to air travel by the WHO 35 Information and Education 4.58 36 Chapter 5: Summary of Recommendations 39 Regulatory arrangements 5.1 39 Research 5.4 39 The cabin environment 5.9 40 Deep vein thrombosis 5.11 40 Infectious diseases 5.12 40 Air crew occupational health 5.14 40 Contaminated air events 5.16 41 Information and education 5.20 41 Appendix 1: Members and Declarations of Interest 42 Appendix 2: Witnesses 43 Appendix 3: Call for Evidence 45 Appendix 4: Seminar 46 Appendix 5: Summaries of Individual Submissions 50 Appendix 6: List of Acronyms and Abbreviations 55 Oral Evidence British Airways Plc, Virgin Atlantic, British Air Transport Association Written Evidence (British Airways Plc) 1 Written Evidence (Virgin Atlantic) 4 Oral Evidence, 26 June 2007 7 Professor Michael Bagshaw, Dr Sarah MacKenzie Ross, Professor Helen Muir, Dr William Toff, WRIGHT Project Scientific Executive Committee Written Evidence (Dr MacKenzie Ross) 25 Written Evidence (WRIGHT Project Scientific Executive Committee) 27 Oral Evidence, 10 July 2007 30 British Airline Pilots Association (BALPA), Air Transport Users Council (AUC), Independent Pilots Association (IPA) Written Evidence (BALPA) 39 Written Evidence (AUC) 40 Written Evidence (IPA) 41 Oral Evidence, 10 July 2007 43 Supplementary Written Evidence (IPA) 52 The Department for Transport, the Department of Health, the Civil Aviation Authority Written Evidence 54 Oral Evidence, 17 July 2007 58 Supplementary Written Evidence (Department for Transport) 74 Further Supplementary Written Evidence (Department for Transport) 97 Written Evidence Aerospace Medical Association 98 Aerotoxic Association 99 Airbus 99 Association of Flight Attendants 103 Aviation Organophosphate Information Site 106 Boeing Company 113 British Airline Pilots Association’s Occupational Health & Safety Group 115 Building Research Establishment 118 Dr Clement E Furlong 119 Global Cabin Air Quality Executive 120 Health Protection Agency 124 Ideal Cabin Environment Project 125 Dr G A Jamal 126 Dr Peter Julu 127 Captain Susan Michaelis 127 NYCO 131 Mr Ian Panton 132 Research Institute for Sport and Exercise Sciences, Liverpool John Moores University 133 Ms Christine Standing 136 Thomsonfly 145 Unite the Union—Transport and General Workers’ Section 147 Unite the Union—Transport and General Workers’ Section—Health & Safety Representative 149 NOTE: References in the text of the report are as follows: (Q) refers to a question in oral evidence (p) refers to a page of written evidence ABSTRACT Our report on Air Travel and Health, published in 2000, brought together for the first time the wide spectrum of health issues associated with air travel. The report stimulated research into air crew and passenger health, not only in the United Kingdom but beyond. Our understanding of the major health issues connected with air travel is now much improved—though there are still some crucial gaps in knowledge. In 2001 the Aviation Health Working Group was created as a free-standing interdepartmental group to work with interested parties in taking forward the recommendations in the report. The Group has been generally well received by industry, crew and passenger representatives. The Aviation Health Unit was set up in 2003 within the Civil Aviation Authority to act as a focal point for aviation health in the United Kingdom, while the Civil Aviation Act 2006 gave the Secretary of State the general duty of organising, carrying out and encouraging measures for safeguarding the health of all persons on board an aircraft. These changes are welcome, though in some areas more work is needed to add substance to the organisational outlines. Certain health issues still remain a concern. The United Kingdom has supported the World Health Organization Research into Global Hazards of Travel (WRIGHT) project that studied the risk of venous thromboembolism (VTE) associated with air travel. The study concluded that for individuals without VTE risk factors travelling by air did not increase the risk of VTE any more than when travelling by other means. Phase II of the project will look more in depth at the VTE risk for individuals with existing risk factors and also will study preventative measures. We urge the Government to continue to support the project. Public and media interest in contaminated air events, or fume events, has significantly increased in recent years. The independent Committee on Toxicity of Chemicals in Food Consumer Products and the Environment (COT) has conducted a scientific review of the evidence for claims that fume events have damaged the health of pilots and others, and has concluded that the link between fume events and health effects is still unproven, though worthy of further investigation. We support this general conclusion; although much anecdotal evidence has been submitted to the COT and to this inquiry regarding fume events, this evidence still falls short of conclusive scientific proof. However, we recommend that research to settle this issue one way or another be taken forward as a high priority. Air Travel and Health: an Update CHAPTER 1: INTRODUCTION Impact of the original report—overview 1.1. At the end of the 1990s public concern about the health effects of air travel became increasingly acute. At the same time the evidence for such health effects was still largely anecdotal and heavily influenced by a number of widely reported cases of deep vein thrombosis (DVT)1. The state of scientific knowledge of aviation health issues was inconsistent and there was no strategy underpinning research. In response to this state of affairs we set up an inquiry in November 1999 to look into all aspects of air travel and health. We heard evidence from a wide range of organisations and individuals representing manufacturers, airlines, cabin crew, passengers and Government departments. Our report was published in November 20002. 1.2. The report was well received and, in the words of the British Medical Association (BMA), “is generally agreed to be the most authoritative and detailed study of aviation health issues yet written”3. The impact of our report was not limited to the United Kingdom. Dr Nigel Dowdall, Head of Health Services at British Airways, told us “the original House of Lords report has stimulated a much greater interest in passenger and crew health, and that is seen not just in the Aviation Health Working Group (AHWG) and the Aviation Health Unit (AHU), it is seen in the activity that is taking place in Europe and in the world” (Q 9).